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Interview with Holly Rosensweig of Spiffy Speech-a Speech-Language Pathologist

A speech-language pathologist (SLP) is a trained professional that works with children and adults who may have difficulty communicating, as well as those with swallowing disorders.

The COVID-19 pandemic has put a lot of strain on families and children that require assistance from a skilled SLP.

Meet Holly.

Holly is an SLP that has been working with the pediatric population since 2008. She started Spiffy Speech while in graduate school, which is an excellent resource for other SLPs and parents!

Check out my interview below with Holly, where we discuss how the pandemic has affected children's speech services and what can be done at home to ensure your child does not fall behind.

The pandemic has made all of us think on our toes, be creative, and learn new ways to communicate, educate, and care for children. How have you adapted your practice to cater to children virtually and meet their needs?

I work for two pediatric private practices. My colleagues and I needed to make an abrupt switch this past March from providing speech-language therapy all in-person to virtually via teletherapy (aka telepractice). There was a learning curve that needed to take place very quickly for those of us who had not provided teletherapy before. However, some SLPs had already been providing teletherapy for years, and they were gracious enough to share their expertise! Overall, SO much collaboration and support are taking place behind the scenes between therapists and educators (real-life colleagues and strangers on social media). It has been incredible to see everyone working together to cope with this situation!

Some parents were expecting that online sessions would consist only of talking to kids using Skype or FaceTime; they were then shocked to see how much more there is to teletherapy than just video chatting. Using Zoom and/or dedicated teletherapy platforms allow SLPs to play digital games with students, show iPad apps, read books, engage in movement activities like Simon Says, watch videos on YouTube, take virtual field trips, and share pictures or documents on-screen! The ability to effectively address speech-language goals via teletherapy has been backed by research. The American Speech Language Hearing Association even approved telepractice as an appropriate method of service delivery in 2005!

What creative tips do you have for parents of children with language disorders to promote the growth of his/her speech-language skills while at home?

One silver lining of the current situation is that parents/caregivers can spend significantly more time with their children at home. Instead of being in a large classroom for most of the day, there is more 1:1 interaction with adults, which can provide even greater opportunities to build communication skills-- for children with and without speech-language delays or disorders.

Unfortunately, the shift to virtual learning means a lot more time spent watching screens, which we now know can be harmful to children's development. While the screen time increase is unavoidable, screen time that involves communicating with a teacher or therapist is considered ACTIVE screen time and can be beneficial and educational, unlike passive screen time such as watching TV/movies. Parents should try to limit their child's screen time outside of virtual learning as much as possible.

The best way to build communication skills is to talk and interact with your child during activities like shared book reading, playing games, playing with toys, playing outside, and engaging in daily routines. Instead of simply reading the words in a book, parents can stop after each page has been read to describe the pictures and ask the child questions. With younger kids such as preschool and early elementary schoolers, parents can ask more basic "wh" questions such as "What is the bear doing?" "Where is he?" "Who is wearing a hat?" With older elementary schoolers, parents can ask more complex types of questions such as, "Why?" "How can you tell?" "How are those two things alike/different?" "What would you do if….?" or opinion questions like "What is YOUR favorite dessert?"

Parents often think about a child's expressive language development or verbal output but not always their receptive language skills or comprehension of spoken language. To support receptive language development, parents can have their child practice following a variety of directions. Examples include first/then directions (ex: "First get your shoes, then spin around,") three-step directions (ex: "Touch your nose, stand up, and dance"), directions with conditions (ex: "If I clap my hands, you jump"), and directions with the words before/after (ex: "Before you sit down, touch your ears."). During shared book reading, parents can target comprehension skills by asking the child to point to pictures by name or given clues (ex: "Point to something hot and bright that's in the sky" and by asking them recall questions about what has been read (ex: "What was the main character's name?" "Where did he go in the story?")

Another great home activity is to send the child on a scavenger hunt for objects that the parent describes. For example, "Find something with a handle that you can use to clean dirt off the kitchen floor." Or, searching for items belonging to specific categories, for example, "Find types of furniture," "Find things that are sticky." You can play iSpy to work on describing and naming from descriptions, whether you are outside, inside, or even in the car.

SLP Lucy Stone of The Speech Express recently put together this great list of additional ways parents can promote speech-language skill development at home.

How can we prevent speech regression in children that require these services during the pandemic?

Continuing with recommended speech-language services is one way to ensure that children with delays or disorders continue to make progress and prevent regression of any skills that are still emerging.

The shift to teletherapy has allowed private practitioners and school-based SLPs to offer speech-language therapy services at the same frequency and without interruptions, which is fantastic. If your child's private SLP is not able to provide teletherapy (or you would prefer in-person sessions but they are not being offered), you might consider switching to another provider. SLPs are often more than happy to communicate with one another about goals/progress, and are typically understanding when parents opt to receive services elsewhere due to logistics!

Despite the increased screen time and scheduling challenges, parents should prioritize specialized services such as speech therapy, occupational therapy, and tutoring instead of dropping them.

In many cases, teachers are flexible and can suggest ways to work in speech therapy sessions during the school day (such as by missing a special or independent work) instead of after school when kids might be burnt out from virtual learning. If the child's SLP provides recommendations for home practice, parents can try to work in these activities during routines and play, instead of trying to find separate times in their busy schedules to complete speech homework. SLPs typically prefer that communication skill practice is more naturalistic anyway since that can help to solidify new skills!

Once kids go back to school in-person, there is a good chance masks will be required. What are your tips for communicating well with a mask on?

Wearing masks can unfortunately present some challenges when it comes to communication. Masks make everyone's speech more muffled and harder to understand. They make it harder to read facial expressions, something that's important for social communication. Masks also eliminate visual cues for individuals who rely on lip-reading to understand others' speech, such as those with hearing impairments.

One alternative to traditional masks is called a smile mask. It consists of a clear vinyl window that allows the wearer's mouth to be still visible. There are numerous sellers on offering smile masks, including ones that are sized for kids! There are also a few sellers on Amazon. Ensure that the mask is made of fabric and not just a clear shield, as these are not considered effective on their own! Smile masks should still have 2-3 layers of fabric below and above the clear window and should still create a tight seal. Keeping in mind that these masks might not be as appropriate for small children because they tend to get hotter than cloth and to fog up. Older children and adults can reduce fogging by treating the vinyl window with Dawn dish soap, toothpaste, or anti-fog spray but might need to re-apply this treatment to the window throughout the day.

In general, mask wearers can try to be conscious that masks will muffle their speech a bit. They should try to speak a bit louder and more slowly and enunciate a bit more, especially when standing at a distance from others or background noise. Young children can be taught to use "slow, loud, choppy" speech while wearing a mask.

One thing parents can do now, especially with younger children, is to practice mask-wearing at home before they are required to wear them at school. They can practice extending the length of time that the mask stays on and can review rules for mask-wearing (ex: keep the mask over your mouth and nose, don't touch your face) to make the return to school easier. There are some free social stories on Teachers Pay Teachers about wearing masks such as this one that might help make children feel more comfortable and understand why wearing masks is necessary.

I have many bilingual infant patients. They may hear Spanish at home, but English at daycare. Now that many kids are at home and have not gone back to daycare yet, what advice do you have for parents who want to raise a bilingual baby?

While children are home, parents can continue to speak their native language and still support the development of the secondary language by providing naturalistic language exposure. Babies and young children don't tend to learn language from passive screen time such as watching shows and videos, so those are not recommended-- even if they claim to be educational. Ideally, parents would find ways to model the second language more functionally by narrating daily routines, talking during play, and reading books.

Even if parents don't speak the secondary language, they can learn some basic, functional phrases and model them at the appropriate times. For example, they might say, "You are drinking milk! Tu bebe leche!" while their baby is drinking milk. If possible, a babysitter or family member who is fluent in the second language could spend time with the baby, playing or reading books to them.

With toddlers, parents can find opportunities for more active screen time to be exposed to the second language. They might have their child participate in virtual storytimes, social groups, or Zoom meetings, such as with their child's daycare/preschool teachers.

I hear the following quite often from parents: "My toddler keeps hitting or biting his brother," or "She keeps having temper tantrums." These outbursts are noticed more now, as some caregivers are working from home. From an SLP standpoint, what can a parent of a toddler do in order to assist his or her child to help them better communicate?

This is a difficult time for everyone. Parents and teachers are seeing an increase in these types of behaviors, as children are trying to cope with so much being out of their control, the change in their usual routine, and the increase in seated screen time (which is surprisingly exhausting). I suggest that parents label the emotion (ex: "I can tell that you're angry," "I understand that you're frustrated") and then encourage the child to also express the emotion using words-- even if it's just being taught to say, "Mad!"

Parents of young children might want to create a calm-down corner-- an area filled with soothing like pillows, blankets, books, squishy toys, or Play-Doh-- where the child can go to decompress when upset or stressed.

Older children can be encouraged to ask for a break when they need one (ex: by saying, "I need a break"), or parents can suggest a break from an activity as soon as they sense that the child is becoming overwhelmed to prevent a bigger meltdown. They can create a "toolbox" together with their child that has coping strategies for them to try when upset (ex: take deep breaths, talk to a parent, go for a short walk, get a drink, squeeze a squishy toy or slime, etc.).

If children are having difficulty with the changes in routine, it might help to create a visual schedule to see what to expect each day. There are some really neat visual schedule apps such as Choiceworks, where the parent can create a plan using photos they take, and the child can check off each activity/event once it's complete. A dry erase board or pen/paper with a drawing representing each activity can work too!

I emphasize the importance of consistency and routines to all of my patients and families-especially nowadays when many are home day in, day out. How do routines help advance a young child's verbal skills?

For young children, daily routines provide essential social interactions between parents/caregivers. When a baby or toddler is getting dressed or having his/her diaper changed, the parent is often making eye contact, responding to the child's vocalizations/facial expressions, singing songs, and may talk to the child throughout the process. For example, "up you go! I'm changing your diaper now. P-U! Stinky! You made a mess! Bye dirty diaper! Here's the new one! I'm putting it under! All clean!") Since routines are repetitive, the child hears the same words repeatedly, which allows them to absorb new vocabulary. During routines such as diaper changes, getting dressed, preparing food, eating, cleaning up, and going for a ride in the car, the more talking the parent does, the better! Parents can and should narrate everything that is happening.

If the child talks, parents can expand their utterances by adding additional words (ex: if the child says, "Cookie!" the parent can say, "EAT cookie! You are eating a cookie! Mmm.") They can also focus on modeling a variety of action words (ex: eating, riding, wiping), adjectives including opposites (ex: clean/dirty, empty/full), and prepositions or location concepts (ex: up, down, in, on, under). These words are considered more important and functional than teaching nouns like "diaper" or "table," or the names of shapes, letters, or colors!

Another great resource for parents is this book, where the author walks you through how to boost speech and language skills during everyday routines.

Making do with what we have at home, what are some tools or items around the house that can be used to stimulate speech and language development?

Anything around the house can be used to stimulate speech and language development, especially if the parent is modeling various verbs, adjectives, and prepositions during routines and play like in the question above! When opening the refrigerator, for example, parents can make it into a game by saying, "Ready, set, _ __ _!" and open the fridge when the child vocalizes or says, "Go!" Parents can model the words "open" and "closed," pretend to shiver while saying "Brrrr it's COLD!", take foods out and pretend to eat them back-and-forth with the child while making chewing sounds.

In addition to books, SLPs recommend "old school" toys and games instead of electronic toys with screens and sound effects. Examples include puzzles, blocks, a hammer/ball pounding toy, trains and train tracks, shape sorters, Little People or dollhouse sets, Play-Doh with cookie cutters, bubbles, and wind-up toys. Any cause/effect toys with an exciting popping action (like many of the games by Goliath Games) or doors that open can help to encourage communication with toddlers. I've provided links to some of my favorite toys/games for facilitating speech-language development here on my website. The key is that any activity is made interactive by the parent participating and talking throughout it!

For children who are not yet talking or just starting to talk, parents can create "communication temptations," such as handing the child a snack container with a tight lid and then merely waiting to see if the child does anything to request help. There are tons of great ideas online to create communication temptations, such as the ones found here.

One day, the coronavirus pandemic will be a thing of the past, and we will read about it in history books, much like the 1918 influenza pandemic. Some changes that we have all made during this time might be here to stay. When that day finally comes, and you are once again having formal, in-person sessions with children, do you feel that certain services will still be offered virtually?

As I touched upon earlier, teletherapy as a delivery model for speech-language therapy has already been around for years but was just not as widespread. Now that so many therapists have become familiar with providing teletherapy out of necessity, and parents see its benefits, I think it will continue to be available as an option in the future.

I don't believe that teletherapy will ever replace face-to-face services entirely. Still, it's a great option to have in several situations where sessions would have otherwise been canceled or discontinued.

In the future, teletherapy sessions could be offered if the child or therapist is getting over an illness if the child or therapist is traveling out of town, if there is a snow day, or if a family moves farther from the office.

In some cases, the child might have the option to participate in a teletherapy session on a computer during their regular school day instead of after school when they would be less alert. As challenging and scary as this situation has been, I think in some cases it is creating some positive and lasting changes.

*Some responses contain Amazon affiliate links.

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