Why Working With the Entire Family Gets the Best Results in Kids Struggling with Speech-Language Issues

Special thanks to Kyrsten Theodotou (MA, CCC-SLP) who offered many of the insights presented in this article. Theodotou works as a pediatric Speech-Language Therapist at the University of Minnesota Pediatric Rehabilitation Clinic. Before that, she served on the Pediatric Brain Injury Team and the Growth and Nutrition Team at Hennepin County Medical Center in Minneapolis.

Seasoned SLP’s will tell you that the patients who make the fastest progress are those with families who are involved and supportive.

The trick, though, is how to foster that supportive attitude and marshal family members – from parents to siblings – for the best possible outcomes.

“In grad school they don’t really talk to you about that,” says Kyrsten Theodotou, CCC-SLP at the University of Minnesota Pediatric Rehabilitation Clinic. “You know you have to work with the parents or…kids of the elderly…[but] you don’t know what it’s really like until you’re in that situation.”

Theodotou’s passion for drawing families into the therapy process grows out of her observation of the long-term benefits.

Family Involvement Often Proves to Be a Key Element to Success

In Theodotou’s pediatric experience, children with highly involved families generally move through therapy more quickly, and research supports this.

• A study of 92 children by Fudala, England, and Ganoung found that those children whose parents attended treatment sessions and were involved at home made significantly greater progress than those whose parents only did assigned homework with the children.
• Research by Law, Garrett & Nye suggests that when SLP’s train parents to help their own children address speech and fluency difficulties throughout the day, the parents can become as proficient as the SLP in helping the child improve. This significantly multiplies the effectiveness of therapy, because children now receive therapy daily – and at multiple points in the day.
• DeVeney, Hagaman, and Bjornsen found that “parent-implemented intervention emerged as potentially more effective than clinician-directed service”.

Recently the Hanen Centre, an organization focused on promoting family-based language, social, and literacy skills, polled seasoned SLP’s around the world to find out what they thought a parent should look for in a therapist. The most popular answer they heard from parents was that ‘the therapist should consider the parent to be an intervention partner.’

“A good therapist realizes that, because the time he/she spends with the child is limited and because parents are so important in a child’s life, parents need to be involved in the intervention and play a major role,” writes Toby Stephen, MA, CCC-SLP of the Hanen Center.

What the Parent-Therapist Partnership Looks Like

The idea of forming a partnership with a therapist shouldn’t feel the least bit intimidating. You’re going to get all the guidance and support you need. Just think of your part as augmenting the therapist’s focused, expert therapy sessions with more of what you’d already likely be inclined to do as a parent. It would just be more targeted so as to incorporate a few effective techniques developed by the experts…

1. Therapy is Most Effective When It Takes Place in the Child’s Natural Setting Throughout the Day

   Theodotou says that in her practice partnership starts by inviting the parent into the therapy room with her.

   “[Families] need to learn and know how to execute strategies to maximize language, to increase feeding at home… it’s my responsibility to…guide the families as they go through this therapy process.”

   During a session Theodotou not only tells the parents what to do at home, but she invites them to do the therapy with her. If she’s teaching a toddler to use his molar area to chew on a carrot stick, she hands Mom or Dad a carrot stick and asks them to do the modeling with her. If she’s teaching a toddler with feeding aversions to play with their food, she shows the parents how and then has them do it. She then sends the parent home with specific skills to work on before the next appointment.

2. Discussing Home Habits with Parents is Crucial

   “If there’s not a lot of progress then it’s a discussion with the parents: Why is that?”

   Kyrsten says it’s here job to work with them to troubleshoot possible barriers to success.

   “It’s really important to tune into the whole family dynamic of meal times: Are the parents putting on cartoons so they can just get more calories in their child? Are they taking extended periods of time to eat? Are the kids constantly snacking all day because they just don’t want to sit at the table? You know, all of these things…factor into how you develop your plan and execute it with the family.”

   One feeding area she often troubleshoots is the family meal. Sometimes parents find it easier to feed a child separately from their own meal time, but Theodotou says this can leave kids feeling isolated and unenthused about the eating experience.

   She emphasizes a positive, pleasant meal experience where family members eat with the child and if possible share food from their own plates with the child, so the child feels a part of the family experience.

3. Using “We” Language Sets the Right Mindset

   Another important aspect of involving parents has to do with the language used during a session. Toby Stephen explains that it’s a good idea to use “we” language instead of “I” or “you” language draws the parent into the team framework and deepens the sense of relationship. It also helps the SLP to remember that the parent is part of the team.

   “I’m always amazed at the impact the simplest ideas can have. I had to force myself to say ‘we’. At first, I had to keep repeating to myself the ‘say we’ mantra. Over time…I was thinking ‘we.’”

Creating an Emotional Connection

“I think empathizing has probably been the biggest lesson that I’ve learned [since graduation],” Theodotou says.

“Because for them [the families], this is out of their control… parents have no idea where to go from here [and] what the future looks like for their child; it’s very overwhelming for them.”

There are three key areas that can help you build this emotional connection.

1. Taking Things Slowly

   She shares that when her own daughter started eating solids she experienced a shift in perspective.

   “I tell my parents all of the time: Just let them explore!” She would encourage parents to offer new foods as much as possible between sessions, and not to let fear prevent exploration.

   When she watched her own daughter gagging and struggling with new food, however, she came to a deeper understanding of the fear parents can experience.

   “I’ve learned to empathize more with the fears of your child choking or not being ready to try something.” Her new understanding means that sometimes she chooses to wait a little longer to introduce food she believes the child is ready for, but the parent does not. At times parents bring a new food into the therapy room so they can discuss whether the size or firmness is appropriate and then try the food together.

   This waiting can be important because children pick up on their parents’ emotions around various activities. If the parent appears anxious or unsettled about a certain food the child may also feel that way, leading to negative connotations from the start.

2. Engaging Parents Means Hearing Their Concerns

   Theodotou and other SLP’s also point to the importance of figuring out what the family’s priorities are with their loved ones in terms of feeding or speech.

   By validating those concerns and making sure to incorporate these concerns into your therapy—even if they aren’t top concerns for you—families will feel heard and understood and often become more engaged with the process.

3. Encouragement, Encouragement

   Finally, take time to encourage the families along the way.

   “When you connect with them, share what went well. Parents often tell me they never received a positive phone call before mine. This doesn’t need to be the norm. Positivity surely increases communication,” explains Phuong Palafox in her article for the ASHA Leader Blog.

When the Family Isn’t Where You Want Them To Be

One frustrating reality all SLP’s face is families that just aren’t tracking with your plans for their loved one.

You send home articulation assignments or feeding parameters only to find out the next week that there was only minimal follow through.

“You may have goals for the kid and the family may not be at those goals yet. So it’s really being a team member with the family and letting them be a part of their child’s planning…and getting families to the point where you want them to be,” Theodotou explains.

She refers back to the family dinner example: Maybe Mom gets home from work just as Dad is leaving the house, or siblings are being shuffled to various extracurricular activities during normal meal hours.

“Maybe say: Start with something small…do this meal together with anybody who’s in the house at the same time. Come to the table for snacks,” she suggests. Ultimately, you work to modify the “ideal” to fit the family’s situation, and start from there.

Another key is helping parents see how they can make therapy a part of the daily routine, instead of something separate that they do at set times.

“As a young clinician who had no children, I was eager to assign parents “homework” sheets for speech practice at home with their children,” says Dr. Ruth Stoeckel, PH.D., CCC-SLP.

“Many times the sheets were taken home and forgotten. As an older and (hopefully) wiser clinician, I have learned to request feedback rather than wait for it to be offered. And I have learned the value of teaching parents ways to insert speech practice into daily interactions.”

This can be as simple as weaving vocabulary practice into trips to the grocery store or emphasizing important words in a sentence (you’re playing with BLOCKS!).

Theodotou says that even though actively engaging families isn’t always easy, it’s ultimately one of the most gratifying parts of her job, especially when they see a significant breakthrough.

Sometimes that comes in the form of saying more words, using their non-verbal cues, or starting to actually enjoy eating.

“The parents see, ‘oh, they can do this’…it’s those little moments that make it the most rewarding.”