by Marlene Schoenberg, Ed.M. CCC-SLP


Segment 2-During the Interactive Video Session

Our first segment last week discussed preparation and planning for teletherapy with children including input from the parents. Today we will talk about what happens during the interactive session and how parents or aides who are sitting with the child can assist.

During the Interactive Video Session:

1.      Check in with the parent or aide with a text message prior to session. This helps both parties understand any delays or tech problems.

2.     Start consistently with a song or an app the child likes. Knowing each child’s personality will help you determine what gets them engaged. One child likes the song,” The Lion Sleeps Tonight” and fills-in words. Another child, who is from Latin America, loved the song, “La Bamba”, but that wore off after a few weeks. Now, he likes to start with the actions for ” The Wheels on the Bus”. Use whatever you can to get the kids involved and interacting from the start.

3.     Aim for 10 short activities with 10 items each for a one hour session. Some SLPs only do 20-30 minute sessions. For longer sessions, 10 items are easy to check off and create an instant percentage.

4.     Be agile. Be willing to go on to something else if the child gets bored or frustrated before the 10th item. Sometimes you can go back to it. Shorten or change the activity if the child is losing interest. Give the child choices for another activity. I gave one child a choice of 4 books (all of which he refused) then he just wanted to do our usual “imitate the word for the picture” task!

5.     Add Motivation!

Give points for prizes as a motivation. Give the children choices for prizes they want to earn. We all have small toys or books that we hardly use . Why not recycle them as prizes? One person’s junk is another person’s treasure.

One child had a difficult session when he was tired. I called his Mom to brainstorm about how to structure the next session for better interactions. We developed a “ 10 Points to Win a Prize” motivational plan, which  worked perfectly the next session.

One student will work for the opportunity for me to put Elmo on my head or shoulder. Directing me gives him a sense of control. When he breaks out into a smile from ear to ear, I have his full attention.

6.     Exaggerate Facial Expressions as well as Large Motor Movements. Use your excited facial expressions and pitch varied voice to reinforce good speech (Don’t just say “Good” but show you really mean it!) Laugh, smile, praise and cheer with signs!

 “2468 who do we appreciate? Elmo! Elmo! Yeah ,Elmo!! (Fill -in the blanks with your own client’s name.)”

 Here is another great cheer:

           “Elmo , Elmo… He’s my man; he can do it. Yes, he can!”

These exaggerations work well with certain clinician and client personalities and not others. It may or may not be right for you and your therapy style. If acting “wild and crazy” (as Steve Martin may put it) isn’t your cup of tea and doesn’t help your client, just remember to  add some elements of surprise.

7.   Use Movement Breaks to Redirect Attention

Notice the child’s non-verbal signals (looking out the window, getting up, trying to turn the computer off) that they are losing interest. You must act fast.

If a child’s attention is wandering, take movement breaks with songs and actions (Head Shoulders Knees and Toes, or The Hokey Pokey work well). Sometimes an adult has to move the child through it.

8.    The Magic of Music

Open with songs they like and always have a good -bye song.

Use music videos to break up the time (Bear Hunt, Laurie Berkner Greatest Hits: I’m gonna catch you, the Planets preschool songs). This will give you a minute to think about the next activity, organize your materials and conserve your voice.

Use the instruments you know…or you may want to learn such as the ukulele.  According to St. Paul Highland Park Storytime librarian, Rose Oyamot, you can play 25 children’s songs if you learn only 3 ukulele chords.

New Songs-When you introduce new songs, ask yourself, Is it repetitive?, Is there a chorus that kids can join in on? Does it connect to something they know? Do they listen to it in a different context?

Use fill-ins and gradually increase length of fill-ins. One child liked the song “Over the Rainbow”. He always filled in “rainbow” for the closure phrase: Over the_______.  After a few weeks, he expanded this to add a 7 word fill-in sentence of 2 full lines.

9.     Stories

Help students create stories with their target sounds. Use popular fairy tales such as “Jack and the Beanstalk” for /dz/ sounds. Programs such as have charts to build up the stories. Sometimes there are short cartoon videos of these stories on line.

Use different sound effects (horns, buzzers, sand paper ) to create radio show sounds to make the stories more interesting. Sometimes you can use sounds as a reward (chimes for the right answer or a good approximation or possibly you can use a buzzer if they are looking away from the screen).

10.  Use Yoga and breathing to calm clients if they are frustrated or distracted.

Check out “Yoga Calm for Kids” on line. You will get many good ideas. You may introduce different breathing exercises with movements and specific sound components to release anger and frustration, focus attention and help self- regulation. Chrissy Mignogna, of Winged Heart Yoga, has taught me about a variety of options for this.

11.  Use Humor and joint laughter as much as you can.  Have on hand a variety of ridiculous short stories, funny books and jokes that suit different age groups. Knock- knock jokes usually work! Sometimes you may have “in jokes” with certain clients. To help a first grader remember the silent e rule, we joked around and whispered, “Don’t wake up the silent e!” He smiles and cooperates when we share this joke; especially when his attention starts to wane at the end of the session.

 Learn as much as you can about Laughter Yoga. You might need to pull that out of your hat at the right moment.

12. Involve Parents (or aides) during the session to build success towards Goals

The SLP is a life-line for families and the virtual session is a relief from boredom and a wonderful event  to look forward to. However, the parents must understand that this is not their free time for you to babysit and for them to go to another room to do their work.

Roles for parent or aide during the session:

1.  Nearby or All In?  Sometimes, parents just need to stay nearby. Other times, they must be actively involved in the session. It depends on the child and on a particular day’s circumstances.

2.  Giving immediate food reward reinforcements when you say so (Use what the child likes and will work for, e.g.  fish crackers, mini-marshmallows). Make sure you know about and avoid what they may be allergic to.

3Redirecting the child’s attention when he becomes distracted.

4. Helping to select just the right toy for the child to hold. There is a fine line between a tactile help and a toy that is too distracting.

5Technology feedback, assists, suggestions, problem solving.

6. Reducing noise and distractions in the home

If younger siblings are screaming and running in front of the screen or there is excessive noise from other calls or loud conversations in the house, talk to the parent about making some changes. One aide and parent chose a “Carpool Karaoke” speech therapy option (with the child buckled securely in his car seat and the car in he driveway) when the household was very noisy. This worked well.  

7. Helping to take notes. Note-taking is difficult for the SLP when you want to maintain eye contact with the camera (aka, the child).  Sometimes ask the aide or parent to check off items in categories you give them or write down examples of what the child says. Give them a grid to fill-in and say, “Please write that down.”, when you want them to record a word or phrase. At the end of the session, they can text their notes to you.

Have a check list, sometimes you may want to check off items or use a clicker. Have your goal sheet set up. Sometimes, if you or the face to face  therapy assistant can’t take notes, write your scratch notes right after the session when your memory is fresh, even if you don’t have time immediately afterwards to write your formal note.

8. Interpreting what the child says which may be hard to understand Some phrases may be in the  child’s non-English home language. One child was counting in  another language.  Sometimes the child speaks too softly to be heard through the microphone.

9. Parents should monitor their children to make sure kids are not trying to be sneaky and turn off the computer or  change any settings. If they       are not watching the child, they may wonder, “How did that happen?”.

10.  Encourage parents to add their own brand of humor and be creative. One Mom had her son wear a fun dinosaur flashlight hat which was a good source for conversation but not a tactile distraction.

11Training a new aide or a different parent than usual. They must observe, understand goals and know how to reinforce the child both in the session and between sessions. Thank them and acknowledge their participation.

In the next Segment we will talk about solving technical problems in teletherapy.