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




-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 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

Fluency Facts

Did you know that Skill Builders offers fluency therapy? This topic can be a little elusive and hard to navigate for parents. Our resident fluency specialist, Julie Aills, took some time to address some common myths for us!

Myth 1: You shouldn’t say the word “stuttering”

Fact: There are many words to describe stuttering, including “dysfluency”, “bumpy speech” and “stuck speech”. The specific term we use is not as important as the intent in which the word is used and the environment we create around the word. The term “stuttering” is the most common term, and it is likely that school age children will hear this word at some point. By creating a taboo atmosphere around one particular word, we may also create the unintended consequence of making that child feel ashamed or embarrassed. It is crucial that fluency therapy, or any discussions about stuttering, is approached in a positive and safe environment. School age children should be encouraged to talk using the terms that make them feel most comfortable.

Myth 2: Stuttering only impacts speech

Fact: Stuttering is classified as a communication disorder because it impacts more than one’s ability to speak fluently. Fluency therapy treats the whole child, including their thoughts and feelings about their stuttering. It is also important that a child who stutters is treated by a speech pathologist so that they can assess the impact the stutter may be having on the child’s expressive language, play and peer interactions.

Myth 3: Stuttering can be caused through exposure to another peer or adult who stutters

Fact: Research has shown that children cannot “catch” stuttering from another person who stutters, regardless of their exposure. Although there is no known, definitive cause of stuttering, current research reveals that stuttering is a multi-dimensional disorder influenced by a variety of factors including: genetics, neurological functioning, language, oral-motor skills, attitudes and temperament, psychological events and reactions to the environment.

Myth 4: Preschool stuttering is normal and the best approach is to “wait and see”

Fact:  Although it may seem difficult to predict whether or not a preschool stuttering will resolve on its own, speech therapists use research-based norms to decide if a child should be monitored or if some level of intervention is necessary. Therapeutic intervention ranges from monthly consultations, short term therapy, parent training or long term therapy. Below is a criteria our speech therapists use when deciding where to start when a family comes to us with concerns about preschool stuttering:

Consultation and Monitor Full Evaluation
Problem present less than 12 mos. Problem present over 12-18 months
Onset under 3.5 Onset after 3.5
Very episodic Fairly consistent
Female Male
More normal types of disfluency Part-word repetitions, prolongations, or blocks
Child is unaware Child is aware or momentarily expresses frustration
Parents not overly concerned Parents are concerned
No other developmental issues Other developmental issues present
No history of stuttering in family Positive history of stuttering

Myth 5: Stuttering can be fixed by telling child to slow down and think before speaking

Fact: Although many people who stutter also present with a fast rate of speech, fluency therapy is not “one size fits all”. There are two main approaches to fluency therapy: stuttering modification and fluency shaping. Stuttering modification includes therapeutic techniques aimed at reducing the frequency and severity of stuttering behaviors and fluency shaping focuses on improving speech fluency behaviors such as pausing and phrasing, healthy breathing behaviors and speaking rate.  Speech therapy for stuttering will also typically include strategies for reducing any negative thoughts, feeling or avoidance behaviors.


For more information about fluency, check out: or  , or contact Julie at




Happy Valentine’s Day! 


Books That Teach Empathy

Did you know that children begin learning empathy as early as 2 months old?  Social-emotional growth is just as important as any other area of development. As adults, it is critical that we encourage our children to be kind and compassionate towards others. I’ve pulled together a list of my favorite children’s books to help teach empathy:

Giraffes Cant Dance Pic

Flora the Flamingo Pic









With all that is going on in the world, there is nothing better to be than kind!


-Elizabeth Clark McKenzie, MS, CCC-SLP


Great Games

As therapists, we are always on the lookout for fun games to use in our treatment sessions. With temps hovering well below freezing, pulling out some board games might help you make the most of your time indoors!  I’ve whipped up a list of our favorites:

Zingo Bingo ZingoBingo

Sunny Day Pond Sunny Day Pond

Pop Up Pirate Pop Up Priate

Race to the Treasure Race to the Treasure

Robot Face Race RobotFaceRace

Guess Who? Guess Who?


Mystery Dish DinerMystery Dish Diner


Frankie’s Food Truck Fiasco   Frankie's Food Truck Fiasco

What are some of your favorite games? We’d love to hear them!

-Elizabeth Clark McKenzie, MS, CCC-SLP




Augmentative Alternative Communication (AAC) is an umbrella term that refers to any set of tools or strategies used to solve communication challenges for those who have limited or no intelligible spoken language. There are many different kinds of AAC including picture boards, sign language, low-tech and high-tech devices. Here at Skill Builders, we are proud to offer an expert AAC team.  Our practice is one of seven “LAMP Centers of Excellence” in the country, and the only one in the state of Virginia! We pride ourselves in striving to constantly seek out the latest research and technologies in this field.

AAC can be a fantastic tool to facilitate communication, but we’ve found that there are some myths surrounding AAC that need to be debunked! Here are some common misconceptions:

  1. “AAC is a last resort”

AAC is just a tool, like any other that we would use in therapy.  Studies show that introducing children to AAC earlier in the process actually supports acquisition of language skills and spoken language skills.  Therefore, we do not have to wait until all other interventions have failed in order to start exploring AAC.

  1. “An AAC device will prevent my child from speaking. “

You might think that if a child uses a device to communicate, he won’t be motivated to try to speak. However, research shows the opposite to be true! The majority of studies of the effects of AAC on speech production in children with autism reveal an increase in speech production, and none of have shown a decline in speech production. This is perhaps due to increase in communication opportunities for the child, reduced physical and social demands to speak, and consistent multi-sensory feedback from the device when communicating.

  1. “My child does not show joint-engagement so he cannot use an AAC device.”

Joint attention is actually not a prerequisite for communication, as once believed. Studies show that introducing an AAC device often leads to an increase in joint-attention, as well as in engagement and play skills.

  1. “My child has challenging behaviors.”

If a child does not have a reliable, effective way to communicate, he/she has no other choice but to use behaviors to express themselves. Appropriate, functional, comprehensive communication is necessary for “appropriate” behavior. AAC can decrease the frequency of challenging behaviors by easing frustration and supporting /providing a means of communication.

  1. “My child can already express his basic wants and needs. He doesn’t need an AAC device.”

Basic needs are such a small piece of what people communicate about. Think of all the things you say throughout your day, and how many of them are actually basic wants and needs? Very few! We use communication to transfer information, ask questions, engage in conversation, and socialize with other people. Our goal is for an AAC user to access to the same functions of communication as anyone else. An AAC device can allow the child to participate in everyday routines, which helps reduce loneliness, and fosters meaningful relationships.

  1. “My child is too young for an AAC device.”

Communication is much more than saying words. The first three years of life are crucial for brain development and foundational language learning.  No studies have been found to suggest a minimum age requirement for introducing AAC. The American Journal of Pediatrics does not recommend screens for children younger than 18 months, so for these children low-tech systems can be utilized until reaching this age.

  1. “My child is too cognitively impaired to use an AAC device.”

Communication is a vehicle for expanding cognitive skills. AAC intervention is designed to meet the child at their current level, and work up from there.


If you have questions about AAC, or are considering exploring this for your child, we are here to talk to you! Feel free to contact our AAC team, or come to one of our AAC Parent Support groups to hear stories from other families.  Contact our lead AAC therapist, Amy Bereiter at


Elizabeth Clark McKenzie, MS, CCC-SLP

Information adapted from a presentation created for Skill Builders by Kaitlyn Jones.

5 Steps Towards Better Behavior


Around this time of year, it is very common for kids’ behavior to take a nosedive. If you stop to think about it, we place a lot of demands on children during the holidays: many changes to the schedule, lots of extra stimulation and excitement, pressure to engage with friends and family members, and time away from teachers, therapists and classmates. It is easy for the whole routine get thrown out the window!  This can be stressful for any child (or any adult…am I right?!) but it is THAT much harder for our little ones who have sensory, language, cognitive or social deficits.

Recently, I’ve been finding myself having conversations with parents about behavior challenges, and I just happen to be living with a feisty little two year old who sometimes gives me a run for my money! I’ve come up with five small changes that yield big results:


It is our instinct to tell our children “No!” a lot—“Don’t touch that,” “No climbing,” “Stop throwing,” etc.  For many children, a natural reaction to hearing “no” is to dig their heels in.  Instead, try giving a positive direction. For example, instead of “Stop throwing,” say “Put the blocks in here.” or instead of “Don’t touch that,” try asking “Can you hold this for me instead?


Similarly, it is really important to be specific with children. As adults, we naturally read between the lines and make inferences about what behavior is expected of us, but this can be really challenging for kids. I constantly overhear parents saying vague things like “Listen!” or “No, Ma’am” or “Behave!” When you think about it, what does any of that even really mean?  When we’re at someone else’s house (usually someone who doesn’t have small children), I tend to follow my daughter around saying “Don’t touch.”…”Nope”….”No Touch.”…”No No.” Why am I not giving her something that she CAN touch?  Be specific about what you want your child to be doing right now. Instead of saying “You need to listen,” try something like “I want you to stand next to me and hold my hand while we wait in line.” This way, you are setting your child up for success, and reducing his chances of making another wrong choice.


For some reason, we tend to ask children a lot of YES-NO style questions when we really just want them to follow instructions.  As a therapist and as a parent, I catch my self asking “Do you want to….?” or “Can you ……?” And what do you think is an easy answer to those questions? “NO!” Then what?! I try my best to offer choices as much as possible. Instead of saying “Can you clean up the blocks for me?” I will say “Which color block should we clean up first?” Offering choices not only reduces the likelihood of getting a refusal, but also makes the child feel like he is in control.


Children often don’t have the ability to think ahead, especially when in the midst of a power struggle with Mom.  It is easy for them to get so focused on the item or frustration at hand, that they forget about all other things. Remind your child about the things that might motivate her to have better behavior. Walk her through what will happen if she follows the direction now: “First, we are going to put on our shoes, and then we will get in the car, and when we get to the school, you get to play with the sand table!


It’s sad but true—tantrums happen, from all kids. This time of year, they seem to happen even more! I like to think of temper tantrums like a hurricane; You can see them coming, and there is not a whole lot you can do to stop them. When a hurricane strikes, we don’t try to rebuild homes while the storm is still happening, right? It is only once the hurricane has passed that we can start to really help. Tantrums are the same way!

Did you know that children under five do not have the emotional maturity or cognitive skills to logically talk themselves out of a tantrum? At a certain point, it is so beyond their control that the child might not be able to even identify what sparked the tantrum in the first place.  The best strategy for tantrums is to be present, letting the child know that you are here to listen, and avoid telling him to stop. Avoid walking away or getting angry yourself. Instead, take a deep breath and wait for the child to start to calm down. Once calmer, validate their feelings by stating what you see. (ex: “I am so sorry that you are disappointed.” or “You are really mad that it is time to go home.”). Once you’ve opened the door of communication, you can start to explain why or give instructions. It’s not about giving into what the child wants, but more about teaching her that communicating will get her further than just throwing a fit.

I always preface my advice with “These strategies work MOST of the time.” 😊  Sometimes, bad behavior is unavoidable, and as therapists, caregivers, and parents, we need to give our selves some grace when we have those less-than-stellar moments. The most important thing is that we challenge ourselves to continue to work with our kids, and never give up on teaching them. Putting in the effort to really manage behavior now will result in decreased frustration, more constructive interactions, and most importantly, more time for fun! Here’s to a calm and joyful holiday season with our kids.


Elizabeth Clark McKenzie, MS, CCC-SLP<<<<

Gifts that Give Hope

It is hard to believe it is already November, and the holiday season is upon us! In this day and age, our kids are bombarded with materialism. It can be challenging to instill a sense of gratitude and generosity when there is such an emphasis on “stuff” – especially during the holidays.

Gifts that Give Hope Logo

Skill Builders is very proud to be sponsoring the Children’s Fair at a fantastic event called  Gifts That Give Hope, which will take place on Saturday, December 9th at Discovery Elementary School in Arlington. GTGH is an alternative gift fair that promotes meaningful gift giving, and raises awareness of both local and global areas of need. Shoppers meet and learn about a variety of non-profit organizations, make a donation to organization(s) of their choice in honor of a friend or loved one, and receive a card to present as a gift. Much more meaningful than a candle or scarf!

Donating money can be very abstract for children to understand, so GTGH also offers a Children’s Fair, which aims to make donations more concrete and tangible. Children can shop a variety of items, all which cost $5, and purchase them for someone in need. Examples of these items include:

  • A pack of diapers for a newborn in need
  • A pair of socks for a homeless man or woman
  • A gift for a child in need to put under the tree for his or her parent
  • A board book for a child with special needs
  • School supplies for an orphan in Haiti
  • Dog treats for dogs in an animal shelter
  • ….and more!

As you can see, there is a variety of causes, and the idea is that kids choose gifts that speak to them. This is a wonderful way to introduce the concept of charitable giving to even the youngest of kiddos!

To kick off the countdown to the big event, we are promoting a Kindness Challenge-complete 30 acts of kindness in 30 days! We are challenging all of our families to join the movement. What better way to get in the holiday spirit than teach our kids to think of others?

Here is our Kindness Challenge Calendar, with a suggestion for each day. You can use our ideas, or come up with your own kind acts! Be sure to post pictures on social media using #NovaKindKids so that we can see your family in action. 🙂

Kindness Calendar

Join us as we spread a little kindness throughout our community!

For more information on Gifts that Give Hope, contact Children’s Fair Director Elizabeth McKenzie at