Therapy Tip of the Week 2.24.12

Hi! Here’s this week’s video:




Puzzles are a staple of speech therapy sessions with young children. In the video I explained many different ways to target language and other considerations to improve participation with this activity with toddlers. Here’s a summary of that information:

1. Offer toddlers variety with puzzles. It is B O R I N G to use the same puzzle week after week for sessions! Collect puzzles with different themes so that you can teach new words and?expand a toddler’s vocabulary. Walmart, Target, and other discount stores often sell inexpensive puzzles and are a great way to build your inventory. Try ebay, consignment stores, or Goodwill for even more of a bargain.


2. Consider a toddler’s motor skills. Larger pegs may make it easier for a toddler to fit the pieces in the puzzle. If a puzzle is too difficult for a child with motor issues, he may avoid the task. However… if it’s too easy, a child may also want to leave you! Find puzzles with doors or another kind of novelty to attract and keep a toddler’s attention. Magnetic puzzles with tools to catch or hook the pieces are tons of fun. In the video I showed magnetic puzzles with cars and a magnetic tow truck and another one with insects and a net, but there are many more options available for you.


3. If a child is refusing to complete a puzzle, look at factors beyond behavior.

  • Determine if a “busy” background distracts a toddler’s attention or overwhelms?his visual perceptual skills. If this is?a factor, choose?puzzles with a plain background.


  • Puzzles target visual matching. If this skill is a challenge, you may want to begin with very simple puzzles with fewer pieces. Color to color or identical picture matching is much easier than matching a colored picture on the piece to a black and white picture on the inset. Matching the piece to the same-shaped spot with no picture as a clue is very difficult for some children (and adults!).


  • Sometimes something as simple as shaking up the pieces in a bag, holding a couple of pieces in your hands and mixing them up, or hiding pieces behind your back are ways to create anticipation and excitement for young children. If you feel yourself losing a child, interject one of these tricks to bring his focus back to you.


  • Change your task midway through the puzzle. If a child can’t complete your expressive goal, switch your focus to a receptive goal. For example, if he can’t name the pieces, ask him to point to the piece you name or complete another higher level receptive language task. Some ideas for receptive language are listed below.


  • A child may not be able to complete all 9 pieces of one puzzle in one sitting and THAT’S OKAY! Look for overall progress. If he can do 2 pieces this week, but 4 pieces next week, you’re on the right track! Give him (and yourself) a break! It’s okay to clean up before he’s finished all 9 pieces. I always target language during clean up time too. Sing “The Clean Up Song” from Barney as both of you?put the pieces back in your bag or better yet, have the child clean up the piece you name.


4. Go beyond naming each puzzle piece. While this is an appropriate goal for toddlers who are using single words spontaneously, it is NOT appropriate for children who are nonverbal or minimally verbal. For these children, puzzles should be used to target receptive language or an easier expressive language goal before you work on naming each piece. Nothing is more frustrating for a toddler than an adult who repeatedly asks, “What’s that? What’s this? Tell me. Say it…” when a child has never before said or imitated the word.

A late talker is extremely unlikely to say a word for the very first time during a confrontational naming task. It is much, much better to model the name and have a child imitate correctly than make him feel like a failure for not knowing what to say spontaneously. If you are consistently met with silence when you ask a child, “What’s that?” please know that YOU are?working on the wrong goal and/or using an incorrect strategy to elicit early word attempts.


5. A much better way to target expressive language for a child who can’t yet name the pieces spontaneously is by having a child imitate your model of the label. Keep it light and fun. Model the word several times as you show him the puzzle piece, but then hide the piece in your clasped hands while you “call” the piece. Or?hide the piece in the child’s shirt and “call” the object. You’re modeling the word over and over which is targeting both receptive and expressive language.

If a child is verbally imitative, then offer choices to facilitate imitation. You’ll get many more word attempts this way than depending on spontaneous productions at this point. For example, “Do you want cow or pig?” Keep your choices going throughout the puzzle by asking, “Does the truck go here or there?” or “Should plane go in or out?”


6. Other expressive tasks might include imitating exclamatory or play words like animal sounds or vehicle noises rather than the names or labels for the animals or vehicles. For example, if a child isn’t ready to imitate the word “dog,” he may be able to imitate your loud and FUN “Woof woof woof!” or a panting sound.


7. If a child isn’t ready for any kind of oral or verbal imitation, try imitation of a motor action such as knocking on a barn door with a farm puzzle, pretending to lick like a kitty cat, patting the pony, or making the bunny hop. MOTOR IMITATION ALWAYS PRECEDES VERBAL IMITATION.


8. Teach signs for puzzle piece names if a child isn’t ready for verbal imitation. Be sure you know the signs for every piece BEFORE you introduce this activity!


9. To target receptive language have a child follow directions. You can do this by holding up two puzzle pieces and directing the child by saying, “Get the ______.” If a child is prone to mistakes with this method, hold the puzzle piece you’re asking for a little closer to the child to prevent him from selecting the wrong piece. This technique is called errorless teaching. You minimize the chance that a child answers incorrectly. If you’re constantly redirecting or correcting a child in receptive language tasks, then this is the strategy you should be using.


10. To work on other higher level receptive language tasks, ask a child to complete requests?with the puzzle pieces such as, “Kiss the baby!” or “Make your?plane fly!”


11. As a prerequisite for two-step commands, have a child select two different puzzle pieces on request. With a puzzle of food items, ask a child to give you “ice cream and cake.” Hold out both of your hands as a visual cue for the two separate pieces.


12. Another great way to target receptive language is using puzzles to teach object functions. Ask, “Which one drives on tracks?” or “Who says quack quack?” or “What do you wear on your feet?”


13. I LOVE to use puzzles to target language processing by mixing up all of the receptive language targets I’ve previously mentioned. Place a puzzle across the room, give a child a verbal direction, and have him run to retrieve the correct piece. I most often use siblings during therapy in this way. This activity is lots of fun for everyone and mimics the processing skills children need in daily routines and real life.


Most of these ideas are demonstrated with children on my DVDs Teach Me To Listen and Obey 1 and 2 and discussed at length in Teach Me To Talk: The Therapy Manual. Check those out so you can SEE how it’s done or review specific instructions.


Thanks for watching! I hope that you’re finding these videos helpful! Please feel free to leave me a comment or ask any questions.


Until next week….. Laura



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Dear Laura,

Thank you for your generosity in sharing so much knowledge in such a clear and enthusiastic way.

As a retired audiologist with a fabulous and language delayed grandson, I used your podcasts and outstanding publication, The Autism Workbook, to inspire and guide me over the past year.

It works!! He went from barely verbal, no gestures, didn't respond to his name etc etc to a verbal, social, curious, ready to imitate anything, fill in the blanks on familiar "set" speech, generate his own totally appropriate and mostly understandable sentences...not just short phrases anymore... full little paragraphs...about imaginary things, what he did during the day, what he wants. True communication!

You make a powerful difference in this world! ❤

With gratitude,

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Sheila, Canada

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We still have so much work to do with our sweet boy, but I know in my heart he would not have succeeded without the education you provided. I will continue to read your emails & watch videos as we go along this journey and face challenges, but credit is due to you, Laura.

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