Time to Play


Play. This word might seem inconsequential to some, but for the developing child, play is absolutely essential.

For many adults, we equate play with relaxing. As in, “First we do our work, and then we get to play.“, or “I don’t understand how he can be so tired- we did nothing but play all day!“.  What many don’t realize is that play IS the work.  Play is how children experience the world around them, master new concepts, utilize their sensory systems, and socialize with others. Research shows that children learn best through discovery and exploration using all of their senses. When young children are playing, they are actually learning to learn. So what you see your 18 month old doing with a bin of blocks is way more than just having fun. She is building the foundation to be a life-long learner!

Just like gross motor skills or language skills, play skills develop in phases. According to Cari Ebert, MS, CCC-SLP, we see play skills develop in this order:

1.Random and Exploratory Play 

In this phase, kids are picking up objects, banging them, mouthing them, holding them, and throwing them. This phase is all about taking in how things feel, and how objects relate to your body in space.

2. Cause and Effect Play

Now, children start to figure out that their actions can lead to an outcome. If I press the button, a light turns on. If I say “ba”, my mommy blows bubbles. If I push the block tower, all the blocks fall down. Cause and effect is the foundation of all other play, because it is the beginning of playing with a plan.

3. Functional Play

In this stage, children begin to play with the functions of objects. They are able to think about the concept of an object, and this directs their play. Children will start to push cars along a road or stir with a spoon which shows that they are applying previously learned knowledge into their play. How cool is that?!

4. Symbolic Play

Once functional play is mastered, a child is now able to think about objects that are not in the room. A plain wooden block can turn into a helicopter and a throw pillow can be a dog to take on a walk. This phase is so fun because the sky is the limit! Your child can now pull any fun idea into his play schema.

5. Constructive Play

At this point, kids will start to use their imagination and previous experiences to create. You might catch your kiddo building houses, skyscrapers, castles or even whole cities! Constructive play also involves building a play space, so you might see your child designate different materials to represent parts of an idea. For example, this pile of leaves is my bed and this pine cone is my alarm clock, and that tree over there is my mom’s bedroom. Kids in this phase may spend just as much time setting up their play as they actually do playing!

6. Dramatic Play

This is where the fun really begins! This is the phase in which they put it all together. Kids use their experiences, imaginations, fears, daydreams and emotions to orchestrate elaborate play schemas that may involve many different toys and materials, or no materials at all. This is the phase where collaborative play with friends really takes off too. Kids in this phase create their own storyline, and use their play as an avenue to explore all kinds of concepts and ideas. As their language skills expand, their dramatic play will too.



It is really important to consider the play phase that a child is in, rather than his chronological age. I advise parents to ignore that recommended ages on toys, and to focus more what what skills their child currently has. There is no need to rush the developmental process because we want a solid, strong foundation to build upon later.

Don’t succumb to the notion that young children need heavy academics and a rigorous schedule of extra-curricular activities to thrive! I’d actually argue just the opposite- kids need ample time carved out in each day that is dedicated completely to “just playing”. The most powerful learning experiences can come wrapped up in the simplest of packages.

Stay tuned to our blog for more tips on how to play with your child! To check out previous posts on play, click here, here or here.


Elizabeth Clark McKenzie, MS, CCC-SLP


Bubbles Bubbles Bubbles


If I could have one item in my therapy room, I would hands down choose bubbles.  You might be thinking “What is so great about bubbles?!“. Let me tell ya…I can target dozens of goals with one little container. Here is a list of my 10 favorite ways to use bubbles in therapy:

  1. Anticipation – For those early language learners, I hold the bubble wand up to my mouth, draw in my breath and round my lips. Then, I wait for the child to make eye contact, gesture or vocalize before I blow a bubble.
  2. Bilabial Sounds – Think of all the bilabial targets that you can hit! BUBBLE, MORE, POP, etc.
  3. Oral- Nasal Contrasts – For children who have difficulty keeping sounds out of their nose, I like to use bubble blowing as a way to demonstrate control of air flow.
  4. Lip Rounding –  Especially with little ones, learning to blow bubbles can be a fun way to model lip rounding! Sometimes, I even add a vocalization of a round vowel before blowing the bubble. (ex: “OO”)
  5. Breath Support– It takes a lot of control to blow a really big bubble! Practicing blowing one big bubble vs. many small bubbles is a great way to develop breath support.
  6. Requesting – Think of all the core words that you can utilize to request bubbles: MORE, AGAIN, GO, UP, DOWN, IN, OUT, PULL, WANT, HELP,etc.
  7. Turn Taking– If your child can blow bubbles himself, practice taking turns. Layer expressive language goals on there by adding “my turn”/”your turn“, or asking a question: “Do you want to try?
  8. Following Directions – My kids love playing the “Bubble Pop” game! We take turns giving each other directions on which parts of our body to use to pop the bubbles- thumbs, pinky fingers, elbows, knees, and even tummies! Social skills groups particularly get a kick out of this one.
  9. Impulse Control – I ask my child to strike a pose and hold it like a statue. I blow a bunch of bubbles around her, and she has to hold the pose without giving into the temptation to pop the bubbles!
  10. Regulation- In my therapeutic dance class, we like to end our class with a little something called “Bubble Yoga”. The children find a comfortable position on their backs or seated, and I blow bubbles all around them. The goal is for the children to watch the bubbles float and pop as their body relaxes into a calmer state. It works like a charm!


So the next time you need some inspiration, or you are running short on time to plan an elaborate therapy lesson, look no further than your trusty tumbler of bubbles! (I like this non-toxic and spill proof variety) Kids can’t get enough of them, and the possibilities are endless.

Have fun!


-Elizabeth Clark McKenzie, MS, CCC-SLP


Executive Functions


I recently attended a continuing education conference that was all about Executive Functioning. It was very eye-opening to think through how much executive functioning skills impact our ability to do just about everything! So what exactly are executive functioning skills? Here is the nitty gritty:

Executive Functioning skills are defined as “higher order cognitive skills that serve  on-going goal directed behavior”. (Meltzer, 2007). You might think of the executive skills as the conductor of a brain’s orchestra, telling us which skills to use when.  Here are the main executive skills according to Peg Dawson, Ed. D, NCSP:

  1. Response Inhibitionthe ability to think before you act.
  2. Working Memorythe ability to hold information in memory while performing other tasks.
  3. Emotional Controlthe ability to manage emotions in order to achieve goals or complete tasks.
  4. Flexibilitythe ability to revise plans in the face of obstacles.
  5. Sustained Attentionthe ability to maintain attention despite distraction, fatigue or boredom.
  6. Task Initiationthe ability to begin projects in an efficient and timely manner.
  7. Planning/Prioritization– the ability to create a roadmap to reach a goal, as well as to make decisions about what is important vs what is not important.
  8. Organization – the ability to create an maintain systems to keep track of information or materials.
  9. Time Management – the ability to gauge how much time a task will take, as well as to work within those time limits to meet deadlines.
  10. Goal Directed Persistence – the ability to set a goal and complete it without getting sidetracked by other interests. 
  11. Metacognition – The ability to self-monitor and self-evaluate, as well as look at yourself from another perspective. 

Interestingly enough, these skills develop in approximately that order, so when looking at what to work on in therapy, it may be helpful to work sequentially. I also learned that it takes about 25 years for these skills to fully mature! This means that even though we are legally adults at age 18, we very well might not possess all the executive functioning skills we need to be fully successful.

As we know, certain diagnoses come with an implication of executive functioning deficits, including ADHD and Autism. However, I think it is important for us to recognize that all people have executive functioning strengths and weaknesses.  Here is a quick survey for adults that will rank your executive functioning skills from strongest to weakest. I did this with my husband, and it was rather enlightening! 😉


I’ve pulled together a list of some fun games that help build executive functioning skills:

And a few other fun, therapeutic activity ideas:

  • Designing, building and executing an obstacle course.
  • 20 Questions
  • I Spy
  • Simon Says
  • Building with Legos or blocks
  • Journaling
  • Playing “Restaurant”
  • The Alphabet or Picnic Game

I’ve found that tackling some of these underlying executive functioning skills has really helped support progress in other goal areas. Parents also really appreciate folding these goals into sessions because executive functioning skills are so directly related to home and classroom routines. It’s a great way to make sure you are providing a robust and well-balanced treatment plan.

For more information, you can check out www.SmartbutScatteredkids.com.

-Elizabeth Clark McKenzie, MS, CCC-SLP

Heavy Work


I don’t know about you, but whenever the seasons change, I notice most of my kiddos have a harder time focusing and self-regulating. They seem to be bouncing off the walls! My super smart OT friends have clued me in on the benefits of heavy work. Heavy work refers to tasks that provide the body with proprioceptive input to the muscles and joints. This can have a calming effect, but also provides increased awareness of where the body is in space. For many children, these tasks can help support focus and attention. (Not to mention all the benefits of physical activity in general!) Here are some ideas:

  • Pushing someone else on a swing
  • Building an obstacle course
  • Climbing up a slide
  • Playing tug of war
  • Animal walks
  • Carrying heavy bags
  • Pushing a cart
  • Pulling or pushing a heavy door
  • Hanging on monkey bars
  • Wheelbarrow walking
  • Playing catch with a heavy ball or beanbag
  • Push-ups
  • Carrying a stack of books
  • Dragging a heavy pillow or beanbag
  • Scrubbing dry erase marker off of a mirror

Bonus- I have been trying many of these with my rambunctious “threenager” at home, and it works like a charm for her! I have her help me carry in groceries or load wet clothes into the dryer, and we’ve noticed a big difference in her mood and behavior. When I really think about it, I tend to be more focused after working out or doing household chores.  It seems like we all can benefit from adding more heavy work to our daily routine! For other strategies for improving attention, check out our previous post on fidgeting.  Got any other inventive ideas? Post them in the comments below!


Better get to work! 🙂

-Elizabeth Clark McKenzie, MS, CCC-SLP

Stories for Social Skills

I know…I know… ANOTHER book post but I just can’t help it! I love using books in therapy because they are so portable, easily adaptable, and easy for parents to use at home. I enjoy using books with all of my kids, but particularly with my social skills groups. We can tackle all kinds of important topics while reading a fun, entertaining story! Self-regulation, making inferences, predicting, perspective taking, problem solving… I could go on! Here are is a list of my favorite books (with links!) to use for pragmatic therapy:

SHH We have a plan

Clark the Shark

Pete the Cat

Chester's Way

Mean Jean the Recess Queen

The Invisible Boy

The Nuts Keep Rolling.jpg

Still Stuck.jpg

The Bad Mood and The Stick.jpg


I like choosing a book to base my whole session off of. I will create 2-3 expansion activities based on the book, which helps bring the story to life. I have also found great “already made” materials on Teachers Pay Teachers , as well as several fun ideas for crafts and games on Pinterest ! (Psst…did you know that Skill Builders has our own Pinterest page?! Lots of awesome pins up there!)

I also recently discovered Storyline Online , which is run by the SAG-AFTRA Foundation. This site has oodles of videos of celebrities reading story books. They do a really nice job bringing the story to life with fun animation and exceptional story telling. Several of the books listed above are on the site! Sometimes, I find that my students enjoy watching a video of someone else reading the story, rather than just hearing my voice for the whole session. It breaks things up a bit!

Got any other recommendations? I am always on the lookout for new books to add to our library.  Post your suggestions in the comments below! For more great book suggestions, you can check out my other book posts here and here.


-Elizabeth Clark McKenzie, MS, CCC-SLP






Have you ever seen a child open up a pile of birthday presents, only to play with an empty box? Sometimes, the most fun toys of all are non-toys! Using everyday or household objects as play tools is not only cost effective and convenient- it teaches some great functional skills! Here are a few of my favorite “non-toys” to have on hand:

*paper towel and toilet paper rolls

*muffin tins/muffin cups

*measuring cups and spoons


*cardboard boxes

*plastic straws

*kitchen utensils

*scrub brushes

*tin cans

*travel size bottles

*throw pillows and couch cushions

*cotton balls/cotton swabs

*laundry basket

*empty wipes containers


*salad tongs

*pots and pans

*full length mirrors

The best part about “non-toys”? The possibilities are ENDLESS! Children really have to use their creativity and ingenuity, and you might be surprised at what even the youngest kiddos come up with. So the next time you find yourself bored with the same old toys, look no further than your own house!


Happy Spring Break!

Elizabeth Clark McKenzie

Talkin’ about Teeth!



As a speech pathologist, I spend a lot of time looking at mouths! I often consult with other professionals, such as ENTs, pediatricians, allergists, and dentists. This week, I had the pleasure of chatting with Dr. Rashita Jaju, a pediatric dentist, educator, and recognized dental laser expert. She answered some of my *frequently asked questions* from parents:


How can I prepare my child for a dentist visit, and how can I ease any anxiety about a dental exam?

“A pediatric dentist and their team’s priority is to make your child feel comfortable and excited about their dental visit. Some parents like to use picture books of their favorite cartoon character going to the dentist!  The AAPD recommends that your child’s first dental health visit should be 6 months after their first tooth erupts or by their 1st birthday. If your kiddo is a little bit hesitant of new places, we can also use a social schedule that walks children step by step of what to expect when they go to the dentist with pictures. The most important thing is to make it sound fun and easy. Many parents have their own dental phobias, so it is important to not project or share that nervous energy. Kids are super smart and intuitive and if their parents look uncomfortable, they will in turn feel uncomfortable. So, get your children started on the path of prevention early in life so that they are able to grow up with a positive outlook on oral health.”


How important is it to brush twice a day? Any tips for making the process easier?

“Between breakfast, lunch, dinner, and snacks, there are lots of food particles left behind on their teeth. While sleeping at night, plaque is sitting in a warm, dark environment. Bacteria grows and the leftover plaque breaks down to acids that eat away at the enamel of your child’s teeth. The AAPD recommends brushing teeth at night to clean away any residual plaque, and again in the morning to clean up any bacteria that developed overnight.” 


My child sucks his thumb/fingers- how will this impact his dentition?

“Finger, thumb, or pacifier sucking is a common habit that many children use as a self-soothing tool during their newborn/infant age. If your little one’s habit is persistent beyond age 3 , changes in the growth and development of their jaw are more likely. You may notice their top front teeth are more flared out and their lower jaw and teeth are pushed in towards the tongue. This puts them at higher risk for trauma to the top front teeth if they trip and fall. Additionally, child’s upper palate can become narrower, compromising the health of their airway. Using age appropriate positive reinforcement and reward methods are always the best way to help your child loose the habit.”


My child grinds his teeth- what can I do to help stop this?

“Children can grind their teeth for a variety of reasons. Often times, because children are constantly growing, so are their jaws! When they are asleep, sometimes the jaw can have a difficult time finding a rest or “home” bite that is comfortable. While grinding teeth by itself may not be a big concern, it can be a red flag for stress and sleep disordered breathing condition. Keep an eye out for if your child  mouth breathes while awake or asleep, snores, or has consistent dark circles under the eyes. A combination of any of these symptoms may warrant an evaluation from your pediatrician, pediatric dentist, or ENT.”


Are there any foods that I should avoid giving my child? 

“Working with kids, we know we can never say never. However, there are some foods we try to limit to special occasions or as treats for our health. Sticky, sugary foods are usually smart to avoid because they like to stick to our teeth. Affecting, not only our oral health, but our body’s overall health. Be weary of children’s gummy vitamins, or carb based foods, such as crackers or puffs. Those foods break down into sugar, and if left on teeth, they can do just as much damage as sweets and candies. Whenever we do have these treats, its always a good idea to follow the snack with water to help rinse out any residual food that may be leftover.”


For more information about Dr. Jaju’s practice, you can visit www.smilewonders.com.




-Elizabeth Clark McKenzie, MS, CCC-SLP

Social Skills


Skill Builders proudly offers a wide array of therapeutic services, and one of our specialties is Social Skills! Our therapists have all done continuing educational courses in a variety of programs including the Zones of Regulation, Michelle Garcia Winner’s Social Thinking Curriculum, and Unstuck and On Target.  Our Social Group Coordinator, Melissa Plummer, sat down with me and explained the importance of continuing to work on social skills throughout childhood:

Parents often ask “How many social skills classes will it take to teach him social skills?”.  This is an impossible question to answer because really, mastering social skills is a life-long journey. Children need to build a solid foundation of social skills on which to build upon as they enter each new stage of life. Social expectations are constantly evolving as we age, and therefore, our social skills must evolve too! While understanding and perfecting these skills is certainly more challenging for some than others, we all are continuously learning with every new phase of life. Think about the last time you started a new job- you had to learn the lingo, figure out what people do at lunch time, and understand those tricky “unspoken” rules of what flies in the office and what doesn’t.  It takes some practice! This is why social skills therapy is designed to grow with the child, tackling the most pressing and relevant social needs at that time. It is important to recognize the value in working on social skills:

Academic Success – In order to successfully understand classroom routines, participate in group projects, understand and analyze materials, and communicate effectively in writing, students must implement pragmatic language skills.

Social Success – Social thinking is key for being out and about among  peers – recess, lunch, and even just walking down the hall!  For older children, learning how to navigate and appropriately use social media can be tricky. Different rules apply than in the real world, which means learning a whole new subset of social skills.

Building Relationships – Social skills allow us to recognize potential pals, maintain friendships, stay safe when talking to strangers, deal with bullies, advocate for ourselves, and even enter the dating world!

Future Employment  – All adults rely on social skills to succeed in the work force.  Accepting responsibility, understand and meeting expectations, taking other’s perspectives,  reading body language and non-verbal communication, maintaining work space…the list goes on.

Quality of Life – Humans are social creatures, and building relationships with others increases quality of life.  This allows children to feel part of a group, develop an identify, and build a support system outside of their immediate family.

Who ever you are and where ever you go, social skills are crucial.

Interested in learning more? Contact Melissa Plummer at Melissa@skillbuildersllc.com to inquire about our popular social skills groups, summer camp, and individualized social skills therapy.

-Elizabeth Clark McKenzie, MS, CCC-SLP

Learning through Touch


Did you know that skin is the largest organ in your body?

This means that touch is the most important vehicle for learning!  We tend to “learn by doing” which means that we are using all of our sensory systems at once- especially touch. The more we interact with an object or a concept, the better we understand it. Try to incorporate tactile learning experiences into everyday activities. Here are some ideas to get your started!

*Touch Different Fabrics: Silk, Lace, Velvet, Cotton, Corduroy…what feels best?

*Water Play

*Finger Paints

*Shaving Cream

*Play-Dough or Clay

*Collect rocks, leaves, and sticks outside

*Fill a bin with rice, beans, dry pasta, lentils, etc.

*Fill the sink with soap bubbles.

*Massage with lotion.

*Crash into a pile of pillows

*Roll down a grassy hill

*Walk barefoot outside on different surfaces.

*Crawl through a tunnel or small space




Don’t feel limited to just touching with hands! Children love to explore the world with their whole body. Allow your child to be free to get messy, discover, and learn, all while sharing fun, new experiences with you.

-Elizabeth Clark McKenzie, MS, CCC-SLP