What could derail the speech telepractice session?

Most SLPs have confronted challenging children during a speech teletherapy session.  And many of you are often at a loss as to how to work with a child who has a problem with motivation, focus, or simply behaving.  While this is the nature of the beast, after all these are children, because these challenges reduce clinical effectiveness they must be addressed.

Face it; frustrations will occur.  So what can you do to mitigate the impact of these problems?  What strategies will assist you in navigating those choppy waters that threaten to capsize the entire session? Implementing the four strategies below will help keep the session on track and perhaps, as importantly, salvage your relationship with the child in those difficult moments.

Establishing Rapport is Critical

Before you begin working with a new child, it is important to conduct a short interview with the parent that contains essentially three fundamental questions.

1 – Does your child have difficulty relating to new people, adults in particular?
2 – Is your child challenged in sustaining attention on a task?
3 – How does your child handle frustration?

You can’t just ask, “Should I expect your child to be challenging?” Explicitly asking if the kid is problematic may affront the parent. Nonetheless, answering these questions will alert you that establishing rapport, so critical in speech telepractice, may take more time, sensitivity and compassion. Surely you will reap the dividends throughout your entire experience with the child.

Don’t Take it Personally

Rule number one is “don’t get into it with the child.”  When those challenging behaviors do arise, don’t take them too seriously, don’t take it personally and whatever you do, don’t escalate it!  Not only will you kill the speech telepractice session, but you may seriously impair that precious rapport you worked so painstakingly to achieve.

Aside from gratifying the child’s impetus to manipulate you with his outbursts, you will be jeopardizing your therapeutic effectiveness.  Being sensitive to the child’s frustration and rewarding inappropriate behavior are two different things.  You need to allow and sometimes even encourage the child to vent his frustrations.  Venting frustration can be very therapeutic.

But instead of that failure triggering a meltdown which will be of no benefit to the child, empower the child to go beyond it bringing him back into the therapy.  Perhaps the task at hand was too much right now.  No problem, either shorten it or move to something else to regain the “therapeutic momentum.” Avoid allowing the outburst to become a prolonged interruption.

Positive Reinforcement and Praise

It seems almost instinctive to react to outbursts by becoming frustrated and dropping a seemingly innocuous comment such as, “we can’t take our break until we finish four more words,” or “I need to tell your mommy that you spoke fresh to me today.”  Why not try, “you almost got it” or “you’re doing great, you’re almost there.”

As child development literature suggests, it is positive rather than negative reinforcement that brings the best results. A corollary to positive reinforcement is the importance of being very generous with praise. Don’t limit heaping on praise to a significant breakthrough, but look for opportunities to recognize and applaud those little seemingly insignificant victories as well.

Consistency with Expectations and Rules

Shifting the expectations or rules can cause the child to become confused. Be sure to establish your standards in a very friendly way at the beginning of the relationship as you are building your rapport with the child, and don’t swerve away from them. Allowing the child to do less opens the door to negotiation; demanding more can cause exasperation and loss of trust.

Take the Lemons and Make Lemonade

It is important to remember that challenging behaviors are generally unrelated to the therapy or the therapist.  That said, they are challenges you cannot ignore.  The effectiveness of your remote speech therapy may depend on how well you recognize and react to those challenges.  Keep these strategies in mind and watch your success to grow by leaps and bounds!