Practice Makes Perfect!

KONICA MINOLTA DIGITAL CAMERACold mornings, snow days, runny noses, high fevers, doctor appointments! These are just some of the challenges this time of year presents for families intending to bring their children to weekly therapy appointments – and even the best laid plans can go awry. However, consistent attendance is crucial to the progress children make in therapy. What’s a parent to do…?

1. Home practice!  Did you know that a child’s time in therapy can be reduced by up to half if they practice on a regular basis? If homework is not provided to you, please ask your therapist what you can do at home to practice skills learned in therapy. Many fun, multi-modal activities can be recommended, including iPad apps, games, and movement break ideas. Your therapist can help you brainstorm ideas to build practice opportunities into your daily routine; homework does not necessarily need to occur sitting down at the kitchen table. Children learn best when they are emotionally invested and having fun. Working on /s/ blends? Try a “splash” game in the tub! Need to work on balance? How about building an indoor obstacle course!  Visit our Pinterest page for additional home practice ideas. And check out these great homework tips from Tactus Therapy.

2. Makeups.  Makeups offer your child the opportunity to catch up on their missed lessons. Should your therapist be unavailable when you need a makeup, consider a makeup with a different therapist. A substitute therapist can often suggest novel activities for your regular therapist to try, as well as provide a second set of eyes and ears on your child’s development. Establishing an ongoing relationship with at least one sub can be helpful, especially for young children who may be shy around new people.

3. Teamwork. Foster collaboration between your therapist and your child’s classroom teacher. Teachers are often eager to help generalize therapy skills, but may want to touch base with your therapist before doing so. This is an important piece of therapy, as it is a time for your child to demonstrate and carryover learned speech, language, and OT skills. When everyone is consistent and on the same page, your child has the opportunity to progress quicker.

Stay warm and happy practicing!


Indoor Snow Fun

snow-on-tree-1534379So it snowed. A lot! Which means your kids have a ton of time on their hands. Feel like you’ve run out of ways to entertain them? We’ve got some game ideas and iPad/tablet apps that your kids will love and will be great to foster their speech, language, and occupational therapy skills!

Preschool and kindergarten kids are at a great age to pick up everything around them. They really are sponges at this age and have a great chance to develop their skills. This is especially true of articulation skills. Typically, kids aged six-seven will have all of their speech sounds (which is also important for those literacy skills!). To be able to play a game that will work on important foundational skills is a win-win! Here are a few fun games and their suggestions for speech/language/OT development:

  • Monkeying Around: this fun monkey game keeps the kids interested every time. They just love to drop those monkeys off the tree and into the water for the alligators to chomp on! Skills targeted: counting, direction following (“Put the blue monkey on before you put the yellow monkey on”), fine motor coordination and pincer grasp (grabbing the monkey and carefully placing it on the tree), turn-taking.
  • Don’t Break the Ice: your kids will delight in this fun game where you take turns knocking down pieces of “ice” – but be careful not to knock over the polar bear! Skills targeted: articulation (print out some words and tape them on the ice cubes or just try to say a word on every turn), turn-taking, and target accuracy.
  • Pictureka: this game is an object-finding game with a timer and some silly items. Older kids will love this game that has them searching for wacky pictures. Skills targeted: turn-taking, visual scanning, categories, decoding.

We get a lot of questions about apps that would be helpful for speech, language, and OT. Here are a few suggestions of some apps that our therapists love!

  • Starfall ABC: lots of schools actually use this computer game to work on sound-letter correspondence. What’s good about this game is that it has all the letters of the alphabet, reinforces their sounds, has entertaining objects that start with those sounds/letters, and has engaging games at the end of some of the levels. It’s great to give your child some extra practice on their pre-reading skills. They’ll never know they’re learning!
  • I Spy with Lola: A great app for visual-motor skills, such as visual scanning and eye-hand coordination needed to manipulate the visuals on the screen and search for hidden items in the game. It also targets the use of visual perceptual skills, particularly figure ground, visual discrimination and form constancy, needed to identify items within a child’s environment and complete writing/drawing tasks. It’s a fun, interactive and skill-driven app with which many children have a good time engaging.
  • Toca Boca Tea Party: this app can be used to target a variety of speech and language goals. Most commonly: turn-taking and pretend play question formulation. For example, the child can ask: “What do you want?” “Do you want more?” or “How does it taste?” Kids who are working on using longer phrases will also benefit from use of this app: it allows modeling of phrases of varying lengths and repetition of those phrases on their next turn. *All the Toca Boca apps are a favorite around Skill Builders. They are also great reinforcer games. Check out: Toca House, Toca Doctor, and Toca Hair Salon.
  • Charades Articulation: this app is great for sound practice. You can set it by sound/position (ie. initial, medial, final), which is great to practice one position at a time. Use this app to act out a word or describe the word for your child and have them guess. It’s good for competition as you can get many words (10+) each round, which lasts 60 seconds.
  • My Play Home: this is an app that is good for following directions (Close the curtains and then turn on the radio), as well as vocabulary around the house. Kids love playing this game as they get to “pretend” they are mom or dad – great for imaginative play. This can also be used for narration and sequence – “What are you doing?” “First, I’m getting the cereal, next I’m pouring it into the bowl.” “What do you need next?” etc, etc. This app can also help with finger isolation, as you need to move objects across the screen to get them to where you want them.

We know buying a ton of apps can get expensive. That’s why we like “Free the Apps.” This app will list apps that have gone free for the day or week. It’s an informational app, but it’s a good one that helps out your wallet and can give you ideas. Who knows what you’ll stumble upon! If you’re interested in additional apps or games, consult with your therapist. In the meantime: enjoy the snow!

Picky Eaters


Many children go through phases of “picky eating” at some point in their lives. For some, this is a short-lived phase and for others, it can be a life-long struggle. There are many factors that contribute to picky eating, including oral motor development, sensory processing, behavioral issues, social anxiety, gastrointestinal problems, and more! A speech-language pathologist or occupational therapist who specializes in feeding therapy can help address picky eating in a therapy setting, but there are many things parents and caregivers can do at home to encourage the child to expand his food repertoire. Here are nine ideas to get you started:

  1. Make it a game!5132157

Using fun games can be a great motivator for trying new foods. Roll a dice or spin a spinner to determine what to take a bite of next! You can also check out some cool plates, like this one from Fred and Friends, that encourage exciting eating at every turn.

  1. Explore foods without pressure.

There are lots of ways to explore new foods beyond taste- look, smell, touch, poke, pinch, stir… Instead of telling your child to “eat this,” encourage them to “check it out.” Build a tower out of fruit or skewer veggies on a wooden stick or paint a picture using different kinds of yogurt. Make a funny face out of some favorite foods and some new ones! Get creative and have fun, and your little one might just decide to take a taste!

  1. Take them shopping.

Taking your young child grocery shopping might sound like more work for you, but the supermarket is a fabulous place for your kiddo to see all different kinds of foods! Who knows what color or texture will grab his attention! Send him on a mission to pick out something fun to try this week. Getting to pick something out himself might be more motivating.

  1. Make a bite chart.try_something_new_chart_-_image

For many kids, having a visual system can be very motivating. It sets the expectation without engaging in back and forth negotiation. Aviva Allen, kids’ nutritionist, has a great deal of resources on her site, including the bite chart pictured here. Bite charts are also great because they give the child something to work towards, decreasing the feeling of this being “work” and increasing “fun.”

  1. Don’t “eat” it- “try” it.

Avoid saying things like “Just eat it” or “Take a few bites.” Instead, talk about new foods in terms of “trying it.” You can say “Give it a try and then you can decide whether or not you want to eat it today.” You can also offer choices of different ways to try (ex: “Do you want to lick it or tap it on your teeth?”).

  1. food-pyramidTalk about the food groups.

Regularly discuss the different food groups with your child, as well as how different kinds of food benefit our bodies. Talk about how grains give us energy to run faster and milk helps our bones stay strong. Guide your child to associate healthy eating with a body that feels good.

  1. Get in the kitchen!

Hire yourself a mini-sous chef! Have your child help you stir, add, chop and sprinkle. Smelling, touching and looking at the food will expose them to new flavors and textures without any pressure to eat it. Allow your little one to help you make decisions as you prepare the meal- should we cut the tomato in little pieces or big pieces? Which should we add first- the corn or the peppers? Should we use long noodles or bowtie pasta? This gives a sense of control, and provides an awesome avenue for exploration!

  1. Dip it!

Dips can be a great catalyst for trying new foods. Find a dip that your child loves- peanut butter, hummus, Nutella, sour cream, ketchup….anything! Dip some preferred and some non-preferred foods and let your child tell you which tastes best.

  1. Make it a family affair!

Picky eaters are famously good at isolating themselves from family meal. Create a culture of adventurous eating by instituting at least one family meal a day. Encourage all family members (siblings included!) to participate in the above-mentioned strategies. This not only takes the pressure off of your picky-eater, it also creates a positive meal time experience for everyone.

It is important to keep in mind that we ALL have preferences when it comes to our diets. Think about which foods you love most, and what foods send you running for the hills.  For many of us, we have acquired tastes for certain foods over time. Remember the first time you tried coffee? Your child is no different. This is why continued exposure to a wide variety of foods is crucial to expand their repertoire. He might reject a food 19 times, and then decide to give it a whirl the 20th time he encounters it. By creating a comfortable, fun, safe environment for your child to explore foods, you are putting your child in the driver’s seat of his own diet and sending him on his way to better eating habits. Bon Appetit!


-Elizabeth Clark McKenzie, MS, CCC-SLP

Back to School… Back to School

back to schoolCan you believe summer is over already?? Some of you may be excited; some of you may be nervous; others may be sad. But no matter how you feel, you are likely to get overwhelmed at some point. There are lots of transitions that occur with the start of a new school year: new faces, new curriculum, new schedule, new everything. Don’t worry, though, because we’ve got you covered on approaching the school year headfirst, especially when it comes to working with your team.

  1. TEAMWORK. Working together is such an important factor in your child’s success. And it starts with you. Parents are most definitely part of the TEAM. Get to know your child’s team as soon as you can. Though you may already know a few familiar faces (oftentimes, SLPs and OTs remain constant across ages), be sure to send a friendly email or even drop by the office just to say “Hi” and “Welcome back!” It’s always better to approach someone (especially if you don’t know them that well) when things are good, rather than having to introduce yourself if and when a problem or concern arises. This way, you’ve made yourself a familiar face.
  2. PREPARATION. If your child has a difficult time with transitions, you know that prepping them is probably a good idea. Use visuals like a poster-type schedule that you can put up in a regular location to remind them what will be coming up that day. There are some schedule apps available as well if that might be more motivating to your child. Check out: Choiceworks Calendar, First & Then, and iPrompts.
  3. MEETING. If anything has changed over the summer that you think your child’s team should know and should be formally discussed, contact the school for an IEP meeting. Anyone from the team can call one at anytime (remember, you are an important part of the team). This will give you the opportunity to adjust any goal areas or accommodations as needed. If your child does not have a current IEP but you would like to explore the option of them having one, raise the concern and get the ball rolling. It can take quite a bit of time for your child to get the services they need as usually 2-3 meetings will need to happen before your child can receive services. This varies by state and county but check in with your school or your district’s website for additional information.
  4. POSITIVITY. You’d be surprised what kids can pick up, given the energy around them. No matter what age, it’s pretty interesting that a child’s current behavior may be affected by the attitude of those around them. Encourage your child, send positive thoughts their way, and work on “I can” statements. You’d be surprised just how motivating these last few suggestions can be. And motivation is the catalyst to success.
  5. HAVE FUN! This one goes along with the last tip. Your child may be growing up, but this is a good thing! Take pictures, make videos, write a journal (can be challenging and successful moments), cherish each moment, and try not to sweat the small stuff. Easier said than done – but it’s great to see how your child grows over the course of time. Growing pains are natural so it won’t always be rainbows and sunshine but just trust that it’s all happening in a way that will work out in the end!

Have a great school year!!

Summer Therapy Home Practice

cartoon sunLast week marked the first day of summer and since school’s out for summer, there’s no better time than to capitalize on all that extra time you’re sure to have in between beach trips, cannonballs at the pool, and all that comes with the carefree laissez-faire days of summer.

Nowadays, it seems like the most natural thing to have the kiddos in front of is some kind of “screen” – a TV, a computer, an iPad, an iPhone (which can be great tools as well) – but there are lots of other fun activities that can help your kiddos stay entertained, while garnering some great skills (without them even knowing it’s work). Here are 5 Non-Screen Summer Activities:

1. Go to the zoo. In my work with kids, especially those that are speech delayed, I have seen many begin to talk a lot more around animals, including sounds and names. Giving your child the chance to experience this firsthand is a great way to get them talking some more. Narrate your visit at the zoo by naming the animals, making the sounds they make, and throwing some action words in there, ie. Go lion; Lion sleep; Elephant eat. Or you can also use a carrier phrase, such as “I see lion!” Check out the National Zoo or the Reston Zoo, for starters.

2. Hang out at the park. Your neighborhood jungle gym might be just the ticket, especially when you’re not up for a more crowded location like the zoo. The park is a great place to visit because it is helpful to have kids interact with each other in a social manner. Here, they can learn the skills of turn-taking, requesting, compromise, and general communication with peers. And don’t forget about those gross motor skills! Kids will learn a lot about their bodies as they move about the playground.

3. Create a summer soundtrack. Summertime may be just the right moment to break out the drums (yep, I said it) and jam out with your kids to harness their creative side. Musical toys tend to be a real hit with kiddos. Additionally, introducing a new playlist for your next road trip might be just the ticket to increasing expressive communication. Research has shown that music helps awaken the opposite side of the brain and can often open up a world of possibilities for attention and development.

4. Get moving with yoga. Rainy days are no fun, but we all know when a summer storm is brewing. When you need to bring the kids in from the pool (or maybe just for a deep morning stretch), try playing some silly movement games to get the energy out and get them moving. Yoga is great for this and lots of our occupational therapists use some of these moves in therapy. This is a great strategy to help decrease stress and anxiety, improve self-regulation abilities, and improve overall motor skills. Get those frog, warrior, and tree poses ready!

5. Play ‘I Spy…” This game is great for improving expressive language. I often work with kids who use “thing” and “stuff” to refer to objects. I’m constantly trying to break them of this habit and get them to use more appropriate specific language. When you play “I Spy” or any other clue-giving game (hey there, Jeepers Peepers and HedBanz), your kids will need to picture your words to guess (receptive language) or will need to give you a specific description to have you guess (expressive language). I always try to get at least 3 clues before the other person can guess. “I spy with my little eye, something that is a red food that is juicy and comes from a tree…”

This is just a taste of some screen-free summer activities. Your therapist can always give you additional suggestions. Happy Summer!

Group Therapy

summerThe word group may lead you to think about the opposite of individual. Why pay for therapy that is not personally suited to your child’s needs? However, group therapy makes me think functional and practical.

There is only so much that can be taught to a child when interacting with an adult alone. In fact, many kids in therapy can interact with an adult but when put with a group of their peers, they are challenged and cannot appropriately participate. This is where groups come in, especially in the case of pragmatic language kiddos.

What is pragmatic language? Pragmatic language is thought of as social language – how we interact and communicate with other people. The necessary skills to participate successfully within a conversation include inferencing (making a “smart guess”), auditory processing (being able to comprehend and respond to what you’ve heard someone else say), interpreting language (think idioms and figurative language), understanding word meanings (two/to/too), and much more. Additionally, in the therapeutic setting, speech pathologists can teach individual concepts, such as those put forth in Michelle Garcia Winner’s Social Thinking principles. However, a group allows the child to apply what they’ve learned and directly understand “expected” vs “unexpected” behaviors in the moment. Not to mention that groups tend to be less of a burden financially, given the amount of kids in a group.

Summer is the perfect time to participate in group language therapy, given the decreased pressures of academics and the carefree living of the season.

If you’re in the Northern Virginia area, Skill Builders has many language groups, articulation groups, and sensory groups available this summer. Check ’em out!


After the big #dressgate a few weeks back, I got to thinking about perceptions and a favorite old social language concept: perspective taking.

What is perspective taking? In Michelle Garcia Winner’s Social Thinking terms, perspective taking is when you have a thought about another person (“I can’t believe she thinks that dress is white and gold!”) and then realize that others have thoughts about us too (“She is crazy if she thinks that dress is black and blue!”). To further think of this concept we must be able to understand how others perceive things and realize that our opinions are not always the opinions of others but that we are always formulating thoughts about those around us whether we realize it or not. Was the dress black and blue or white and gold? Does it really matter? Are we so freaked out by the reality that others can see something differently than we can? And actually in this case, science can explain a lot to us.

duck rabbit 3_18_15This isn’t a new concept, however. Take one of my favorite books: Duck, Rabbit! Do you see a duck? Or maybe it’s a rabbit. But does it matter? The point is that we are able to defend our choices, explain them, and accept that others may not always agree with us. You have a thought and I have a thought – it’s what we do with those thoughts that enables us to form and maintain relationships with others. Often, our kids cannot understand this concept. They usually think because they like Minecraft or learning about black holes that others must like the same. We all find joy in a variety of topics, no matter who we are. And this is the concept I work on with my kids. If you can defend your opinions and accept the concept of agreeing to disagree, then I certainly feel successful. Furthermore, if you can realize that you are not the only one with thoughts (and that others will be perceiving you a certain way based on what you say or do) then we are definitely making progress.

Black and blue, white and gold, duck or rabbit. I can see the argument for any. Let’s work on acceptance of the argument and explaining what YOU think. We could all use a little flexible thinking.

Photos originally from and

Childhood Developmental Milestones

baby 3_17_15As a speech-language pathologist, I am often sought after by friends and family to provide solid information on development. My go-to responses often include: one year-one word, two-word combinations by 18 months, and walking around a year. Early developing sounds include all vowels and consonants /b, p, m, t, d, k, g/ (within the first 2-3 years).

However, this is not a perfect science. In fact, there are several schools of thought in the research about the when of sound development. The Virginia Department of Education uses the Iowa Nebraska Articulation Norms in schools as a guide but then the Goldman-Fristoe Test of Articulation Norms present some discrepancies.

So what do we do? This seems far from NORMal. My rule of thumb is often to use these as a guide. When testing children, we need to have some kind of reference and we can think about early (those named above) vs. late (“th” and “r”) developing sounds.

Another important “milestone” that is a good measure of sound development comes within a child’s intelligibility. I usually think of the following numbers when it comes to intelligibility to an unfamiliar listener (parents and teachers are deemed “familiar listeners”) when context is unknown: by 2 years old a child should be about 50% intelligible; by 3 years old a child should be about 75% intelligible; and by 4 years old a child should be about 100% intelligible. Keep in mind that I don’t think anyone is always 100% intelligible – this will specifically happen on the phone, in a crowded and noisy room, or when someone mumbles. Remember, these numbers are just a guide to get a general idea, as all children develop differently.

In any case, I always recommend visiting a licensed speech-language pathologist to assess articulation if you have the slightest concern. “Mother knows best,” as they say so go with your instincts. It’s always better to be safe than sorry!