Games for “R”

“R” is one of the last sounds to develop, and one of the most difficult sounds to make.  It is really important to make therapy fun and keep the child motivated. Here are some of my favorite games that really lend themselves to tackle that pesky “R” sound:

Race to the Treasure




Robot Face Race




Sneaky Snacky Squirrel




Frankie’s Food Truck Fiasco




Mermaid Island












Raccoon Rumpus




Of course, you can work your targets into any game, but I like that these words come up naturally during game play. This is especially important when you are working towards generalization. Parents also like that they can order these games to have at home!


-Elizabeth Clark McKenzie, MS, CCC-SLP

Get Outside!

colors empty equipment grass

Spring is officially here and the warmer weather has all of us itching to get outside! There are lots of skills to be worked on while enjoying the great outdoors. Think like a therapist and get the most out of your play with these fun ideas:


This classic game is perfect for working on counting, turn-taking, jumping on one foot and motor planning! It is also easy to change the rules to meet your child’s goals. For example, instead of numbers, you could write target words in each square to sneak some articulation practice in.

Sidewalk Chalk

Speaking of hopscotch, sidewalk chalk opens endless possibilities to work on fine motor skills, visual motor skills, copying pictures, letter formation and arm strength. Kids can choose fun colors and when the work is done, they can spray away the chalk with a hose!

Playing Catch

Tossing a ball back and forth actually takes a lot of hand-eye coordination and core stability. Take your game up a notch by asking your child to name items in a category while you play.

Playground Equipment

Look no further than your local playground to give your child a comprehensive workout! Monkey bars and other climbing equipment allow children to increase strength, coordination, and balance. Swings offer sensory input which can be organizing and have a calming effect for later in the day.


Core stability is key for riding scooters and bikes. Additionally, riding toys strengthen bilateral coordination and visual motor skills. Learning to ride a bike also let’s children learn to follow important social rules.

Nature Walks

Nature is filled with so many different textures and colors. Take a walk through a nature center or even around your own neighborhood and see what you can find.  Expand vocabulary by describing how things look and feel, or practice observation skills by playing a game of “I Spy” as you walk.


If you think about it, working in the garden is a total sensory-motor experience! Dig, scoop, pinch, pull and pat. Don’t be afraid to get dirty! 🙂

Freeze Tag

Learning games with rules is an important life skill. I especially like Freeze Tag because it allows children to practice keeping their bodies in control, following auditory directions, and tolerating frustration.

Lemonade Stand

A lemonade stand is an awesome way to help your child practice conversation and social skills! Plus, making lemonade (or another easy treat) is a great way to work on following directions.


Bubbles never get old- no matter what age you are! Practice those oral motor skills by having a bubble blowing contest, or practice gross motor skills by jumping to pop the bubbles!

Rain Puddles

Don’t let a rainy day stand in your way of having fun! Jumping in puddles and feeling the rain fall can be an amazing sensory experience.

water jumping photographer beauty

Did you know that research shows that just 15 minutes of outdoor time can improve a child’s behavior for the entire day?  Outdoor play has also been shown positively impact attention and social-emotional stability. And guess what- the same applies to us adults too! Access to nature has been linked to improved mood, mental acuity and energy levels. So make it a priority to tuck the screens away and get your family outside as much as possible. Happy Spring!


-Elizabeth Clark McKenzie, MS, CCC-SLP

Cooking Together

abstract art cooking cutlery

At our practice, therapists will often use food preparation as a fun avenue to tackle treatment goals. If you think about it, cooking requires several different skills that need to be integrated all at once. Both OT and SLP goals can be easily addressed through a cooking project.  Here is how I like to approach cooking with children to allow them to get the most out of the experience:

Step 1: Pick a dish.

Skills targeted:

*Social Wonder questions (“What do you like to eat?” or “Have you had ____ before?“)

*Perspective taking (“If my friend does not like chocolate, we should pick a dish without chocolate.”)

*Decision making (“I need to think of my own idea or choose between a few choices.”)

Step 2: Read a recipe. (Or watch a tutorial on YouTube!)

Skills targeted:

*Comprehension (reading or auditory)

*Sustained attention

*WH Questions (I like to pause videos periodically and ask questions as we go to ensure comprehension.)

Step 3: Make a list of ingredients.

Skills targeted:

* Working memory/recall


Step 4: Gather ingredients and materials. 

Skills targeted:

*Working memory

*Problem solving (“Where can we get the ingredients?”)


Note: For older kids, I have even taken a field trip to a grocery store to shop for ingredients. Talk about unlimited opportunities to practice problem solving ,executive functioning and social skills! 

Step 5: Prepare the food. 

Skills targeted:

*Following directions (Use a visual schedule if needed!)

*Fine motor skills (cutting, pouring, scooping, etc)

*Sensory experiences (Don’t be afraid to get messy!)

Step 6: Clean up. 

Skills targeted:

*Motor planning

*Independent task completion

*Sharing responsibility

Step 7: Enjoy and/or share with others!

Skills targeted:

*Trying new foods (I find that kids are much more likely to try something that they made themselves!)

*Social language

person flattening dough with rolling pin

I look for recipes that require no more than 5-6 ingredients to make things easier. We don’t have a full kitchen in our office, so I choose no-cook dishes or things that can be cooked in the toaster oven. I typically divide this up over a few sessions- we use 1-2 sessions to prep and then another to actually prepare our food. Doing this in a social skills group adds a whole other layer because the kids have to negotiate responsibilities, be flexible, and work as a team!

Here are a few ideas to get your started:


*Rice Krispie Treats

*Homemade Ice Cream

*Fruit Salad

*Ants on a log


*English muffin pizzas

And if you are working with a child with food restrictions, you can make something non-edible such as slime or play dough. There are lots of great video tutorials on YouTube and several of them feature kids doing the cooking! Always check with parents ahead of time to make sure you are aware of all allergies and sensitivities.

Parents- this is just as therapeutic at home! Get in the kitchen with your kiddo and cook up something fun! 🙂

-Elizabeth Clark McKenzie, MS, CCC-SLP

Making Articulation Practice Fun!

Articulation therapy- not the most exciting thing you’ve ever done but certainly important. As an SLP, I am always looking for ways to make articulation practice more enticing to my little friends. Here are some tried and true ways to spice up your articulation practice:

  1. Stickers – Stickers are seemingly simple but man on man, do my clients love getting to use them! Depending on the fine motor skills of the child, I will hand her a sticker each time she says a target, or I will let her peel the stickers off the sheet herself.  Those old-school metallic star stickers are perfect for practicing s-blends! (STAR; STICKER; STICK; STUCK)   919r+eOSGpL._SL1500_
  2. Ball Toss – A ball is an easy thing to keep tucked in your room or therapy bag. Kids love rolling, tossing or kicking a ball back and forth as you practice target words and phrases. I also like using an empty box or trash can as a makeshift basketball hoop! balls-3288122_1920
  3. Mailbox – I have been using a deck of flashcards to play post office. Preschoolers especially enjoy pushing cards into the slot of a mail box and opening the doors. You can easily make a mailbox out of a shoebox but I love this wooden one here. 71TCWuEYtlL._SL1500_
  4. Swing- I frequently incorporate a swing to motivate my kids to practice. We either negotiate a number of targets to earn a push, or we do one push for every target. At our office, our swing has a little slot on the side which is perfect for slipping articulation flashcards through!81Z783dBAOL._SL1500_
  5. Bingo Markers – It is very easy to photocopy or print out word lists and worksheets to use for articulation practice. I’ve been using these fun bingo makers to mark off each word picture. They add a nice sensory component to our work, and I find that kids of all ages find fun in making patterns or pictures as we go. 71oijqqy6yl._sl1200_.jpg
  6. Muffin Tin – This is a cheap and fun way to shake up articulation practice! I grab a mini muffin tin along with small objects (cotton balls, fake coins, figurines, cheerios, etc) and have the child drop an object in each well every time he says a target. Then we go back through and pick them up using tweezers, tongs, a spoon or our fingers. I’ve also done this using objects containing our target sounds. (ex: CAR, ROCK, CUPCAKE, etc)61sUFsB6sAL._SL1080_
  7. Stairs – I often give this tip to parents for home practice, and I like to try to use this when I see a client at a school. I will have the child say a target in order to move up or down a step. This works well because the child can see clearly how many more steps are left. I also find that most kids think it is really fun to roll objects down the stairs. I will use small balls or Slinkies. If he says 10 targets, we get to launch it down the stairs! A15q+e2HFSL._SL1500_
  8. Flashlight – A few years ago, I had a client who was very hard to motivate in our sessions. After trying several different activities, I finally got him excited about using a flashlight! I taped articulation cards to the wall and flipped off the lights. He used a flashlight to spot each picture, and when he found all of them, we plugged each word into a sentence. Super fun, minimal prep and very easy to replicate at home!51W0tiJn+DL._SL1100_
  9. Faux grass – If you’ve had a baby in the past 5-6 years, you are probably familiar with these “grass” drying racks.  I discovered that these are perfect for propping up artic cards! My kids seem to enjoy putting cards in themselves, or using tweezers to pluck the cards out of the grass. (Bonus- you can also use this for kids who aren’t yet able to hold a fan of cards up for a card game!)61htjk0ZmXL._SX522_
  10. Bubble Wrap – What is it about bubble wrap that is so addicting? This is a good trick to have up your sleeve for those elementary school aged kiddos who might be kind of over the same old drill work. Pop a bubble for every target OR say 25 targets and get to pop the whole sheet! OTs like this one too. :)A1+KKYQEylL._SL1500_


How do you motivate your kids to practice? I always tell parents that the most important thing is getting as many repetitions in as possible. Whatever works!


-Elizabeth Clark McKenzie, MS, CCC-SLP


Love Language

white black and red person carrying heart illustration in brown envelope


These are three little words that we say to our children all the time without much thought. Of course, we mean it when we say it, but most of us can agree that we often say “I love you” out of routine or habit. “Love you” is an easy way to end a conversation, bid farewell or say goodnight to your little one.  Our kids get used to hearing it and are conditioned to say “Love you too” in response. In order to make children feel truly loved, and to model ways to express affection, check out these alternative words of affirmation:

  • “I’m proud of you.”
  • “I’m happy to see you.”
  • “I love your ______” (smile, eyes, hair, laugh, etc)
  • “Excellent work!”
  • “You’re really good at _______” (soccer, math, playing piano, etc)
  • “You’re special.”
  • “I love _____ with you.” (singing, reading, baking, etc)
  • “You can do it!”
  • “I like the way you ______.” (shared, tried, said)
  • “I will be thinking of you.”

Don’t forget about those important non-verbal signs of affection too. Kids get a lot from eye contact, a warm smile, a pat on the back or a high-five.  This is not just for parents! Teachers, therapists and caregivers also have a big impact on a child’s social-emotional well-being. Feeling loved and secure gives children the confidence to try new things and gain independence. And of course, there is nothing better than feeling that love in return. 🙂


baby touching woman s face

Happy Valentine’s Day!

-Elizabeth Clark McKenzie, MS, CCC-SLP

Toys and Games for Fine Motor

Happy 2019!

As we know, fine motor skills are important for academic performance and activities of daily living.  Many children can learn and perfect these skills through day to day activities without much direct instruction, but for children with fine motor deficits, it might take more of an effort. We all tend to avoid tasks that are hard for us, and you might find that your child isn’t wild about sitting down to practice handwriting or cutting. A great way to work on fine motor skills at home is to strategically select toys and games that lend themselves to using those fingers and hands. Here are some of our favorites:

For little ones:


Hi-Ho Cherry-O is a great first game that encourages little fingers to use a pincer grasp!


Look for puzzles that have small pegs. This encourages children to use their fingers rather than a whole hand.


Brush-style blocks need to be oriented and fit together in order to build with them.



Squigz are so fun and help strengthen hands and fingers.



Zingo Bingo requires fine motor control to pick up and organize the bingo chips. I also love the slot on the dispenser- you have to orient the bingo chip a certain way and push it in with your thumb.



3-D matching games offer a fun twist on your standard memory game.  Players must fit corresponding pieces together to make a match!



For Older Kiddos:


Operation is an oldie but a goodie! This classic game uses tiny tweezers to remove small pieces from compartments.



Battleship’s tiny pegs allow for numerous opportunities to perfect fine motor skills as you play.



This fun version of putty is called Discovery Putty, and it comes with little figures buried in the putty. Children must use their hands and fingers to stretch, pull, punch and poke in order to find all of the hidden items.



Trouble is another tried and true board game that packs a fine-motor punch. In addition to the pegs that must fit precisely in the holes, the “pop-o-matic bubble” requires a solid amount of hand strength.



Suspend is one of my very favorite games to play with a group. Children need to use precision and control in order to gently hang game pieces without making the structure fall.



Legos are super popular, versatile and perfect for working on manipulating tiny pieces.


What are some of your favorite fine-motor toys?


Psst- did you hear that our ever-popular summer camp is almost sold out?! Check out our post from last year to see what all the fuss is about! Registration information can be found on our website here.

Elizabeth Clark McKenzie, MS, CCC-SLP

October is AAC Awareness Month!




October is not just for costumes and candy. It also happens to be AAC Awareness Month! Our assistant director, Amy Bereiter, MS, CCC-SLP, is a LAMP certified professional and leads our AAC team here at Skill Builders. She is taking over the blog today to give us the basics on AAC!

What is AAC?
AAC stands for Augmentative or Alternative Communication (AAC). This is any system that augments a person’s existing speech (augmentative) or is replacement to speech (alternative) when speech is not possible. AAC systems can take many forms. A low tech system has no voice output, a id tech system has voice output but has a static display, and a high tech system has voice output and a dynamic display screen.

Who is AAC appropriate for?
AAC is for anyone across the age span with congenital, developmental, or acquired communication challenges. Anyone who:

*Has little to no speech
*Has speech but very few spoken words (language), or limited variety of spoken words
*Has speech but it is not intelligible
*Has speech but language is not spontaneously used or is echolalic

At Skill Builders, because we are a primarily pediatric clinic, we see a lot of children who are still developing language. AAC is a highly effective tool that we can use to help them do just that! We often work on speech simultaneously, and for those with no speech or when speech is very difficult to produce, we continue to develop language and communication skills via AAC.

There are many myths floating around out there about AAC, but here some frequently heard myths about AAC:
*It will inhibit my child’s speech development- FALSE
*My child has some words so he doesn’t need it- FALSE
*The child has to have mastered various other low tech systems before gaining access to a high tech system- FALSE
*The child has to have strong cognitive skills in order to use AAC- FALSE
*I can understand my child/know what they need so he doesn’t need AAC- FALSE
*Once a child gets an AAC system, he should immediately know how to use it FALSE

General principles:
*Communication happens in all settings across the day! Therefore, AAC systems should be available across all settings.
*AAC systems should allow access to a large amount of vocabulary from all parts of speech.
*AAC should not focus solely on requesting, but on the many communicative functions we use.
*AAC should make life easier, not stressful, and the child should not feel like it is ‘work.’
*For kids, whose occupation is play, it should be taught in a play based context and in functional activities.

There is so much that could be said, but we hope this helps to raise awareness about the value and benefit of using AAC for children with communication challenges! For more information, check out our previous post on AAC Myths. You can also check out the Center for AAC and Autism’s page about the LAMP approach. Skill Builders is proud to be the only LAMP Center of Excellence in the state of Virginia.


To talk to a professional about whether or not your child might benefit from AAC, contact Amy at


-Elizabeth Clark McKenzie, MS, CCC-SLP



Tips for Halloween

Halloween is almost here, and for most kids, that means getting excited about costumes, pumpkins and way too much candy. But for children with social, sensory or communication disorders, Halloween can be a stressful holiday. Here are some expert tips to help make sure your kiddo has a Happy Halloween!

person holding pumpkin beside woman

Prep prep prep

Social expectations, rules and normal routines all change on Halloween. This can be confusing or stressful! Read books, watch videos, or create your own social story about what to expect that day/evening. Help your child practice what to say, and review what is expected of him. Talk about hypothetical situations that might come up and brainstorm solutions to potential problems. I recently worked with a child who is very fearful of masks. We talked through what he could do if he encountered anyone in a mask on Halloween, and mentally prepared for the fact that it was likely he would see some masks that day. By getting ahead of these worries, we are able to alleviate some stress and come up with some realistic solutions.

Creative costuming

Kids with sensory issues might have a hard time tolerating certain costumes. It is important to test-drive a costume in advance to make sure it is going to work. Consider the fabric, fit and mobility of the costume. If you do encounter an issue, get creative. Could your child wear his regular clothing with an embellishment or two? Could you fashion a mask to a hat instead of having to wear it on his face? Could you add a tell-tale accessory (or written label!) to help others easily recognize what the costume is? Getting creative and being flexible will allow your child to really enjoy dressing up.

Rally the troops

If your child has a communication disorder, Trick or Treating and chit-chatting about costumes can be a tall order. Send out an email to friends and neighbors and offer some tips or strategies to help your child be successful. For a child who struggles with WH questions, neighbors can ask “Are you a ____?” rather than “What is your costume?“.  If your child uses an AAC device, prep your neighbors so that they know to wait for a response. The more successful interactions your child has, the more he will enjoy the experience!

Less is more

Setting realistic expectations is so important. If your child’s school makes a big fuss over Halloween, don’t hesitate to pick and choose which events to go to. If you have a child who needs routine, try not to throw too many changes at him at once. It is better to have one really fun experience than four stressful ones.

Start your own traditions

If your child doesn’t enjoy trick-or-treating, create a new tradition that suits your family better. I know a family that goes to the movies every year on Halloween, and I know another that does a Disney sing-a-long in the backyard. It is OK to break away from the standard Halloween festivities to make sure your family has fun.


There are many local organizations that offer Halloween festivities tailored to kids with different needs. Scope out what is available in your area. Our therapists are also ready to help you problem-solve issues specific to your child.

Happy Halloween!

-Elizabeth Clark McKenzie, MS, CCC-SLP


Encouraging Reading Time

adult baby book boy

As speech-language pathologists, we often stress the importance of providing children with access to early literacy. Research shows that reading to young children prepares their minds for success in school, exposes them to diverse content, and builds intimacy and bonding with others.  It is no secret that reading to a young child supports their development! But what do you do if your child has difficulty sitting still? Or their attention to a book is brief? Or all they want to do is close the book the second you try to open it or rapidly turn the pages? Being able to sit still and listen to someone read is a skill. For some children learning that skill can take a long time to develop. The good news is that this can be taught! I sat down with Sarah DeWhitt, MS, CCC-SLP to hear her best tips to encourage children to get the most out of reading time at home.

Here are Sarah’s 5 tips on how to make book reading more fun for a young child:


1. Think about positioning and time of day

a. Positioning: We all love snuggles from our children and perhaps you think having them sit in your lap allows you to contain their attention but snuggling or being rocked might not put your child in a “ready to learn state”. Your child might respond better if he is allowed to read books in a different position. For example, if you are working on developing articulation, you could to have your child sit across from you and hold the book near your mouth so he can watch how your mouth moves. If your child needs increased core strength or increased input to calm his body, having him lay down with his belly on the floor (prone) might be a better position for him to read. Another way to increase input to the body is having your child lay in a bean bag or rolled up like a burrito. Increasing body input can increase the ability to remain calm.

b. Time of day: As adults, we all have a time of day when we are most productive-children are the same! Perhaps your child is too tired right before bed to engage as an active participant in reading or maybe your child needs to use the morning time to run around and be active so afternoons work better for quiet activities. Observe your child and find a time during the day they seem most calm. Maybe that is right after a trip to the playground? Or maybe it is right after a bath? If your child is only calm when seated at mealtime strapped into a high chair, you might want to consider pairing reading books with mealtime.

2. Establish a beginning, middle, and end to the activity

Young children like to know when transitions are about to take place. Establishing a routine to an activity prepares the child to meet your expectations. Make a routine of saying “open book” to begin reading; “Turn page” is a helpful phrase to signify the act of reading; and “all done” lets the child know the activity is finished.  To build up towards increased attention, perhaps you only require your child to help you open the book, turn all the page, and close the book at first. The whole act of book reading would only take 1-2 mins. Once the routine and expectation of book reading are established, then you can increase the time spent looking at each page. If your child starts walking around before the book is over, try encouraging them to say “goodbye” to the characters before moving on. Ask your child to put the book away to signal that reading time is now over.

3. Add gestures, funny voices, and noises

Make the characters and pictures come to life by adding gestures, funny voices, and noises. A bunny doesn’t really make a noise but maybe you use your hand to hop across the page. Perhaps you take time to literally stop and smell the pictured roses. Pretend to eat pictures of food and have your child “eat” food too. Stomp around like the dinosaurs in your story. The Three Bears is a great story for practicing a low Papa Bear voice, a middle-sized Mama Bear voice, and a wee little Baby Bear Voice. (Bonus points-this also teaches vocal play and volume control!) Maybe your child loves cars and vehicles so you can practice the sounds of the sirens or the horn. Focusing on what your child is already interested in will help maintain attention for longer. This will also aid in your child’s comprehension of the world around them and increase their receptive (understanding) language.

4. Follow the child’s lead

Find books that are motivating to your child! Motivating books usually discuss topics of interests for your child (trucks, cars, animals, farm, getting dressed, etc). Also, consider the language level of the books. Perhaps your child would respond better to books that only have pictures and no words. Involve your little one in the process as much as possible by allowing her to turn the page or hold the book. Provide options to choose from to give some ownership over the activity. Try to observe your child’s eye gaze and comment on the pictures that she is looking at. If she points or gestures to something in the book, don’t be afraid to pause and respond!

5. Consider the words you are saying

You don’t have to read the words of the book! You can talk about the pictures and draw connections to your own family experiences. Make up your own version of the story or sing a song about the picture. Over time, as your child’s attention increases, he will be able to sit for the duration of the story. In the early years, the most important thing is to make sure that reading time is fun, meaningful and low-pressure. Teach your kiddo to enjoy storytime now and you are helping to foster a life-long love of reading.
As a final thought, be realistic about how long you are asking your child to attend. As a minimum, a child should be able to attend to a book for double the minutes of their age: So a 2-year-old should attend for at least 4 mins; A 3-year-old should be able to attend for at least 6 mins; A 4-year-old for at least 8 mins; etc.

Check out our previous book posts here, here and here.
Happy Reading!

adorable blur bookcase books

-Elizabeth Clark McKenzie, MS, CCC-SLP