Is this typical for speech therapy with a 2 year old?

Amamsneb

DS (27 months, autism) had his first appointment with the SLP today. So far, she's not my new best friend. She's not friendly, and doesn't come across as someone who likes people very much. First, she makes him sit in a chair, something he hasn't really mastered doing for more than a few seconds at a time without some kind of buckle. He puts a toy in his mouth. She says, "No mouth." I let her know that we've been using and getting response from, "Mouth off," and she looks at me like I'm crazy. He wiggles in his seat. She tells him to be still. He tries to get up. She puts him back in the seat. After a few times of this he scratches her (this is pretty new, and is usually a sign that he's overwhelmed). She grabs his hands and says, "No scratching." So far the only thing that really bothers me is that for a speech therapist, she doesn't listen very well, either to anything I'm telling her or the nonverbal communication he's giving that he can't sit still anymore. And I'm not crazy about seeing her restraining him with her hands on his wrists. Later, she asks me if we do time out. I tell her we don't. She says, "Well we do" and proceeds to tell me he'll be put on a stool for two minutes every time he misbehaves. Now, so far, this woman is SO not my style with my kiddo that I'm really feeling defensive, but there's not many options in our town, and I've been on her waiting list for 2 months. WDYT? I feel like I should give it a fighting chance with her, but I'm not sure he currently has the cognitive abilities for her rigid structure. I feel like we'll be spending all session, every session fighting with him about the rules instead of learning.

Florak8

 I'm not sure he currently has the cognitive abilities for her rigid structure. I feel like we'll be spending all session, every session fighting with him about the rules instead of learning.

 

Maybe explain this to her before the next session? Part of speech therapy as I understand it is helping the child learn how to function in a classroom environment, so s/he can show what s/he knows. Our SLP has worked on things like attention span, pointing to the answer, following instructions. So that may be yours' focus.

 

I might try to discuss your concerns and ask her where she is coming from before writing her off.

MaxandRuby

Personally I would change therapists. If I don't like them, then it will show and I do not need to adversly effect the relationship. Maybe others here would disagree but this is how I am. I have only ever switched a therapist once (we've seen a ton) and it happened to have been a SLP because I did not like the tone she took with me and I did not like something she did with my son (honestly it reminded me of me and I don't want that in a therapist!). I did stay with her until I found a replacement which was about 2 sessions later....different therapist in the same clinic.

FWIW, from what you described it is the polar opposite of how DS2's (2.75yr with CP) speech therapy sessions go. Our SLP completely goes with the flow but she also has rules that she won't allow him to break. Those rules are things like he has to do X number of things (like label pictures) before he can have a play type break and choose what he wants. She does not do time outs with him nor has she ever suggested it, but DS2 has never done anything to warrant a time out. 

Amamsneb

-auntie-:

Sounds like she's doing Verbal Behavior Therapy. You're really fortunate to have access to this kind of therapy.

I know it isn't a warm and fuzzy approach to watch, but it's seriously effective for most kids on spectrum who are basically non-verbal. Her choice of phrases is likely very deliberate, and in place to help him with his receptive language. Her discipline is what will make it possible for him to access the therapy and later globalize it to sitting when it isn't his first choice activity which might help him be mainstreamed for more of the day come school.

That makes sense...I guess I'm not sure how to handle the time out thing. I planned to institute it at some point, more as a sensory break on a bean bag than a punishment sitting upright in a rigid chair, and we do have methods in place for calming him when he is having trouble, like slowly counting and breathing. He is usually a very gentle kid. The scratching only happens when he is really pissed, not that it's an excuse, just that he's not tantrumy. I have to look at how much of my reaction to her is that she never greeted me or shook my hand, and I don't think she told me her past name. She's the sort of therapist I would avoid for myself, and I know from past experience that can mean she's the right person to help.

ridesbuttons

I learned early in speech therapy (both my kids attended starting at about 20 months old) that the hardest thing to do is sit on my own hands and keep my mouth shut.

As a parent, it is nearly instinct to do things for your child, to answer for them, to make things easier.  Speech therapy is a challenge for the child, and for the parent it presents a different sort of challenge.

It is also a long trip.  DS2 is just now on hiatus for the summer but I have attended speech therapy with him since he was 20 months old.  He is now 3y5m.  He only recently tested within a typical range for kids his age.  Between DS1 and him I've spent nearly 3.5 years in speech therapy with my kids.

I have learned a great deal attending speech therapy and it has been great for my kids.  But it can be hard, particularly in the early going.

Good luck.

Amamsneb

-auntie-:

Amamsneb:

That makes sense...I guess I'm not sure how to handle the time out thing. I planned to institute it at some point, more as a sensory break on a bean bag than a punishment sitting upright in a rigid chair, and we do have methods in place for calming him when he is having trouble, like slowly counting and breathing. He is usually a very gentle kid. The scratching only happens when he is really pissed, not that it's an excuse, just that he's not tantrumy.

That kind of is a tantrum. Reacting with aggression when asked to do a less preferred activity is what most clinicians would consider a tantrum.

I have to look at how much of my reaction to her is that she never greeted me or shook my hand, and I don't think she told me her past name. She's the sort of therapist I would avoid for myself, and I know from past experience that can mean she's the right person to help.

But it's not about you. She's there to help your son gain the skills he needs to thrive in places where he isn't accommodated. If she's good, and she may be or may be not, it's about the skills she can teach your son. I get where you're coming from. My DH thinks DS's a certain member of DS's team is something of a world-class asshat, but over time (like years) he's come around to understand that there's a method to what seems like harsh standards.

Do you have other options where you live? Have you looked at ABA, ESDM or Floortime and decided which meets your objectives for growing your son to his best self?

You're right. I know you are. The scratching is new, in the last few weeks. think I'm holding my hands over my ears and singing la la la la pretending I can have the only kid in the world with autism who doesn't have behavior issues. His personality has always been so sweet and, well, passive, that it's hard to accept this change. Sadly, there isn't much in the way of any kind of therapy where we live. It's taken me and the EI program almost 3 months since his diagnosis to find OT and speech for him. I was really hoping for a more play-based speech therapy, maybe with music, but that doesn't seem to exist out here.

susanmosley

-auntie-:

Sounds like she's doing Verbal Behavior Therapy. You're really fortunate to have access to this kind of therapy.

I don't really agree with auntie on this, but I do think you should give them 2-4 weeks together (assuming she is coming a few times a week) before you even consider a change or form too strong of an opinion. 

kcisthebombdotcom

I would give it some time to see if it works before changing personally.

I didn't get the warm fuzzies from our current SLP at first (and still don't) but she's doing a great job with him and his language has really improved, so we're sticking with it.

MirandaHobbes

That sucks- I'm sorry you don't feel better about her. Without question we've been 100% in love with our therapists- so I guess we're lucky (daycare teachers are another story- it's rare we get real warm fuzzies from them). I will say this: I learned early on that it was imperative that I leave the room during speech therapy. He would goof off and run to mom when I was there- when I wasn't he paid attention and did his work. It is true that it will be uncomfortable for him- it's supposed to completely modify his behaviors. That said, our ST sessions always included fun stuff too like "do this 10 more times and then you get a ride on the therapy swing". I hope it goes better for you..

annibes

I see most of my on-spectrum toddlers in a toddler classroom with a pretty rigid schedule. I work my speech time into what they are doing. They have free play and break times which is when I keep interactions natural as possible and don't push if they don't have interest- they lead. The problem with that is that they often don't want my input (but they're sloooowly getting used to it and starting to interact a bit). During our short table time sessions, designed to get them used to teacher-directed activities when they enter school, is when I get some more progress. I have an opportunity to sabotage activities to encourage communication, there are clear boundaries in between short shoe-box activities so I know what they like best and I can play off of that a little, and when they have expected outcomes (have to open a container to complete an activity, need more items to fill up a box, get paint all over their hands and want help cleaning it off), those moments are great for helping encourage communication. 

I would give it some time. If you still aren't happy by Fall, get the ball rolling on a new therapist. At the very least, write down some of her strategies and use them in a more play-based manner at home. 

One thing to consider on the phrases used: I don't know her schedule, but I work 2 days/week in EI and I see 21 kids (4 of them 2x a week). I also am doing ESY and summer programs and I see an additional 21 kids in the remaining 3 days of the week (9 of those 2x/week). I do my best to remember everything I can about each one, but I have phrases I teach and use with all of my kiddos (feet on floor, no mouth, safe hands, etc). If I don't have some consistency, I won't know which phrase to use with which kid and I don't want to confuse them when I'm trying to improve their receptive language.  

annibes

MirandaHobbes:

That sucks- I'm sorry you don't feel better about her. Without question we've been 100% in love with our therapists- so I guess we're lucky (daycare teachers are another story- it's rare we get real warm fuzzies from them). I will say this: I learned early on that it was imperative that I leave the room during speech therapy. He would goof off and run to mom when I was there- when I wasn't he paid attention and did his work. It is true that it will be uncomfortable for him- it's supposed to completely modify his behaviors. That said, our ST sessions always included fun stuff too like "do this 10 more times and then you get a ride on the therapy swing". I hope it goes better for you..

I have a LOT of kids like this. Very distracted by mom/dad in the room. You might be surprised, OP, at how well your DS does if you wait in another room. If you try it, be sure to ask for homework/strategies to try on your own.  

duchess0727

My daughter has serious attention issues and a very difficult time sitting in a chair for more than 30 seconds.  But I understood that in order for her to get anything out of ST, she needs to sit still and pay attention to the SLP.  It's something she needs to learn to have any kind of success in school and as a result, we did not have a problem with her being forced to sit still.  Now, it took about 2 months for her to get to a point where she did not scream and yell or deliberately ignore everything the SLP said/did.  Because we understand the importance of her learning and because we know that she understands, we allowed the SLP to push her to the point of tantrum - she needs to be pushed.  But I honestly wanted to cry after every session for the first 2 months. As for the time out, if you feel that your LO would respond better to a positive reinforcement, I would ask the SLP about that.  My daughter has responded very well to a token board (she gets a token each time she sits still and then the prize is either a snack she likes or to rock in her rocking chair).  I would give it time - it is going to take some time for your LO to get used to the SLP and her methods.  In the meantime, I would talk to her about positive methods rather than time out and I would talk to her about working in the chair for shorter periods of time - maybe 10 minutes and then he gets an opportunity to do something he enjoys outside of the chair.  Good luck!