Balance your ratio of mastered skills to new skills. This lesson came to me about fifteen years ago from a person I heard speak during a conference who used an ABA approach. It was completely NEW for me. I’d never heard this before in any of my SLP experience or coursework, but it immediately made a HUGE difference in my speech therapy sessions with late-talking toddlers. I now talk about this concept often when I teach courses, on my podcast, and in everyday conversations with families, but I don’t include the word “ratio” as I’m discussing this. Usually I say something like:
“Don’t start at the goal when working with a toddler. Meet him where he is.”
Lots of SLPs mess this one up every single day. Let me give you a prime example: A nonverbal child comes to us for speech therapy, and we immediately jump in and work on saying words, regardless of his developmental level or readiness to talk. It can go something like this:
“Look! It’s a ball. Ball. Say ‘ball.’”
“You can do it. Say ‘ball.’”
No response. Child reaches for ball.
“No, no. You have to tell me before I will give it to you. Say ‘ball.’”
Child walks away to find something else he can do.
“Come back. Say ‘ball.’”
Child doesn’t even look back. Why should he? He knows he can’t say it.
That approach can, from time to time, work in initial sessions. However, for most late-talking toddlers, if it were going to be that easy, they wouldn’t need speech therapy in the first place!
For so many of our little clients, we need to address the prerequisite skills needed for talking – social engagement, cognitive skills, comprehension, and the ability to imitate and vocalize on request using easier, earlier play sounds – rather than beginning with trying to make them say actual words.
Most of the time in therapy, we should begin with what a child can already do, what he’s already mastered or is at least trying, so that we build a pattern on success right from the start, rather than frustrating a toddler by asking him to do things we KNOW he can’t do yet.
ABA therapists incorporate this concept pretty well. I’ve talked with some BCBAs who say they use a 75% Mastered Skills to 25% New Skills ratio for their sessions. They don’t word it that way. I believe their term for this is “interspersal,” and for those of us who aren’t that familiar with the ABA lingo, it basically means mixing it up.
Is that new for you? It could be! Sometimes, without realizing it, an SLP may be working at a 10% Mastered Skills to 90% New Skills ratio, or worse! What kid – or adult, for that matter – do you know who likes for virtually everything new or hard? When we approach it this way, including only new targets that we’ve never, ever heard or seen a child do, it’s almost as if we’re setting a child up for failure. No wonder our little friends seem to get it “wrong” so much of the time when we’re working on brand new skills! No wonder we see so many frustrated kids!
You may be thinking how else you could do it if you’ve never thought about organizing sessions in this way before. It may be too dramatic of a change for you, and as an SLP, you may think you’re “wasting time” to include so many things a child can already do during precious therapy minutes. I get it and truth be told, I don’t adhere to a 75/25 ratio unless I KNOW a child needs that level of success to keep him engaged and trying.
But if you’re like me and you’re always looking for better ways of doing things, give this a try! Here are some simple ways you can incorporate this principle when it matters most:
- Always begin a session, particularly those first several sessions, with something you KNOW a child can do. If you’re working on words, pick a word he says spontaneously and consistently. Use this as your target for the first few trials. This “primes his pump,” so to speak, and gets him ready to respond correctly. If you’re working on signs, select an established sign to begin the session. If social interaction is your goal, play his favorite games first so you’re likely to elicit the responses you want to see, and then introduce newer games.
- When you’re ready to move to something completely new, sneak it in there between easier things you’re asking your client to do. Sometimes a child will surprise you (and himself!) by performing the new skill. Actually, this occurs because you’ve set him up for this success!
- If a child seems to be exasperated when you’ve asked him to do something over and over that he can’t do (meaning he’s responded incorrectly multiple times or he’s NOT responded at all) you should immediately back up to something you know he can do. Gradually work your way back to that more difficult or newer target.
If you’re using a coaching model for speech therapy with toddlers, you may be wondering how you can share more difficult and technical concepts like this with parents. It’s much easier than you think. Talk about it in the same way I have here. Say to Mom something like: “I know you want him to talk and pop out a new word every time you try to teach him to say something new, but usually with late-talkers, it doesn’t work that way. We have to warm him up a bit. Let’s start by asking him to say words we know he already knows so he feels successful, then we’ll move on to a few newer words when we feel that he’s primed and ready.”
I use this example routinely with moms and it comes to them more easily over time as you continue to gently reinforce why it works, again using the same kinds of examples I’ve provided here in this post.
This model of balancing New Skills and Mastered Skills actually does something else for children – it provides enough practice for an emerging skill to be “mastered,” “generalized,” “carried over…” whatever word you prefer.
I hope that last sentence resonates with you as much as it does for me! Sometimes we don’t think of therapy in this way. We’re always pushing for the “new” word, the “new” sign, the “new” everything. Here’s the truth – when we give a child’s little system a chance to stabilize and catch up through practice, even those “new” goals are met more quickly!
I’m ending this series next week with one final post… “What an ABA Therapist Can Learn from an SLP.” It’s going to be good!! Join me then!
If you missed the first posts in these series, catch up!