What Do You Do When NOTHING Is Working?

Teach Me To Talk Therapy Manual

I’m writing this article to read later when I need to cheer myself on.

As a pediatric SLP who has made a living doing speech therapy for toddlers, there are times when I leave a session thinking, “I’ve tried EVERYTHING I know to do, and it’s not working.” There are times when I wake up in the middle of the night with one of my little friends on my mind, and I stare at the ceiling thinking, “Hmmmmm. What am I going to do about THAT kid?” There are certainly times when I call friend who’s a therapist to commiserate and say, “I’ve done x – y – and z, and NOTHING is working! UGH!!!!!”

Some days go along beautifully when every child you see has their best session ever. Most everyone on your caseload is clickin’ along. And then it happens. You eval a new kid who you just can’t get a good read on. Or a child who started out like gang-busters and said 15 words in his first session has suddenly hit a brick wall and not made a hint of progress in weeks. Or you walk out of a home when the only person talking was YOU! Mom sat there bewildered, and the kid ran circles around you, and it’s gone so horribly that you look around the room for the hidden camera and wait for someone to jump out and say that you’ve been punked since it couldn’t possibly go this badly without someone planning it!

There are some sessions, and occasionally even some children, who make you wonder what the heck you know about anything anyway.

What do you do when you’re the therapist, the person who’s supposed to know how to make things better? What do you do when you’re the mom who’s looking at the person who’s supposed to know how to make things better, and it’s not going the way either of you hoped?

Here’s my best advice – the same advice I give myself, or anyone else who asks me, on those days.

1. Critically analyze everything you’re doing – during sessions (for therapists) and between sessions (for parents).

The key word here is “critically.” If you were called in for a consult on your own case, if you were supposed to “mentor” you, what would you recommend? This “objective” analysis of your own actions, either during sessions for therapists and between sessions for parents, can shed lots of light on what’s going wrong.

Look at your overall approach. Does it match the developmental age of your child? I think this is the #1 reason early intervention and preschool therapists struggle. You can’t take approaches designed for older children and expect them to work with young children – especially babies and toddlers! When something is not working for a young child, try to back it down a developmental level or two and see what happens.

For example, you want a child to imitate words and you’ve tried and tried to elicit a core set of words, but he’s silent, despite all your best tricks. Reassess the situation. Is he vocalizing at all? When? Simulate these circumstances in a session. Instead of words, try sounds, or better yet, sound effects first. You want a child to play interactively with you, but he’s still preferring cause and effect toys. Meet him where he is. Use his own preferences first, before you try to force a big cognitive jump he’s not quite ready to make.

More ideas for using sound effects in play…

Look at external factors and circumstances. Should you try a different time or day for the session? Should you try a different environment? Sometimes something as easy as playing in a smaller room with fewer distractions can make a huge difference. Sometimes going outside can break the monotony of your same old routine. If you’ve tried to play with the same things for weeks in a row and it’s not working, break out some new toys! If you’ve tried books and puzzles and she hates it, get up and get moving!If a child is clingy with mom in the room, try to have mom be “busy” within eye-sight and ear shot, but with a lap that’s not quite so accessible, or try to go when Dad or grandparents are the primary caregivers. If a child is floundering in a not-so-great daycare situation, supportively suggest a change.

Have you tried several different approaches, or are you stuck in a rut? Are you using at least a few different methods and focusing on a few different things during each session and during play with your child? Are you changing it at least a little from week to week rather than doing the same thing over and over day in and day out?

For example, for parents, if one of your goals is identifying body parts and your only approach has been to ask your child, “Where’s your nose?” when he’s sitting on your lap, shake it up a little. Honk Daddy’s nose. Play with Elmo’s nose. Look for a new doll in the store and find her nose. If you’re a therapist and are working on body parts while you play Potato Heads, look around for other opportunities. Get creative!

On the other hand, for those of you who are like me (hyper with undiagnosed ADD), have you given your approaches enough time to work? Are you looking for small, attainable changes, rather than long-term goals? Earlier in my career I would jump ship just before I should, or make my expectations so lofty that no child with delays could reach them quickly enough for me! Now I have learned to look for lots of different ways to target one specific goal, give a Mom and Dad several different ideas to work on the same core skill from week to week, am happy with more realistic gains, and then lastly, BREATHE, while I wait for my little friend (and his mommy and daddy) to catch up!

2. Check back in! Make sure YOU’RE focused on what needs to be done.

Sometimes therapists who have worked for a while get on automatic pilot. Sometimes your crazy personal life can cause a temporary disconnect to last longer than the build up to your wedding, well after maternity leave is over, and beyond whatever “crisis” is going on in your everyday, non-professional, but real life. You have to remind yourself to get back in the game. Really think about your client that’s having a hard time. Spend some time planning what you’re going to do.

For a parent, you can have the best intentions to “do your homework” with your child, and then you realize that your next therapy session is TOMORROW and you’ve not done one thing you promised yourself you would try during last week’s session. Commit. Make yourself follow-through.

Check back in. Connect. Make sure you’re looking at what you’re supposed to be doing to make things better. Don’t totally blame it all on the kid (“He’s so autistic. He may not ever make progress”), or the therapist (“She’s so young! Does she even know what she’s doing?”), or the parents (“If that mom really tried during the rest of the week, things would go a lot better for me while I’m here!)

While all of those things may be true, it’s really easy to place blame squarely on someone else’s shoulders rather than your own. Usually when things aren’t going well, everyone is at least a little responsible.

3. Read (AND DO) what the experts recommend.

For therapists – Don’t get stale in your approaches. If you aren’t reading and looking for new stuff to try between mandatory, annual continuing education requirements, you may not be staying fresh and current. Can’t stand journals? Look for easier-to-digest material on websites. Don’t have time for a whole book? Pick a new title and read only the chapters that apply to what you’re looking for. You may surprise yourself by reading backwards for more info! Not sure what “experts” to look for? Ask your other therapist friends what they’re reading or who they recommend.

For parents – Ask your therapists who and what you should be reading. If your therapist can’t recommend anything for you, ask them to get back to you.  (P.S. That’s a red flag! Or she could be so shocked that she needs a week to scramble and find you something!)

4. Ask REAL people for help and new ideas.

For therapists – If you have no friends who are therapists, make some! Get out your clients’ IFSPs, or IEPs, or releases, or whatever documents professional contacts are listed on, and call them! If the therapists aren’t your same discipline, even better! Isolation does not breed professional growth! Almost every therapist I know can’t resist a phone call or e-mail that starts with, “Can I pick your brain for a minute? I have this kid who………”

If you’re fresh out of grad school in a brand new city, or feel totally alone in your new school district, find a mentor. Latch onto someone who seems like she knows what she’s doing, and ask away! Embarrassment over not knowing what to try next is completely overcomeable with practice! The good advice you’ll get will outweigh any initial shyness you might have in asking for help.

(One other side note for therapists – Cultivate the habit of regularly asking moms and dads what their child is doing for them AND for any other therapists he may have. If you’re getting better reports that your sessions indicate, call the other therapist ASAP! Ask what works!)

For parents – Befriend other parents who are going through similar struggles with their own children. Don’t know any other parents of language-challenged kids? Ask your child’s therapist. Chances are, she can hook you up with someone, and that person can recommend a good resource for you. With social media, you can find a page or group for ANYTHING. Search, search, search!

5. Be ready to move on if, or when, you need to.

For parents, if your child needs a new or different approach and you’ve done everything you can to elicit a change with your current therapist with no luck, it may be time to look for someone else. Give it your best try with your child’s current person because sometimes there is no one else, but if you can’t make it work, move on, and don’t look back.

For therapists, this is even more difficult. Sometimes your personality, or philosophy, or skill set, or even scheduling constraints, are not a good match for a child and his family. Know when to throw in the towel. Help a family help their child by knowing when to say when. It’s a much more honorable thing to do than prematurely discharging a child claiming the goals are met when you know it’s really you who’s done, or keeping them on your caseload when your heart is not in it, or when you’re in over your head. Although we’ve all had kids who were a challenge, who stretched us beyond our current abilities and made us become better therapists, sometimes, for whatever reason, it’s just not worth it. Let the family go. Apologize profusely, help them find someone else if you can, but help them move on for their child’s sake.


I hope these ideas help some of you! I promise to read them to myself on days I need them, and we all have those! Laura



  1. Alayah on August 15, 2008 at 9:35 am

    Do you have any good ideas for doing mouth exercise at home to help my son talk more clearly. He is hard to understand. I have read about low mucle tone. This might be problem but don’t know how to fix on my own. Thank you very much for you reply. I live outside of USA and can not get much help on this subject.

  2. Laura on August 15, 2008 at 9:49 am

    I am working on an article about this right now which should be ready by the first of next week. However, I will tell you that there is very little research to support the continued use of non-speech exercises to help improve speech intelligibility. This is shocking since so many SLPs over-rely on these methods to treat a variety of speech issues in children. Check back for the full article. Laura

  3. Amy on August 15, 2008 at 10:41 am

    Thank you for this information Laura! Even though we’re currently with an awesome therapist for my son, this is great info to have if (most likely when…gotta love the military lifestyle) we have to move.

  4. Annette on August 16, 2008 at 4:02 pm

    Hi Laura!! Thank you!! Boy did this article come at the right time! I have been scanning the web again, looking for new activities and fresh ideas to keep things moving along for my Jake! I love your term Undiagnosed ADD, I think I have that! I can’t stay on a toy for very long because I get bored, and yet, Jake can play for hours with one activity! I am always looking for new things to play with, and I think it’s mainly for me!

    I came to your website today, to write to you, then I saw this article and it stopped me in my tracks! The picture of the lady pulling her hair out reminded me of me! HA! So it got me off track for a minute, but I loved the article! You are so timely with your nuggets of information!

    The reason I am writing today is, I would like to ask you: Do you have a particular list of toys that really get you results in your sessions? I am already compiling Christmas lists, and I always try to get educational toys, but this year, I want to get things that encourage more language. Toys that get kids talking!

    If you find time, could you jot down a few recommended toys, that are proven with you, that really get kids talking?

    Thanks Laura.. and as usual, the best ‘read’ of the day!!
    Thanks so much!

  5. Laura on August 16, 2008 at 6:53 pm

    Hi Annette! Here’s the list of my tried and true toys and how I use them in therapy sessions. Hope you get some new ideas!


    I also wrote the Mama tips after your call to the show yesterday. Hope these work for Jake too! Laura

  6. Jo on August 25, 2008 at 4:16 am

    Hi Laura,

    When therapy doesn’t work or improvement is very slow and little, the child may have biomedical problems which are hampering the development of his/her brain, e.g., heavy metal poisoning, food intolerances or nutritional deficiencies. A DAN doctor (autism.com) can help with this. Good luck!

  7. Loki_31 on August 27, 2008 at 10:15 pm

    Hi Laura,
    I just found this website today and have been reading so much! Thanks for such a great website! I have a 2.5 year old boy who is speech delayed. He sees a SLP once a week and has been doing so for 6 weeks. He is only speech delayed, has passed all other tests just fine. My question is how do you tell the difference between a speech delay and apraxia? I found a couple of articles here and he fits into some of the catagorizations but not all for apraxia. Our SLP has never mentioned Apraxia, I am thinking she would if she thought he had it but some of the signs do remind me of him. Here is a little about him: He has about 20 true words, he also has about 20 sounds for objects that I am currently not counting as words. He will not imitate unless he already knows the word/sound. If he already knows the word he will play the imitate game all night! For words that he does not say he always says “A -da” I have always thought that was his way of saying “What’s that” and I would tell him over and over what everything is. He did babble as a baby normally, but really stopped making progress between 12-18 months. At 18 months he started up with Momma and Dadda. He is a great eater, we have never had a problem with him eating. He did have ear infections from 5-10 months when he got tubes, but his hearing has tested fine since. His father and grandfather were both speech delayed (until aprox age 4) and are fine. Basically my question is how do you diagnose apraxia from a normal speech delay? thanks for your time!

  8. Laura on August 27, 2008 at 10:43 pm

    Melanie – First of all, I am so glad you found the site and are getting information you need to help your son.

    Secondly, I think most of your questions should really be addressed to the SLP who’s seeing your son. The key word here is “seeing.” I could try to form an opinion, but I don’t really have all of the facts, even with your details, because I haven’t SEEN him. I’d recommend that you print out the article with the characteristics of apraxia and discuss these with her, and then the both of you can decide yay or nay based on what you’re both actually seeing. Just based on what you’ve said, he does have some red flags that might make me suspect something other than AND/OR in addition to a language delay. Again – talk to your SLP. It sounds like you have a good relationship with her and trust her, so explore these diagnostic issues with her. Many, many SLPs are reluctant to discuss apraxia unless a child is over 3 or has been in therapy for a while. I am not in that camp, but there are many competent professionals who are. Your best bet is working through this with her, and then getting another opinion if you still have that nagging feeling that something isn’t right.

    The good news is that you have a family history of speech delay resolving with no long term consequences. I’m still so glad you’re doing speech therapy because if his issues don’t resolve, you’d have kicked yourself for wasting precious time.

    Good luck with everything! Laura

  9. Holly on August 28, 2008 at 1:57 pm

    Just from a mom who’s been where you are and am still going through it….you need to bring up apraxia. My son was in EI at 2 1/2 and I had NEVER heard of apraxia nor had it been mentioned to me. He then entered the school district for therapy and still nothing was mentioned to me. I then did my own research and found this site plus many others concerning apraxia and like you started to wonder. When I did ask my son’s slp she agreed he was definately apraxic and told me she didn’t mention it because most parents get very upset since it’s a neurological disorder so she said she stayed away from using the term so as not to scare parents. Oh course I was very mad and didn’t really see her point at the time. I also phoned his EI slp from before and asked her her opinion and she too said she thought he might have apraxia but because he wasn’t 3 yet, she didn’t want to say either way. My son like yours has no other issues and only had a few that matched up to the apraxia guide lines. I agree with Laura to bring the article with you and question your slp because like mine, she might not be using the term ‘apraxia’ for her own reasons. One thing I did learn after all this time, even after knowing he was apraxic is that treatment is a lot the same as a regular delay. The biggest difference I found though was how you handle them not saying a word, being apraxic you can’t push it on them because they CAN’T say it versa the WON’T say it. It sounds like your son like mine understands everything you say to him and therefore fusteration will occur with apraxia because they know what they want to say but can’t no matter how hard they try and if you push too hard at home, they’ll start to resent you for it which of course no mom wants not too mention it really doesn’t help the situation. I hope this helped and let us know what your slp says.

  10. Angie on December 28, 2009 at 11:09 pm

    I have a 4 1/2 yr old that I know is so smart, yet sometimes, i wonder what he is understanding and what he is not due to his lack of verbal communication… Different behaviors that I cant seem to break, trying to get him to talk to me, for example asking him what happened when either he or one of the other kids in the home are upset, even as simple as asking him where his cup is. all he will respond with is “i dont know where is it?” I really dont know what to do sometimes and there are so many times that other people that we interact with on a daily basis will look at me and be frustrated with me because of his behavior. I have been told that consistancy with time outs are the key but even that doesnt seem to phase him. I am at a loss and dont know what to do. I need advice, answers, something

  11. Laura on December 29, 2009 at 8:52 pm

    Angie – Without more information I don’t think I can give you any concrete recommendations. Is his language delayed? Does he have receptive (how he understands) and expressive (how he communicates) delays? Is he in speech therapy right now? Does he have a formal diagnosis? Is he following any directions for you? Can he participate in a conversation that’s not related to discipline? Let me know these things and then maybe I can give you some more specific advice. Laura

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