teletherapy studies

Teletherapy: Solving The Least Known Common Childhood Condition

Developmental Language Disorder (DLD) is probably the least known common childhood condition. DLD is diagnosed when children fail to acquire language acumen for no apparent reason. This results in children who have difficulty understanding what people say to them, and struggle to articulate their ideas and feelings. Research shows over 6% of children suffer DLD.

Recognizing Developmental Speech Disorder

Speech development is fairly predictable for most children. They cry at birth, start random babbling at 3-4 months and try to imitate speech at 6-11 months. A child not developing according to the following timeline may have DLD that requires attention:
  • 12 months – recognizes own name, understands basic instructions, uses one/two words
  • 18 months – uses 5-20 words
  • 1- 2 years – growing vocabulary, uses two-word sentences, imitates animal sounds
  • 2-3 years – 450-word vocabulary, enjoys hearing stories, uses short sentences
  • 3-4 years – Uses sentences with 4-5 words, 1,000-word vocabulary
  • 4-5 years – Uses past tense, has the vocabulary of 1,500 words, starts asking questions
  • 5-6 years – 6,000-word vocabulary, can describe things, use 5-6 word sentences

3 Common Myths

She’ll outgrow it!

Well-meaning friends and family may try to alleviate parental anxieties by sharing stories of children who practically didn’t talk before 5 and then came out with complex sentences! However, research indicates that a child beginning school with limited language most probably will have language deficits throughout school, and maybe into adulthood if not addressed.

She’s either lazy, disinterested or bad!

Children with DLD often find it difficult to comprehend what others are saying, especially when there are distractions or the speaker is moving too fast. Consequently, the child fails to do what is expected.  Ironically this is often misunderstood to be either inadequate attention or disobedience when truthfully neither have anything to do with it.

It comes from poor parenting

Some erroneously think that DLD is a result of parents spending too little time speaking with their kids.  In fact, research has shown that most of the time DLD arises from genetic influences affecting early brain development. However, it must be remembered that language is a two-way street and therefore needs constant practice and encouragement from parents.

Teletherapy to the Rescue

Speech Pathologists who practice teletherapy have several strategies to help these children such as:

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  1. Activities focused on language intervention can enhance a kid’s understanding of language while giving her a chance to practice skills. Teletherapy provides an impressive array of intervention activities for children. For example, describing each step of a process models to the child how to use language to explain actions in an orderly way.
  2. SLPs using the medium of teletherapy use pictures, objects, and books to elicit responses from the kids with whom they work. When the child responds incorrectly, the SLP will gently and carefully sound out the name of the object and explain how it is used in very simple terms that the child can easily understand.
  3. In teletherapy, when the SLP practices articulation exercises and activities, children are encouraged to say words correctly. Depending on the kid’s particular age and stage of development, the child may be asked to tell a story about what happened today. When the SLP hears words enunciated incorrectly, she will help the child slow down and sound out every sound carefully.
teletherapy questions and answers

Therapists: Answers to Your 5 Most Pressing Teletherapy Questions

Despite the accelerating growth of teletherapy across the country, there are still therapists who hesitate to consider it.  For some, this may be an aversion to technology or change. However, for others that hesitation is grounded in serious questions. While the first group will benefit, it is to the second group that this blog is written.

1. Does Teletherapy enhance the performance of the therapist?

While some therapists are comfortable with the traditional and wouldn’t consider anything but delivering therapy face to face, others are beginning to appreciate the benefits of teletherapy.  The convenience of working from home and the elimination of travel time makes for a more relaxed, focus therapist. Imagine the impact on performance.

2. Are there specific challenges regarding the teletherapy setting?

It goes without saying that there are rural school districts that have a poor internet connection.  This may cause the video or audio to be jumpy and erratic. However federal legislation has recently been approved that promises to solve this problem. But there are potential client engagement issues with teletherapy also.  See my previous blog for tactics and strategies to solve these problems as well.

3. Is there any specific clientele for whom teletherapy is not a good fit

Despite the many benefits of teletherapy, like everything else, it isn’t for everyone. Before suggesting teletherapy as the modality of choice, the therapist should ask the following questions, which may indeed disqualify some:
  • Does the child have the motor control required to access and interact online?
  • Will the child’s hearing adversely impact the session?
  • Is behavior an issue, and if so, is there an adult available to assist?
  • What is the child’s cognitive capacity to understand and follow instruction?
Perhaps these questions will spawn others as well. Bottom line, determine in advance if teletherapy will benefit this particular child!

4. Can you perform teletherapy while living or traveling abroad?

From a purely technical standpoint all you need for teletherapy is a high-speed internet, a webcam, and a headset for high-quality audio. So as long as you can find that internet connection, be it G5 or wifi, you are good to go. But remember that streaming video takes considerable bandwidth, so don’t assume any wifi connection will be sufficient. Going abroad, don’t forget to consider the time zone differential. Otherwise, why not?

5. Is teletherapy as rewarding as traditional face to face therapy?

If you like helping children, then you need to consider the following.  Your actual enjoyment in the session may feel a bit more “remote” in a teletherapy session, but keep in mind that you may be helping a child who would not receive services at all if it wasn’t for teletherapy. Alternatively, you may feel isolated working on your own. Before taking the plunge, perhaps you need to consider the “bigger picture.”

Bottom Line

The benefits and rewards are many.  For some, the trade-off with traditional face to face therapy may boil to economics or opportunity, and for others, personality.  Keep one thing in mind. Teletherapy is here to stay, and as the technology is perfected its market share will continue to grow. It may behoove you to find your place in it.
future of speech therapy

The Future of Speech Therapy: Teletherapy and 4 Other Trends

What does the future of speech therapy look like? The Bureau of Labor Statistics predicts that the demand for speech therapy services will increase 18% within the next decade. But aside from that impressive quantitative growth, what are some of the qualitative changes to expect to impact the world of speech therapy in the coming years?

1. Teletherapy on the March

Teletherapy has been growing for some time now. Ever since the landmark study conducted by The Mayo Clinic some 20 years ago, the acceptance and impact of teletherapy continues to expand, especially in those communities that are either underserved or understaffed. But aside from the benefits for the clients and the school administrators seeking to serve their students, the plethora of teletherapy benefits for the therapists are driving the growth as well.

2. The iPad Revolution

At this point, practically every SLP around has an iPad. This increased iPad use is more than just those in the profession keeping pace with the technology. It happens to be that there is a wealth of apps expressly designed for the iPad that facilitate many treatments. Aside from being portable and easy to use, there are inexpensive iPad games that can be used as rewards for the kids.

3. Once it was games, now its digital downloads

It has been estimated that well over half the educators out there have downloaded something from TeachersPayTeachers. Let’s face it, what could be more convenient than downloading precisely the material that is needed? In the increasingly mobile world that we live in, it is essential for materials to be no more than a click away. This convenience and availability promise to change the face of the entire profession for the indefinite future.

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4. 3D Printing

Many local libraries already have a 3D printer. And it could be that this is evidence that the world of the printers is forever changed. In fact, as we know, the world of 3D is not limited to printing but is encroaching into other realms a well. Regarding speech therapy, the applications are limited only by the human imagination, as therapists will now be able to take their clients beyond the “page” and share practically real life duplications with their clients.

5. Virtual Reality

But perhaps the most radical changes to the speech therapy will be in the world of Virtual Reality driven by the accelerating developments in Artificial Intelligence. Although there is some debate within the speech community regarding the benefits to the profession, there is no question that it is only a matter of time before Virtual Reality is tweaked to bring children to places previously unimagined. Imagining dysphagia or a swallow study that can actually be experienced by children.

The Future is Now

While there are those among us that are skeptical of any change, and justifiably so, in the end as we all know, technology and advancement march on regardless of our feelings. So it would be prudent to be aware of the changes that are already in motion so that we can understand them, and be better prepared to extract from them the intended benefits.

sacrificing telepractice

Telepractice: Are You Sacrificing the Therapist Client Relationship?

The Biggest Challenge of Telepractice

If there was one area more than any other that would seem to highlight the deficiency of telepractice it would be in the arena of the relationship between the therapist and client.  Research shows that a high percentage of the success in any therapy is directly proportional to the relationship between therapist and client, otherwise known as the “therapeutic alliance”.


1. The Therapeutic Alliance

According to the world-renowned psychologist, Carl Rogers, “There are three important qualities a client should look for when seeking a therapist: empathy, genuineness, and respect.” These qualities are at the core of what is known as the “therapeutic alliance,” the precious bond between the therapist and client, essential to any successful therapy.


Although Carl Rogers was speaking specifically about psychological therapy, there are certainly parallels to other types of therapy as well. After all, the success of even the most skilled and experienced telepractice therapist will be heavily impacted by the relationship with the client. What are the components of the therapeutic alliance?


A. Empathy

Empathy is the ability of the therapist to identify with and understand the client’s situation, feelings, and motives. If the speech therapist isn’t sensing where the child is at the moment, the therapy is going nowhere fast. This, notwithstanding that the teletherapy session is of a more technical nature than psychological counseling.


B. Genuineness

Aside from empathy, the client needs to sense that the therapist’s interest is genuine.  Perhaps nothing is more damaging to the clinical experience than for the client to believe that the therapist is “in it for the money” or some other ulterior motive. In any therapy, the client is exposing his/her vulnerabilities that bring discomfort.  This discomfort will only be magnified by a therapist who is disingenuous.


C. Respect

Respect is necessary to establish the safety that is instrumental in the therapeutic alliance.  It is only when the client is fully accepted, both strengths and weaknesses, that an environment has been established where transformation can hope to occur.



While conveying empathy, warmth and respect may be more of a challenge in the telepractice venue; they cannot be avoided.  And has been amply demonstrated by many a therapist, sincerity in all its forms can be conveyed through the webcam when the necessary effort is continuously made.


2. A Surprising Discovery

A study conducted by Simpson (2011) in the Shetland Islands, found that clients not only were able to develop a positive therapeutic relationship through video conferencing, but they also reported feeling as though the videoconferencing enhanced the therapeutic relationship.


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According to two different clients, video conferencing “is sufficiently personal without being so personal as to be confrontational…there was good personal contact but without an invasion of personal space, and the clients in the videoconferencing condition reported being able to speak more freely and felt less self-conscious than they would if they had met with a therapist face-to-face.”


In other words, the distancing effects of video conferencing promote a sense of security helping clients feel more comfortable and less scrutinized. This consequently makes them feel more at ease.  Again, although while this study was done in the psychological realm, its findings can be extended to speech therapy and telepractice as well.


3.  Increasing client-therapist rapport in telepractice

While the therapeutic alliance is necessary, it is not sufficient.  Another critical component of effective therapy is an excellent rapport between client and therapist.  The client needs to experience the therapist as being “right there.” What then can be done to neutralize the inherent challenges germane to telepractice to maximize this rapport?


A. Active listening

Active listening is vital in all therapy, no less so in telepractice. Therapists need to pay very close attention to the words and reactions of the client.  They need to assure the client that his/her voice is being heard and understood. This is critical to any success the therapist wishes to enjoy with the client.


B. Verbally engaging

Research shows that rapport increases as the therapist becomes more verbose. The more the therapist engages the client in dialogue instead of only listening, the better rapport will be. Related to this is the need to engage the client emotionally, even in speech therapy.


C. Emulating the client’s speech

When speaking with the client, the therapist needs to use metaphors, phrases, and words that are familiar to the client to build a strong rapport. This begins with the therapist listening carefully to the client’s language and expression, and then attempting to imitate it in the therapist’s communication. Devoid of direct eye contact and body language, this “verbal connection” is all the more crucial in telepractice.

The Bottom Line

While telepractice poses unique challenges regarding both the therapeutic alliance and therapist-client rapport, for the dedicated therapist these are hurdles that can and must be surmounted.  The powerful combination of commitment, caring and wisdom will address this vital concern so that the plethora of benefits afforded by telepractice can be fully enjoyed.