Tag: How to Handle Therapy

Evidence-Based Practice and Controversy Over My Work

By Pam Marshalla

Q: The lead SLP at my agency will not allow me to attend Pam Marshalla’s workshop on R therapy. She feels that Pam’s book suggests an oral motor approach that is not evidence-based. I think there is some confusion in our profession about the difference between placement techniques and oral motor exercises as a isolated activity. I work for a progressive educational agency that seems to be running scared of any controversial terms. Honestly, the amount of misunderstanding about oral…

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Teaching Phonemes: Advice to Preschool Teachers

By Pam Marshalla

Q: I am a preschool teacher and am wondering how to teach the “K” sound to one of my students. Let’s broaden your question to: How does one teach a child to say a new phoneme? This is what I would tell a preschool teacher: Show her how to make the sound: Ask her to watch and listen to you say the sound. Pause slightly before you say it. Make the sound stand out by saying it a little louder, by…

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Esteem vs. Rappprt

By Pam Marshalla

What is the first most important goal of speech-language therapy? This question came up at a workshop recently. One seminar member answered, “Build the child’s self esteem.” This is not correct. The first most important goal of therapy is to establish rapport with the client. All the old-time speech-language textbooks taught this. Establish a trusting relationship between yourself and the child early in therapy, and continue to build this relationship as therapy progresses. If the child doesn’t trust or like…

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Frequency of Therapy with Childhood Apraxia and Dysarthria

By Pam Marshalla

Q: How often should a young child (2-4 years of age) with apraxia or dysarthria receive speech-language therapy services? I have a baseline that all my clients with motor speech disorders have to meet. They must attend once per week for one hour at a minimum. Twice per week is very nice. Three times per week is a complete luxury. More than that is unnecessary because these children do not change very fast. Children with motor speech disorders take a…

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The Essence of Therapy With Little Kids

By Pam Marshalla

Q: Our son is three and was non-verbal. Our SLP seems really good at helping him learn to talk. But he is very hard to understand. What can we do? The essence of speech therapy for little children is to learn about words and sounds. We need to focus on both when working with young children. Many of today’s younger therapists put all their focus on building vocabulary, and they spend very little time focused on the actual production of…

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Is a Diagnosis of Apraxia Necessary for Therapy?

By Pam Marshalla

Q: Is it necessary to get a diagnosis of apraxia with a young child who does not talk, or can we just proceed with therapy? The answer to that depends upon the rules and regulations of your treatment center or school, and whether or not insurance providers are involved. But in my opinion, as far as the actual therapy is concerned, you do not need a diagnosis to start. Just start. Time in treatment will tell you increasingly more about…

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Counseling Parents About Articulation Deficit

By Pam Marshalla

Q: What do you tell parents when they ask what caused their child’s articulation disorder? First I draw whatever conclusions I can from the child’s medical and physical history. For example, I explain how the child’s errors might be related to his positive history of ear infections, oral injury, structural deficit, neuromuscular disorder, sensorimotor dysfunction, and so forth. Second, I draw conclusions from information I have about the client’s cognitive level. For example if the client is four-years-old, but he…

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Evidence Based Practice – Chopping Down Trees To Save The Forest

By Pam Marshalla

Q: I have heard you say that you have a real problem with Evidence-Based Practice (EBP). Why would you be opposed to something that so clearly will help and protect our clients? I am not against using EBP. I am for EBP. However, I am concerned about several recent results of the EBP philosophy. I am especially opposed to three new ideas: I am against throwing out everything we have learned through a century of trial-and-error speech-language therapy just because we…

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Time Off From Therapy

By Pam Marshalla

Q: Do you recommend therapy breaks for preschoolers with phonological delay? For example, summer off after the year of early childhood in a public school? I have usually found that a break from therapy (especially in the summer) is a fruitful experience for kids. Most often they come back to therapy having made considerable progress on their own. It always seemed to me that all that sunshine, gross motor activity, and new experiences helped them move along. Plus, they are…

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