The  Tipping Point: Supporting Families in Articulation Beyond the Therapy Room

Do you find yourself repeating the same message over and over to parents about how to support their child’s articulation goals? Do you wish you had 30 minutes to sit down with them and lay it all out—how to support the child in self monitoring and self correcting, how to make it fun and natural, and how to avoid constantly reminding them to speak correctly? Finding time to communicate all I wanted about generalization was a struggle for me, so I recorded this podcast specifically for parents of soon to graduate speech clients.

*** Show Notes ***
Science Bob’s website is full of great experiments and clear directions. The science behind each experiment is also explained, which is a good opportunity for clients to summarize why the experiment worked. Some of my favorite experiments are:
Build a Fizz Inflator
Fantastic Foamy Fountain
Blow up a Balloon with Yeast
Make Slime with Glue and Borax
Rapid Color Changing Chemistry

Here’s a site with easy no bake kid recipes:
https://www.tasteofhome.com/collection/no-bake-recipes-for-kids/

My favorite recipes for snacks are located at my website in PDF format. 

Music: Simple Gifts performed by Ted Yoder, used with permission

Transcript

Dan: Welcome to The Mindful SLP, the podcast for SLPs looking for simple tools and optimal outcomes. Your host is Denise, experienced speech therapist specializing in all things pediatric and Dan, business manager for her private clinic.

Denise: Welcome back, and thanks for tuning into The Mindful SLP podcast. Today, our podcast is directed towards parents, but SLPs you might find this valuable too, especially if you have clients who haven’t made the leap to generalizing at home. Just know that my comments are directed towards parents. And I know you therapists can tease out the parts that you would use.

Parents do you have a teen or pre-teen who has been working on a sound, maybe an R or an S, and your therapist is telling you how fantastic they are doing and that they are almost ready to graduate. But you, the parent, aren’t hearing the correct sound at home very much, if at all.

Dan: Well, that can be really challenging. I mean, your therapist has years of experience. You just know what you’re seeing at home and sometimes it just doesn’t seem to match up.

Denise: Yeah. So if your therapist says he’s almost done and you don’t hear that at home, a sort of discomfort can begin to build between you and the speech therapist, because the therapist is saying one reality and you’re seeing another reality.

And then a tension often begins to build between the parent and the child, because the parent is frustrated that the child isn’t carrying through. Then you as a parent may become anxious that the child will be released without having accomplished the end goal in therapy. I mean, you spent all this time and money and they’re just going to be let go, and it’s not done.

And therapists may become frustrated because they are running out of activities to do with a client who has little or nothing left to work on in the therapy setting. This is the point when a mother might ask me with a note of uncertainty, do I just nag her then?

Dan: Oh dear. No, that’s not going to work.

Denise: No nagging never works. As the parent knows and is communicating by the tone in her voice, but not knowing what else to do. So there is a way through this impasse and it’s emotionally rewarding for all parties, far superior to nagging or never ending speech therapy. There’s a way to help these clients reach the tipping point.

Dan: What do you mean by the tipping point?

Denise: Okay, I’m going to quote the definition from the dictionary here. A tipping point is the critical point in a process beyond which a significant and often unstoppable effect or change takes place. So in speech therapy terms, it is the point beyond which the client will continue to progress and master the skill they’ve been working on, regardless of whether further intervention is provided. It’s working yourself out of the client’s need for you.

Dan: So it was kind of like getting to the top of the hill in the therapy room as the child starts to coast down the other side of the hill, they’re going to get there all the way. It just may not all happen at once.

Denise: Yeah. That’s exactly. That’s a good analogy. They’re going to roll down. I think gravity is going to help them.

Dan: So what can the parents look for as a signal that their child is getting near to that tipping point?

Denise: That’s a great question. So parents, the skills I’m describing next are the therapist’s responsibility to teach and bring forth as much as possible. They are all realistic for a typically developing child. So I want to be very clear about that because later on, we’re going to go into detail about the child’s responsibility and the parent’s responsibility.

So in order for this to work, everyone needs to be really clear about their roles. So these are the key skills I look for before suggesting clients are nearing completion. They need to be able to say the sound easily. So for example, if you said ma and you said it several times in a row, it would sound like what mama, mama that’s right.

It wouldn’t be ma ma it wouldn’t have those pauses in between. So they need to be able to do that. They got to say this sound easily and repeatedly, and then they need to be able to transition between words easily. So for example, if you said red rabbit say the child was working on R they would need to be able to go red rabbit, not red… rabbit, right. Because that’s how conversation works. It’s sequenced, our words slide into and out of each other. So I have this, um, worksheet I do called Fast Phrases With R, where we do that kind of thing. One of the phrases, where is he? And I talked to the clients about how we’re kind of saying Rizzy where is he?

We don’t go where. Is he is? It’s where is he? It was like, the word Rizzy is hidden inside of there. Right. And one of my clients looked at me and after I explained to him that that’s how you talk. He asked the people who don’t speak English, listen to us and think that our words all run together too. Just like we think foreign language words run together

Dan: Trust me, they do. I talked to the Japanese when I lived there and they could never understand things like Rizzi, it’s not in the dictionary.

Denise: Yeah. So they need to have that skill. That’s a conversational skill. Right. And so number three, can they use a sound at normal conversational speed in conversation? I mean, perhaps they have to slow down for a few words. Like if you’re working on are, worldly, particularly.

Dan: Those are really struggling. I can’t even say those fast some days.

Denise: So I’m not going to say a child isn’t ready to graduate if they have to slow down for that a little bit. Um, I want them to be able to say it. So number four, they can and they do self monitor and self-correct in therapy.

They can hear their own accuracy and the stream of conversation in therapy.

Dan: But in the therapy.

Denise: So this is in the therapy room. So that’s where we’re getting them in the therapy room. Right. And then number five, an accuracy percentage that will meet the tipping point criteria. So I’m trying to get them there. Maybe not all the way there before I suggest parents start doing these things, but they’re getting close. Right, right. Okay. So it’s interesting that studies have shown and I’m going to quote here again, phonological therapy can be terminated when a target sound is produced with 50% accuracy in conversation because targets continue to progress and carry over to full correct use in conversation without additional interviews.

So that’s interesting because 80% has been a kind of standard we therapists are accustomed to using some research has shown that 50% in a conversation is the tipping point.

Dan: What do you do to help parents help their child bridge that gap?

Denise: I have a two tiered approach, which I’m going to call tier one and tier two for a lack of better terms.

Um, don’t confuse it with anything, the school is using their terminology with tier one and tier two. Okay. The first tier developed from an interaction I saw a current in my waiting room between a mother and her teenage daughter. The daughter I’m going to call her Brianne was ready to be released, but her mother didn’t feel she was and she said to me with Brianne standing right beside me in the waiting room, “She doesn’t practice.”

Dan: Ouch, uh oh, that’s not going to go over well with a teenager.

Denise: Oh, you could have cut the tension with a knife. It’s never a good idea to refer to your teen in the third person when they’re standing right there, especially in a critical way.

Parents can forget that in their anxiety. So earlier Brianne’s mother had confided in me that she was worried Brianne would sound like an adult relative who still had a lisp. So, you know, I understood her anxiety, but I needed a way to help her dial it down.

Dan: Okay. So what did you do?

Denise: Later I emailed her and told her that her primary objective should be to preserve the relationship with her daughter.

Every kind of feedback should be given with preserving the relationship in mind. So then I shared some very valuable advice that a counselor once shared with me. He said that our children know when we don’t have confidence in them and it damages our relationship. Over-anxiety for our children can translate into, “I don’t believe you have what it takes.”

Finally, I gave her some suggestions for how to practice speech from a we’re in this together viewpoint instead of a do your assignment mentality.

Dan: Okay. So what were those suggestions?

Denise: Well, I said ask Brianne to show you how to say the sound the right way in the wrong way. Have her teach you the wrong way. And then explain how to correct it. Learn to recite something together, like a poem, a song, a skit, have fun with it, ask each other for feedback.

And this is really important as the adult ask your child for feedback. So you may not have a speech impediment, but there will be something you can improve on. Maybe the way you said a line, maybe the way you sing a note. Model asking for feedback and being very open to accepting it. Now, with that trust in place, you can start to offer feedback to them, but oh please always, always mention a few things they did well, a few things they knocked out of the park before mentioning one thing they might want to correct. So you see the choice to correct their speech is absolutely in their ballpark and they need to want it. And they know this at that stage. They know it’s their choice.

Dan: That makes a lot of sense. I mean, you really need to build up… Well, it’s it’s, this is good beyond just speech therapy. This is just good way to interact with people. Just, you know, learn, give people positive feedback and, you know, and, and build up what they’re doing well. And then when you do have something that they can correct, they’ll automatically take it much better.

Denise: At this point, your child’s speech may not be very noticeable to peers. And so you may be the only one who seems to think they need to change from their point of view. So that’s why it’s really important that this be done in a really positive way.

Dan: So what was the result for Brianne?

Denise: Oh, it went so well. It was like a dream result.

Her mother took my suggestions to heart and the next therapy session, when I asked if they want it to continue, her mother talked about how capable and talented Brianne was, how she could handle it on her own and they didn’t need to come back. And Brianne just glowed. I mean, how often do you get to see your teenager glow?

Dan: No kidding.

Denise: It was the complete opposite of what happened just a week before. And for Brianne, that was all, she needed. Just some support and breathing room to reach her tipping point.

Dan: Oh, that’s so important to give your client, your child, breathing room, room, to grow room, to make mistakes and to correct them. So you talked about two tiers, so I gather some clients need more than this.

Denise: Yeah. Some clients really struggle with awareness and tier two is such a great way to work on it, both in and out of the clinic

Dan: Okay, what do you mean by awareness?

Denise: It’s the ability to hear and be cognizant in the stream of unstructured speech, when they make a mistake. With that skill, they can correct themselves.

And then they start to anticipate an error and make a course correction before they even say the word. Eventually their correct speech becomes automatic. For some clients, the transfer of this skill between the home and clinic is particularly challenging. As a parent, your role is not to correct their speech, your role is to bring them to a state of awareness. If they’re unaware in a state of acceptance, if they are in denial about their speech errors.

Dan: Well, that sounds pretty complex actually for me as a parent, I hope you have some easy ways to do this.

Denise: Oh, I do. And by the way, the groundwork has been laid in the clinic for recognizing awareness acceptance that they’ve been in denial. It’s just, they don’t always carry that home with them. So there are a couple of different activities you can do in tier two. One is playing board games and the other is making videos.

Dan: That’s just like playing, uh, explain how playing a board game is going to work for building awareness.

Denise: Okay. So you can do this game with a group or just you and your child.

You kind of decide where your child’s at, but everyone needs to be on board with setting a goal and measuring it themselves. And it’s not an accuracy goal, it’s an awareness goal.

Now as a parent. What’s that?

Suppose we’re working on the R sound, and I’ll say we need to say at least one word with R in it every time we take a turn. Decide how many R words you’ll say for each turn and write your goal down. Every person has a piece of paper. Every person writes it down.

Dan: This is an addition to my Monopoly, and I’ve got to have these extra goals that I’m discussing with my child.

Denise: But it’s only one goal. It will be, I will say one word with R in it every time we take a turn or I will turn yeah, yeah.

See and they’ll point that up. My goal was one R, but I said two Rs, or maybe their goal will be two Rs. So every person who takes a turn and notes, whether they met their goal. They give themselves a plus a checkmark, whatever. What is great about this is it’s self-correcting the game does not proceed until the person who just took her turn has recorded it.

And you don’t need to say anything if they forget you just wait. And the silence or the game not progressing forward is their clue. They’ll look at you like “It’s your turn.” And sometimes I’ll just silently point to their paper cause they hadn’t made their mark yet. Okay. Then they’ll start thinking about what they said and you’ll their eyes will do that, thinking back to the past, you know how our eyes move and they’ll start rehearsing it in their mind. And then if they realize they didn’t or if they don’t even remember, then they’ll quick throw something in like, oh, it’s your turn. And then they’ll make their mark and you’ll go on. I can guarantee you that most of what they say will be accurate from the start, but what you will see an improvement in is in their awareness.

Dan: And that’s which we’re really going for. Can you give me a real concrete example of how this works?

Denise: So sure. If you’re playing pickup sticks like I did today, and both of us had the same goal that we would say one word with R in it, we said things like, um, I’m removing this stick. This one is hard to get to. Now it’s your turn. This is worth three points. This is a three-pointer, here’s an easy one, and so on.

Dan: So that sounds pretty easy actually. And a lot better than constantly reminding them to, you know, say an R word or something like that.

Denise: Yeah, to make sure you say your R word correctly.

Dan: Did you put an R word in there? You’re just, you’re just looking at them and waiting until they realize, oh wait, I didn’t put it in an R word.

Denise: And you’re not even talking about the accuracy. Cause at this point they can monitor that. If they realize they need to say it, they can make it accurate, most of the time. It’s so much better emotionally for all concerned and plus it works. But sometimes you need to do even more. Then it’s the time to harness the power of audio visual. That’s right. It’s time to make your child a potential YouTube star.

Dan: Wow. Okay. This sounds really complex. What kind of videos did we do?

Denise: Well in the clinic, we will do food videos without any actual cooking, science experiment videos, and sometimes part of a movie or a fairy tale script. So for example, we might make fruit pizza with Nutella, a flour tortilla, and fruit.

We always make fantastic foamy fountain for science. That one is super awesome. Most clients in this age group loves some of the scenes from Princess Bride. So we often do a scene from that, you know, “Inconceivable!” they love that one. And so parents, you can do some of these same things.

Okay, this sounds really complex though. I mean, is this like a full blown video production? Do I need to buy lights and camera and equipment? I’m. I’m already just getting overwhelmed here.

Oh, not at all. Just gather a few things around the house. Get yourself a camera person. Um, even your phone can record, right. Make a brief plan. And off you go.

Dan: You’re asking me to do the same activity that you’re doing in a clinic.

Denise: At this point, yes, and I really encourage it.

Dan: So if it’s the same process, how will this help my child reached their tipping point what makes the difference?

Denise: Oh, that’s such a good question. So the therapy room is a very controlled environment and the home is not. You can involve siblings and friends, and there are bound to be interruptions, it’s real life happening to all around you in a real life situation.

All of these kinds of distractions are what clients who struggle to generalize need to learn to deal with while maintaining their new skills. The videos in the therapy room are one of the most unstructured, hands-off, you’re on your own activities I can do, but it’s no match for the home environment.

So what’s the process I follow? How do I make, how do I make a video?

Okay. It really comes down to two ideas to make it work for this speech therapy process, previewing the material to prepare for optimum success and then reviewing the results to evaluate performance.

Dan: Can you explain each one of those further, please?

Denise: Yeah. If it’s an instructional videos such as cooking or science, previewing the material means reading it over and figuring out how to say it in your own words. It’s making sure you’re clear on the steps and perhaps practicing a few tricky words. Maybe you need to make a few notes to follow. I don’t encourage reading the directions, um, because then they’re just not engaging with the audience. And just seeing the words is enough sometimes to give that client more support than they need when we’re trying to remove the supports, they need to say it in their own words. And if it’s a science experiment, maybe they just make a few notes on a sticky note, do this, do this, do this.

Right. Okay. And previewing a movie script means memorizing some lines and playing around with timing and intonation. That can be really fun.

Dan: Okay. So what’s involved with reviewing the results?

Denise: So this is the most structured part of the process and where the most learning occurs. This is where we finally talk about the roles and responsibilities that I alluded to earlier for the parent and the child.

When you’re going to review the results, everyone gets a piece of paper and a pencil. It’s everyone’s responsibility to make a note of things they did well and things they wanted to improve.

Dan: This is me and the child and everybody who’s involved. If their friends are over, everybody’s do this.

Denise: And I suggest a three to one ratio of positive negative.

Dan: And this is a self-critical thing. right, so each person is coming up with three things that they did right, and one thing that they could improve on?

Denise: Yeah, nothing has to be that cut and dried no three to one, but as a parent, you can keep that ratio in the back of your mind and model it.

Dan: Right. So if you see somebody and it doesn’t have to even be the child that you’re working with, but you know, it could be anybody, is starting to really beat up on themselves and come up with the seven things that they did wrong, be nurturing, help them think, well, what did you do right.

Denise: Yeah. Yeah. And even the camera person makes notes because believe me as the camera person from my clients, I’ve made lots of errors in the times I’ve forgotten to turn the audio on. That makes me blush. So after everyone has made their notes, you might need to play it back a few times for everyone to notice something to improve on, or a few things to do well. So feel free to tell others what they did well, but let each person decide, like we said, what to improve on, you know, your child with a speech error, they should understand that that’s one of the things they should be noticing, and you can establish that understanding before you start the whole activity.

You don’t need to say it in front of their friends, but they do know that this is one of the things they are doing, to help them focus and build awareness for their speech, because at some point that does have to enter in.

Dan: Right. Oh, what I hear you saying though, it’s not my role as the parent to point out the child’s speech errors.

Denise: Right? Yep. Now going to be hard for some parents.

Dan: Oh yeah, that’s all I’ve been doing for 10 years.

Denise: So think about it this way. If you’re listening to this podcast and if you’re thinking, yes, that’s my child, all right, he’s just not sounding like the therapist says he can. And if you fall into the habit of pointing out their errors, I’d like to point out that it hasn’t worked. So you need a new plan. The new plan is to nurture your child’s role as the one responsible for their speech.

Dan: So what should I do if the video was really just, just full of speech errors?

Denise: Okay. First of all, don’t be surprised. Okay. So one of my clients who had quite a hard time with awareness, He was only 30% accurate on his first video.

So this was after he had been really accurate and lots of other unstructured activities and therapy. So you can see that was quite a discrepancy. Um, we went for shorter videos. We just kept reviewing them and redoing them and he kept building awareness. I mean, we just had to do them again and again..

Dan: It’s a hard thing to learn, to really notice it. I mean their whole life they’ve practiced not doing it correct. This is a hard thing to start being aware of.

Denise: Yeah. And then, but it happened, he reached this tipping point and then his accuracy just shot up. So, but it began with him noticing a few of his errors and remembering them long enough to correct them when we did a retake.

Right. Okay. And then he had to do some tier two activities at home because it wasn’t transferring outside of the. And then he graduated. So we made it. Yeah, it works.

Dan: Yeah. So it really is like getting to the top of the hill and slowly starting to pick up speed and then they will get better and better and better until it just becomes second nature, and then we’re done.

Upon reviewing the video, you know, your child is, should be able to notice at least a few errors. If the therapist has fulfilled their role, they’ll have this capability and there might need to be some back and forth discussion. If it seems to you after a few reviews, they’re totally incapable of noticing the error.

Denise: Sometimes in therapy. If I had to backtrack a little bit from where I thought they were and that’s okay. And then we just move forward again. They should be for most of the situations I’m talking about. I think you’ll just be able to go on. They will notice a few errors and just one or two was all you need.

Take any notice of any error as a victory and praise the noticing. In fact, everyone in the family gets rewarded for being brave enough to notice what can be done by.

Dan: Yeah, so we’re not gonna worry about the mistakes that they made. We’re going to be very excited about the fact that they notice that they made a mistake.

Denise: Yeah, it’s all about the noticing.

Dan: That makes sense. So what’s the next step after reviewing and evaluating?

Denise: Everyone chooses one to two things they will focus on doing better, and you do a take two. That’s what movies are all about, right? Take two. Then you follow. Then you follow the same process of reviewing and evaluating.

Um, I don’t know how many want to do, you know, you get to decide that as a family, then choose a new topic to video and repeat. So I predict over time, you’ll see a gradual improvement in your child’s speech until they reach the tipping point.

Dan: I get this, I think this sounds really good, but it’s still kind of intimidating and this really sounds time-consuming. Isn’t this what I’m paying you to do?

Denise: I totally understand what you’re saying. I know it’s intimidating to listen to three to five minutes of video and decide whether dozens of sounds were said correctly or not, so don’t do that. Don’t try to record all those data points. That’s what therapists do, and we’re not even too fond of it.

I have two suggestions. One trust the research that says 50% in conversation is the point at which speech therapy can be terminated and do these activities to build your child’s awareness of what they can do and your confidence in them. If you’re so anxious about, oh, I can’t be done yet, they can’t be done yet, this is a way to get over that anxiety. And it just builds the confidence that yes, it is going to happen. And two, perhaps every other week use a recording app and record a conversation with your child, date them, and listen to them in sequence in hear the differences. You can do pluses and minuses for data, you know, if you want to and get a really firm idea,

Dan: What do you mean by pluses and minuses?

Denise: So if they say the sound wrong, a minus that they say the sound right.

Dan: Oh, like writing these down or something, if I’m really concerned about this.

Denise: And you can get a percentage, um oh, okay. But you should also be able to hear progress over time, even without doing that, our ear can, oh, they’re sounding better, so it’s kind of up to you.

Oh, by the way, I bet your speech therapists would love to hear some of those recordings too. And they do, do those pluses and minuses a lot.

Dan: That’s what we do pay you to do.

Denise: Um, but to answer your concern about isn’t this what we pay you for, I want to return to what I said earlier about roles and responsibilities. So I consider it my responsibility to teach your child to say this sound easily, transition between words easily, use the sound at normal speed in conversation, self-monitor, self-correct, and develop an accuracy percentage in conversation that will get them to the tipping point criteria. That is as far as my role can realistically go. You could continue to pay me for therapy, but the returns will be diminishing. What your child needs now is something that I can’t really do.

It’s time to pass the baton, but I will have gotten the far enough that they can complete the journey with you.

Dan: Do you have some resources to share?

Denise: Oh, I sure do. So in the show notes, I’ll link to the science experiments and the snack instructions I use. Remember you can also recite poems or sing songs as a family or tell family stories or do magic tricks.

I mean, there are lots of options. What do they love to do?

Dan: So really? We can just put this together into our family time. Just incorporate this all sorts of different ways.

Denise: Yeah. Remember once our kids recited and illustrated the Jabberwocky and made it into little video? Oh, it was hilarious. We loved watching it. So the videos besides being a way to get them to the finish line in speech can become a fun part of your family scrapbook.

Dan: To wrap this up, please go over this just real quick again.

Denise: We covered the speech therapist role, which was teaching them to say this out easily, naturally, transition between words, build up speed, get to a certain accuracy percentage. Once they’re there, then the speech therapist can start to pass some things off to you.

I mean, they have been doing homework along the way, but conversational, unstructured things to you. So we’ve got tier one, uh, where the idea is that you’re going to give them breathing room. They’re already, mostly there. You’re going to have, uh, we’re in this together approach. And that’s all they need to reach their tipping point.

We’ve got tier two, a little bit more structure where you can play the board games where they just bring in that awareness of, oh, I’m saying that word and they’re going to start saying it right. And they’re just gonna become more and more aware of it. And then a little bit more in tier two, making the videos where they really have the chance because you have recorded it, to go back and listen to it. So the kids who have a poor memory, poor auditory memory, this really helps us build it. They get to hear it. Oh, I didn’t say that right.

Dan: If you want to go back to the analogy of this child’s speech problem being a hill, the speech therapist is really working with them, doing all the heavy lifting, pushing them up the hill.

Once they get to the top, the kid starts to accelerate down past the tipping point and they’ll start picking up momentum and they will eventually start to pull away from the speech therapist. But you as the parent, we’ll be at the bottom of the hill to catch them and to support them and to help them. And they’re going to just keep going faster and faster, and then they’re going to be, you know, there. They aren’t going to be a hundred percent when they graduate necessarily from therapy.

Denise: No, and that’s not realistic because it takes some time for that very last few words to tumble into place, but they, they will, and they don’t need the speech therapist anymore.

Dan: And i, as a parent, don’t panic. Just because I hear the mistakes they’re going to get better and better. And just do these activities to help shore them up and help them make those last few percentage points of accuracy until they’re just like, we’ve all forgotten that we ever had speech therapy.

Denise: Yeah. That’s the goal we have forgotten. They had speech therapy as a dim memory.

Dan: Well, great. Thank you for explaining it all.

Denise: Thanks for listening to The Mindful SLP.

Dan: Thank you for listening to The Mindful SLP. We hope you found some simple tools that will have optimal outcomes in your practice. This podcast is sponsored by SLP Pro-Advisor. Visit SLP pro-advisor dot com for more tools, including Impossible R Made Possible. Denise’s highly effective course for treating those troublesome Rs.

A link is in the show notes. If you enjoyed this podcast, please give us a five-star rating and tell your fellow SLPs. And please let us know what you think. Join the conversation at SLP pro-advisor dot com.