Marisha

Basic Concepts in Speech Therapy: 5 Research Backed Tips

November 10, 2025 by Marisha Leave a Comment

Why Basic Concepts Matter

These foundational concepts help students follow directions, understand stories, and access academic content—especially in math and reading.

In this post, I’m sharing five evidence-based strategies for targeting basic concepts that actually stick. We’ll walk through research, practical examples, and how to bring it all together using one of my favorite books, Zoe Gets Ready.

1. Keep Instruction Clear and Focused

When targeting basic concepts, clarity is everything.

Work on one concept at a time and make sure a student masters it before adding more. This helps reduce confusion and cognitive overload—especially for students with language delays.

💡 In Practice
If you’re working on under, stick with that target until the student can identify and use it consistently. Once mastered, move to the next concept.

📘 What the Research Says
Seifert & Schwartz (1991) found that preschoolers learned basic concepts best when clinicians used direct instruction combined with interactive and incidental teaching. This blend supports generalization and retention while keeping instruction focused.

Seifert, K. L., & Schwartz, S. E. (1991). An instructional approach to teaching basic concepts. Early Childhood Research Quarterly, 6(2), 143–158.

2. Embed Concepts in Meaningful Contexts

Once a student can identify a concept during structured tasks, bring it to life!

Embedding learning in context helps students apply and retain new concepts more effectively than drill alone.

💡 In Practice
→ During storybook reading: “She put the hat on her head.”
→ In play: “Put the shoes on the doll.”
→ During routines: “Put your folder in your backpack.”

📘 What the Research Says
Bracken (1982) emphasized that teaching basic concepts in natural, meaningful settings, like play and routines, improves both comprehension and generalization. Contextualized learning builds stronger conceptual frameworks than decontextualized drills.

Bracken, B. A. (1982). The importance of basic concepts for preschool children: An assessment of conceptual development. Journal of Psychoeducational Assessment, 1(1), 3–20.

3. Use Multiple Exemplars—Strategically

Using varied examples helps students generalize new concepts, but timing matters.

Start small to establish understanding, then increase variety gradually.

💡 In Practice
Begin with a few consistent items (e.g., “Put the apple on the plate,” “Put the cup on the table”).
Once students grasp the concept, vary the context, setting, and materials.

📘 What the Research Says
Nicholas et al. (2019) suggest that limiting variability early in instruction can improve conceptual learning for children with language delays. Gradual expansion of exemplars ensures solid understanding before introducing new forms.

Nicholas, E., Light, J., & Romski, M. (2019). Teaching basic concepts to young children with developmental delays: Effects of variability in exemplars. Journal of Speech, Language, and Hearing Research, 62(4), 1120–1133.

4. Pair Words with Gestures or Visuals

Pairing verbal labels with visuals or gestures helps anchor abstract ideas.
Gestures act as visual cues, supporting comprehension and memory.

💡 In Practice
→ On: one hand placed on top of the other
→ Under: one hand slides beneath a fist
→ Big: hands spread apart
→ Little: fingers pinched close together

📘 What the Research Says
Vogt & Kauschke (2017) found that iconic gestures (i.e., gestures that visually represent meaning) enhance children’s learning of new words and concepts. Using consistent gestures alongside verbal cues leads to stronger recall and faster understanding.

Vogt, S., & Kauschke, C. (2017). Observing iconic gestures enhances word learning in typically developing children and children with language impairment. Journal of Child Language, 44(6), 1458–1476.

5. Collaborate Whenever You Can

When SLPs work with classroom teachers, PE teachers, or paraprofessionals, students see and hear consistent models across environments, which boosts carryover.

💡 In Practice
→ In PE: Practice over, under, and through during obstacle courses.
→ In art: Discuss on top of or next to while creating collages.
→ In class: Coordinate with teachers to reinforce concepts in daily routines.

📘 What the Research Says
Lund et al. (2019) found that preschoolers learned more concepts when SLPs collaborated with PE teachers. The combination of movement, meaningful context, and language repetition supported stronger outcomes.

Lund, E., Douglas, S. N., & McNaughton, D. (2019). Collaboration between speech-language pathologists and physical educators: Effects on preschoolers’ concept learning. Language, Speech, and Hearing Services in Schools, 50(2), 214–228.

Bringing It All Together with Zoe Gets Ready

Now, let’s put it into practice using one of my favorite books, Zoe Gets Ready by Bethanie Murguia.

This story is perfect for targeting spatial and descriptive concepts (on, under, next to, big, small).

Here’s a quick literacy-based therapy flow:
– Direct Teaching: Use a structured activity for your target concept (e.g., “on”).
– Vocabulary Pracitce: Use dress-up play—“Put the tiara on the doll.”
– Model During Reading: Emphasize the target as you narrate the story.
– Comprehension Check: Ask, “Where are her shoes?” → On her feet.
– Parallel Story: Act out Zoe’s routine and have students use gestures as they retell.

This mix of explicit teaching + contextualized play supports both understanding and generalization.

Key Takeaways

→ Teach one concept at a time for clarity.
→ Embed practice in meaningful contexts.
→ Use multiple exemplars strategically.
→ Pair gestures and visuals with verbal models.
→ Collaborate across environments for consistency.

Each of these steps is grounded in research—and when combined, they make concept learning more natural, effective, and fun.

Ready to Save Time and Teach Smarter?

If you’d like ready-to-go materials for these strategies, check out the Basic Concepts Skill Pack and Literacy-Based Therapy Plans inside the SLP Now® Membership.

You’ll get structured lessons, play-based extensions, and built-in visuals—so you can spend less time planning and more time connecting with your students.

👉 Start your free trial today

References

Bracken, B. A. (1982). The importance of basic concepts for preschool children: An assessment of conceptual development. Journal of Psychoeducational Assessment, 1(1), 3–20.

Seifert, K. L., & Schwartz, S. E. (1991). An instructional approach to teaching basic concepts. Early Childhood Research Quarterly, 6(2), 143–158.

Transcript

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Hey there. Today we are chatting about strategies that we can use when targeting basic concepts. So these small but meaningful words like ""on under before"" are the foundation for understanding classroom directions, understanding stories. They're embedded in the curriculum, especially when it comes to math.

We are going to be reviewing some practical evidence-backed strategies that we can useand then we're going to tie it all together with a book, Zoe Gets Ready. So we'll talk about how we can embed this into our literacy based therapy units. First up we have a few strategies that we can use when breaking down concepts for students.

I'll share all the citations in the show notes, but one strategy involves keeping it clear in focus and working on one concept at a time,making sure that a student masters a concept before we add in more concepts. And this helps reduce confusion, especially for, students with language delays.

If we have vocabulary goals, it might make sense, to keep our instruction more focused for these students. There's a study by Seifert and Schwartz, 1991,and they inspired how I set up all of our basic concepts units in SLP Now. They talk about combining direct instruction, with interactive and incidental teaching.

And they did this with preschoolers and found that this direct instruction plus embedded practice, resulted in meaningful gains in preschoolers' understanding of basic concepts. We get really good results when we do that explicit teaching and then give students the opportunity to practice and see these concepts in action in meaningful contexts, like when reading a story or during play or during their routines.

and like I said, I'll share that research study in the show notes. It's a great practical read. All of the basic concepts unitsin SLP Now help implement the evidence back strategies for that direct instruction, and then when it comes to embedding concepts in meaningful context, we don't want to just drill. As we're reading stories, we can emphasize the concepts in the reading and through all of our literacy based therapy activities like our virtual field trip, for example.

And then if we're doing play-based activities, our early language books include tons of play-based activities, and we can practice our concepts and model and recast them during our play and routines as well. There's a lot of ways that we can embed those.

Then strategy three is interesting and nuanced depending on our student, but, we want to use multiple exemplars, but we want to be strategic with how we're doing that. We want to expose students to the concept. Let's say our focus for our next therapy session is on the basic concept.

We want to expose students to that concept in different contexts. whether it's play-based or during their daily routines. and with different items. So put the apple on the table, put the toy on the floor.However, Nicholas et al 2019, suggests limiting the variety of objects early on. And so this kind of goes along with that, starting with direct instruction. So maybe this is a way to kind of reconcile that research. So when we are doing our direct instruction, we wanna just have a few exemplars. Start really simple and then expand as students start to understand the concept, keeping it consistent at first. And the activities in SLP Now help you do that, so that's great. And then the fourth strategy is to pair verbal labels with iconic gestures or visuals. We can use gestures that look like what they mean. For the example with on, we can hold up our fist and put the other hand on the fist. That could be our iconic gesture for on, or put our hand under our fist for under.

Or like spreading our hands apart for big, or just sitting with a little pinch for little. We can use those gestures or icon cards to represent the concept. There is the Vogt & Kauschke, sorry if I butcher any of these names from 2017, is the study that talks about iconic gestures supporting concept learning.

We can use those gestures or other visuals to help support students. Keeping that gesture or icon consistent can help with understanding.

And our fifth strategy is to collaborate when you can.

A study by Lund et al in 2019 found that students learn more concepts when an SLP collaborated with the PE teacher. Pairing concept teaching with those movement activities might be part of what was happening. But it's also practicing those concepts in a meaningful activity.

So again, bringing us back to strategy number two, but that's another really good one. So those are our five strategies and now we'll take a quick minute to chat about what this could look like. The book that I picked to demonstrate how we can target basic concepts using literacy based therapy is Zoe Gets Ready.

And so let's say we're focusing on on, so we'll use that iconic gesture throughout. If the on is a totally new concept, we might want to start with that structured teaching activity. If you are a member of SLP Now, you can go to the therapy plans tab and type in Zoe Gets Ready ,and then go to the Targets tab and you'll see all of the basic concepts there. If you click on on, it'll launch the structured teaching activity for on, and this will give the student different exemplars, and it'll use the evidence backed strategies that were pulled from the Seifert and Schwartz article,and help you do that direct instruction.

So before we dive into the thematic unit, we can do that structured practice. Once we've gotten exposure to that target, we might wanna revisit that activity multiple times, depending on how helpful it is for the student. Once we do that, we can dive into the actual contextualized activities.

So what those can look like throughout the unit is pre-story knowledge activation. We might do a virtual field trip, like a YouTube video of different outfits.

And so that can be something that we can do for the virtual field trip, or we can look through the pictures of the book and talk about what we know about clothing and dress up. Throughout those activities, we can model and recast, examples like she's putting on the tiara and she's putting on the boots.

And then we can use our iconic gestures or our visual icon to emphasize that. We can do activities too. If you have a doll set with different clothing items, that can be a way to introduce the vocabulary that's going to be in the story.

We could also use that for phase four of the unit. For step two, when we're actually reading the book, we can model the concepts naturally and maybe just put a slight emphasis on them and talk about the things that are happening, like using, emphasizing the on as it's happening on the story pages.

Then for story comprehension, we can ask questions that embed that concept as well. So like, where are her shoes? And they can say on her feet if we're at that level, if that's appropriate. We can use visual supports and all of that as we're giving that exposure. Then for step four, this is where we can revisit the unit. We can do some more of those play-based activities. In the early language unit, we have tons of play-based activity suggestions, like the dress up activity Check out the unit for even more ideas. And then for step five, this is typically the parallel story, so we can act out the story as a comprehension type of activity. This is a great meaningful context to target whatever basic concepts we're focusing on throughout the unit. They can create their own version of the story, and act it out and then we can emphasize those concepts and yeah, that's super fun.

Our takeaways here. Teach one concept at a time. Embed those concepts in meaningful context, after direct instruction. Use multiple exemplars. Starting with just one exemplar in the beginning might work better for some of our students. Using iconic gestures or visuals. And then collaborate when we can, embedding these concepts in the classroom, in PE, during snack time, all of that. So that is a recap of our strategies for basic concepts. I'd love to hear how you are using these and check out the show notes for the research articles and all of that good stuff.

If you are not a member of SLP Now yet, you can sign up for a free trial to check out the therapy plan and all of the activities I mentioned. The link will be in the show notes, but just head to slpnow.com/trial. You can sign up for free, no strings attached.

And you can access the therapy plans, like I said, all of those basic concepts, activities, we'll hope to see you soon and we'll see you in the next episode too.

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5 Evidence-Based Strategies to Boost MLU (That You Can Use Tomorrow!)

November 4, 2025 by Marisha Leave a Comment

Why MLU Goals Matter

Mean Length of Utterance (MLU) is one of the most reliable and widely used measures for tracking expressive language development (Brown, 1973; Miller & Chapman, 1981). It helps SLPs identify where a student is, monitor progress, and plan therapy that supports steady, functional growth.

In this post (and the SLP Now Podcast episode), we’ll walk through five evidence-based strategies for boosting MLU in a way that’s fun, functional, and easy to monitor—plus an example from a Little Blue Truck therapy plan.

1️⃣ Identify Targets Using a Language Sample

Before starting intervention, collect a language sample to get an authentic picture of your student’s communication.

Language sampling provides:
– An accurate baseline for MLU (Brown, 1973; Miller & Chapman, 1981)
– Insight into which structures and parts of speech are missing
– Data for ongoing progress monitoring

Many SLPs find language sampling intimidating, but it doesn’t have to be!

💡 Try This: Use the Language Sample Freebie to automatically calculate MLU and extract metrics for reports. The spreadsheet even helps you organize utterances and visualize growth over time.

2️⃣ Embed Targets in Play, Books, Songs, and Routines

Once you know your student’s targets, embed them in natural contexts, like play, shared book reading, songs, and daily routines. Research consistently supports that language learning is strongest when embedded in meaningful, interactive experiences (Fey, 1986; Justice & Ezell, 2002).

Why it works:
– Encourages spontaneous use of new language
– Supports generalization across settings
– Keeps therapy fun and functional

Try this:
– Reenact story scenes (“Truck stuck!” “Push truck!”)
– Sing songs like The Wheels on the Bus
– Incorporate targets into daily routines (“Open door”)

✨ Explore SLP Now’s Play-Based Units for ready-made activities designed to build MLU through storybooks and play.

3️⃣ Model Just Above the Child’s Level

Modeling slightly longer utterances (about one morpheme above a child’s current level) is the core of MLU intervention.

This approach, supported by decades of research, helps children expand expressive language naturally (Brown, 1973; Fey, 1986; Camarata, Nelson, & Camarata, 1994).

Here are some potential strategies:

Expansions: Add grammatical elements while maintaining the child’s meaning.
Child: “Dog jump.” → SLP: “The dog is jumping!”

Extensions: Add related, new information.
Child: “The dog is jumping.” → SLP: “The brown dog is jumping!”

Recasts: Reformulate the child’s utterance using correct syntax.
Child: “Him run.” → SLP: “He is running!”

Focused Stimulation: Model the target without requiring imitation.

📏 The Rule of Thumb: Model just one step above what the student currently produces.

4️⃣ Use Sentence Frames and Visual Supports

For students who benefit from more structure, sentence frames and visuals can make language more accessible and concrete.

The SLP Now Sentence Pack includes:
– Movable icons for core parts of speech
– Sentence strips organized by MLU level
– Visual scaffolds for building utterances

Example:

Child: “Truck.”
SLP: (adds icon) “Truck stuck!”
Next: “Truck stuck in mud.”

Visual modeling helps students connect words with meaning, supports working memory, and facilitates sentence expansion—especially for early language learners or students with ASD (Kaiser & Roberts, 2013).

5️⃣ Use Contingent Responses and Time Delay

Last but not least: pause and wait.

Time delay and contingent responding encourage children to initiate and elaborate on their own utterances (Kaiser & Roberts, 2013).

How to implement:
– Utilize expectant pauses in play.
– Give processing time before asking another question.
– Use contingent comments (“You see the truck!”) to maintain interaction.

This small shift gives students processing space and often leads to longer, more complex utterances.

🛻 Therapy Plan in Action: Little Blue Truck

Here’s how all five strategies can fit into a single literacy-based therapy plan using Little Blue Truck (Schertle, 2008):

Before diving into the unit, we want to make sure we know where the student is at. Review the student’s language sample to determine what the “+1 Approach” might look like.

We can use expansions, extensions, recasts, and/or focused stimulation throughout all of the unit activities.

If a student needs additional support, we can use the Sentence Pack visuals and sentence frames to scaffold responses.

And we don’t wait to forget about wait time!

Here are a few quick examples of what the unit might include:
– Pre-Story Knowledge Activation: Take a virtual farm field trip.
– Shared Reading: Read the story.
– Comprehension: Ask WH-questions.
– Focused Skill Practice: Reenact the story using toys. (This is a fun context to target MLU, but also support early narrative skills!)
– Parallel Story: Help students create their own version of the story.

This aligns beautifully with Dr. Ukrainetz’s (2015) Literacy-Based Therapy Framework, which emphasizes meaningful language practice across reading, listening, and play.

✨ Final Takeaways

To help students grow their MLU naturally and confidently:
1️⃣ Start with a language sample to identify a baseline.
2️⃣ Embed targets in meaningful, play-based contexts.
3️⃣ Model one level above using expansions, extensions, and recasts.
4️⃣ Support with visuals and sentence frames.
5️⃣ Pause, wait, and respond contingently.

Each strategy builds on the next, supporting both language growth and engagement.

🔗 Resources Mentioned

Language Sample Freebie

Sentence Pack

🧠 References

Brown, R. (1973). A First Language: The Early Stages. Harvard University Press.

Camarata, S. M., Nelson, K. E., & Camarata, M. N. (1994). Comparison of conversational‐recasting and imitative procedures for training grammatical structures in children with specific language impairment. Journal of Speech and Hearing Research, 37(6), 1414–1423.

Fey, M. E. (1986). Language intervention with young children. Allyn & Bacon.

Justice, L. M., & Ezell, H. K. (2002). Use of storybook reading to increase print awareness in at-risk children. American Journal of Speech-Language Pathology, 11(1), 17–29.

Kaiser, A. P., & Roberts, M. Y. (2013). Parent-implemented enhanced milieu teaching with preschool children with intellectual disabilities. Journal of Speech, Language, and Hearing Research, 56(1), 295–309.

Miller, J. F., & Chapman, R. S. (1981). The relation between age and mean length of utterance in morphemes. Journal of Speech and Hearing Research, 24(2), 154–161.

Schertle, A. (2008). Little Blue Truck. Houghton Mifflin Harcourt.

Ukrainetz, T. A. (2015). School-age language intervention: Evidence-based practices. Pro-Ed.

Transcript

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Today we're going to chat about five evidence based strategies that we can use to boost students' mean length of utterance or MLU, in a way that's fun, functional, and easy to keep track of. I'm really excited that we'll be sharing some strategies that you can use in your very next session.

And then we will tie it all together, and show you what it would actually look like in context when you're applying these strategies. Our first strategy is to identify the baseline, using a language sample. Language samples can be a really helpful way to calculate the student's current MLU, and also see what types of utterances they're using and tracking that progress over time.

Regular language sampling helps us ensure that we're modeling at the right level. I love language samples, but a lot of times when I mention them to SLPs, I get a little bit of an eye roll, because they feel really time consuming and difficult.

I put together a, spreadsheet, maybe a decade old at this point, but it still works really well. it helps you calculate. So you just use it to type in your transcript, and then you separate it out by utterances, and then it automatically calculates the MLU and it helps you grab some other metrics so you can write a really fancy report based on the data or include it in your evaluation area or progress monitoring. It makes it really easy to grab the data that we need,for easy progress monitoring. I'll add the link to the language sample sheet that I made in the show notes. It includes a video and walks you through how to set it up.

That is a really helpful starting point, because we'll use this data as we go through. Our second strategy is to make sure that we're embedding targets in meaningful contexts, like, play, books, songs, routines.

And I'll share some specific strategies, of what we actually do in those functional contexts, but if we are embedding our strategies in those types of activities, we are thinking about generalization from the start and setting our students up for success and making sure that the targets are very meaningful.So that brings us to strategy number three. Different research articles will share different strategies, but there's a lot of overlap between the strategies and, I just wanna share the names of the strategies and what they are, and you'll see that there's some overlap.

I'll wrap up with a general takeaway of what we can do with these strategies. Expansions are where we add grammar while keeping the child's meaning. If the child says, "dog jump," you can say "the dog jumped," or "the dog is jumping."

An extension is adding new information. If the child says "the dog is jumping," we can say "the brown dog is jumping."We can do an extension where we add new information, but that's still related.

And then focused stimulation is when we're providing models and recasts without requiring imitation. It's just strategically using, those strategies. a recast is when we restate the child's utterance, but maybe do a correction, which is really similar to an expansion.

There's also research talking about modeling one level above the child's MLU, which expansions and extensions kind of naturally do. If the student says "dog run," and then if we suddenly go, "the excited dog is running quickly."

We're expanding and adding the grammar and we're adding multiple new pieces of information. It's helpful to think about just going one level above the child's MLU and not having a whole, massive expansion.

So if the child says "truck stuck," we can say, "yeah, the truck is stuck." Or we can say "stuck in the mud." We get to use our clinical judgment to decide if that is appropriate because if they just say "truck stuck," but their MLU is five, then I think "The blue truck stuck in the mud" might be okay.

That's why we collect that MLU to know what might be appropriate for the student.

Strategy four is to use sentence frames. In SLP Now, we have a Sentence Pack. It's a booklet based on the modified Fitzgerald key. It has nouns verbs prepositions and all the components we use to build a sentence.

And it also includes sentence strips based on Brown's research of all the different utterance types. So you have tons of utterances that you can go with . We also have sentence frames with just like for one MLU, and two, and three, and four, and five. And so you can build sentences with any of the components.

If I notice that the student is only using nouns, or if there's a part of speech that's completely missing, I might strategically try to include that more and expand the utterances in that way. That's, a visual that I really like to use. We grab the icons to create sentences. It's really nice because the pieces are movable, It's a tactile experience too, and the students can build it and then you can point to it as you're modeling.

If the student just says truck, truck, truck, and we're trying to expand from one MLU to two MLU. We have like an icon for truck, and then we have one for stuck, and then we would just build the sentence using those icons. Once the truck is out, we can say truck out or truck in if it's in the mud.

Having those icons is really helpful. Verbal strategies help the majority of my students, but there are those who need something extra.

And including those visuals is something that has worked for a lot of the students. So that's how the Sentence Pack came to be. I also use it for different grammar goals. If they are dropping the auxiliary verbs or if they're having trouble understanding that pronouns replace a noun.

So there's lots of ways that I use that, but it's especially helpful for those MLU goals and for those students who need those extra visuals. And then the fifth strategy, which is just too provide contingent responses and time delay. So we really just wanna give our students space to respond and give them some processing time.

And we don't have to fill every second. It's okay if we have some silence in the session. If a student starts to say something, if they say truck, we can just pause a second and see if they say anything else first.

Or if we turn the page and give them some time to look before we really jump in and start talking at them. So that is just a reminder for myself because I sometimes go a little too fast. In terms of what this would look like actually applied. Let's say we're using the therapy plan an SLP Now for a Little Blue Truck, which is a super sweet story about a truck who gets stuck in the mud.

We like to use literacy based therapy units based on Dr. Ukrainetz's research. The first step is pre-story knowledge activation. We might do a virtual field trip of a farm, and we're gonna be doing a lot of talking during that activity. And we can target the MLU goals during that conversation.

As we're reading, we can model expansions and recasts. The third step is comprehension. We can ask simple WH questions and use those sentence starters in the sentence frames to support the student. And then, the fourth step is focused skill practice.

We often have mixed groups, so we're targeting multiple goals with students. We might have some play-based activities related to little Blue Track. We might be reenacting the story or whatnot. This is a early language unit, so it has play-based activity suggestions and all of that.

So that's how that would work. That's just a peek at how we might incorporate this in a literacy based therapy unit.

And then, a quick recap. We wanna start with a language sample. So we know the students' baseline and we can easily see like, oh, they're only using nouns.

Seeing it on paper helps us come up with a good plan.We want to make sure that we're embedding our practice in meaningful context, whether it's play stories, routines. And we want to model just above the child's level and use those verbal strategies. once I set up parents and teachers with that strategy of modeling one level above and then how to do that, it skyrockets from there. If our students need more support using the Sentence Pack and those sentence frames can be really helpful.

And then also just giving them time to respond using some of that wait time. So those are our strategies that will hopefully help you see meaningful growth in your students when it comes to communicating and building beautiful sentences. Head to the show notes to check out the Sentence Pack and the Therapy Plans. If you're new to SLP now, you can do it for free. if you're a member, type in Sentence Pack to find that download or go to the Therapy Plans to check out Little Blue Truck. I hope this was helpful and we'll see you real soon.

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Making Syntax Simple: Strategies for Passive Voice and Clauses

October 27, 2025 by Marisha Leave a Comment

Why Syntax Matters (Even for Kindergarteners)

Syntax isn’t just for older students! Research shows that even five-year-olds produce subordinate and coordinate clauses.

A 2024 study by Owens, Pavelko, and Hahs-Vaughn analyzed conversational samples from 196 children ages 5 to 10 years, 11 months.

Five-year-olds used an average of 1.25 subordinate clauses and 2.05 coordinate clauses, and that number increased steadily with age.

If your students are only producing simple sentences, they may need support with syntax. Limited syntax can affect comprehension, writing, and overall language performance.

Owens (2016) found that about half of five-year-olds understand reversible passive sentences (e.g., “The dog was chased by the cat”), and by age 8, 90% can comprehend them.

This means that targeting syntax — even with kindergarteners — helps build comprehension and expressive language skills that impact reading and writing success.
👉 Prefer to listen? Check out the full podcast episode above for a quick blitz through all five strategies.

Step 1: Start With a Thorough Syntax Assessment

Syntax varies across contexts, so assessment should too. Guo & Schneider (2016) demonstrated that tense and grammaticality measures from narrative tasks can help differentiate students with and without language impairments. Nippold et al. (2005) also found that children use more complex syntax in expository tasks than in conversation.

Here’s how to assess syntax comprehensively:

– Collect multiple language samples (e.g., conversational, narrative, persuasive, and expository).
– Observe in the classroom to capture naturalistic syntax use.
– Review writing samples to see syntax in an academic context.
– Include structured assessments targeting comprehension and production.
– Gather teacher and parent input to identify functional impacts.

💡 SLP Now Tip: Use our Language Sample Analysis Tools to streamline your syntax assessments.

Step 2: Make Syntax Explicit, Then Contextualize It

Explicit teaching sets the stage for understanding.

According to Zipoli (2017), lessons should begin with a clear explanation of the sentence structure and its purpose, followed by modeling and guided practice.

Best practices for explicit syntax instruction:
– Use clear, concise, and consistent explanations.
– Provide multiple examples with visual and auditory cues (color coding, sentence frames, etc.).
– Gradually fade supports as students gain independence.

Once students understand the structure, transition to contextualized practice. As Ukrainetz (2015) emphasizes, students learn syntax best when it’s embedded in meaningful activities like narratives, classroom discussions, or writing tasks.

💡 Try This: Incorporate syntax instruction into your literacy-based therapy sessions using storybooks or nonfiction passages that naturally include target structures. SLP Now has skill packs and therapy plans to make this super easy to implement!

Step 3: Evidence-Based Syntax Intervention Strategies

Let’s look at a few proven techniques you can implement right away.

1. Focused Stimulation

Provide frequent models and recasts in natural conversation.

Student: “The boy ran.”
SLP: “Yes! The boy ran after the dog that escaped.”

This implicit modeling approach exposes students to variability, which strengthens learning (Plante et al., 2014).

2. Directed Questioning

Use scaffolded questions to build comprehension of complex structures, like the passive voice:

Sentence: “Diego was found by Rebecca.”
Ask: “Who was found?” “Who did the finding?”

Pair this with pictorial supports to make abstract syntax more concrete.

3. Visual Supports and Picture Sequencing

Visuals clarify sentence meaning. In SLP Now, you’ll find syntax visuals, icon cards, and structured activities for passive voice, relative clauses, and adverbial clauses.

Try using picture sequencing to teach adverbial clauses:

“Before I take the test, I will study.”
Students can arrange icons representing each clause to show temporal order.

4. Sentence Combining

Help students merge simple sentences into complex ones to develop flexibility:

“The dog barked. The mailman came.” → “The dog barked when the mailman came.”

Use conjunction cards or sentence starters to scaffold learning.

5. Sentence Decomposition

Break down complex sentences to promote comprehension:

“The dog that barked at the mailman ran away.” → “The dog barked at the mailman. The dog ran away.”

This strategy pairs well with sentence combining to support both understanding and production.

Step 4: Embed Syntax in Meaningful Contexts

Syntax intervention works best when it’s functional and engaging. Move beyond isolated drills and integrate targets into authentic communication: storytelling, retelling, explaining science experiments, or writing persuasive paragraphs.

SLP Now’s skill packs and literacy-based therapy units are designed for exactly this, giving you ready-made materials that embed syntax goals into real contexts. You can model and recast complex sentences, scaffold comprehension with visuals, and collect data effortlessly.

Bringing It All Together

Syntax development is a critical skill for every school-age student. By assessing across contexts, teaching explicitly, and applying evidence-based strategies, you can help students grow from simple sentence users to confident communicators.

If you’re ready to simplify syntax intervention, explore the SLP Now Membership for therapy materials, sentence-level visuals, and built-in supports for your literacy-based lessons.

References

Guo, L.-Y. & Schneider, P. (2016). Differentiating School-Aged Children With and Without Language Impairment Using Tense and Grammaticality Measures From a Narrative Task. Journal of Speech, Language, and Hearing Research.

Nippold, M. A., Hesketh, L. J., Duthie, J. K., & Mansfield, T. C. (2005). Conversational versus expository discourse: A study of syntactic development in children, adolescents, and adults. Journal of Speech, Language, and Hearing Research, 48(5), 1048–1064.

Owens, R. E., Jr., Pavelko, S. L., & Hahs-Vaughn, D. (2024). Growth of complex syntax: Coordinate and subordinate clause use in elementary school–aged children. Language, Speech, and Hearing Services in Schools.

Plante, E., Ogilvie, T., Vance, R., Aguilar, J. M., Dailey, N. S., Meyers, C., … Burton, R. (2014). Variability in the language input to children enhances learning in a treatment context. American Journal of Speech-Language Pathology.

Ukrainetz, T. A. (2006). Contextualized language intervention: Scaffolding preK-12 literacy achievement. Austin, TX: PRO-ED, Inc.

Ukrainetz, T. A. (2015). School-age language intervention: Evidence-based practices. Austin, TX: PRO-ED, Inc.

Zipoli, R. P. (2017). Unraveling difficult sentences: Strategies to support reading comprehension. Intervention in School and Clinic, 52, 218–227.

Transcript

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Hello there, and I hope you are in the mood for some talk about syntax. Last week, we talked about compound sentences and I wanted to continue the conversation with more types of syntax, like passive voice and relative clauses. Before you hit pause because you're like, well, I work with kindergartners or I work with second grade,this is still a relevant thing to target with our students. There was a study by Owens et al in 2024. They reviewed conversational language samples for 196 children, ages five to 10 years, 11 months, They found that five year olds are using an average of 1.25 subordinate clauses and 2.05 coordinate clauses, so even five year olds are using complex syntax and the number continues to increase with age. So if we are seeing our students only use simple sentences, that is a sign that they may need support with syntax and we might want to look into it a little bit for further. It's easy to hear if they're using simple sentences, compound sentences, complex sentences, and all types of clauses.

If we're not seeing this in their communication, they may be struggling to comprehend that complex syntax as well. And that is an absolutely age appropriate skill for our school age students. Approximately half of five year olds are able to comprehend reversible passive sentences, and that's from Owen's 2016.

And 90% of children between the ages of seven and a half and eight are able to comprehend reversible passives. So very early on in the school age years, this is something that's typical and something that we might want to support if our students are struggling with it.

So hopefully you're still intrigued. I am going to be sharing strategies that we can use in our assessment and intervention when targeting these types of goals. The first strategy, and this has been a common theme, but we want to start with a thorough assessment. Collect language samples and consider multiple contexts because we use different types of syntax when generating narratives, retelling narratives, describing a picture, summarizing a text, explaining how to do something, trying to persuade someone.

So all of those types of samples will elicit different syntax. We want to consider different language samples. We will also want to observe in the classroom because the language that we're hearing in the classroom will be a little bit different. We can look at work samples and look at their writing.

And we can also collect parent and teacher report. And then we can also do a more structured assessment of the comprehension and production of syntax.

In terms of actual treatment strategies, I'm pulling a lot of these from Zipoli 2017. I'll share the citation in the show notes. Lessons should begin with clear explanations of the target sentence structure and give the purpose of the lesson so we can model comprehension and production of sentence structures. We'll want to use clear, concise, and consistent language as we're doing that.

When we're providing demonstrations, we'll give multiple examples and use visual and auditory cues to make the syntactic features more explicit. There's a lot we can do to support the teaching of that. One strategy is focused stimulation.

This is one that applies to all grammar goals and that I have found to be incredibly impactful. This is a little bit more implicit, but this is when we provide frequent models and recasts in a variety of activities. So, when we're modeling the passive voice or a relative clause, we highlight that naturally in conversation. When we recast, we might correct what the child says or modify it. If they produce a simple sentence in our literacy based therapy activity, I can recast the student's sentence and add in that relative class.

Using those models and recasts is what they call focused stimulation in the research and we can incorporate that in all of our therapy activities. That is a great way to implicitly target some of these skills.

Other strategies we might use for passive voice are using directed questions to enhance and scaffold comprehension. So if we have a sentence like Diego was found by Rebecca. We can say who was found and who did the finding, and ask some questions about that statement.

And we can use pictorial support as well and asking students to draw pictures to represent those sentences. The example I gave was with the passive, but we can also do this with a active voice. So instead of Diego was found by Rebecca, we can do Diego found Rebecca. And in SLP Now we have syntax activities attached to the majority of our literacy based units. We embed these strategies in the activities for passive voice, for example. So we have a sentence, with pictures and visual choices to help the students.

We have pictorial support as well, and we give you statements and questions so that you have support as you're implementing these types of strategies. For verbal clauses, which is another type of syntax we might want to target, we can use sentence starters.

This is an effective technique for helping students understand and write more elaborate sentences. If we give them a starter, they can fill in the sentence and create more. We also have picture sequencing. If we have pictures of the different items, for example, before I take the test, I will study. You can have a icon representing studying and taking the test, and you can do that practice using those adverbial clauses. In SLP Now we have icon cards for the conjunctions that you would use with the sentence starters.

We also have pictures to practice and support that understanding. We give you tools for sentence starters and picture sequencing. In terms of relative clauses, two more evidence backed strategies are to use sentence combining, which we talked about last week.

This is where we're combining two or more simple sentences. You can use simple sentences from whatever book or article you're reading and then use our conjunction cards to help students combine those. The other strategy we talked about last week is sentence decomposition, where you take a complex sentence and break it down into simpler sentences.

All you need is the book or article you're reading and identifying those simple, complex, and compound sentences. That is a quick blitz of some strategies we can use for our syntax goals. Check out the show notes for references and more detail about the resources if you want help implementing this.

I hope that this was a helpful review for you and we'll see you in the next one.

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How to Teach Compound Sentences: 5 SLP Strategies

October 20, 2025 by Marisha Leave a Comment

In this week’s episode of the SLP Now Podcast, Marisha shares five practical, evidence-backed strategies to help students learn, practice, and generalize compound sentences. She also shares strategies to help make it easier for students to understand those abstract conjunctions!

👉 Prefer to listen? Check out the full podcast episode above for a quick blitz through all five strategies.

1️⃣ Start with clear visuals.

Give students an intro visual that defines a compound sentence and shows the FANBOYS conjunctions (for, and, nor, but, or, yet, so).

Then, build on that with:
– A “recipe card” showing sentence + comma + conjunction + sentence
– Symbol cards for conjunction meanings

These concrete visuals help students internalize the function of conjunctions, not just the form.

Visual and multimodal supports strengthen students’ metalinguistic awareness and retention (Cook, Mitchell, & Goldin-Meadow, 2008).

Click here to download the visuals for compound sentences.

2️⃣ Teach sentence combining explicitly.

Give students two short sentences and model joining them with a target conjunction.

Cued combining: Provide the sentences and the conjunction.

Open combining: Remove supports as students gain independence.

Sentence-combining instruction reliably improves syntactic maturity and writing quality when scaffolded and faded over time (Strong, 1986).

3️⃣ Use sentence expansion and reduction.

Encourage flexibility by asking students to expand simple sentences into compound ones or reduce compound sentences into shorter forms.

This back-and-forth manipulation builds syntactic control and comprehension.

Alternating expansion and reduction helps students generalize grammar goals across tasks (Fey et al., 1997).

4️⃣ Add movement for meaning.

Make conjunctions physical!

Assign one student per clause and another as the conjunction.

The “conjunction student” can hold or act out the joining symbol (like a plus sign for and).

Movement helps learners encode meaning through multiple modalities.

Gesture and embodied practice make abstract grammar concepts more memorable (Cook et al., 2008).

5️⃣ Plan for generalization.

Don’t let the skill stay in the speech room!

Collaborate with classroom teachers so students can:
– Use mini visual reminders at their desks
– Identify compound sentences in reading passages
– Apply conjunctions in writing assignments

Integrated service delivery—where SLPs and teachers align targets—leads to stronger transfer of language skills (Cirrin et al., 2010).

Why This Matters

Understanding compound sentences helps students:
– Combine ideas clearly
– Improve written cohesion
– Build complex syntax essential for reading comprehension (Scott & Balthazar, 2013)

And when students see and act out those conjunctions, abstract language becomes tangible.

Free Resource

Click here to download the Compound Sentences skill pack!

References

Cirrin, F. M., Schooling, T. L., Nelson, N. W., Diehl, S. F., Flynn, P. F., Staskowski, M., Torrey, T. Z., & Adamczyk, D. F. (2010). Evidence-based systematic review: Effects of different service-delivery models on communication outcomes for elementary school–age children. Language, Speech, and Hearing Services in Schools, 41(4), 252-270.

Cook, S. W., Mitchell, Z., & Goldin-Meadow, S. (2008). Gesturing makes learning last. Cognition, 106(2), 1047–1058.

Fey, M. E., Cleave, P. L., Long, S. H., & Hughes, D. L. (1993). Two approaches to the facilitation of grammar in children with language impairments: An experimental evaluation. Journal of Speech and Hearing Research, 36(1), 141–157.

Myhill, D. (2012). The ordeal of deliberate choice: Metalinguistic development in secondary writers. In V. W. Berninger (Ed.), Past, present, and future contributions of cognitive writing research to cognitive psychology (pp. 247–274). Psychology Press.

Scott, C. M., & Balthazar, C. H. (2013). The role of complex sentence knowledge in children with reading and writing difficulties. Perspectives on Language and Literacy, 39(3), 18–30.

Strong, W. (1986). Creative Approaches to Sentence Combining. NCTE/ERIC.

Transcript

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Hello there. I hope you are having a fabulous week, and ready to dive into some practical evidence backed strategies that you can use when working on compound sentences with your students. So I have five tips for you today.

The first tip is to actually teach what a compound sentence is.

This is the first step with any of our skills but we wanna make sure that we provide our students with an initial explanation, but then also some visuals that they can use to understand what we're asking them to do. And then also to help with that generalization.

Some examples of visuals that I like to use. I have a intro little one pager that says what a compound sentence is, and it includes the conjunctions, the fanboy acronym.

That helps them know what a compound sentence is, and we're on the same page, I also have a little recipe card, that students can use when they are working on building sentences. It shows a visual of the sentence, the comma, the coordinating conjunction and the sentence, just a little graphic.

We have different versions of that. We have bigger sentence maps they can use with interactive cards and sentence starters to help them implement the strategies we're going to talk about. The visuals that I shared so far are just that introduction visual, different visuals to show the sentence structure.

I like to introduce specific conjunctions, because each conjunction has a different meaning. And, this can get really confusing for students. These conjunctions are a little bit more abstract, so I wanna make sure that I'm scaffolding that and helping them learn the different meanings of those conjunctions.

So we have little cards that include an icon to help them visualize the meaning of the conjunction. For "and" we would have a plus sign, for "but" we would have a lightning bolt. Each conjunction has a symbol that goes with it. And we have examples of sentences being used.

We also show the meaning of the conjunction. This is a really great way to introduce the conjunction. Like I said, the little icon cards and sheets for each conjunction with different examples, and it has all the visuals to help understand what that conjunction means.

That is strategy one. Having visuals to help break down complex concepts for students, especially the abstractness of the conjunctions. It really helps have some visuals for that. And then if you want access to these visuals, you can totally create your own. But if you want ready-made visuals, you can sign up for a free trial of SLP Now.

It's totally free. Just go to SLPnow.com/trial. And then you can create your free account. Go type in compound sentences on the materials page, and you'll have access to all of these visuals and other materials as well. Now let's move on to strategy number two, which is to teach sentence combining.

So we would start by giving students two independent classes or two simple sentences, and then model joining them with our target conjunctionI like to start with one conjunction, just so they get the hang of it, and then we might add in another one.

We do wanna give students opportunity to practice combining two simple sentences and getting a feel for how that works. There's different types of combining you can do.

You can do cued combining, where you give the students the two sentences and the, conjunction and they just have to literally put them together, or you can make it more complex where you just give them two sentences and they have to do that. Definitely check out the Strong article for more detail on the protocol for that.

On to strategy number three, we can also do sentence expansion and reduction. We can have students expand simple sentences, so we can give them one sentence and encourage them to make it into a compound sentence. Or we can identify compound sentences in our reading and break them down into the individual sentences.

And so that's just practicing breaking and putting sentences together, expanding them and reducing them is the technical term that, also has some evidence to support using that as a strategy.

Then strategy number four is to incorporate movement. If you have multiple students in your group, this is super fun.

in SLP Now our compound sentences skill pack has sentences or students can come up with their own. Let's say you have three students in the group. One of the students can act out the first sentence, and then the other student can act out the second sentence. And the third student can be the conjunction. They can choose the conjunction if you're giving them a field of conjunctions to choose from, or if you're just practicing with one, the student would hold that conjunction.

And maybe they can come up with a gesture. If it's "and" then maybe they just put their hands out and connect the idea between the two students.

So all three students are acting it out It really shows the meaning change and the power of conjunctions, and it gives that really meaningful practice, in that they're visualizing it, acting it out, their whole body is engaged in the activity.

The fifth strategy I want to leave you with is to collaborate with classroom teachers and think about generalization from the start.

Maybe you make a tiny version of the visual and put it on the student's desk or whatever the conjunction of the week is, you put that on the student's desk or binder and then they get extra exposure. You encourage them to use that in their writing or in classroom discussions.

So bringing the visuals into the classroom is an easy thing to do. You can also use text from the classroom as you're doing these activities, as inspiration for your sentence combining and sentence expansion and reduction activities.

So those were our five strategies starting with teaching and using visuals to break down the skill. Then we talked about strategy two sentence combining. Strategy three is sentence expansion and reduction. Strategy four was to incorporate movement and act out the sentences in conjunctions.

And then strategy five is to think about generalization. I'd love to hear which strategies you are using in your speech room. If you have any favorites, that I missed or if I shared your favorite or if there's a new one that you're trying, reach out to us on Instagram. We'd love to hear what you're up to.

That's a wrap. We'll continue this series and talk about more skills on the podcast going forward. I hope this was super helpful and that you have some new inspiration for how to target compound sentences with your students, or at least a boost of confidence, based on what you're doing already.

And then again, we have all of these visuals and practice activities and tools inside SLP Now. When you sign up for a free trial, you can download this skill pack and a few others completely free. I just want to help set you up for success and make your job as easy as possible.

Thanks for joining me, and we'll see you next time.

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234: 5 Practical Strategies to Teach Following Directions (Backed by Research)

October 13, 2025 by Marisha Leave a Comment

Teaching students to follow directions effectively is a foundational skill for both academic success and functional communication. Whether students are navigating classroom routines, participating in group activities, or playing on the playground, their ability to understand and act on directions impacts every aspect of their day.

In this post, we’ll explore five practical, evidence-based strategies SLPs can use to support students in their ability to follow directions. These strategies are backed by research and designed to help you plan intentional, effective therapy sessions.

👉 Prefer to listen? Check out the full podcast episode above for a quick blitz through all five strategies.

1. Start with a Thorough Following Directions Assessment

Before targeting “following directions” directly, it’s essential to identify the root cause of the difficulty. Not all one-, two-, or three-step directions are created equal. A student may struggle due to:

– Vocabulary (e.g., temporal, quantitative, and spatial basic concepts like “before” or “under”; instructional verbs)
– Morphology (e.g., smaller vs. smallest)
– Syntax (e.g., relative clauses, temporal clauses, complex sentences)
– Executive function (working memory, attention, shifting, inhibition)
– Sensory regulation
– Attention and processing differences

A differential assessment can help pinpoint which of these factors are at play. For example, you might present several types of directions and observe whether students have more difficulty with vocabulary, syntax, or the number of steps involved.

Dynamic assessment is another useful tool. We can teach a strategy or provide cueing, and observe whether the student’s performance improves.

Classroom observations and teacher/parent input add valuable context about how these challenges appear across the school day.

📌 Pro Tip: Use SLP Now’s Following Directions Skill Pack to guide your assessment. It includes tools to break down directions by vocabulary, morphology, syntax, and executive function–helping you plan more targeted intervention.

NOTE: While following-directions assessments provide valuable information about a student’s performance, they should be viewed as a lens for uncovering underlying language difficulties. Rather than writing goals focused narrowly on the task of “following directions,” we should focus on targeting the foundational skills that make following directions possible—such as syntax, vocabulary, and morphology. As Wallach (2014) reminds us, effective intervention requires shifting away from isolated, task-specific goals toward addressing the underlying language systems that support academic success.

2. Incorporate Movement to Support Language Learning

Movement isn’t just a fun way to boost engagement. It’s a powerful way to anchor language in action, supporting comprehension, attention, and memory. Research shows that pairing linguistic input with meaningful physical activity can strengthen language learning for a variety of students.

In a classroom-based study, Kosmas, Ioannou, and Zaphiris (2018) implemented motion-based learning activities and found that students made significant gains in expressive vocabulary and short-term memory compared to traditional instruction. By embedding movement into language-rich contexts, students were able to engage more fully and retain new concepts more effectively.

Lund, Young, and Yarbrough (2019) explored co-treatment sessions between SLPs and adapted physical education teachers focused on teaching basic concepts to children with Down syndrome. When concept instruction was integrated into movement-rich physical activities, students made significantly greater gains in concept development than those who received SLP-only treatment. This demonstrates the power of multimodal, embodied approaches for building foundational skills that support direction-following.

Mellor and Morini (2023) found that physical exercise was associated with improved word learning in preschool-age children. This finding supports incorporating movement-based tasks—like gross motor games, obstacle courses, and action-based language activities—into therapy to facilitate vocabulary and concept acquisition.

Here are some fun, functional ways to incorporate movement:

– Obstacle Courses: Great for multi-step directions involving sequencing and concepts (e.g., “First jump over the line, then touch the door”).
– Scavenger Hunts: Combine receptive vocabulary with movement (“Find the object that is under the table”).
– Simon Says: Perfect for targeting basic concepts and syntax in a playful way.

Movement-based activities increase engagement and create natural opportunities for repetition.

3. Teach and Model Strategies Explicitly

Many students benefit from explicit instruction in strategies. Techniques such as rehearsal, visualization, drawing icons, asking for clarification, and self-monitoring (Stop–Think–Do–Check) give students a toolkit for decoding and acting on multi-step directions.

One of the strongest empirical supports comes from Gill, Klecan-Aker, Roberts, & Fredenburg (2003). They taught students with specific language impairment to use rehearsal and visualization strategies in following-directions tasks. Compared to traditional therapy, students using those strategies made greater gains immediately, and importantly, retained those gains over time.

In practice, you can model your own thinking aloud (e.g., “I’m going to repeat that direction to myself. I’ll make a movie for the direction in my head. If I get stuck, I’ll ask, ‘Can you say that again?’”).

You can scaffold students in these techniques using:

– Visual strategy cards
– Prompted rehearsal (You say it with them, then fade support.)
– Drawing simple icons to represent steps
– Scripts to ask for clarification

4. Share Strategies with Teachers to Increase Carryover

For students to master following directions, we need to extend practice beyond the therapy room. Collaborating with teachers is key to support students in the classroom and promote carryover into real-world settings.

Cirrin et al. (2010) conducted a systematic review examining the effects of different service delivery models on communication outcomes for elementary-aged children. They found evidence supporting classroom-based and collaborative models, showing that SLPs working alongside teachers in the classroom can lead to positive communication outcomes.

You might:

– Share visuals, checklists, or strategy posters with classroom teachers.
– Encourage teachers to chunk directions into smaller steps.
– Collaborate on prompting routines (e.g., reminding students to rehearse directions before starting).
– Align classroom accommodations (e.g., visual supports, repeated directions) with your therapy goals.

These indirect supports empower students to use their strategies across contexts, increasing the likelihood of generalization.

📚 Additional Resources

A Guide to Collaborating with Teachers

5. Plan for Generalization from the Start

Generalization shouldn’t be an afterthought. It should shape how we plan our intervention.

Even if a student can follow complex directions in the speech room, that skill must transfer to the classroom, playground, and beyond.

We can build generalization by:

– Embedding direction-following into functional, contextualized activities, like literacy-based lessons, crafts, or science experiments.
– Practicing classroom routines that students encounter daily.
– Coordinating with teachers and caregivers to reinforce strategies consistently.

When we plan for generalization from the start, we help students become more independent and successful communicators in their natural environments.

Dr. Ukrainetz’s book, Contextualized Language Intervention, is a great read if you’re wanting to learn more!

📦 Resource Spotlight: The Following Directions Skill Pack

Ready to put these strategies into action? The Following Directions Skill Pack includes:

– Differential assessment tools
– Strategy visuals for students and teachers
– Visuals to teach and scaffold following directions
– Ready-to-use therapy activities and data collection forms

References

Cirrin, F. M., Schooling, T. L., Nelson, N. W., Diehl, S. F., Flynn, P. F., Staskowski, M., Torrey, T. Z., & Adamczyk, D. F. (2010). Evidence-based systematic review: Effects of different service delivery models on communication outcomes for elementary school–age children. Language, Speech, and Hearing Services in Schools, 41(3), 233–264.

Gill, C. B., Klecan-Aker, J., Roberts, T., & Fredenburg, K. A. (2003). Following directions: Rehearsal and visualization strategies for children with specific language impairment. Child Language Teaching and Therapy, 19(1), 85–103.

Kosmas, P., Ioannou, A., & Zaphiris, P. (2018). Implementing embodied learning in the classroom: Effects on children’s memory and language skills. Educational Media International, 55(4), 324–339.

Lund, E., Young, A., & Yarbrough, R. (2019). The effects of co-treatment on concept development in children with Down syndrome. Communication Disorders Quarterly, 40(3), 165–174.

Mellor, L., & Morini, G. (2023). Examining the relation between exercise and word learning in preschool-age children. Journal of Speech, Language, and Hearing Research, 66(10), 4004–4015.

Ukrainetz, T. A. (2015). Contextualized language intervention: Scaffolding preK–12 literacy achievement. Thinking Publications.

Wallach, G. P. (2014). Improving clinical practice: A school-age and school-based perspective. Language, Speech, and Hearing Services in Schools.

✅ Takeaway

Start with solid assessment, give meaningful feedback, incorporate movement, teach explicit strategies, collaborate with teachers, and plan for generalization from the beginning. Implement one or two of these strategies this week!

Transcript

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Hello there. I hope you are having a great day so far. I am really looking forward to diving into five strategies, backed by research, that we can use when targeting, following directions. I hope that you'll walk away with a boost of confidence and maybe a thing or two that you can try.

We all know how critical following directions are to being able to access their curriculum. Even if they're on the playground and their peers are teaching them to play a game, there's so many important, social, academic and safety benefits, to targeting this skill.

So we are going to dive into five strategies.

Strategy number one is to start with a thorough assessment. This is critical because we need to identify the underlying skills that a student is struggling with or that need support. It might be a vocabulary issue, or a syntax issue, or a working memory issue, or some other aspect of executive function.

We want to do a differential assessment to determine which of those apply. You can do this using a direct differential assessment. I have one in SLP Now that helps you break down if it is more of a vocabulary issue, a syntax issue. Not all one step directions are created equal, and the same applies to two and three step.

We're increasing the complexity when we're moving from one to two to three, but there is a lot of different syntax that can be in those, different types of vocabulary that students might struggle with. The research shows that all of those elements are important and play a role in how students are able to follow directions.

A differential assessment is really good at piecing apart whether it is vocabulary, syntax, working memory, et cetera, et cetera. But we can also do a dynamic assessment where we teach some strategies and see if that makes a difference or provide different types of cueing and see if that improves the student's, ability to follow the directions.

We can also do classroom observations, or collect parent teacher feedback and get some more context in terms of how this is showing up across the school day.

And strategy number two is to incorporate movement. Pairing language with movement based activities has been found to help the language learning process. Movement engages multiple cognitive systems, which can help boost comprehension, retention, and all of that.

So some examples of what this could look like. We could set up a little obstacle course in this speech room, where we could use that to work on multi-step directions. Or we can do scavenger hunts or Simon Says types of games. If we have students practicing directions with movement and engaging those multiple systems to help really work on that skill.

Strategy three is to teach and model strategies, and there are a lot of different strategies that we could use. In SLP Now, the skill pack for following directions include some little strategy cards that we can share with the student. We have some little cards for students to use to remind them of different strategies to help them follow directions. Some things we can do are rehearsing their direction, repeating it. Visualizing, as they're hearing their direction making a little movie in their head. Drawing quick icons like the example I gave earlier, touch your nose and then sit down. Maybe they just do a quick little nose picture and then an arrow to remind them to sit down. Especially if you're giving more directions, using that icon drawing can be helpful. Teaching them to ask for clarification. Those are just a couple examples of strategies that we can teach to students to support them with following directions. If we identify that it's a vocabulary issue or a syntax issue, we obviously wanna target those as well. but giving our students strategies can help if it is more of the working memory and executive function.

So those are just a few strategies. Again, the blog post will include more details on things that we can teach students to help them. And then strategy number four is to share strategies with teachers.

I have a visual in the Following Direction Skill Pack, that includes those strategies as well. This will help with generalization and support, like we might write accommodations for these students to help set them up for success in the classroom.

So teachers might incorporate visuals or checklists or chunking their directions. Instead of giving 10 directions at once, they practice giving two or three steps at a time Or modeling the strategies, reminding the students to use their strategies. So there's lots of things that we can do to support students indirectly by working with teachers.

And the fifth strategy is to plan for generalization from the start. What happens in the speech room should not stay in the speech room. It doesn't matter if a student can follow a 20 step direction in the speech room if it's not moving into the classroom. And so we wanna make sure that we're embedding directions in functional, contextualized activities and being intentional with how we're targeting these goals. It's something that we need to think about from the start. How can we target this goal in a way that will set students up for success? I like to use literacy based activities that are contextualized.

We can do crafts, science experiments, real life tasks, practice their classroom routines if there are common ones they struggle with. Thinking about the context they'll be using these skills in and strategies we can use to help them in the classroom, on the playground, whatnot. And then also coordinating with teachers and parents and other members of the team to make sure that we're all on the same page and all helping the student master the skill.

Hopefully one of these strategies sparked a new idea for you. Go ahead and jot down one that you'd like to try using and then check the show notes for a link to the blog post with all of the details. I mentioned the Following Direction Skill Pack. This is available in the SLP Now Materials Library. If you're a member, just type in following directions and you'll get to download that skill pack. If you are new to SLP Now you can sign up for a free trial and download this skill pack for free. Your free trial includes five downloads, so you can get a hundred dollars of free materials, no strings attached, no credit card requiredI just wanna make sure that you have access to awesome materials and that you're able to easily implement these evidence backed strategies and have high quality materials to help make your job a little bit easier.

That is a wrap on our six strategies for following directions. Thanks for joining me, and we'll see you soon.

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WH Questions for Speech Therapy: Full List, Materials, Strategies

October 7, 2025 by Marisha Leave a Comment

If you’re feeling stuck on how to get your students to consistently answer WH questions accurately, the secret isn’t more drill cards—it’s moving through a structured, evidence-based framework: Assess, Teach, Scaffold, Focus, Embed, and Repeat. By combining explicit instruction with visual supports and meaningful practice, we can help students connect the question word to its actual purpose and confidently use WH questions in the classroom and beyond.

WH questions—who, what, where, when, why, and how—are at the heart of communication. But as you’ve probably seen on your caseload, answering these questions isn’t always easy. We’re going to break down exactly how to teach WH questions efficiently, so you can stop reinventing the wheel and start seeing faster progress, even with your most challenging mixed groups.

Even if WH questions are already part of your therapy toolbox, this episode aims to fine-tune your approach with six strategies that streamline planning and maximize student progress. You’ll hear about:

– How to use leveled assessments to pinpoint a student’s starting point
– Explicit methods to teach WH words using visuals and clear definitions
– A scaffolded hierarchy for structuring instruction
– How to select targets
– Embedding WH practice into meaningful contexts to boost carryover
– The importance of repetition + varied practice for generalization

Why WH Questions Matter for Kids

I’m so excited to dive into one of the foundational skills we target in speech therapy — WH questions!

These little question words — who, what, where, when, why, and how — may seem simple, but they’re at the heart of communication. Whether we’re working on classroom comprehension, social interactions, or general language development, success with WH questions is essential for building strong receptive and expressive skills.It’s a skill that shows up everywhere: in reading comprehension, group discussions, and even playtime.

But as you’ve probably seen, answering WH questions isn’t always easy for our students. Children with language delays, autism, or other communication disorders often struggle to process the meaning behind each question type. Research by Parnell and colleagues (1986) found that students with language delays often produce appropriate but inaccurate responses. For example, a student might a “who” answer to a “who” question but name the wrong person. It’s a subtle but important distinction, and one that tells us we need to explicitly teach both appropriateness and accuracy.

That’s where structured intervention makes all the difference.

When we combine explicit instruction, visual supports, and meaningful practice, we can help students connect the question word to its purpose, and eventually use WH questions confidently in any context.

To make this easier for you, we created the WH Questions Skill Pack, a ready-to-go resource that includes:

Leveled assessments to identify each student’s starting point
Visual supports and cue cards for every WH question type
Structured practice activities to promote generalization

It’s everything you need to assess, teach, and track progress — all in one place.

WH Questions Skill Pack

Leveled assessments to identify each student’s starting point
Visual supports and cue cards for every WH question type
Structured practice activities to promote generalization

The WH Skill pack includes evidence-backed visuals, activities, and data sheets to teach every WH question type

👉 Join to Download WH Questions Skill Pack

What Are WH Questions? (and Why They’re Important for Kids)

Before we jump into specific strategies, let’s take a quick step back.

WH questions are the foundation of how kids learn to gather and express information. Each WH word serves a specific purpose:

Who → a person
What → a thing or action
Where → a place
When → a time
Why → a reason
How → a process or explanation

Complex WH Questions (and How They Differ from Early WH Questions)

As students develop stronger language and reasoning skills, WH questions naturally become more complex. Early in therapy, we might focus on straightforward questions like “What is this?” or “Who is eating?” that can be answered by labeling something visible. But as comprehension grows, students begin to tackle questions that require more inference, reasoning, or background knowledge — such as:

“Why did the boy wear a coat?”
“How do you know she’s sad?”

These types of complex WH questions ask students to go beyond what they see and instead make connections, draw conclusions, or explain cause and effect.

Research by Swanson (2001) shows that explicit instruction — clearly defining and modeling each WH word — helps students make faster progress with these more challenging question types. In practice, that means we can’t assume a student will automatically generalize skills from “what” to “why.” Each WH question type benefits from direct teaching, modeling, and plenty of repetition.

Functional WH Questions in Everyday Routines

Beyond structured practice, it’s important to use functional WH questions throughout the day. These are questions embedded naturally into a child’s environment and daily routines. For example:

During snack time: “Where’s your spoon?”
In the classroom: “Who is the line leader today?”
At home: “Why are we washing our hands?”

Embedding practice in real contexts helps students connect WH questions to authentic communication, not just drill work. This kind of contextualized learning supports better carryover and generalization, meaning the skill sticks outside of the therapy room.

By understanding how WH questions vary — from simple WH questions that focus on labeling and describing, to complex WH questions that require reasoning and background knowledge, and functional WH questions used in everyday routines — we can meet each student where they are and design activities that move from concrete understanding to abstract reasoning.

In the next section, we’ll look at how WH question development progresses by age and skill level, so you can confidently select the right targets for your students.

WH Questions by Age and Skill Level

As with most language skills, WH question comprehension develops gradually — from concrete labeling to abstract reasoning. Understanding these stages can help you pinpoint where each student is in their learning journey and plan intervention accordingly.

WH Questions for Preschoolers

Preschoolers are just beginning to connect language with the world around them, so WH questions at this stage should focus on concrete, visual concepts — typically what and where questions.

At this level, I like to use picture cards, storybooks, and play-based routines to teach WH questions in meaningful contexts. Research by Justice and colleagues (2002) shows that literacy-based intervention (using shared storybook reading and contextual prompts) helps preschoolers improve comprehension and vocabulary simultaneously.

Here are a few examples you can use in therapy:

“What is the girl doing?”
“Where is the dog sleeping?”
“What do we use to eat?”
“Where do we go to play?”

As you read or play, pause to model and reinforce the question word’s meaning. Visual supports, like cue cards or icons, can make a huge difference in helping students recognize the purpose of each WH question word.

📘 Related Reading:

How to Use Books in Therapy

Tips to Implement Literacy-Based Therapy for Students with SLI

WH Questions for Early Elementary Students

By the early elementary years (around kindergarten and first grade), most children begin to understand and respond to who, when, and why questions. However, these question types can still be tricky for students with language delays or comprehension challenges — especially when they appear in connected text or classroom discussions.

Research by Ukrainetz (2015) highlights the importance of contextualized intervention, embedding WH questions directly into meaningful routines and activities. Instead of isolated drills, try incorporating WH questions into story retells, science observations, or classroom routines, such as:

“Who helped the teacher clean up?”
“When do we eat lunch?”
“Why do we wear coats when it’s cold?”

These questions are more effective when practiced in context, giving students real-life opportunities to apply their growing comprehension skills while promoting generalization across settings.

WH Questions for Students with Autism

Students with autism often benefit from a structured, visual, and highly consistent approach when learning WH questions.

They may need explicit modeling, repeated practice, and visual supports to connect each question word to its meaning. For example, using a picture of a person for “who”, a place for “where”, or an object for “what” helps students understand what type of answer each WH question is asking for.

Here are a few ideas for building comprehension and confidence:

Use WH question visuals (icons or cue cards) to represent each question type.
Provide clear models and immediate feedback when students respond.
Practice across multiple contexts — stories, classroom routines, or play — to promote generalization.

The goal is to build functional understanding, helping students recognize WH questions as tools for communication and connection, not just as structured “drill” items.

💡 Try this: The WH Questions Skill Pack includes visual cue cards, leveled assessments, and structured practice sheets that make it easy to support students with autism using evidence-based methods.

WH Questions Skill Pack

Leveled assessments to identify each student’s starting point
Visual supports and cue cards for every WH question type
Structured practice activities to promote generalization

The WH Questions Skill Pack includes visual cue cards, leveled assessments, and data sheets designed for both structured and naturalistic practice.

👉 Join to Download WH Questions Skill Pack

WH Question Examples and Lists (Free Preview)

Now that we’ve covered how WH questions develop, let’s look at specific examples you can use in your therapy sessions.

Having a variety of questions ready makes it easier to differentiate by level — from simple, concrete questions to more abstract, inferential ones. These question lists can be used for data collection, sessions with mixed groups, or at-home practice with families.

Here’s a free preview from our WH Questions Skill Pack, which includes printable lists and visuals for each question type.

What Questions for Speech Therapy

(Focus: Labeling objects or actions)

Simple:

What is this? (Show a picture of a ball.)
What do we use to eat?
What animal says “moo”?

Complex:

What should you do when it rains?
What makes the story funny?
What can we do to help a friend?

Where Questions for Speech Therapy

(Focus: Identifying places or positions)

Simple:

Where is the cat?
Where do we put our shoes?
Where do we eat lunch?

Complex:

Where do you think the boy is going?
Where should we go if we feel sick?
Where do butterflies live?

Who Questions for Speech Therapy

(Focus: Identifying people or roles)

Simple:

Who is eating?
Who helps us learn at school?
Who is your best friend?

Complex:

Who do you ask for help if you’re hurt?
Who do you think will win the race?
Who is the main character in this story?

When Questions for Speech Therapy

(Focus: Identifying time, connects sequencing and routines)

Simple:

When do we eat breakfast?
When do you go to bed?
When do you brush your teeth?

Complex:

When do flowers grow?
When do you feel proud of yourself?
When is the best time to wear a coat?

Why Questions for Kids

(Focus: Understanding cause and effect, developing reasoning and inferencing)

Simple:

Why do we wear shoes?
Why do we wash our hands?
Why do we sleep at night?

Complex:

Why was the girl sad in the story?
Why do people help each other?
Why do we need to listen to directions?

How Questions Examples

(Focus: Explaining processes and feelings)

Simple:

How do you open a door?
How do you draw a circle?
How do you make a sandwich?

Complex:

How can you tell someone is surprised?
How do you know it’s winter?
How can we make someone feel better?

These examples illustrate the natural progression from simple to more complex questions, moving from labeling and describing to reasoning and inferring.

If you’d like a complete list of questions organized by difficulty and question type, plus matching visuals and leveled data sheets, you can grab the full resource below, 👇

👉 Download the Complete WH Questions List and Skill Pack Activities
Includes over 120 WH questions, visual cue cards, and printable tracking forms, all aligned with evidence-backed strategies for school-based SLPs.

Teaching WH Questions in Speech Therapy (6 Evidence-Based Strategies)

Over the years, I’ve found that effective WH question intervention follows six clear steps. Each one builds on the last to help students progress from identification to mastery, and every step is backed by research.

These strategies come straight from the framework I use in my own sessions (and inside the WH Questions Skill Pack): Assess → Teach → Scaffold → Focus → Embed → Repeat.

1. Assess — Find the Starting Point

Before teaching, we need to know exactly where each student is starting.

Students with language delays often give responses that are appropriate but inaccurate. For example, answering “who” with a person, but naming the wrong one. Research by Parnell and colleagues (1986) highlights this distinction and reminds us that accuracy comes after appropriateness.

I always begin with a leveled assessment that includes:

Simple picture-based questions (“Who is eating?”)
General knowledge questions (“Where do you sleep?”)
Comprehension questions about short passages

This helps pinpoint whether a student needs work at the picture, sentence, or story level. The WH Questions Skill Pack includes an assessment and probe set that makes this step quick and consistent.

🧩 Pro Tip: Once you identify the student’s level, use that same probe to monitor progress throughout intervention.

2. Teach — Use Explicit Instruction and Visuals

Once we know where to start, it’s time to teach the meaning of each WH word explicitly.

Research by Swanson (2001) supports explicit teaching as one of the most effective ways to improve comprehension. I like to introduce one question word at a time using:

Visual cue cards (with icons or simple images)
Student-friendly definitions (e.g., What = a thing or action; Who = a person)
Concrete examples (“What is she doing?” → running)

You can make your own visuals or grab the pre-made ones from the Skill Pack. Each card pairs an icon with examples and definitions, so students can see the difference between question types.

👉 Explore the WH Questions Skill Pack. It includes visuals for every WH word plus student definition cards.

3. Scaffold — Move From Simple to More Complex WH Questions

Once students grasp the basic meaning of each question word, we start to build complexity.

I move from:

Questions about pictures or objects
To general knowledge questions
Then comprehension questions about stories
Finally, conversation-level questions

This scaffolded hierarchy helps students bridge from concrete understanding to inferential thinking.
As Swanson (2001) emphasized, success with more complex WH questions depends on clear, sequenced instruction — not just repetition.

Example:

Simple: “What is this?” (show a picture)
Complex: “Why do we use an umbrella?” (requires reasoning)

4. Focus — Teach One WH Type at a Time

While it’s tempting to target multiple question types at once, research (including Parnell et al., 1986 and Isenberg, 2014) supports focusing on one question type until mastery.

For example:

Start with “what” and “who” questions, since these are more concrete.
Once students achieve 80% accuracy, move on to “where,” “when,” “why,” and “how.”

This approach reduces cognitive load and helps solidify comprehension.

🧩 Therapy Tip: If your student already understands “what,” use it to support a harder question type (e.g., contrast “Who is eating?” vs. “What is he eating?”).

5. Embed — Practice in Meaningful Contexts

After structured drill practice, it’s time to move into real-world application.

Research by Justice and colleagues (2002) and Ukrainetz (2015) shows that embedding WH question practice into literacy-based or contextualized intervention improves generalization.

Here are some ways to embed practice:

During shared storybook reading
In classroom routines (“Who is the line leader?” “Why are we washing our hands?”)
Through play-based or functional activities (“Where should the toy go?”)

Embedding WH questions in meaningful contexts turns abstract drills into functional communication.

📘 Related Resources:

6. Repeat — Provide High Repetition and Varied Practice

Finally, students need lots of practice in many contexts.

Repetition builds mastery, but varied repetition builds generalization.

This means asking questions across:

Different materials (pictures, books, real life)
Different partners (teacher, parent, peer)
Different environments (therapy room, classroom, home)

It’s kind of like basketball drills. Practicing “dribbling” (structured tasks) is important, but students only master the skill when they can “play the game” (use WH questions in natural conversation).

The WH Questions Skill Pack includes structured practice materials and story-based prompts that make this kind of repetition simple to plan and track.

Using the SLP Now WH Questions Skill Pack

If you’re ready to put these strategies into action, the WH Questions Skill Pack makes it easy to assess, teach, and track progress — all in one place.

WH Questions Skill Pack

Leveled assessments to identify each student’s starting point
Visual supports and cue cards for every WH question type
Structured practice activities to promote generalization

It’s everything you need to assess, teach, and track progress — all in one place.

👉 Join to Download WH Questions Skill Pack

I originally created these materials while managing a triple-digit caseload, trying to make therapy both effective and doable. The goal was simple: give SLPs everything they need to target WH questions with research-backed structure and minimal prep time.

Here’s what’s included:

🧩 1. Leveled Assessments

Quickly identify each student’s starting point with assessments that move from simple to complex WH questions, from picture-based prompts to story-level comprehension. You’ll also find progress probes that make it easy to measure growth across sessions.

Perfect for goal writing and data collection.

🎨 2. Visuals and Cue Cards

Visual supports are one of the most powerful tools for students with language delays or autism. The pack includes WH question visuals for each question type, including icons, definitions, and examples.

These visuals are especially helpful in ABA-style sessions, where students benefit from consistency and repetition. They also work beautifully in small groups or whole-class lessons.

👉 Try pairing the cue cards with real-life photos, storybooks, or interactive classroom questions for quick generalization practice.

📘 3. Structured Practice Activities

Each WH type comes with guided activities designed to align with the six-step teaching framework:

Start with explicit instruction
Move through scaffolded levels
Practice within meaningful contexts

Activities include picture cards, short passages, and conversation prompts, so you can easily target receptive and expressive WH questions at any level.

📊 4. Data Sheets and Goal-Tracking Tools

You’ll find editable tracking sheets that make it easy to monitor both appropriateness and accuracy, a distinction emphasized by Parnell et al. (1986). These templates help you visualize progress and report growth efficiently, without extra paperwork.

🌟 Why SLPs Love It

Saves hours of prep each week
Works for any age or setting (preschool through secondary)
Built on evidence-based strategies from Swanson (2001), Justice et al. (2002), and Ukrainetz (2015)
Includes everything you need to start (o additional materials required!)

👉 Access the WH Questions Skill Pack Now →
Get evidence-based visuals, leveled assessments, and structured activities designed to make WH question instruction simple, effective, and fun.

Setting Goals and Tracking Progress

Once you’ve assessed your students and started using evidence-based strategies, the next step is setting clear, measurable goals and tracking progress along the way.

I like to think of this process as closing the loop. We start by assessing where the student is (their baseline), then we teach, scaffold,embed the skill, and finally, we measure growth to show what’s working.

🧠 Writing SMART IEP Goals for WH Questions

Strong goals focus on both accuracy and context. It’s not just about answering the question correctly; it’s about understanding and using the skill functionally across settings.

Here are a few examples:

Simple WH Questions:

When given a field of 3 visual choices, Student will answer “what” questions about a story with 80% accuracy across three sessions.
When given a short story, Student will answer “who” and “what” questions about the story with 80% accuracy across three sessions.

Complex WH Questions:

After listening to a short story, Student will answer “why” and “how” questions with 70% accuracy.
Given a classroom narrative or book, Student will answer inferential questions about the story with 80% accuracy across three sessions.

Functional WH Questions:

During classroom routines, Student will answer functional WH questions (e.g., “Where is your backpack?”) with 80% accuracy across three consecutive sessions.
During classroom activities, Student will ask appropriate WH questions to gather information in 4 out of 5 opportunities.

These goals can easily be adapted for your students’ unique needs.

📊 Tracking Progress Effectively

Consistent data collection helps you see whether students are generalizing their skills and whether your current strategy needs adjusting.

Here’s what I like to track:

Appropriateness: Did they respond with the correct type of answer (e.g., a person for “who,” a place for “where”)?
Accuracy: Was their response correct based on the content?
Cueing Level: How much support did they need (independent, verbal cue, visual prompt, etc.)?
Context: Were they successful in structured vs. naturalistic activities?

The data sheets in the WH Questions Skill Pack make this easy by breaking progress into small, measurable steps. You can record both accuracy and cueing, see growth trends over time, and quickly share updates with teachers or parents.

🧩 Connecting Data to Instruction

Data shouldn’t just live on a sheet; it should drive your next steps.

If a student’s accuracy is improving but responses are still inappropriate (e.g., answering “where” with a person), revisit explicit teaching of question word meanings.
If accuracy is high in structured drills but low in conversation, focus on embedded, contextualized practice.
If progress plateaus, consider targeting one question type at a time again before mixing multiple WH forms.

By consistently looping data into your instruction, you’ll ensure each student continues to build mastery — not just in the therapy room, but across their entire school day.

FAQs About Teaching WH Questions

Even though WH questions are a familiar goal for most school-based SLPs, there are always a few tricky areas that come up in practice. Here are some of the most common questions I hear from fellow clinicians, along with strategies and resources to help you feel confident in your approach.

At what age do kids learn WH questions?

WH question understanding develops gradually between ages 2 and 6, though the exact timeline varies by child.

According to Blank, Rose, and Berlin (1978) and later summarized by Paul and Norbury (2012), WH-question understanding typically develops between ages 2 and 6, though every child progresses at their own pace.

Here’s a general progression:

Age 2–3: Begins to answer what and where questions (with visual support).
Age 3–4: Starts to understand who and when questions.
Age 4–5: Begins to respond to why questions (cause and effect).
Age 5–6+: Understands how questions (processes, emotions, and reasoning).

If a child is struggling with WH questions beyond these ages, especially in comparison to peers, that’s a good indicator for targeted speech therapy support.

How do visuals help teach WH questions?

Visuals are a game-changer for students who need support with WH questions. A simple icon or cue card helps students connect the question word to its meaning. For example, showing a person for “who” or a place for “where.”

Visuals reduce cognitive load and give students something concrete to anchor their understanding. Research by Swanson (2001) supports this approach, showing that explicit instruction paired with visual scaffolding leads to stronger comprehension outcomes.

The WH Questions Skill Pack includes visual cards and student-friendly definitions for each WH type, so you can introduce, cue, and review the skill consistently.

What’s the best order to teach WH questions?

In general, start with simple and concrete question types and move toward abstract or inferential ones.

Here’s a hierarchy that works well for most students:

What (objects and actions)
Where (places)
Who (people)
When (time or sequence)
Why (reasoning)
How (processes or emotions)

This sequence aligns with developmental norms and research showing that simple WH questions (e.g., “what,” “where”) develop before complex WH questions (e.g., “why,” “how”).

How can I make WH question practice more engaging?

Keep it fun and functional!

Incorporate WH questions into storybooks, games, and classroom routines.
Use visual supports and movement-based activities (e.g., scavenger hunts.
Rotate between structured drills and open-ended tasks to maintain engagement while still targeting accuracy.

You can find dozens of ideas in the WH Questions Skill Pack, which includes printable visuals, story-based practice pages, and leveled assessments that make planning a breeze.

Up next, we’ll wrap up with a quick summary of the research behind these strategies, plus related resources if you want to dig deeper into literacy-based therapy and contextualized intervention approaches.

Evidence & Further Reading

As with all of our therapy approaches, everything we’ve talked about in this guide is grounded in research. Below are a few of the studies and frameworks that inspired the strategies shared here — along with related blog posts that show how to put the research into practice.

🧠 Evidence & Research Highlights

Parnell et al. (1986)
Found that students with language delays often give appropriate but inaccurate responses to WH questions. This study helps us remember that children may understand the structure of a question before mastering its meaning, which is why explicit instruction and consistent data collection are so important.

Swanson (2001)
Demonstrated that explicit instruction significantly improves comprehension skills for students with language-based learning difficulties. When targeting WH questions, this means clearly defining each question word, modeling responses, and using visuals to support understanding.

Justice et al. (2002)
Supported the use of literacy-based intervention, showing that shared storybook reading with embedded WH questions improves comprehension and expressive language.

Ukrainetz (2015)
Highlighted the effectiveness of contextualized language intervention, embedding WH questions into meaningful classroom or play activities to encourage generalization and functional use.

Together, these studies form the foundation of the Assess → Teach → Scaffold → Focus → Embed → Repeat model used throughout this post and in the WH Questions Skill Pack.

📚 Related Blog Posts

If you’d like to explore more ways to use these evidence-based strategies in your sessions, here are a few related resources:

Tips to Implement Literacy-Based Therapy for Students with SLI — Learn how to embed WH question practice within book-based units and classroom routines.
How to Use Books in Therapy — Practical strategies to connect storybooks, comprehension questions, and language goals.
How to Use a Pocket Chart for Easy Literacy-Based Therapy — A visual scaffolding technique that makes WH question practice more interactive and structured.

💡 Putting It All Together

If you’re looking for a way to apply this research without spending hours planning, the WH Questions Skill Pack combines all of these strategies into one easy-to-use resource. You’ll find leveled assessments, visuals, and printable data sheets that bring the research to life, so you can focus more on your students and less on prep time.

✅ Evidence-based. Classroom-friendly. Ready when you are.

That’s a wrap on WH questions! I hope these strategies, examples, and tools make it easier for you to plan effective therapy sessions and help your students build lasting comprehension and communication skills.

Transcript

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I am so excited to continue our series about how to teach different skills. Today we are diving into strategies for wh questions, and I think we all know how fundamental wh questions are for success in the classroom, literacy development, social interaction, all of the things. Before we dive into the strategies, I wanted to share a couple tidbits from the research, and I will share my citations in the show notes.

Parnell et al talk about how students with language delays produce less appropriate and less accurate responses to questions. And those are two things that we want to consider as we're approaching intervention and strategies that we're using.

So an appropriate response would be that we're responding to a who question with a who answer. So like, who went to the zoo? The girl did, and not responding with like a what or a why. If we say who went to the zoo because they wanted to, that would be an inappropriate answer because they're using the wrong question word and it would also be inaccurate because it's the wrong response.

But we wanna look at are they identifying the question word and responding. So if they say who went to the zoo and they say the girl, but it was really the penguin who went to the zoo, then that would be an appropriate response because they're identifying the who and giving a who answer. But it would be an inaccurate response because that's not the correct answer. But they are identifying the correct question word. So that's one thing we want to consider. Students with language delays often show appropriateness before accuracy, so we might see students start to give more appropriate answers before they become totally accurate. So that is something helpful to consider and something that we might look at in our data collection. I make skill packs for a lot of different skills and I started this because I was working as a school-based SLP managing a caseload in the triple digits, and I was not feeling my most confident and I wanted to make sure that even if I was spread very thin, I was providing the best possible intervention for my students and that I was doing it without breaking my neck. Enter the skill packs and a bunch of other things that I've made over the years. I dug through the research, and I started this process about 11 years ago when I started working and managing that massive caseload.

I made these skill packs to help organize the practical strategies and give me access to materials right at my fingertips. I'm going to pull from that, as a practical example of what this could look like, but the focus will be on the actual evidence backed strategies that we can use.

How I structure these packs are through assess, teach, practice. So we want to have tools to assess a skill. We wanna make sure that we're appropriately teaching the skill. This is a step that I would often skip as a newer SLP.

And then we want to give students the opportunity to practice.

So we're going to start with the assess portion. We talked about appropriateness versus accuracy, which is important to think about all throughout intervention when working with wh questions. But we'll move through strategies for assessment and then teaching and practice.

Strategy number one is to assess to find our starting point. We need to make sure that we're meeting students where we're at. I like to get a baseline assessment to help me determine what goal is even appropriate for the student, but then also where we need to start and what levels of support they need.

If they're at 0% accuracy, my approach is going to look a lot different versus if they're at 50% accuracy. So like to have a strong baseline assessment. and usually that's leveled to pinpoint exactly where we want to start with the goal. I also like to have a probe for the goal I end up writing, and I use that probe to assess the student's progress throughout intervention.

We do wanna find our starting point. We wanna start with that baseline assessment. I go from simpler to more complex and look at the different question types because, research shows us that some question types are more complex. They might struggle more with a certain question type. So I look at their responses to all of the question types, like who, what, when, where, why, how, and then I increase the complexity of that.

So I might start with responding to questions about a simple picture. I might include general knowledge questions, and comprehension questions about a passage. I can pull out my assessment packet and look at all of those different levels, and then wherever the student starts to struggle I'll be able to identify their strengths so we can leverage that in intervention. Also I want to find that sweet spot of, okay, where does it make sense to start intervention? Answering questions about a picture or are we all moving all the way to responding to questions about a story?

And there's different levels of complexity there. Having a strong baseline helps us identify what makes sense for that. The skill pack in SLP Now includes that leveled assessment to help you do that really good baseline to identify where students need to start. We also have probes for all of the different goals that you might write for that ongoing intervention.

That was our strategy one using a baseline assessment to figure out where to start.

Then strategy two is explicitly teaching the question words using visuals. Swanson 2001 talks about explicit teaching. How we do that with WH questions is we select a question word to focus on and we might have a visual to help the students understand what that word means. We might also have a quick student friendly definition. So we might have a picture of an object, and an action. A simple definition for a what question is a thing or an action. Then we would practice, answering questions. So, we have a number of different visuals inside the WH question skill pack. You can also do quick drawings and make your own little cards for the visuals for students. We have, little cards for each question word with the icon and the, quick student friendly definition.

We also have sheets that have examples of answers. The what page has the icons and the student friendly definition as well as examples of things like an apple, watching, stretching, clapping, all of those types of things. We have that for all of the different question marks.

Then we have a bunch of different ways to help you. You have that visual to help you teach it. And so you would introduce like, today we are practicing what questions, this is what a what question is, and then strategy three is to scaffold using a hierarchy. So part of that, we talked about already in strategy one, in just using that assessment to determine where students are at, are they able to answer questions about photos, general knowledge questions or questions about a text, question about conversation.

This is where teacher, parent report would come in, classroom observations, all of that good stuff. We would write the goal for the appropriate level. and then we have activities to practice those. So we have photo cards where you can practice who is in the picture, and then you would pair that with the visual. if you're practicing who today, you would have the little who card or the little who page, and you can have practice discrimination too. Like maybe have the who and the what poster, if they're already good at responding to what questions. That's how we can leverage their strengths. You can have these picture cards and you can ask who is in the photo, and then you'll pause. Okay, what word are you hearing? What question word is that? So first identifying the question word. So, oh, we heard the who, so we're looking for a person. then you look at the picture. Who's the person in this picture? They can say, A boy.

And then to leverage their strength and to practice that discrimination can say, okay, what's the boy doing? What kind of question was that? Is that a who or a what? And so you can point to the appropriate card, and then they can respond giving an appropriate and accurate response to that question.

And so you could rinse and repeat for all of the different question types. And then you can move on from simple photos and you can use the photos in the skill pack, any photos that you have in decks of cards, or you can look at pictures in books or ask questions about the immediate environment.

There are so many ways to scaffold that depending on where the student is at in the hierarchy. Strategy four, which we've touched on a little bit, is to teach one wh question at a time. Parnell et all 1986 Isenberg 2014 talk about focusing on one question type as a way to support mastery and reduce cognitive load.

We can, use the assessment to identify which question, like if they're really good at who and what questions, then we don't need to target them. We can leverage those as a strength. And then, if they are struggling with one questions, for example, we would put our focus on one question and just focus on that question type.

And then as they master that we can move on to more.

Strategy five is to embed wh questions in meaningful context. The four steps I've talked about have been very decontextualized. We're doing assessment, using visuals, and doing very structured practice to help teach that concept. Then we want to move into a meaningful context.

So we wanna move away from these card decks and structured activities and move into books and classroom activities as quickly as possible. I could share a lot of references to support the use of meaningful context for this skill.

Dr. Ukrainetz's research emphasizes this. There's also a study by Justice et al. from 2002 about using short shared storybook reading. lots of evidence to support using this approach. The reason why we want to make sure that we jump into embedded practice as quickly as possible is that it facilitates generalization.

I think that's the biggest thing. It doesn't matter if they can respond to the most complex wh questions in the speech room if they're not able to use that in the classroom. We want to think about where we ultimately want them to use the skill and give them the opportunity to practice that as quickly as possible.

It would be like if I were a basketball coach and only ever had my students do drills. If it's game time, they're really going to struggle if only did dribbling practice and never practiced the coordination of all the things in a game.

And so it's the same thing with all of the skills that we target, but it also applies to wh questions. Then our last strategy is to provide high repetition with varied practice. Repetition builds mastery and the varied context support generalization. We do want to use the question cards and structured practice to build that repetition. Then we want to make sure again, that we're moving into that embedded practice as quickly as possible, because that is critical for generalization. In terms of WH questions, the varied practices that we're not asking the same question over and over, we are asking if we're doing a storybook, there's variability and varied practice built in.

We're answering questions about different activities throughout the story unit. Last week I did a podcast episode about how I used Apple Trouble to target all of the skills. That'll give you a lot of ideas for varied practice with WH questions, from doing the KWL chart to the book walk to the virtual field trip to the story.

There's lots of varied practice built into a literacy based therapy unit, and we'll leverage that. So those are our six strategies for wh questions.

So a quick recap.

One, we wanna have a high quality assessment to help us determine which level is most appropriate for students. We'll use that to inform our goals and how we structure intervention. Strategy two is to explicitly teach the word meanings and to leverage visuals. Strategy three is to scaffold using a hierarchy. Based on the assessment results, we might start with questions about pictures and then move up to general knowledge and then about a passage

We want to teach one question at a time. Strategy five is to embed this practice in a meaningful context to facilitate generalization. Strategy six is to provide high repetition with varied practice. Those are our six strategies. Check out the show notes for the references and examples of what this looks like.

If you want to access the WH questions unit with all the assessments, visuals, and structured practice in one nice download. It's totally no strings attached. You'll just enter your name and email, set up a password, you'll get logged in.

You can go to the materials page, download the WH questions pack, and have the access to this awesome resource. Or you can check out some of our other skill packs and therapy plans and resources.

I started creating these materials as a very overwhelmed SLP who still really wanted to serve her students well. These materials have been 11 years in the making. We're constantly updating and revamping them, and I hope that they make your life a little bit easier and make it easier to implement some of these strategies.

So that's a wrap for today. Thanks for joining me, and I'll see you soon.

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5 Evidence-Backed Strategies to Teach Past Tense Verbs

September 9, 2025 by Marisha Leave a Comment

Many of our students have goals for past tense verbs, but sometimes progress doesn’t come as quickly as we’d like. When that happens, it’s helpful to have research-backed strategies in our back pocket.

Before diving into the strategies, let’s take a step back: why do we even target past tense verbs?

Communication: Marking tense is an essential skill for telling stories, sequencing events, and being an effective communicator.
Diagnosis: Research shows that tense marking is a reliable indicator of language impairment (Guo & Schneider, 2016).

With that foundation, let’s explore five strategies supported by research that can help our students succeed.

1. Focused Stimulation

This strategy involves giving students rich, meaningful exposures to past tense verbs.

Example 1: Read a picture and emphasize the past tense verbs.

Example 2: If a student says, “I run at recess,” you might recast with, “Yes, you ran at recess today!”

You can coach parents and teachers to use this too.

Fey, M., Long, S., & Finestack, L. (2003). Ten principles of grammar facilitation for children with SLI. AJSLP, 12, 3–15.

2. Contrastive Imitation

Contrastive imitation highlights the difference between present and past tense forms.

Example: “Today we jump. Yesterday we jumped.”

Use picture cards, actions (jumping, clapping, tapping) or simple activities in your therapy room.

Encourage students to repeat the targets as part of the activity.

This contrast helps students connect meaning with form.

Connell, P. J. (1982). On training language rules. Language, Speech, and Hearing Services in Schools, 13(4), 231–240.

3. Visual and Kinesthetic Supports

Visuals make abstract grammar more concrete.

Try pointing to a visual cue for present tense versus past tense.

Incorporate kinesthetic activities. Students can act out verbs and then reflect on what they did.

Consider approaches like shape coding for added clarity.

These supports are especially helpful if students aren’t progressing with auditory-only strategies.

Ebbels, S. H. (2007). Teaching grammar to school-aged children with SLI using Shape Coding. Child Language Teaching and Therapy, 23(1), 67–93.

4. Interactive Prompting

Interactive prompting provides additional scaffolding.

Give students a field of two choices: “You pull the cart or you pulled the cart?”

If needed, model the correct form: “Say it like me. You jumped.”

Eisenberg, S. (2014). What works in therapy: Further thoughts on improving clinical practice for children with language disorders. LSHSS, 45, 117–126.

5. Increase Lexical Variability

Instead of drilling the same verb (e.g., jump → jumped), rotate a variety of verbs.

Research by Plante et al. (2014) suggests that variability facilitates morphology learning.

This prevents rote memorization and helps students generalize the past tense rule.

Plante, E., Tucci, A., Nicholas, K., Arizmendi, G. D., & Vance, R. (2014). Lexical variability and morphological learning in children with SLI. JSLHR, 57(2), 516–528.

Final Thoughts

If your students aren’t making the progress you’d expect, these strategies may provide the boost they need. Many are simple to implement with activities you already use, and they’re backed by strong research.

If you’d like access to ready-to-use visuals and therapy materials, sign up for a free trial!

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Because we analyzed all the books, identified the targets, and created unit plan pages that suggest activities based on the skills you’re targeting and your students’ needs. This is the one-stop shop for all your literacy-based therapy needs, including resources for virtual field trips and visuals to help those concepts stick.

We’ve talked about so many activity options during this series… but there are even more literacy-based ideas and evidence-based resources waiting for you on the other side of SLP Now. 🤗

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Transcript

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Hello there and welcome back to the SLP Now podcast. Today we are going to be chatting about five evidence backed strategies that we can use when targeting past tense verbs.

A lot of our students have these goals, and it's helpful to have some good strategies in our back pocket, especially if students aren't making the progress that we would expect.

And taking another step back. Why do we even write these goals in the first place?

It is a very important communication skill and being able to mark tense is really important when telling stories and being an effective communicator. It is also a diagnostic indicator, so if students are not marking tense, that is a very reliable indicator of language impairment.

This is according to Guo and Schneider in their 2016 article. I'll link all of the different articles in the show notes, if you are wanting to dig into anything in a little bit more detail. I also apologize if I butcher any of these names. I always read this and don't hear it talked about quite as much.

I think we're all on the same page in terms of why we might want to target these goals and why it's important, so now we can dive into five strategies.

The first strategy is to build awareness through auditory bombardment. We provide rich, meaningful exposures of these past tense verbs. We can use this for other grammatical morphemes and grammatical targets as well.

We want to give multiple exposures to these targets and emphasize them. Focused stimulation is what some of the studies call that. The main goal here is giving them lots of meaningful exposures to those targets.

So first strategy is that auditory bombardment, focused stimulation. This is a strategy that I often share for intervention, before a student might be on my caseload.

I teach this to parents and teachers. just having them give that focused stimulation, and recasting. So if a student says I run during recess, we can say, yeah, you ran during recess today. That is a helpful strategy and I find that teaching that strategy and getting parents and teachers on board often helps students start using that target. They just need a little bit of extra exposure, and for some students that does the trip, which is amazing.

Now on to strategy two, which is contrastive imitation. There's a whole protocol for this in the research article.

An example of what this could look like is if we're using the present and the past tense verb. Today we jump, yesterday we jumped. You can use picture cards potentially having a picture of a girl jumping and then having her be done jumping.

She jumped. Just having that contrast and semantic representation of the meaning. You don't have to have materials for the contrastive imitation. Have the student actually jump or push or tap or whatever.

You can be like you are tapping and then, oh, you tapped when they're done tapping. You can do this with a lot of different games and activities that you already have in your therapy room.

The protocol might include having the students actually repeat the targets as well. I'll link to that in the show notes so you can see what that looks like.

Then strategy three is using kinesthetic and visual supports.

in the SLP Now membership, we have different visuals to help students so that we can point to an indicator of this is present tense, this is past tense. We also have different cards that can help with that strategy one and strategy two using a bunch of different verbs.

There's lots of different ways that we can do this. There's also shape coding. There's some research behind that as well. in just giving students some different types of visual supports.

So considering some of those options, especially if students aren't making progress with focused stimulation and contrastive imitation from the first two strategies. That brings us to step four, which is interactive prompting. This is an example of what this would look like.

You pull the cart or you pulled the cart. You give them those two choices. If you are doing different jumping activities, like you are jumping or you jumped, like which one is true. if they're doing it while they're jumping, they can say, I am jumping. If they finish jumping, then they can say, I jumped.

If they don't answer that independently with that forced choice, you can say, say it just like me. You jumped, and scaffold that production. And then you can combine that with your visuals and your other strategies as well.

Giving those choices and eliciting those imitations can support grammar when recasts aren't enough. That's something that we have seen in the research as well. The fifth strategy is to have high lexical variability. Instead of using the same verb over and over again, we want to rotate the verbs that we're using in the session.

So instead of just doing tons of practice with jumping, we would include different types of verbs like play, climb, wash, call, sit, stand, and being mindful of whether we're doing a regular or regular past tense verbs. But then that helps students learn that pattern more versus just memorizing, oh, the past tense of jump is jumped if they're generalizing it to a bunch of different words.

Plante et al their 2014 article is really an interesting read in looking at that lexical variability. if we have more variability that can facilitate morphology learning. and so being strategic with the words that we're selecting. And that article gives some suggestions for that.

So those are our five strategies. Hopefully this is a confidence boost of things that you're already doing. And if you're listening to this because a student isn't making the progress that you would expect, hopefully you have some great strategies now that you are reminded of, that you can try to implement.

So just a quick recap. Our first strategy was that focused stimulation, auditory bombardment. The second strategy is using that contrastive imitation, and the third strategy was incorporating visuals or kinesthetic supports. Strategy four is some of those interactive prompting strategies like giving that forced choice, that elicited imitation.

Okay. And then strategy five is making sure that you're including a variety of verbs in your session and not just drilling one over and over and over. And then check out the Plante at al article from 2014, for some different strategies on lexical variability.

So those are our strategies. We are going to continue this series of different strategies we can use for grammar intervention. This will partially be based on any questions. So if you have a question, send us an email [email protected] or dm us on Instagram at slpnow. Some of the future episodes will be focused on generalization and focusing on that from the start and having those meaningful context for this intervention.

But if any, if you had any questions about anything that we chatted about today, let me know. That's all for now. Thanks for joining us, and I'll see you very soon.

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Fluency Strategies for Stuttering: What They Are and Why We’re Rethinking Them

July 17, 2025 by Marisha Leave a Comment

For decades, fluency strategies have been the foundation of traditional stuttering therapy. Techniques like easy onset, slow rate, and light articulatory contact are still taught in graduate programs and practiced in school settings across the country.

But what if those strategies aren’t actually helping?

In this interview with Ezra Horak—stutterer, advocate, and founder of Stutterology—we explore why it’s time to rethink what support really looks like for people who stutter. Through Ezra’s powerful lived experience, we examine how fluency goals can do more harm than good—and how a shift toward acceptance, agency, and authentic communication is long overdue.

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Understanding Stuttering and Its Impact

Stuttering is more than just a disruption in speech—it’s a deeply personal and often misunderstood aspect of communication. For school-based SLPs, gaining a foundational understanding of what stuttering is (and what it isn’t) is key to supporting students in a meaningful way.

What Is Stuttering?

Stuttering is a neurodevelopmental communication difference characterized by disruptions in the flow of speech. These disruptions—known as disfluencies—can include repetitions of sounds, syllables, or words, prolongations of sounds, and involuntary blocks or pauses in speech. Stuttering can also be highly variable, changing day to day or even moment to moment depending on the situation, setting, or emotional state of the speaker.

The Layer of Secondary Behaviors

In response to these disruptions, individuals often develop secondary behaviors—physical or behavioral reactions that are meant to help push through a stutter or avoid it altogether. These might include blinking, facial tension, body movements, or even avoiding eye contact or certain words.

Over time, these coping mechanisms can become habitual and may be misinterpreted as the stuttering itself. But what’s most important is understanding why these behaviors emerge: they are often a reaction to societal pressures, negative feedback, or the internalized belief that stuttering must be hidden.

The Emotional and Social Toll

The visible signs of stuttering are only part of the story. As Ezra Horak describes in their interview, the real weight of stuttering often lies in its psychological and social impacts—especially when fluency is positioned as the gold standard.

Many students who stutter become acutely aware of how others react to their speech. They may experience anxiety, shame, or a desire to withdraw. Without a supportive environment, they may internalize the message that fluent speech is the only acceptable kind of speech.

By understanding stuttering from a holistic perspective—including both the observable behaviors and the emotional layers underneath—SLPs can better support students in becoming confident communicators, just as they are.

“It takes so much effort to control and even that leaves us grasping for straws. The other thing that’s really important to understand is that when you’re asking someone to do these things, it doesn’t feel quote unquote fluent for me to do fluency techniques. So if someone’s wanting me to be fluent… To me, there’s no other reason to want that except for a listener reaction.”

— Ezra Horak, Founder of Stutterology and Board Co-Chair of SPACE: Stuttering, People, Arts, Community, Education

Traditional Fluency Strategies: What They Are—and Why They Fall Short

In many school-based settings, stuttering therapy often begins with traditional fluency strategies. These techniques aim to reduce stuttering through structured methods that promote smoother speech. While well-intentioned, these approaches may unintentionally reinforce harmful expectations about what successful communication should look like.

Common Fluency Shaping Techniques

Fluency shaping techniques are designed to alter the way a person speaks. Some of the most commonly used strategies include:

Easy Onset – Gently easing into speech by starting with a soft sound
Continuous Phonation – Keeping the voice “on” to maintain fluid speech
Light Articulatory Contact – Reducing tension by making lighter contact between speech articulators
Diaphragmatic Breathing – Breathing from the diaphragm to support speech control

These strategies are typically practiced through drills, word lists, or scripted reading, with the goal of reducing disfluencies.

Stuttering Modification vs. Fluency Shaping

In contrast, stuttering modification strategies focus on changing the way a person stutters rather than trying to eliminate stuttering altogether. These include:

- Cancellations – Pausing after a stutter and repeating the word more easily
Pull-outs – Gaining control during a stutter and easing out of it
Preparatory Sets – Anticipating a stutter and using a technique to ease into the word

Stuttering modification aims to make stuttering less tense and more manageable, often paired with desensitization and counseling.

Where These Strategies Fall Short

As Ezra Horak points out, even well-meaning techniques can send an unintended message: that fluency is preferable to authenticity. For many students, the goal of fluent speech is not only unrealistic but emotionally damaging.

Therapy that centers on reducing stuttering—even subtly through praise or repetition of “fluent” speech—can create shame, pressure, and a sense of failure. It reinforces the idea that their natural way of speaking is not good enough.

Instead of building confidence, traditional fluency strategies can contribute to the very anxiety and avoidance behaviors they aim to reduce. As Ezra shared, “Stuttering is variable. It comes and goes, it changes. And now you’ve just assured someone, great, thank goodness you’re at 90% fluency now. And then when you start stuttering again, you’re well aware that people are going to be disappointed.”

The takeaway for SLPs? It may be time to reconsider whether fluency-focused methods are truly serving our students—or if they’re setting them up to feel like they’re always falling short.

“If you’re putting expectations like that.. They will fail you. Like they will. That’s not up for debate. And they’ll fail themselves and they’ll know it and they’re aware of it. Kids are really good at picking up on wanting to please the people around them… You’re clapping or you’re telling them good job… All of those things are examples of things a kid is going to pick up on, and they’re going to know what the expectation is.”

— Ezra Horak, Founder of Stutterology and Board Co-Chair of SPACE: Stuttering, People, Arts, Community, Education

Beyond Fluency Therapy – Rethinking Success

For many students who stutter, traditional speech goals revolve around one question: How fluent can you become? But what if that’s the wrong question?

Prioritizing Communication Over Fluency

Ezra Horak invites SLPs to rethink what success looks like in stuttering therapy. Instead of chasing “perfect” speech, Ezra encourages professionals to focus on making communication feel easier and more authentic for the student. This means moving away from goals that measure fluency and toward goals that empower students to speak freely—however that may sound.

As Ezra shared on the SLP Now podcast, the difference between fluency and communication is huge:

“One is asking you to be fluent and the other one just is asking you to talk and doesn’t care how it comes out.”

When we measure success based on fluency alone, we risk rewarding performance rather than progress. Praise like “That was smooth!” or “You didn’t stutter that time!” may seem encouraging, but it subtly tells students that stuttering is failure.

The Psychological Toll of Fluency Demands

These messages have weight—especially for young people who are still developing their identities. Ezra reflected on the long-term impact of fluency expectations in their own life:

“It really broke the way that I saw communication. And I think it still impacts me to this day, unfortunately.”

In therapy sessions where stuttering is implicitly discouraged—even through something as simple as repeating a word “correctly”—students can internalize shame. They learn that what matters most is how they say something, not what they’re saying.

“Success” Shouldn’t Be Performative

If the student feels they must perform fluency to be praised, they may begin to hide their stuttering or speak less. And when disfluencies inevitably return (because stuttering is variable), they may feel they’ve failed.

Ezra emphasized that therapy should support the whole communicator, not just their speech:

“We don’t need to target fluency to help someone who stutters.”

By shifting our mindset from “fixing speech” to “supporting communication,” we create a more inclusive, sustainable, and affirming path forward for our students.

“It just really broke the way that I saw communication. And I think it still impacts me to this day, unfortunately… it causes some pretty intense and deep running impacts to have this expectation to talk in a way that’s not how you usually talk—especially if it doesn’t really benefit you all that much and you’re aware that it’s for other people.”

— Ezra Horak, Founder of Stutterology and Board Co-Chair of SPACE: Stuttering, People, Arts, Community, Education

Empowering Approaches to Stuttering Therapy

If the goal of therapy is to help students become confident communicators, we must meet them where they are—through practices rooted in trust, collaboration, and empowerment.

Let Communication Lead the Way

Instead of fluency-centered benchmarks, therapy sessions can focus on what makes communication easier and more enjoyable for the student. That might mean exploring communication in comfortable settings, building confidence to self-advocate, or creating goals around participation and connection—not speech perfection.

Ezra underscores this idea clearly:

“We don’t need to offer fluency to help someone who stutters.”

Build Relationships, Not Just Plans

Therapy works best when it’s a partnership. Ezra emphasized how transformative it was when SLPs genuinely listened and took their experience seriously:

“Listen to your client… and really listen. Not just a surface level… It takes time. It’s about building a relationship.”

This relationship-first approach opens the door for students to express what they actually want. When asked, many may say, “I want to be fluent,” but as Ezra points out, it’s essential to dig deeper:

“What does fluency mean to you?” can unlock a conversation about identity, self-worth, and personal goals—far beyond surface-level speech metrics.

Empower Through Self-Advocacy

One of the most effective ways to support students who stutter is by teaching self-advocacy skills. These include:

Explaining stuttering to peers or teachers
Requesting more time to speak
Practicing scripts for disclosing their stutter
Reframing internalized beliefs about communication

When students have the language to talk about their stutter confidently, they’re more likely to own their voice—no matter how it sounds.

Let Go of Harmful Habits

Just as important as what to do in therapy is what to stop doing:

Avoid asking students to repeat themselves “more fluently”
Refrain from praising “smooth” speech over brave communication
Don’t count stutters as a metric of progress

As Ezra shared, the best SLPs made them feel safe, heard, and respected—never pressured. That kind of environment lays the groundwork for real growth.

“I think one of the main things is listening to your client and really listening, not just like a surface level… It’s about building a relationship… that really helped give me that agency. So I think agency is another thing—allowing the child to kind of be leading some of the direction and you help guide that.”

— Ezra Horak, Founder of Stutterology and Board Co-Chair of SPACE: Stuttering, People, Arts, Community, Education

Accommodations and Societal Change

Stuttering is not a problem to be fixed—but a difference that deserves understanding, respect, and space. While individual therapy can be transformative, lasting change also requires rethinking how schools and society at large accommodate communication diversity.

Rethinking the Environment

Students who stutter often face barriers that go far beyond speech. Classroom participation rubrics, time-limited presentations, or voice-activated tech can all create unnecessary stress. In many cases, it’s not the stutter that causes the challenge—it’s the system’s inflexibility.

Simple, student-centered accommodations might include:

Providing alternate ways to participate (e.g., written responses, partner presentations)
Allowing extra time without time penalties
Teaching classmates about communication differences to build empathy
Ensuring students never feel rushed to speak

As Ezra explains, these accommodations shouldn’t be about minimizing stuttering—they’re about maximizing communication access.

“I was going to block and I knew I was going to, so I would use a fluency technique for that because I had to. Not because it was easier—but because it’s a necessity of a broken society that doesn’t currently have an accommodation… I do hope it will one day.”

We Need Societal Change—Not Just Therapy

Stuttering doesn’t exist in a vacuum. It intersects with systemic issues like ableism, performance culture, and narrow definitions of intelligence or competence. Ezra’s work through Stutterology and SPACE speaks to this broader advocacy effort—to change not just how individuals speak, but how society listens.

Speech therapists are uniquely positioned to be part of that change. By shifting therapy goals, educating school communities, and advocating for more inclusive systems, SLPs can create a ripple effect far beyond the therapy room.

Changing the Narrative

Imagine a classroom where it’s normal to stutter. A school where students are empowered to express themselves however they speak. That future is possible—and it starts with each of us letting go of outdated fluency ideals and embracing communication in all its forms.

“There are ways to accommodate disabilities in the world. We have learned that with certain things. So let’s get creative… The stutter is not the enemy. That was something I didn’t know. I always assumed… we talk about our stutter that way: ‘My stutter holds me back.’ But if we were to sit there and very like rationally approach it from a different mindset… we don’t need to offer them fluency.”

— Ezra Horak, Founder of Stutterology and Board Co-Chair of SPACE: Stuttering, People, Arts, Community, Education

Conclusion

For decades, fluency has been the assumed goal in stuttering therapy. But as Ezra Horak’s story and insights so powerfully illustrate, it’s time for a shift.

Chasing fluency often comes at a cost—creating shame, reinforcing harmful expectations, and sidelining the very voices we aim to support. By rethinking our definitions of success, SLPs can move beyond performance-based goals and instead foster environments where students feel heard, respected, and empowered to communicate as themselves.

That means building relationships, focusing on ease of communication, and embracing stuttering as a valid way of speaking. It means equipping students with tools for self-advocacy and pushing for systems that honor all forms of expression.

In Ezra’s words, “The stutter is not the enemy.” Let’s make room for that truth in every therapy room, classroom, and conversation.

Frequently Asked Questions About Fluency Strategies

What are fluency enhancing strategies for stuttering?

Fluency enhancing strategies include techniques like easy onset, light articulatory contact, and continuous phonation. While these are designed to reduce stuttering, they can unintentionally place pressure on students to speak a certain way, often at the expense of confidence or comfort.

What is the difference between fluency shaping and stuttering modification?

Fluency shaping aims to prevent stuttering through structured speech patterns. Stuttering modification, on the other hand, helps individuals manage moments of stuttering by reducing tension and developing comfort with disfluency. Ezra Horak advocates for rethinking whether either strategy should be the default, especially if the focus shifts away from genuine communication.

What is the pull-out technique in stuttering?

The pull-out technique is a stuttering modification strategy where the speaker gains control during a stutter and gradually eases out of it. While helpful for some, it’s essential to ensure that students understand they aren’t required to “fix” their speech to be heard or valued.

Should fluency be the goal of stuttering therapy?

According to Ezra—and a growing number of advocates and professionals—the answer is no. Therapy should prioritize ease of communication, self-expression, and self-advocacy over fluency. Success looks different for every student and shouldn’t be measured by how fluent they sound.

Is it okay to let children stutter?

Absolutely. Creating an environment where stuttering is accepted and not corrected helps reduce shame and supports healthy communication development. As Ezra emphasizes, “Make it okay to stutter. And actually make it okay—not just say it.”

Stuttering Resources

🔗 From SLP Now

🔗 From Ezra Horak & Stutterology

Stutterology Website – Educational content and advocacy tools for people who stutter, parents, and SLPs

Stutterology on Instagram – Follow for community stories, affirming messages, and advocacy content

At SLP Now, we are hard workers… but we also like to work smarter.

That means we’re constantly improving our materials, therapy planning resources, and the ways we support SLPs like YOU — so you can skip the hard work part and just work smarter. 👇

How is that possible, you ask?

We’ve talked about so many activity options during this series… but there are even more literacy-based ideas and evidence-based resources waiting for you on the other side of SLP Now. 🤗

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Marisha (00:01.294)

Hello there and welcome to the SLP Now podcast. We are kicking off a new series on all things stuttering and I cannot tell you how excited I am to have our speaker today, our interviewee. Ezra Horak is a stutterer and the founder of stutterology. And if you don't follow them on Instagram yet, go and...

Switch to Instagram, search Stutterology right now, or check out their website stutterology.com. There are just so many amazing resources there. They are also the board co-chair to space. So Stuttering People Arts Community Education, which is a nonprofit that creates more space for stuttering and changes how society listens. So yeah, I am so excited to have Ezra here today and

just a little bit of context. So I've been on my own personal or professional development journey when it comes to stuttering and it's been a process over the past several years. But I'm really excited to get Ezra's perspective today just to kick off this whole series. We'll be talking about best practices for assessment and treatment and counseling and all of those things. But today we get to hear from Ezra on just

kind of getting our context and our mindset and our framing correct. So without further ado, that was a long intro, but hello, Ezra.

Ezra Horak (01:37.572)

I'm really excited to be here.

Marisha (01:42.2)

Yeah, likewise. I'm just so, grateful for you being so generous with your time and willing to share a little bit about your story, which leads us to the first question. Would you mind sharing just a little bit more of your story? I shared super quick bio that does you absolutely no justice, but tell us a little about you and kind of what led you to start stutterology and yeah.

Ezra Horak (02:08.932)

Sure, yeah. So I've been stutterin' since I was about six years old or so. I was actually already in speech therapy at that time for reverse swallow and not being able to pronounce my Rs. And I began stutterin'. This is in, I'm gonna just let people know how old I am. This is in 1997. And I immediately...

my self-esteem kind of started to drop and my mom had asked me like, you like this speech therapy? And I said no. I she asked me like, do you think it's help, help, helping? I said no. And she pulled me out. And she, I don't even know how she researched this in 1997, to be honest. But she looked her, like she found stutterings, bimashalas, and we got

really, really, really lucky that in the Sandy A. Ago area there happened to be some people. so she took me there instead, which I'll always think is like just a mind boggling thing. I don't know anyone else who has a story like that, especially from the 90s. I grew up, it was just my mom, my brother and me. And then my grandparents were pretty involved.

And my mom didn't know anything about stuttering. Prior to my onset, she had never heard of stuttering before. I asked her recently, I was like, well, what did you think like Porky the Pig was doing? And she's like, I don't know, I just thought he was like being funny or something. I know it was a thing. So had zero context. Which in hindsight, I'm almost like maybe that was a good thing because she got to be a blank slate. And when we went to this

second speech, the therapist, this lady sat her down and was like, okay, you know, it's been going on for six plus months. It might continue for the rest of their life. And we need to make sure you're prepared for that, that you're prepared for the teachers, how they're going to react. You're prepared with future SLPs that you're going to have, like really sat down and said, you know, things will be chat.

Ezra Horak (04:29.284)

challenging, but the most important thing is that your kid continues to talk. That's number one. And I really think that if I hadn't had that, my whole life would have gone a totally different way. I still, as you'll see with my story, it still doesn't go in an ideal situation because there's still like society and there's the future speech therapy I would get and there's other influences, but it still made a foundation that I think I just feel so lucky to at least have had that start.

So then fast forward, eventually I have to go to a different speech therapist. I went through a private school and so it was like not through the school district. It was through, we had to like go through this whole rigmarole, get insurance improved. So I have like letters that teachers wrote about how desperately I needed speech therapy if I wanted to be successful in life going on, which my mom kept everything. And so I still have all of that, which feels odd.

But as far as my mom went, she made number one thing of like, I just want to make sure you keep talking. So I was a very, very social outgoing kid. And you could see that start to take hits as things happen. I was always volunteering and teachers wouldn't call on me in class. I wanted to be in a play in third grade. And the parents of my classmates took my lines from three lines to half a line.

Every time I stuttered they were asking me, are you sure you want to do this? And I was, I, that was my first memory of stuttering. I'd been stuttering for several years, but my first memory was being on stage and those parents asking, are you sure you want to do this? And that's the moment it became very clear to me that people didn't want me to stutter. That like, well, I didn't care. My mom didn't care. At that point, I don't know if I was seeing the same space therapist, probably not.

But other people cared. And it was a battle after that. You know, I had different speech therapists, my family had different reactions. My mom was amazing about my stutter my whole life. I asked her she ever practiced fluency techniques at home because I know that's a pretty common request. And she said one time she was asked to and she started to.

Ezra Horak (06:50.454)

then was like, what am I doing? Like, asked me, do you like doing this? And I was like, no. And so she's like, okay, well, we'll stop. Just listens to me, which I feel so unbelievably grateful. My grandma who helped raise me was a very different story. She was always telling me to slow down, to do my techniques constantly every time I talked.

And she would tell me if I couldn't talk correctly, I should wait until I could, which I think everyone can agree is a pretty harsh and rude thing, especially to a kid who's excited. But my grandma was pretty harsh, and there's a twist to that, but I wouldn't know it for another 25 years. And so anyway, so then I went to public high school and...

did speech therapy through the high school and that was, I'm sorry, that was my worst speech therapy experience. Hands down, this person was quite a bit older and I think she was about to retire. She had a lot of outdated thoughts and wasn't interested in learning more. So as a kid, I had no problem telling my speech therapist they needed to learn more about stuttering. I was, I don't know what that first speech therapist did to make, or if it was just like me and who I was, probably a combination.

But I

clearly had no interest. And then high school was probably, things were pretty hard for me emotionally. I just had like a lot of different things that I wasn't aware. I was undiagnosed ADHD. So I struggled a lot. I did well in school, but it was a struggle. And then I went to college and that's really when things hit the wall. That's really when...

Ezra Horak (09:10.466)

You know, people have asked, what was your hardest year of stuttering? And I, after thinking about it, I realized it was when I was 18, 19. And I was kind of on my own. You know, I was away from my mom and my mom had done so much advocacy on my behalf, had helped me with advocacy things. And I was away from home. I was away from my normal friend group. None of my friends cared that I stuttered, but I never really talked to them about it, unless it was an offhand comment. No one knew.

how much I was thinking about it, how consumed by it I was. They knew I did it and they didn't care, but they didn't realize how much it encompassed like everything I saw and did. I ended up picking to do my degree in accounting, even though I didn't like accounting and it gave me a headache to do because I thought, well, I stutter, I'm capable of this, I'm first generation college, so I'm like picking the safe option.

part of it and another part of it is, well, I couldn't do communication. I couldn't be a journalist because I stutter, right? A lot of it was that. I told myself it was the safe option, but I think a lot of it came down to being afraid that I wouldn't succeed if I had a stutter and I would rather have picked something that was as opposite of what I wanted to do than something that was close that I couldn't do.

because I was so worried other people weren't gonna let me do it, because those were the experiences that I had had. At the end of college, my friend was at my rival college, learned about a senior project this guy, Morgan Lott, was creating called This is Stuttering. And it was like a self documentary he made for his project and his last attempt at speech therapy to get fixed basically before he was gonna graduate college.

And when I sat there and I went to the school, I had emailed him, I went to it, and I sat there and I saw myself on screen for the first time. Like it was him, but he was so, he had so many similar like secondaries. So he would like touch his face in all the same ways I did and like bit his, and like you could tell he wanted to talk and he stopped himself. It was a very transparent documentary that was very painful, but also very, I saw myself and.

Ezra Horak (11:33.8)

I was thinking, no Morgan, like you can do it. And then I had to realize, you know, like, and I, didn't want to realize that the same could apply for me. That was, that took a long time. But, when I walked out of there, I went home and I wrote and I, I, a big, I've always liked to write. and I had a Tumblr at the time and I wrote, I think I'm going to have to.

Accept that this is the rest of my life that I'm not gonna wake up one day It's gonna be gone. So that's what I kept hoping for one day It'll be gone in my life and start that this is gonna be my life and I don't have to like it I can hate it. I But I at the time I was religious and so I saw this but I can thank God that it's here because it's it's a kind of the mindset but the idea was I can hate this but acknowledge that it's here and move

forward with that. And so that was a changing point. That was 11 years ago. It took me a year and a half before I joined one of the local chapter groups with the National Stuttering Association and I started to meet. I was so scared to go to those. I on an email list and every month I was like, I'm coming. And then every month I was like, I was sick or whatever. And the chapter leader was such a sweetheart and was like, well,

I was, hope you feel better. We'll see you next month. And he knew what I was doing, but what just was very sweet. And eventually I went and there was a regional conference in Anaheim that I went to and it was terrifying. It was so scary to meet other people stutter. but when I talked at like an open mic or I made connections, people were so excited and they saw me. They were like, you're an outgoing person. I had never had anyone say that to me. they could see.

like, past the stutter to who I was. They could see those like nervous things, but they knew what they were. They knew it wasn't my personality. And it started to change how I saw myself as I met other people. And I realized how cool some people were. And you meet lawyers, you meet all these career paths, you meet journalists, you meet public speakers, who've mastered those masters or like a grand master.

Ezra Horak (13:59.714)

All these excuses you've told yourself, you meet people who have done it, and it started really shifting and I realized, why aren't we, why are things the way that they are still? Like, why is this something everyone who said or seems to go through this whole, l-l-l-l-l

And so as I went on my own journey for the next like 10 years, I eventually realized I really wanted to create my own thing. wanted kind of a freedom to really say some of the things that I wanted to say, because some of the things I knew I wanted to say could come off to some people as controversial, even if I put a lot of thought, even if I'm really careful, I knew that it was going to rub some people the wrong way. And so

I kind of stepped away from all of the different places I was volunteering and a part of at the time so that I could just like not have any ties and just do it from me from Ezra on stutterology and that's it. And so that's what I started to do. it originally I originally I was just going to be talking for two parents. That was the point of my podcast at first was parents need resources. They need to know like my mom.

The reason she was able to set me up for success is because she was prepared. Someone gave her those resources. So I thought, okay, how can I help to do that? But most of the people I know are people who stutter and they started to listen and they were like, you got some really good stuff in here. We want more of this. And that encouragement, when I first started actually, I would have, if you had asked me,

How do you feel about fluency goals in speech therapy? So not just techniques, I separate those out when I talk about them. I'm sure we'll get into that. But like the goal is fluency. When I first started stutterology, I would have said, well, it depends the person, you know, it's probably okay sometimes if that's what they want. And I had some speech therapists actually who don't stutter who reached out and were like, I'm gonna ask you to think about this a little more. Like, you you're allowed your thoughts, you whatever you want. But like,

Ezra Horak (16:17.622)

you seem like you have these beliefs, but that contrasts with this. And if it's because you're afraid to be bold on this, like here's some thoughts. And it was extraordinarily helpful. And it did help me really rethink things. And so we'll get into that, but yeah, eventually that did change. And I've grown a lot since I even started that. And I'll give you the twist with my grandma since I hinted at it. A couple of years back, we were at, I think it was like a

Mother's Day brunch. And she goes, so you went to your thing this year at the conference. And I was like, yeah, grandma. I went to my stuttering conference and I, cause the NSA has an annual one and she goes, so you guys just accept it. And I was like, yeah, grandma. And she's like, well, I guess it doesn't hurt anyone. Yeah, grandma. And she says, you know,

When I was a kid, I had a stutter.

Ezra Horak (17:23.722)

And that moment, I felt like a reverse, like that's so Raven, where I sat there and everything she had ever said, every comment that was mean, and not that it excused it, but I saw it in a whole new light and I realized she was scared.

And my mom was very upset. My mom was there and almost stood up and left because she had been asking my grandma my whole childhood, do we have any family history? Has anyone in our family ever said or did? My grandma always very confidently said, no. No one has ever. So my mom was upset and I was in shock and my grandma was oblivious to having caused this reaction and no one said anything really. We're just like, okay. And moved on. But it was, it was a very,

eye-opening moment for me to realize that a lot of these times, some of the hardest stories I've heard from people who stutter with parents, often the parent has had a stutter or has one and they're repressing it, there's a trauma reaction, and unfortunately it's taken out on the child. And it just was such a mind-blowing though.

It didn't make any of the things that she had said feel great, but it definitely made it feel different. So that's the twist. That was quite a twist at the time.

Marisha (18:50.92)

Wow. And I think that is so in the series where one of the things we talk about is like navigating this with parents and all of that too. that is like, that is such a beautiful example of, cause the, not all parents are like your mom who like, there's some very, very different reactions, more like your grandma. And as speech therapists, when we're navigating that,

it's important to think about like, like these, like this was, you just provided one example of what might be behind that reaction. But I think a lot of it is fear, whether it's like personal experience, kind of trauma related, or just like fear for your kiddo too. So I think that's such a beautiful example. And my gosh, so many, I feel like I'm gonna have to re-listen to this like 10 times because there's so many.

Ezra Horak (19:44.804)

you

Marisha (19:48.834)

like nuggets and takeaways. my goodness. so thank you so much for sharing so authentically and just so much of your story. I think this will be really helpful for speech therapists to be able to do that perspective taking and, yeah, you did such a beautiful job with that. So, wow. Okay. so I think now I guess we can transition now to chatting about

fluency expectations because that was kind of a common thread in your story in like the difference between the speech therapists that you felt was and I'm interpreting this so you can correct me, but you had a good experience with the speech therapist and not so good experiences with a lot of speech therapists and it seemed like one of the factors was fluency expectations and I guess that could be and that was illustrated in

Ezra Horak (20:23.821)

Okay.

Ezra Horak (20:32.514)

Yeah.

Marisha (20:49.004)

the contrast between your mom and your grandma to potentially. And so I feel like you gave us a lot of different examples, but I think it'd be nice to just like take a bird's eye view and chat about why those expectations can be detrimental and how fluency treatment might be harmful for kiddos.

Ezra Horak (21:10.18)

to definitely yeah, yeah, I will say that is gotta be the biggest game changer for the differences and experiences is one is asking you to be fluent and the other one just is asking you to talk and doesn't care how it comes out. I've also told people one of the best things my mom did. I don't have a single memory of her ever praising fluency. Not single ever. It was always

I'm glad that you talked. I'm glad you shared. It was never good job at how you said it, ever, ever. I don't remember a single thing. And I think that really speaks to that idea, right? It's not even just punishing someone for stutterin'. It's just hoping and wanting. You can't stop the hope and the want, but you can monitor how it comes out and how it happens. And you can work on that for yourself. I know you guys talked to Nino already.

And I know she does a lot of work on processing, parents especially, but species therapists too, like processing some of this on their own time, not in front of the kid. And the reason it makes such a difference is we know that there's no cure for stuttering, right? Like people can argue till they're in the face about if there's things you can do to hide it, but there's not a cure.

The, of kids who stutter, you know, the commonly thrown around percent is that 20 % continue to stutter. And I always frame it that way because I think when we say 80 % grow out of it, we're focused more on that 80 % and why? I want us to focus on the 20%. That's not a small number. That's a lot of, of these kids. And when you're asking them to do something that is physically impossible.

You can't be cured. It's not going to happen. And you're hoping for that for a kid. You're putting those hopes on the kid. You're putting expectations like that. They will fail you. Like they will. Like that's not up for debate. Like it won't. And they'll fail themselves and they'll know it and they're aware of it. Kids are really good at picking up on wanting to please the people around them. So even if like with the praising for fluency, even if you're not saying the negative things about

Ezra Horak (23:33.124)

but you're clapping or you're telling them good job, or when you're doing some of the fluency techniques, you're making them repeat if they stutter during it. All of those things are examples of things a kid is going to pick up on, and they're going to know what the expectation is. And that's only going to be amplified more if they're having some negative experiences outside of the speech therapy room. So like the story, one of the stories I told was about a play that I was in in third grade.

And that was apparent to a classmate. So they were outside of like my mom's level of influence, right? And it impacted me so negatively that it would have eventually impacted the speech therapy room because now I didn't need them to tell me it wasn't okay to stutter. I went in assuming it wasn't okay and then was like, would have needed to be reassured in different ways and by proof.

not just telling me it's okay to stutter, but actually making it okay to stutter. I don't have a lot of memories of that first speech therapist, because I was young. And also, I didn't leave with any trauma, I guess. so, you know, I don't, but I, my mom said, you mostly just went in there and like, you guys talked and you had a good time and you played and, you know, she'd ask you about how you felt. She'd ask you how things were going and she'd ask questions, but it wasn't, you weren't,

sitting there with a list of words, doing these different techniques every time, which is what most of my speech therapy after that was about. And there's different reasons it's frustrating because even if you quote unquote see improvements, which I don't talk about it that way, but like if you know, that's the traditional way to talk about it. If you're seeing these improvements, stuttering is variable. It comes and goes, it changes.

and now you've just assured someone, great, thank goodness you're at 90 % fluency now. And then when you start starting again, you're well aware that people are gonna be disappointed that you didn't keep that up. It's just such an unsustainable and irrational expectation to have on something that isn't.

Ezra Horak (25:52.298)

isn't as easily understood for one, and two, it takes so much effort to control and even that leaves us grasping for straws. The other thing that's really important to understand is that when you're asking someone to do these things, it doesn't feel quote unquote fluent for me to do fluency techniques. So if someone's wanting me to be fluent,

To me, there's no other reason to want that except for a listener reaction. I know that that's not true for everyone who stutters. I know for some people, you But for me, that goal was for other people. It wasn't really for me because I was gonna struggle whether someone else heard stutterate or not. It was gonna be a struggle.

So the only reason to make that goal is if you want it to sound clean. If you don't like how I sound and you want me to sound clean, then we'll do it your way. And it just really broke the way that I saw communication. And I think it still impacts me to this day, unfortunately. It really does come down to exactly like what you said, this like expectation for something that I couldn't give. And even if now I'm okay with my stutter and I feel good,

it seeped into all these other areas. You probably know growing up as a girl or different things, you have other things telling you it's not okay to be who you are and that you're supposed to be smaller and quieter. And there's like an intersection that happens with stuttering that like really amplifies all of those things too. And so even when now I've done so much work and I feel good about my stutter, I don't always know if my voice is, I doubt that my voice is welcome.

conversations very often. And it's probably not just the stutter, but it would be lying to say that that has had no impact, even if I've worked through it. So it causes some pretty intense and deep running impacts to have this expectation to talk in a way that's not how you usually talk, especially if it doesn't really benefit you all that much and you're aware that it's for other people. Hopefully that answered your question.

Marisha (28:11.382)

Yeah, no, that was beautifully said and gosh, so many things. but yeah, and I think that having the focus on having communication feel easy and we don't need fluency techniques. Like from your experience, fluency techniques make communication feel very not easy. So

Ezra Horak (28:36.611)

Yes.

Marisha (28:38.732)

I think that's a really helpful reframe of, cause I think when I first started learning more about the, like the shift away from fluency, that was something that I struggled with a little bit of like, but how do I help them? What do I do? But I think that like focusing on, okay, what can we do to make communication feel

Ezra Horak (28:57.518)

Yeah.

Marisha (29:06.89)

easy and what can we do to empower these students? And unfortunately, there's, it's like, we need major societal change to really address it. But like, what if we lived in an alternate universe where everyone just talked how they talked, there wasn't like a right or a wrong way. And we could just talk like we wouldn't. I don't know. That would be so

Like you wouldn't have felt like you couldn't pursue journalism if that was the universe that we lived in.

Ezra Horak (29:35.79)

Yeah.

Ezra Horak (29:39.33)

Right. Right, you know, and there's probably a couple things that, you know, Duterte would like, like what I would do when I would talk about the journalism suggestion is I'd be like, well, what if I'm at a press conference? I always look the most extreme example. What about a press conference? And I can't yell the word out faster than everyone else. Like that's a reality. And so for that reason alone, I'm not pursuing this entire career. just, but one of the things I think is that like we,

got to get more creative with some of this, you know? Like there are alternatives to things. There are ways to accommodate disabilities in the world. We have learned that with certain things. And so let's get creative. You know, I think of someone like, and maybe I should be careful using a different disability as an example, but I think of someone like Stephen Hawking, who spoke often through, know, who spoke through this, I forget the word for it.

but alternative way of speaking, right? And people who stutter will say, well, we don't wanna, a lot of people sort of resist certain things and resist accommodations. And they'll say, well, at the end of the day, people aren't gonna take us seriously because we stutter. And it's like, well, people didn't take him any less seriously, right? Like maybe some people, but like, no, what he said was important and that's what counted. Like that's what we count. And so I don't think there's any reason to think it's impossible.

to find accommodations. There might be pushback, you know, we're not all, like that's an extreme example of someone who is very prominent. But to me, it sets this idea that it's possible. Like it is possible to find accommodations, even in situations where it seems like, well, that's an option where maybe you would have to do this or that. Like I think maybe not. I think it's at least worth considering.

Instead of the problem, I think that kind of touches on what you were saying, the problem, we often see the thing we, like speech therapists want to help, the parents want to help people who stutter from is the stutter itself. And the, yeah, and the stutter is not the enemy. And that was something I didn't know. I always assumed, you know, and a lot of people who stutter, we talk about our stutter that way. go, my stutter holds me back, my stutter this, my stutter this. But if we were to sit there and very like rationally,

Marisha (31:48.622)

That's not what you need,

Ezra Horak (32:05.924)

approach it from a different mindset of more of like, I'm working on a post right now of the disability models and like the medical model and the social model and all the different ones because there's a whole bunch. But when we work on shifting that and we see it as, wait, there's other things going on, we realize that by helping someone who stutters, we don't need to offer them.

fluency, you know, and you mentioned easy speech and I think I've seen an unfortunate number of people who just swap fluency with easy speech. And they're saying the same thing because they watch someone stut-ut-ut-ut-utter and it looks like a struggle. Whereas if you watched me not talk, you might not think I'm struggling because it's not apparent to you. But for me, not talking or using these fluency techniques would be a lot more of an inner struggle for me than

talking with a setter, even if maybe it doesn't look that way from an outsider's perspective.

Marisha (33:08.418)

Yeah, yeah, I love that.

Okay, and then, so, gosh, there's, I'm gonna just try and process out loud a little bit in terms of maybe some takeaways for SLPs. And there's so many things. I wish I could process it a little bit better. But, so you had said, like, we know there's no.

career first stuttering and like some people will like a percentage of people will grow out of it. And that may or may not be because of the strategies. And like I think taking your experience into consideration is really helpful because

Our ultimate goal is for you to communicate. You have so much to share and your like, yeah, everyone gets to communicate in their own way and just having some acceptance around that would make the ultimate goal of you communicating easily so much easier.

Because even if we're using fluency techniques, that makes communication harder for you.

Ezra Horak (34:43.396)

For me, yeah. And I always acknowledge that when it comes to techniques, there's a difference in different people and there's a difference in where somebody is at life. So maybe at one point in time, they wanna use them and then later they don't. And it is important to at least have them be taught at some point, but depending on the situation and from an informed stance. not one of the things like what was really common.

my friends and I was that we thought we were supposed to use fluency techniques every single time that we started, right? Because the goal was to be fluent. And that's the issue is that when the goal is fluency, that's not going to happen. But when, if I'm on, if I'm stuck on a phone call that's voice activation, I would use a fluency technique for that because I have to. If I'm going to block and I know I'm going to, I'm going to pull something out that I never use. It's not easier.

in conversation, but it's a necessity of a broken society that doesn't currently have an accommodation that I do hope will one day. And I think we can fight for that. And I think there's a responsibility to fight for those types of accommodations. But I, and I've also seen people use that as an excuse to continue with everything that they're doing. And I think there's a difference between showing up on day one or two and overwhelming someone with fluency techniques versus

bringing it up at some point and offering it, seeing how they respond and explaining this isn't for every day. This is for if a situation like this happens, this is for when it is, when it does feel easier for you. And if it doesn't feel easier for you, then absolutely don't do it. Like the goal is, right, like you said, the goal is actually making it easier for the person. that, with me, it almost never means doing any of those techniques.

But everyone is different with that. So I wouldn't want to throw everything out, but I would want to throw all the fluency goals out. And I just want to re-approach the way we see all of this. I don't think they're necessary. I don't think fluency techniques are necessary for everyone.

Marisha (36:55.894)

Yeah, I love that. And so if the ultimate goal is easier communication, then we can tailor the therapy approach to what the individual needs and what actually feels easier to them. So I think that's a really nice takeaway. You explained it so much better than I tried to. It's like trying to consolidate, but yeah. So if we can make the ultimate goal easier communication, and then we can work with the student.

to figure out what that looks like. But it sounds like, especially taking, like the takeaways from your story are that just making it okay to stutter and really just focusing on that overall message. Yeah, okay, awesome.

Ezra Horak (37:43.256)

Yeah, yeah, I think it's huge and I think I wouldn't have been able to get to where I'm at, even though it took a while, faster still than a lot of people I know because I think I had a foundation that was very strong, that even when it got covered with everything else, it was still there. So, yeah.

Marisha (38:05.004)

Yeah, and the speech therapist listening can be that for, like they can provide that same foundation for other students. Okay. And then, so you kind of shared some of this already, but if we're embracing stuttering as like a natural part of communication and we're focusing on just like, okay, what can we do to make communication feel easier? What?

What are some of the things that like your foundational SLP did that were really helpful? And maybe what are some other things that others speech therapists or whether it doesn't matter who did what, but what are some things that weren't helpful in like working towards that goal? you have, can we maybe recap like a handful of things?

Ezra Horak (38:56.612)

Yeah. I think one of the main things is listening to your client and really listening, not just like a surface level, like, you know, asking questions and understanding, because we'll sometimes parrot back what we've heard. If you would have asked me my goal in high school, I would have said fluency. And then you would have written fluency in my goal. And it would have taken, well, what does fluency mean to you? Right. What what's different about your life? If you're like what's

what's really going on. And that takes time. It's about building a relationship. I think my first speech therapist did that. I think some of the other ones I had, not in high school, but a little bit later on, did work on that. And you could see that it did benefit us to have built a relationship and for them to really be listening. And sometimes they were wrong. And the...

I remember the times I called it out, they were embarrassed, sure, as a child saying something to an adult, it's gonna feel a little weird, but they listened to me and in the future changed things. And so I think that really helped give me that agency. So I think agency is another thing is allowing the child to kind of be leading some of the direction and you help guide that, right? You don't just give them, but like you...

the child led kind of thing I think is really important. And knowing that everyone's different, I was super social. I liked to raise my hand every moment I could if I even thought maybe I knew the answer. Not everyone's that way. Some kids may not want to ever raise their hand and it might have nothing to do with stuttering at all, right? Just like there's a variation with non-stuttering kids, there's a variation with stuttering kids. So just kind of trying to suss that out though, needs a relationship. So it really all comes down to like,

listening and building a relationship and having a difference in the expectations, obviously. And she helped prepare the people around and we did self agency things or self advocacy things, I mean. And so would teach me, okay, you you're talking to your teacher, you want to let them know that you set her, how are you going to let them know? And helping me build those kinds of things. Role play, is it something that like

Ezra Horak (41:16.504)

I did much, but I've heard other people really speak highly of it as far as kind of helping build that same confidence. So focusing on like the confidence of the child and if they're spontaneously speaking, because even if they're not an outgoing kid, you would hope that at home or in the therapy room, they're spontaneously speaking of their own accord at times, because that is something that you do expect to see in, maybe not all children, but like a good amount of them. And so just trying to...

navigate more. think Chris Constantino, he's a researcher. He talks about spontaneous speech as a shift in goals. And then some of the things that weren't helpful were lists. And I hate that because I know it's easier and it's like, and I know how overwhelming speech therapists are. But when it's just like, you're going down a list, you're doing the technique, and then you have to repeat things that you do, quote unquote, wrong. Because why else would you repeat it unless you

did it wrong and it was considered wrong if I stuttered when I did it, right? So even if maybe the sweet therapist didn't realize that, being very mindful when you're doing, because sometimes you do, you do your practices, you do your lists or maybe instead of a list you have them like read from a book, which sometimes I did, and practice it on words from the book instead. And just being mindful of what you're doing every time you interrupt someone who stutters.

because it's not gonna be, it's being received as, I did something wrong. Letting go of absolutely any goal that involves or any practice that involves counting how many times someone stutters. And I know that that can be an intro. I'm sure you'll cover it in future ones of how that goes. But the more you can let go of that, especially having the kid or even adult count is...

Ezra Horak (43:11.428)

How do I say, I'm not, I don't want to say like abusive, but it's going to cause trauma. Like that will definitely. And yeah, I think there's like a lot of the things that feel like, okay, well, this would be easier to do. This is measurable. You want to question that. You want to question, well, what am I actually measuring?

is this a full picture of someone? And so it's hard. I'm giving more instead of like a list of things of it's more of a like thought process with the different things, but like questioning when something feels straightforward in stuttering therapy because it's usually not, and I'm sorry, but it's you're working with human beings and we are nothing. We are not straightforward. That's not a word and not consistent across the board. Right. And so

The more nuanced something is, probably the better territory you're in.

Marisha (44:13.718)

Yeah, that's really helpful. And the subsequent episodes will dive into a lot more of the like specific things that we can do and what it looks like to implement that. because there are ways to, cause we need to have our numbers for billing or whatever. And there are some beautiful, like neurodiversity affirming child friendly, child led ways to.

meet our requirements and do what's best for students too. So stay tuned for all the future episodes because we are going to dive into all of that. yeah, Ezra, this was so helpful in just getting to kind of set the stage and thinking about some of the different perspectives and

Like thank you for doing such a nice job of sharing your story. And I feel like I got to kind of.

I don't know. feel like it just has really helped with my perspective and you just shared some really beautiful examples. is there anything else that you, I know that we could probably talk for hours and hours and hours, but are there any, is there anything else that you really wanted to share before we wrap up?

Ezra Horak (45:38.212)

Yeah, and I think the main thing is keeping in mind, you know, that people have a lot going in, that they have a history going into speech therapy. And so what might sound like something really clear, I want fluency, maybe, but maybe it's worth going further into those things. I think to me, that's the biggest thing is most people think someone who stutters wants fluency. It's a pretty common thought. It's not true all the time. But I think that that's

mostly a problem in a lot of people who stutter think that everyone who stutters wants fluency because they've never been told anything else. They've never considered anything else. So sometimes you're going to be exposing someone to something they've never even considered in their life and it goes against everything their worldview is based off of. so being aware of that and

mindful of that and knowing it might not go, you're not gonna tell someone, it's actually okay to stutter. You're be like, okay, great, it's great now. It's gonna be a process and it's gonna be probably hard depending how much that person has built it up. Maybe they have nothing, maybe they're like me at six years old and they go in and they're like, okay, it's okay to stutter, sure, great. That's awesome, I want that. I hope that's more and more common as time goes on.

But it's also possible you're gonna get the opposite of that. And also my last thing is, yeah, that kindness with parents and guardians, whoever's helping raise that kid, it's, I imagine, unbelievably hard sometimes. I remember fights between my grandma and the speech therapist. And finding ways to appease them while also protecting the kid is really hard and it's not an easy task. And I admire...

Some of those speech therapists, maybe I didn't have 100 % perfect experience, but I do remember that they found it important to, no matter what they said to her, made sure I felt safe in the speech therapy room. And that was the most important thing I think that they could have offered me at that time.

Marisha (47:50.604)

Yeah. And I love that you, what you pointed out about ask, one of the questions that you said was like, what does fluency mean to you? Because society is telling us that and telling our students you need to be fluent. Like that's kind of the societal expectation at this point. And I feel like it's starting to shift.

Ezra Horak (48:16.568)

Yeah, and I feel like people don't, yeah, sorry.

Marisha (48:19.128)

There's more acceptance in certain places than others. But asking, what does fluency mean to you? And using that to dig down a little bit more and figure out what the student, because the student is probably going to tell us they want to be fluent. I don't know if that would.

Ezra Horak (48:35.748)

Mm hmm. It, checks the box. Yeah.

Marisha (48:39.084)

Yeah, but what do they actually want and what would actually be helpful? And I feel like you gave some really nice examples on how to like dig into that and we might not be taking what students say right at face value.

Ezra Horak (48:54.094)

Yeah, yeah, yeah, because I think people don't even realize how different it can feel for like for me. When I said I wanted to be fluent, what I meant, I didn't want to think about the way that I talked. That's what I meant. And so offering me fluency techniques was to me, that's not fluency. That's still stuttering. I'm still dealing with the stutter. So that's not fluency. But what I didn't know then was that I could not think about the way that I talked and

Marisha (49:04.716)

Mm-hmm. Yeah.

Ezra Horak (49:23.054)

stuttered. I didn't know that that was an option until I was in my 20s. So you'd be surprised by what different people... so that's not the only view of what fluency means. You'll be surprised by the differences that different people have.

Marisha (49:37.25)

Yeah, yeah, I love that. Well, thank you for being an example of kind of what we can just like one of those perspectives and as speech therapists, we get to have those discussions with all of our students or clients and really get to know them and what they need and just empowering them to be the communicators that they are. So.

Yeah, thank you again. This was incredible. I'm so, grateful. I hope that, and then I hope that the listeners have some great takeaways too. The show notes are linked in the description and I'll link to Ezra's Instagram and website and other resources. But yeah, I think that's a wrap.

Ezra Horak (50:26.884)

Great, good. ahead and me on st-t-t-t-t

better. So thank you for doing this.

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5 Quick Questions to Audit Your Referral Process

July 8, 2025 by Marisha Leave a Comment

Let’s be real. Referrals can be a total time suck.

If you’re constantly chasing paperwork, reviewing inappropriate quality referrals, or feeling like your system is non-existent, this post is for you.

Based on insights from over 400 school-based SLPs, I’m sharing 5 quick but powerful questions you can ask yourself to audit your referral process.

This mini audit will help you spot time-wasters, cut down on chaos, and build a system that actually works for you (not against you).

Question 1: Do you have to chase down teachers or parents for info every time?

If the answer is yes, it might be time to implement a referral form. A simple Google Form (or a HIPAA-compliant tool like what we have inside SLP Now), can help you collect key info upfront.

→ No more back-and-forth emails.
→ No more trying to remember which questions to ask.
→ Just one streamlined form that gets you what you need.

A well-designed form can save hours of follow-up time and ensure every referral starts on solid ground.

Question 2: Do most referrals end in “not eligible” or “RTI needed first”?

Too many referrals that don’t lead to evaluation = a system breakdown.

It could mean your team needs more education around developmental norms or interventions. Supporting teachers with guidance and tools can boost referral quality and save everyone time.

→ Share developmental checklists.
→ Offer intervention ideas.
→ Train staff on when a referral is truly needed.

It doesn’t take much, but it can change everything.

Question 3: Can you describe your referral workflow in under 30 seconds?

If you’re winging it every time, you’re not alone, but there is a better way.

Having a simple, 3-5 step process that you follow every time will:

→ Save your mental energy.
→ Help you respond faster.
→ Make things more fair and consistent for students.

Think: “I get the referral, I review the form, I screen or consult, then I decide next steps.”

That’s it. No wheel reinvention required.

Question 4: Do referrals feel like a surprise flood?

Referrals shouldn’t feel like a tidal wave, but for many SLPs, they do (especially in the spring).

Here’s what helps:

→ Frontload teacher training in the fall.
→ Track referral patterns over time.
→ Explore proactive screenings in high-need grades.

We can’t eliminate all the surprises, but we can make them more manageable.

Question 5: Are referrals taking you more than 3 hours each?

According to our survey, the average SLP spends 3+ hours per referral. That’s a lot.

Next time you process a referral, take note:

→ What’s eating the most time?
→ Are you doing steps that could be simplified or skipped?
→ Is it time to refine your form, workflow, or teacher guidance?

A referral should not take more time than an evaluation. (And with the right system, it won’t!)

So, how many yeses did you get?

If you said yes to 1 or more of these, that’s a sign your system could use a tune-up.

But the good news? Even one small change can free up your time and make referrals way less stressful.

Want more help? I’m sharing my best tips (plus a bundle of free referral resources) at my SLP Summit presentation.

Sign up for free here: slpsummit.com

Let’s simplify referrals together! You’ve got this, SLP. 💛

At SLP Now, we are hard workers… but we also like to work smarter.

That means we’re constantly improving our materials, therapy planning resources, and the ways we support SLPs like YOU — so you can skip the hard work part and just work smarter. 👇

How is that possible, you ask?

We’ve talked about so many activity options during this series… but there are even more literacy-based ideas and evidence-based resources waiting for you on the other side of SLP Now. 🤗

Join thousands of SLPs and get the support you need

Subscribe to the SLP Now podcast and stay tuned for our next series. We’re kicking off September by helping you get your data collection, paperwork, and therapy planning processes in tip-top shape!

Listen to The SLP Now Podcast on Apple ★ Spotify ★ Google ★ Stitcher ★ Castbox or wherever you listen to podcasts.

Transcript

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Hello, there. I am so looking forward to continuing our conversation around referrals. Last week, we talked about the struggles that SLPs face when it comes to referrals, based on our survey of over 400 school-based SLPs. If you're listening to this episode, you are probably an SLP who is struggling with referrals or at least want to make referrals easier.

And I have five questions to help you start that process and figure out how you can make referrals easier for yourself. Jot down a quick note anytime you say yes to these five questions. It'll help us come up with our game plan for how to move forward. The first question is, do you have to chase down teachers or parents for information every time? When you receive a referral, are you having to run around to get the information that you need to make your decision? This is a struggle that a lot of SLPs talked about in our survey. If you're answering yes to this, you can start thinking about some teacher and parent input forms.

A lot of SLPs said that they use Google forms. We also have this built into SLP now in a HIPAA compliant way. By having a template in the form of a Google form or the SLP Now forms, you don't have to waste time thinking about what questions you're gonna ask. You have the templated way to organize it, and if you're in the habit of using paper forms instead of digital, this can save you time because you have all of the information in one place versus having to organize all of the papers.

One thing that an SLP said in our surveys was that collecting all the background information and accessing the student's academic history is almost more work than an evaluation. A referral should not be more work than an evaluation. We need an easy, streamlined way to collect that information and quickly make those decisions.

By having a streamlined process that includes a form, you can potentially save hours with each referral depending on how much time you're already spending.

Question two is, do most of your referrals result in not eligible or RTI needed first? Are you getting a lot of inappropriate referrals where you are having to say, "No, they're not eligible. They need intervention." We really should be getting high quality referrals that generally lead to an evaluation.

Hopefully there's enough supports upfront where anytime we receive a referral, it is a very high quality referral, when they've exhausted their resources and we really need some help. If you are having a lot of those not eligible or RTI needed first referrals, that is a red flag that, we need to educate our teachers and maybe teach them about developmental milestones and when it is appropriate to refer, or arming them with different interventions that they can use.

And it makes sure that they're supporting students before it gets to a special education decision. A quote from our surveys was that teachers make referrals for every minor speech error and administrators are making language referrals in place of full psych evaluation.

So again, those are some examples of what this might look like, where we're not getting appropriate referrals and we need to do some education. I'm presenting at the SLP Summit , and I am going to be sharing handouts to help you with educating teachers and administrators, in terms of what makes an appropriate referral and what is appropriate for each grade level.

It's an epic bundle of handouts and resources, and anyone who attends my presentation will get this handout. So, head to SLPsummit.com if you wanna check that out. I'm really excited to, share even more tips around referrals, but then also help you, by giving you these free resources that you can use right off the bat.

Question number three is, can you describe your referral workflow in under 30 seconds? In the survey, a lot of SLPs said that they don't have a clear or consistent process. They're reinventing the wheel every time.

One SLP said, no, I'm just winging it every time. The cost of winging it is really so much extra time and so much stress. If you're having to figure out what to do for every referral versus if you have a three step process of I send out the form, I do this, and then I do this, and then the referral is taken care of, it reduces the mental load and decreases the time it takes to manage your referrals. It also improves the quality because every student is getting the same quality of referral and consideration, not skimping on some students versus others. My SLP Summit presentation will walk through, an example of a process and how you can build your own workflow, and it really should just be a couple simple steps. This may vary depending on your district's requirements, but we really should be able to keep it short and simple.

My fourth question is, do referrals feel like a surprise flood? Are there seasons where you are getting tons of referrals, and feeling really overwhelmed? This typically happens in the spring when teachers are realizing that it's time for students to move to the next grade and they're realizing that maybe they didn't do everything that they wanted to.

If you're answering yes to this, you might consider front loading our teacher training, or at least tracking patterns and trying to find ways to make this more manageable. Increasing the quality of our referrals and providing teachers with interventions, they, should be able to more quickly identify students who might need support.

They can consult with you for help on interventions earlier on so that when it gets to the end of the year, they feel confident that the student actually made progress and doesn't need that support. Or they can decide earlier like, oh, I implemented these interventions and it is very clear that this didn't do the trick.

So that is question number four. Do you have a flood of referrals at a certain time of year? You can consider teacher training, proactive screening and other strategies depending on where you are in the journey. If you're feeling like you don't have a process at all, it might be helpful to think about training teachers.

If you have a streamlined process and you're still having floods of referrals and educating your teachers, you might consider doing more proactive screenings or providing more teacher support in specific areas based on what you're seeing.

And that brings us to question number five. Are referrals taking you more than three hours on average? In the survey results, the average time that SLPs indicated they were spending on referrals was about three hours. Ideally the time. you spend on referrals is much less than that but that's where we're sitting as an average.

so there's definitely room to reduce that. A great goal could be to get your referrals done in an hour or less. If you are in the camp of referrals taking 3, 4, 5, or more hours, next time you have a referral, think about what's taking the most time?

Or maybe think back on your past referrals and where have you spent most of your time? Is it the paperwork? Is it trying to hunt down information? Is it the inappropriate referrals? You might also consider the number of referrals. You can ask your colleagues, how many referrals are you getting in the different schools?

And that could be a strategy to think about too. As you're thinking about the steps of your referral process, you can think about, do I really need to do this? Is there a way to make this easier? Or do I need to do some upfront work to, maybe prevent the need for this step?

So those are our five questions. Question number one is, do you have to chase down teachers for information? Question two is, do a lot of your referrals result in not eligible or RTI needed first. Question number three is, can you describe your referral workflow in under 30 seconds or is it a very complicated process? Question number four is, do you ever have a flood of referrals? And then question number five is, are referrals taking you more than five or three hours on average? So how many yeses did you get? I'd love to hear where you're at. One or two or three yeses is a sign that you have some room to tune up your referrals and save yourself some time, and make your work life a little bit easier.

If you are wanting to learn more, please do join me at my SLP Summit presentation. You can sign up at slpsummit.com.

It is free to attend, and I'm going to be sharing a bundle of free handouts for anyone who attends. I'll see you next week as we continue this conversation, and I hope you have a fabulous week.

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The SLP Referral Struggle: 5 Common Challenges (And How to Fix Them)

July 1, 2025 by Marisha Leave a Comment

If you’re spending hours tracking down teacher data and losing your prep time to a disorganized referral process, you are definitely not alone. We recently surveyed over 400 school-based SLPs and found that the average referral takes a staggering 3 hours to process. In this post, we’re breaking down the five biggest referral struggles—from incomplete background info to the dreaded springtime flood—and exploring how we can start reclaiming those 45 extra hours a year with a streamlined system.

You’re not behind, and you’re not doing it wrong. You are simply working within a broken system. Let’s look at the five major challenges SLPs face when navigating referrals and how we can work smarter, not harder, to fix them.

1. The Background Info Black Hole

The #1 struggle? Incomplete background information.

Referrals rely on input from teachers, parents, and admin. Coordinating all of that takes time and a lot of chasing people down. Without a clear system in place, most of us end up cobbling things together on the fly.

→ Ever tried to make an referral decision without classroom data?
→ Or received a form with one-word answers (if it’s filled out at all)?

Yeah. Not great.

We need background info to make good decisions, and we need systems to make gathering that info sustainable.

2. When Referrals Aren’t Appropriate

Another huge theme? Inappropriate or premature referrals.

Sometimes teachers refer students who are simply developing normally for their age. Other times, they refer without trying any classroom interventions first.

Neither is ideal.

And here’s the kicker… Once a referral lands on your desk, the clock starts ticking—whether or not it’s truly necessary. That adds pressure, work, and (often) a full evaluation to your plate.

3. The Wild West of Referral Processes

This one hit home… Most SLPs said they don’t have a standardized referral process.

Not even within the same district.

One school might have an entire team to support the referral process. In another, you’re left guessing what admin expects.

That inconsistency leads to confusion, delays, and way too much mental load.

4. The Springtime Referral Flood

While referrals happen all year, the majority of SLPs reported getting swamped in the spring. It’s like the floodgates open in March and suddenly there are 10+ new referrals to consider, on top of the rest of our already heavy workload!

5. Time. Always, Time.

Here’s the math:

Average time to complete one referral = 3 hours

Average referrals per year = 15

That’s an average of 45 hours of extra work.

And that’s before we even talk about evaluations or IEPs that come from those referrals.

It adds up fast. And if your system isn’t streamlined? That time multiplies.

So… Now What?

If you’ve been white-knuckling your referral process or blaming yourself for falling behind, I hope this post is a giant exhale for you.

You’re not behind.
You’re not doing it wrong.
You’re working within a broken system, and you’re doing your best.

Over the next few weeks, I’ll be sharing strategies to simplify referrals, build out systems that work, and reduce the chaos (without adding more to your to-do list).

Because we deserve a process that supports us, and students deserve thoughtful, well-informed decisions.

Ready to Simplify?

📌 Listen to the podcast episode for the full breakdown! (You can find the audio at the top of this post, or tune in with your favorite podcast app!)
💬 Have a referral challenge I didn’t cover? DM me on Instagram at @slpnow. I’d love to hear your story.

At SLP Now, we are hard workers… but we also like to work smarter.

That means we’re constantly improving our materials, therapy planning resources, and the ways we support SLPs like YOU — so you can skip the hard work part and just work smarter. 👇

How is that possible, you ask?

We’ve talked about so many activity options during this series… but there are even more literacy-based ideas and evidence-based resources waiting for you on the other side of SLP Now. 🤗

Join thousands of SLPs and get the support you need

Subscribe to the SLP Now podcast and stay tuned for our next series. We’re kicking off September by helping you get your data collection, paperwork, and therapy planning processes in tip-top shape!

Listen to The SLP Now Podcast on Apple ★ Spotify ★ Google ★ Stitcher ★ Castbox or wherever you listen to podcasts.

Transcript

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Hello there and welcome to the SLP Now podcast. We are excited to be kicking off a new series all about referrals. We are going to be spending the next month or two diving into this topic, because it's an area that a lot of us struggle with when it comes to our workload.

We sent out a survey to the SLP now email list and 434 SLPs responded and shared their feedback in terms of how they're managing referrals and what it looks like and what the struggles are. And so we have some really, really good data.

We asked the years of experience and the setting and the basic demographics It feels very representative of, the school-based SLP world.

I'm really excited to share this with you. Today we are going to be diving into the five common areas that came up, in terms of areas that SLPs are struggling with when it comes to referrals. the goal of this episode is to set the stage and identify what we're seeing as the trends. Hopefully if you are struggling with referrals, you'll realize that you're not alone in this. We are going to spend the next month, and even more time breaking this down and making it more manageable for all of us, because there are major challenges when navigating our referrals.

Let's dive into the five areas that we identified after hearing from 434 SLPs.

The first challenge was incomplete background information. It's really challenging to collect all the information we need from teachers and parents, to make an appropriate referral decision, and that takes a lot of time to coordinate with the teacher. A lot of us don't have a solid process in place either. sometimes we're trying to track down teachers and figure out what questions to ask them, and we may or may not have a form to help us with that. It is really challenging to get that solid background information to make an appropriate referral decision.

Number two was inappropriate referrals. There are two main types of inappropriate referrals. One is when teachers are over referring because they don't know what's developmentally appropriate or expected, and they may be referring for something that is typical for that age. So there definitely is some education that needs to happen to improve the quality of our referrals. And then the other aspect of that is inappropriate and premature referrals. If teachers are referring students without having implemented any interventions, it can be really hard for us to determine if a student really needs specially designed instruction, or if a simple intervention would do the trick. It's hard to make that. decision on whether we need to evaluate or not, if they haven't done that work, to set things up.

Then the third common struggle was that there's not a clear process. So every school, every teacher, every administrator seems to have different expectations around referrals and how to manage that. Every SLP does it a little differently. Maybe if there's 10 SLPs in the district. Everyone manages referrals differently, and it's different depending on the school you're in. If you're an SLP in a district and working in two schools, the referrals are handled differently from school A to school B, which makes it really hard to manage that.

The fourth common struggle is that we get a lot of referrals at once, especially in the spring. We may get 10 referrals on our desk at the same time. Having the capacity to navigate that on top of all the other things happening during that heavy referral season, which typically sounds like it's this spring.

The fifth common, struggle that SLPs were sharing was time. It is challenging and related to all of these pieces of having incomplete background information, inappropriate referrals, unclear, inconsistent processes across schools. And getting those referrals when our workload is already very high. During especially busy times of year, like when progress reports are due or, when we are having an influx of IEPs and evaluations on top of the referrals. so those are all things that lots of S LPs were sharing about. So if you're experiencing that, you're definitely not alone.

When we looked at the responses, the average time it takes to complete a referral is about three hours.

And the average that we calculated was that, SLPs are receiving about 15 referrals in a school year. If the average referral takes three hours and the average SLP gets 15 referrals, that's 45 hours of additional workload on top of meeting our students' service times and managing IEPs and evaluations many of these referrals turn into evaluations.

If we're getting inappropriate or premature referrals or whatnot, because we received the referral and we have that timeline, we might recommend an evaluation, and those evaluations take even more time. It makes sense why referrals are a big challenge for SLPs. if you have any unique insight or a challenge that you don't think we addressed, please reach out to me on Instagram.

I'd love to hear as we're going through this process and having this discussion. Our goal will be to share different strategies and tips. Some SLPs shared great strategies, in the form we sent out. I've been working on optimizing my own referral process and, helping other SLPs do the same.

So I'm really excited to continue this series. Again, reach out if you have any feedback, or unique experiences that you'd like to share. We'll see you next week to continue the conversation.

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School-Based Accommodations for Children Who Have Auditory Processing Disorders (APD)

May 4, 2025 by Marisha Leave a Comment

In recent years, the prevalence and awareness of Auditory Processing Disorders (APD) has skyrocketed. As a result, Speech-Language Pathologists (SLPs) are receiving more and more referrals to evaluate and treat children who have APD in outpatient clinics and in schools.

So… What is APD anyway?

According to the American Speech-Language-Hearing Association (ASHA), “APD refers to how the central nervous system (CNS) uses auditory information.” It is also defined as being “a problem or dysfunction of the auditory system specifically the central auditory, or the portion of the system that runs from the ear to the brain” (Bellis, 2003).

Individuals who have APD do not have ear-based problems such as hearing loss or deafness; rather, they have difficulties with processing information auditorily. Individuals should be careful not to confuse APD with higher-level thinking or attention problems such as intellectual disabilities, autism, or ADD/ADHD. In some cases, however, APD may co-exist with ADHD or other disorders.

More specifically, individuals who have APD demonstrate deficits in the following areas: auditory discrimination and pattern recognition, sound localization, temporal resolution, masking, integration, ordering, and auditory performance with competing signals. In order to receive a diagnosis of APD, deficits must be observed in one or more of the before-mentioned areas. The diagnosis of APD can be made only be an audiologist following an extensive evaluation consisting of several tests and assessments. Additional characteristics of APD might include:

Weaknesses in expressive language, receptive language, and/or literacy skills
Difficulty listening in background noise/environments where there is competing noise
Trouble with following directions and/or recalling information that was heard
Poor organization skills
Frequently asking “what?” or “huh?”
Needing more time to process information/slower processing speed when answering questions

Teachers and parents of children who have APD might report concerns with the child’s ability to:

Discriminate between short and long vowel sounds
Blend (sound out) unfamiliar words
Combine parts of words to make a whole word
Recall the sounds that specific letters make (letter-sound correspondence)
Identify rhyming words
Read sentences/passages with the appropriate rate, prosody, and fluency
Generalize learned reading strategies/patterns of sounds from one moment to the next (working memory)
Perceive similarities/differences between sounds

The Academic Challenges Students with APD Face

School-aged children may have challenges academically due to their diagnosis of APD.

Some of these students may be seen as behaviorally challenged, as APD can often be confused with other attention deficit disorders such as ADHD or ADD. Students who have APD might be enrolled in additional services through their schools, including speech-language therapy, occupational therapy, reading intervention/support, and/or special education services. However, it should be noted that not all children who have APD will qualify for additional services that are offered.

In order to participate in a regular classroom environment at school, many students with APD will likely benefit from having some accommodations in place to help them succeed. Some of these students may qualify for an IEP (Individualized Education Plan) or a 504 Plan through their school system.

List of Accommodations for Students Who Have APD

A non-exhaustive list of some possible accommodations for students with APD might include:

Preferential seating at the front of the classroom during instruction
- The teacher’s face should be clearly visible to the student and the teacher should be away from competing noise sources
Individual seating in a quiet, separate area for independent work and/or testing
Improve acoustic access by modifying the classroom/changing materials
- Add carpet, room dividers, tennis balls on the legs of chairs, regular pencils instead of mechanical pencils/pens to reduce “clicking” sounds
Reduce background noise
Provide a note-taker (possibly for older students)
- Use “guided notetaking”- teachers can help students learn to identify key information in a lecture and organize it in written notes
- Notetaking during class requires jumping between auditory and visual modalities, which can be distracting for students who have APD
- Allowing the student to get notes from another child or compare notes with the teacher may be a better solution
Repeat or rephrase information during lectures/classroom instruction
Make frequent checks for student understanding (check points)
- Ask the student to rephrase what has been said (sometimes the student can repeat verbatim, yet still not comprehend the message)
- Redirect discreetly and gently
- The teacher might have a “secret sign” or “secret signal” with the student who has APD (teacher waves her finger around, which signals the student to look around to see what the other students are doing)
Extended time on assignments/tests
Utilize visual aids, such as a planner, to help organize assignments, thoughts, important dates, etc. and to make lists of academic tasks to be completed
Encourage the student to maintain a clutter-free work area to reduce distraction and stress; clear/straighten the student’s work area at the end of every day
Try to avoid auditory fatigue
- Allow the student to use noise-cancelling headphones during individual work or testing
- Allow for listening breaks/break breaks periodically throughout the school day
Teach the student to engage in self-monitoring
- The student might eventually learn to ask himself/herself questions like “do I understand this?” or “what do I need clarification/help with?”
“Pre-teach” new information and vocabulary before the lecture
- Before a new topic is discussed, the teacher should provide the student with key vocabulary and critical concepts in writing
- Students with APD demonstrate challenges with filling in the missing pieces/information without knowing the new vocabulary/key points first
Use positive reinforcement
- Teachers should acknowledge strong effort and hard work in the student regularly, which could lead to more motivation, higher self-esteem, etc.
Highlight key information when reading passages/books to refer back to
Teach the student to engage in and practice auditory memory strategies
- Chunking information — breaking down long messages or lists into smaller components and grouping similar concepts/objects together
- Elaborating on what you heard — use of analogies and acronyms
- Rehearsing/verbally repeating information aloud to yourself
- Organizing — outline and relate to what you already know)
- Visualizing — make a visual picture in your mind
- Making acronyms/use first letter of words (JFMAMJJASOND for months of the year)
- Paraphrasing – use different words to summarize what you heard

In certain scenarios, some students might benefit from the use of artificial intelligence (AI) resources to support their academic progress. A non-exhaustive list of some possible AI accommodations for students who have APD might include:

Reading:

Read Along by Google
- Recommended for ages 5-12
- Free, but requires a Google/Gmail account
- AI listens and gives positive feedback
Microsoft Reading Coach
- AI listens to kids read and provides guidance on mispronounced words and fluency
- Provides reading progress reports for teachers and parents
- Free, but required a Microsoft email account
Rewordify
- Paste complex reading passages, and the program will simplify vocabulary and make passages easier to read for emerging readers
- Teaches vocabulary and provides comprehension tasks for older readers
- Free for students, teachers, and parents

Classroom Accommodations:

Microsoft Teams Live Transcription and Google Meet Captions
- Live transcription of verbal speech to written text for notetaking
  - Help students who need to process information visually and need support with note taking
  - No additional personnel support required
    - Google Docs (Chrome Books)
      - Voice in Speech to Text
      - Font and Contrast Customization
        
        Arial and Lexend fonts are easier to read
        
        Chrome extensions: High Contrast and Grayscale
        
        High contrast text is visually beneficial for struggling readers
        
        Speak Feature
        
        Reads highlighted text aloud to students
        
        Organization Tools
        
        Headings, bulleted/number lists and Table of Contents features
        
        Helps organization for clear structure
        
        Can be used offline
        
        Helps with limited internet access

Conclusion:

Students who have APD can be successful in a classroom setting if given the appropriate services or accommodations. No student with APD is the same; different strategies will be used for each individual student, and there is no one treatment approach that is appropriate for all children with APD. School-based SLPs can support teachers by providing useful strategies and techniques to help their students with APD to be successful in the classroom. SLPs can also provide individual speech-language intervention for students with APD so long as an underlying language disorder is present. Some students with APD may respond well to intervention and show improvement with the use of compensatory strategies, while others may seem to deal with these deficits forever. However, with the appropriate tools and use of individualized compensatory strategies, students with APD can learn to utilize their strengths in life as opposed to focusing on their areas of weakness.

Author Bios

Marilyn Owens has been with the University of Tennessee Health Science Center (UTHSC) Department of Audiology and Speech Pathology (ASP) since February 2022, serving children and adults who are deaf or hard of hearing and supervising ASP graduate students. Mrs. Owens provides aural/oral evaluations, auditory training, and aural rehabilitation treatment to individuals who use cochlear implants and hearing aids. She also works with children who have more complex communication disorders who use AAC (Alternative and Augmentative Communication) and children who have Auditory Processing Disorders (APD). She is also fluent in American Sign Language (ASL).

Jestina Bunch has been with the University of Tennessee Health Science Center (UTHSC) Department of Audiology and Speech Pathology (ASP) since August 2015. Her specialty is serving children and adults who are deaf or hard of hearing. She also supervises ASP graduate students. Mrs. Bunch provides aural/oral evaluation, auditory training, and aural rehabilitation treatment to individuals who use cochlear implants and hearing aids. She also has extensive experience working with individuals with complex communication disorders and children/adolescents who use AAC (Alternative and Augmentative Communication).

Resources/References:

https://www.asha.org/public/hearing/understanding-auditory-processing-disorders-in-children/
Bellis, T.J. (2003). When The Brain Can’t Hear: Unraveling the Mystery of Auditory Processing Disorder. New York, NY: Atria Books.
Bellis, T.J. (n.d). Understanding Auditory Processing Disorders in Children. In American Speech-Language-Hearing Association.

Speech Therapy for Stuttering: A Joyful Approach for K–12 SLPs

April 24, 2025 by Marisha Leave a Comment

Meet Dr. Danra Kazenski, a passionate speech-language pathologist and stuttering ally who is reshaping how we approach fluency therapy in schools. With nearly two decades of experience and a personal connection to stuttering, Dr. Kazenski brings a deeply empathetic and empowering perspective to her work. She’s the founder of Vermont Stuttering Therapy and the #NormalizeStutteringChallenge, and currently teaches as a Clinical Associate Professor at the University of Vermont.

In this episode of the SLP Now podcast, Dr. Kazenski shares how embracing stuttering—not fighting it—can lead to more joyful, meaningful communication for students. Her approach blends narrative therapy, playful techniques like naming the stutter, and a “joyful scale” that empowers students to define success on their own terms. This guide captures her insights and practical strategies tailored specifically for K–12 speech-language pathologists.

Whether you’re just beginning to explore fluency strategies or are looking to enrich your current toolkit, this student-centered, acceptance-based framework offers a refreshing way to support students who stutter—by helping them feel heard, understood, and proud of their voice.

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The Importance of Stuttering Awareness and Advocacy

Stuttering awareness isn’t just about identifying speech patterns—it’s about understanding the experience of stuttering from the inside out. Dr. Kazenski breaks this down into three powerful levels: personal, community, and societal.

At the personal level, students begin by noticing their own stuttering. What does it feel like? Where do they notice tension in their body? What kind of stutter is it? Tools like the “speech machine” activity and narrative therapy help students explore these questions creatively. Some may draw their stutter as a character—like a fog or a unicorn—giving it a name and personality. This allows them to talk about their stuttering with distance and clarity.

In the community, awareness expands to include trusted people in the student’s life. Dr. Kazenski uses the “Who’s in Your Box?” activity to help students identify who they feel safe stuttering around—and who might join that circle with time and support. She also highlights the crucial role of family, peers, and teachers, encouraging collaboration and education to reduce stigma and foster inclusion.

Finally, at the societal level, stuttering advocacy becomes a call for normalization. Dr. Kazenski shares her vision of a world where saying “I stutter” is as simple as stating your pronouns. Her #NormalizeStutteringChallenge encourages people who stutter—and their allies—to proudly speak up and take space, showing that stuttered voices deserve to be heard and respected.

These layers of awareness form the foundation for self-acceptance and advocacy. As Dr. Kazenski puts it, fluency isn’t the goal—confidence, joy, and connection are.

“Fluency is overrated. We’re encouraging our students to take back their power, be big, make sure they know that their stuttered voice has value. We’re listening to them. They deserve to be heard. They’re not alone.”

—Dr. Danra Kazenski, PhD, CCC-SLP

Dr. Danra Kazenski’s Unique Approach to Stuttering Therapy

Dr. Kazenski brings a deeply personal, joyful, and student-driven approach to stuttering therapy—one that prioritizes connection over correction. At the core of her method is a shift from fluency-focused goals to embracing stuttering as part of a person’s identity.

🎨 Narrative Therapy

One of her key strategies is narrative therapy, where students are invited to “draw and name their stutter.” This creative exercise opens up important conversations: Is the stutter a friend or a foe? How do they relate to it? For some, it might be a unicorn with rainbow sparkles. For others, a dark, fearsome figure they want to defeat. Either way, it gives SLPs a window into how students feel—and a safe way for students to express complex emotions.

🌈 The Joyful Scale

Rather than using severity ratings, Dr. Kazenski co-creates a Joyful Scale with her students. This tool flips the typical fluency model on its head. The “top” of the scale isn’t zero stuttering—it’s joyful communication, which may still include stuttering but is free from struggle and fear. Students define what joyful stuttering looks like for them—like talking freely without hiding, or expressing themselves without tricks.

✨ Mantras and Identity

Many students also develop personal mantras that reflect their goals and values, such as “I deserve to be heard” or “Stuttering is just how I talk.” These mantras reinforce identity, confidence, and self-worth—key pillars of Dr. Kazenski’s therapy philosophy.

This unique blend of creativity, empowerment, and acceptance offers a refreshing alternative to rigid, fluency-driven interventions. It puts the student in the driver’s seat—and supports them in building not just skills, but self-acceptance.

“Instead of like a stuttering severity rating scale, I have them work pretty early in the process of creating like a joyful scale… joyful stuttering includes stuttering, but maybe it’s not as effortful. You’re talking to who you want to talk to. You’re not using a lot of tricks, those kinds of things.”

—Dr. Danra Kazenski, PhD, CCC-SLP

Effective Stuttering Treatment Programs

While there’s no one-size-fits-all approach to stuttering therapy, Dr. Kazenski emphasizes the importance of programs that go beyond surface-level fluency. Instead, she recommends therapies that promote self-awareness, reduce avoidance, and build meaningful communication skills.

🌱 Acceptance-Based Approaches

At the heart of Dr. Kazenski’s practice is Avoidance Reduction Therapy (ART), inspired by the work of Vivian Sisskin. This model encourages students to face their stuttering experiences directly—rather than hiding or avoiding them. It’s about learning to tolerate discomfort and finding confidence through honesty and authenticity.

🧰 Beyond Fluency Tools

Dr. Kazenski is candid about the limitations of traditional fluency tools. Techniques like easy onset or slow speech may provide temporary results, but often aren’t sustainable—especially for young students. Instead, she focuses on building trusting relationships and helping students redefine what success looks like.

📋 Supporting Resources

She also integrates tools like the TASCC questionnaire (Teacher Assessment of Student Communicative Competence) to help identify participation-based needs in school-aged children. This can be a critical step in supporting eligibility for services in educational settings.

Whether it’s through narrative work, joyful communication scales, or community support, the most effective stuttering programs empower students to take risks, reduce avoidance, and speak freely—even when they stutter.

“Generally, tools are annoying and unsustainable… Instead, we need that relationship built and start doing these things to help take risks and accept themselves fully as people who stutter.”

—Dr. Danra Kazenski, PhD, CCC-SLP

How to Help Someone Who Stutters

Helping someone who stutters starts with listening—really listening. As Dr. Kazenski emphasizes, support isn’t about “fixing” speech. It’s about creating a safe space for authentic communication, reducing pressure, and honoring the individual behind the stutter.

💬 Start with Curiosity and Compassion

Dr. Kazenski encourages SLPs and caregivers to approach each student with curiosity, not assumptions. Ask open-ended questions like “What are your best hopes?” or “What does stuttering feel like to you?” This helps build trust and empowers students to become their own advocates.

🎯 Promote Self-Defined Goals

Rather than imposing goals, let students define what progress looks like. For some, it might be raising their hand in class. For others, it’s ordering at a restaurant or telling a joke without changing words. Helping them reach these moments—on their terms—builds true confidence.

🧠 Reframe the Role of Communication

Helping students see that communication isn’t about perfect fluency—it’s about connection—can be a game-changer. Use positive self-talk, mantras, and role-playing to build resilience and reframe negative beliefs. Reinforce that their voice matters, no matter how it comes out.

🤝 Practical Tips for Supporters

Pause before responding. Give students time to finish.
Avoid “slow down” or “take a breath” prompts. These often feel dismissive.
Acknowledge their courage. Stuttering openly is a brave act.

When support is grounded in respect and empathy, it allows individuals who stutter to thrive—not just as speakers, but as whole people.

“We’re encouraging our students to take back their power, be big, make sure they know that their stuttered voice has value… They deserve to be heard.”

—Dr. Danra Kazenski, PhD, CCC-SLP

Strategies for Speech Stuttering Therapy in Schools

Working with students who stutter in a school setting comes with unique opportunities—and challenges. Dr. Kazenski offers a wealth of practical, student-centered strategies designed specifically for K–12 speech-language pathologists.

🧑‍🏫 Build Trust First

Before diving into techniques, build a relationship. Dr. Kazenski stresses that students must feel emotionally safe before they’re ready to take communication risks. She recommends creating a welcoming space, validating each student’s experiences, and resisting the urge to “fix” too quickly.

🗺️ Create Safe Communication Maps

Use tools like the “Who’s in Your Box?” activity to help students identify who they feel comfortable stuttering with. From there, work together to gradually expand that circle, using classroom interactions as real-life practice opportunities.

🎯 Focus on Participation, Not Perfection

Dr. Kazenski encourages SLPs to prioritize participation-based goals—like speaking in class, joining a group, or reading aloud—rather than trying to eliminate stuttering. It’s about helping students say what they want to say, not how they say it.

📘 Integrate Narrative Therapy and Joyful Tools

Incorporate expressive activities like drawing their stutter, developing a Joyful Scale, or creating mantras. These strategies not only support communication, but also reinforce self-acceptance and reduce avoidance.

💬 Collaborate with Teachers

Empower students to self-advocate with their teachers—whether through writing letters, sharing how they prefer to participate, or preparing classroom presentations. Dr. Kazenski shares that these experiences are not only therapeutic, but deeply affirming.

When therapy becomes a partnership built on trust, creativity, and advocacy, school-based SLPs can help students redefine success—not by fluency, but by freedom of expression.

“Don’t underestimate the power and importance of developing a trusting relationship first… If you’re going to ask them to walk naked through a minefield, they’re going to need to trust you first.”

—Dr. Danra Kazenski, PhD, CCC-SLP

Support Systems and Community Engagement

A student’s journey with stuttering doesn’t happen in isolation—it unfolds within a web of relationships. Dr. Kazenski emphasizes the importance of surrounding students with supportive, informed communities that uplift rather than isolate.

🏠 Engaging Families

Parents and caregivers are often eager to help, but may feel unsure of how. Dr. Kazenski recommends tools like the Palin Parent-Child Interaction Therapy approach, along with separate sessions to explore parents’ hopes and anxieties. Asking questions like “What does a good enough outcome look like for you?” helps families shift from fear to possibility.

🏫 Partnering with Educators

Teachers play a critical role in a student’s communication environment. Dr. Kazenski encourages students to write personal letters to their teachers—explaining their stuttering, sharing what helps, and outlining participation preferences. This fosters advocacy and builds a bridge between the student’s goals and classroom realities.

🧑‍🤝‍🧑 Building Stuttering Community

Whether it’s a peer who stutters at the same school, an NSA chapter, or online spaces like Sisters Who Stutter, connecting with others who share the experience is transformative. Dr. Kazenski calls this the “Stamily”—a family forged through shared identity and mutual support.

💡 Coping with Unkindness

Unfortunately, students may encounter stigma or rude responses. Dr. Kazenski equips them with cognitive tools like predicting and checking the evidence to challenge assumptions and reduce anxiety. Mantras like “Let them think what they think” help build emotional resilience.

Incorporating these broader support systems into therapy ensures students are not just learning to speak—they’re learning to belong.

“Many people feel like they’re going through their stuttering alone, but there is a huge—what we call the Stamily—the stuttering family is enormous and very enthusiastic and supportive.”

—Dr. Danra Kazenski, PhD, CCC-SLP

Stuttering Resources

Here’s a curated list of tools, communities, and expert content to support SLPs working with students who stutter. These resources reflect the evidence-based, person-centered approach shared by Dr. Danra Kazenski.

🔗 Featured Tools and Programs

TASCC Questionnaire – Teacher Assessment of Student Communicative Competence
More Info
Avoidance Reduction Therapy – Learn more from Vivian Sisskin at Open Stutter
Open Stutter YouTube Channel
Spero – Video: Nurturing and Empowering Your Child Who Stutters
Watch on YouTube
Stuttering Therapy Resources Verbal Diversity™
Explore the Verbal Diversity Framework
National Stuttering Association (NSA)
Find Support at WeStutter.org
Normalize Stuttering Challenge
Follow and participate in Danra’s ongoing stuttering awareness movement:
@vermontstutteringtherapy on Instagram
Vermont Stuttering Therapy Website
Linktree for Additional Tools

Frequently Asked SLP Questions About Stuttering

To wrap things up, here are answers to some of the most common questions K–12 SLPs have when supporting students who stutter, with guidance grounded in Dr. Kazenski’s experience.

What is the best age to start stuttering therapy?

There’s no universal “right” age—therapy should begin when the student is experiencing emotional, social, or academic impacts. Early intervention is valuable, especially when it’s rooted in acceptance and awareness rather than fluency drills. Even very young children can benefit from playful, supportive exploration of their speech.

How can I improve my child’s stuttering at home?

Focus less on correcting speech and more on creating a low-pressure environment. Use patient listening, reduce interruptions, and model acceptance. Reading books featuring characters who stutter, drawing speech “machines,” and using mantras like “I deserve to be heard” can empower children at home.

What should I do if my student doesn’t qualify for services but still needs support?

Use tools like the TASCC questionnaire to highlight how stuttering may affect social participation or emotional well-being—even if academics appear unaffected. You might also explore general education support plans, classroom accommodations, or connecting families with outside resources.

How do I explain stuttering to a classroom or staff?

Student-led presentations, Jeopardy games, or brief letters to teachers can help educate others and reduce stigma. If the student is willing, encourage them to share their experience with peers. Otherwise, act as their advocate by providing insights and facilitating understanding.

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Transcript

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Welcome to the SLP Now podcast. I'm really excited to have Dr. Danra Kazenski with us today. She is a speech language pathologist and stuttering ally who works as a clinical associate professor in communication sciences and disorders at the University of Vermont. She's also the owner of Vermont Stuttering Therapy and the founder of the Normalize Stuttering Challenge. And she's a co-chapter leader of the Vermont chapters of the National Stuttering Association or NSA support groups. And she raises funds for the NSA with two online stores. that was just a small snippet of what all of the things that Dr. Janna Kaczynski is up to. But without further ado, let's just hear from her. Thank you, Marisha. I'll take any excuse to talk about stuttering. So thank you for having me. Yeah. And this is an area that I've been really wanting to learn more about. So I'm really excited and grateful that you're here to share with us today. Thank you. And so I read your bio and shared a little bit of your background. But can you share a little bit of your story and kind of... how you ended up where you are today and what led you down this path? Sure. I had never met a person who stutters until I started working with Barry Gattar at the University of Vermont when I was a student there. His class was a game changer for me because I was really inspired by how many complex unanswered questions there are about stuttering and the- the depth of the counseling skills that are involved with that. And Barry, don't know if you know him or have met him, but he's just the nicest human that ever lived. So if you need a good model of how to connect with people and show, like he's basically walking empathy, is how I describe it. And he's very open about his own stuttering. So I just kind of learned how to try and soak all of that up. And I'm not a person who stutters myself. So I try and do that from the... the non-stuttering angle of that and to be open and not make assumptions, those kinds of things. So after school, I worked for five years in Montreal, and then I came back and did my PhD with Barry, and I have stayed at the University of Vermont since then. So I supervised graduate students working with people who stutter there, but I really missed kind of also doing a lot of the hands-on work myself. And Vermont is a very rural state. And so unless you live up near the university, it's hard to access those services. So I did start a private telepractice to kind of offer services outside, you know, a certain distance from the university. And in the meantime, my niece was born and it turns out that she stutters and we don't have anybody who stutters in our family. So that was really interesting. I was there the day that she started to stutter at Christmas. And to see it from that personal angle after working with people who stutter for so long just brought, you know, just it was a different perspective to have it be in my family. And so then I have done this for about 18 years and I have heard a lot of stories from folks and many of them are uplifting, but a lot of them are very upsetting. So in terms of my drive to kind of take some of these advocacy steps, I've One of the men I worked with said that every time he stuttered as a child, he got punched in the head by his father. And a man that I work with just recently got banned from a coffee shop because of his stuttering. I'm sure that he must have had a lot of secondary behaviors and they thought something else was happening, which is terrible. And I've heard really unfortunate stories of even teachers making fun of kids who stutter here in Vermont. Um, and, uh, I also, and this is a content warning for folks. Um, I have lost two of the folks that I work with or were friends with who stuttered to suicide. And, um, so I am, I get very protective of people who stutter and their voice. And it really charged me up to do more, um, and to step in and to generalize, to normalize stuttering and, you know, not just in our own circles, but globally. And so I'm trying to give a platform to stuttered voices. And so I did create those stores. So I do sell basically stutter advocacy swag. I also sell things for allies, so SLP's and SLPA's and audiologists. But the overarching theme that I try and focus on is to is for just the basic human right to be heard, right? I mean, that's really all the people who stutter want and need is to be heard and to say what they want when they want and to have it be okay that when they say it, it's stuttered. So I definitely take more of an acceptance-based approach to how I run things. Yeah. Wow. Thank you so much for sharing that. Your heart for all of this just really shines through. It's great to see that. Amazing. I think it's pretty clear, but I guess just to make sure we're all on the same page, what is stuttering awareness? Yeah, love this. Yeah, juicy question. like a juicy one. If it's okay, I want to break it down into some chunks. The way I think of it is the smallest chunk would be personally for that person. And then the wider chunk is the community. And then the biggest would be society and just globally. So on that real personal level, I like to think of it as just starting to be willing and genuinely curious about what's noticing and noticing what's going on with your own stuttering. Like, what is this all about? And as a person who doesn't stutter, I spend most of my time listening very carefully. to their core message and trying not to make any assumptions about what they think about it. So I have to genuinely ask questions. And also with that gauging kind of what they're ready for me to do. Like what is their readiness for this? Cause everybody comes in at a different level and what we're asking them to do is hard. I've had one person describe it as walking naked through a minefield. Like you're asking me to do that? And like, well, You don't have to step into the red zone yet, but what would you consider being okay as a step towards doing that? And so some people are a hard nope, and some people are like, sure, I'm willing to try this thing for now. And then of course that changes over time. But some people don't even realize the kinds of stutters that they have. Like, oh, I didn't know that when I stretch out my words like this, it's called a prolongation. And sometimes I use, you know, Play-Doh to help with kiddos get to understand that, or we can name it something. Like I have some kids call their stutters clones because they're repetitions and they like Star Wars, things like that. And so the more awareness of also like just how we talk, right? You know, and so I'll get kids to lay on the ground and do an outline of their body to do a little speech machine activity to point out, you know, this is how we talk. put little sticky notes where you feel tension when you stutter and you get really interesting unexpected answers. Like sometimes they say, I feel my stuttering in my back or in the back of my brain. And you get to learn a lot more and it allows them to start talking about something that might have hard to talk about. And then just encouraging them to start noticing those things and the, like what kind of eye contact do I make when I talk to people? Am I actually listening to the other person or am I thinking about what I want to say? You that's a common thing that can affect, you know, your connection and regular conversation, just starting to notice it. And how do you feel about those things? And what changes are important to you? And what difference would that make in your life to help them make their own goals? And so I'll ask them what their best hopes are as a person and how stuttering fits into that. I don't know if you've done anything like narrative therapy. That's one strategy that we use. Yeah. I don't know if that's applicable only to stuttering or if it to other areas. But basically, we have them draw and name their stutter, which gives you a real immediate feedback about what their relationship with their stuttering is right away. Like, is this their friend or a foe, basically? So like, I've seen very colorful unicorns with the words coming out of their horn and, you know, the kiddo says, I wanna take my stutter out for s'mores and we're gonna go skateboarding. It's like, okay, cool. And then they've got other kiddos who draw very dark, like bloody with lots of weaponry and they know, they say, I hate him. And that's important to be able to have a way to get that out. And for that kiddo, we ended up drawing a bunch of his stuttering characters, putting them on bottles and shooting them down with ping pong guns and throwing them in the garbage. He wanted to say, I hate you. And that's the stage that they're at. But for some of the kiddos, it's a really positive. I've... I don't know if you've seen that the Stuttering Foundation of America has a really good newsletter where they'll publish anything that a kiddo will draw or say about their stuttering. And we've had like six of them or so go in and the kids are so proud, you know, like, so they're willing to make something that will help other kids too. So I'm just going to keep going because I can talk forever. That's okay until you tell me to stop. No, this is amazing. Keep going. I'm eating that. Okay. and instead of like, you know how they often could use different scales because we want them to kind of be able to participate in this noticing of their stuttering. So instead of like a stuttering severity rating scale, I have them work pretty early in the process of creating like a joyful scale, you know, and having them define what each end of the scale means for them. Because normally the bottom end of the scale if you were doing severity would be no stuttering. But in this case, that end of the scale is joyful stuttering and it includes stuttering, but maybe it's not as effortful. You're talking to who you want to talk to. You're not using a lot of tricks, those kinds of things. So actually it would be on the other end, like if you were totally fluent, but you were just using all kinds of ways to avoid saying what you wanna say, that is not where we're aiming for the kiddos to be. So I also, in that process, they kind of define what is meaningful to them, like what to flip something that might have been negative into a positive. So they might come up even with like a mantra related to joyful talking. And some of the kids that I work with, we actually say those mantras together at the beginning of every session, like, okay, here we go, let's say our mantras. And some of them would be like, I deserve to be heard, I was born that way and that's okay, stuttering is just how I talk, et cetera. And one adult that I work with actually said that he wanted his scale to be what his, he wants to be the person his younger self would be proud of. And so every week when he comes in, I was like, okay, what did you do this week that your younger self would be proud of? So generally with that whole personal sense of self-awareness, stuttering awareness, I want them to start to be aware of everything that's going on for them and to start considering accepting that full identity as a person who stutters instead of like taking on the false role as somebody who does not stutter and learning to let go of it instead of having those strong needs to like control or to to hide. So that was the personal one. Before we move on to the next one, I know that because I think SLPs are always looking for ways of like, okay, I know that, like, because a lot of us are realizing that we should probably be doing like in working through or like, My words are not working today, but like what we learned in grad school in terms of stuttering therapy is a little bit different than what we're learning about today. I think for many of us, I think a lot of SLPs are like, okay, so how do I navigate this? And what does this look like? And you just gave a beautiful, like so many beautiful examples, but I feel like I'm sure that they'll want to know more about the joyful scale. So it sounds like you kind of customize that scale depending on your client or do you have like a resource as with an example of that? I'd be happy to share one after in the show notes too, but literally I can come in with a blank sheet of paper and say, okay, we're going to just find a way. I'm going to check in with you every week about how you feel you're doing. And we, in order to do that, we need to kind of know. how to gauge that. And so you're, I like to give a lot of power to the students to do this, you know, give them a lot of control in general. So yeah, they might not want to call it joyful talking, they might want to use a different word. And I just kind of go with that. And they're going to define what the other side of the scale means. And then I just try and guide them so that gently that the joyful you know, are you okay that the joyful side includes some stuttering? As long as it's easy, you can say what you want and it doesn't interfere with what you want to do or be or say. They're like, oh yeah, that's fine. And you know, so it just, I give some shaping along those lines, but otherwise, you know, the kiddo is going to define it for themselves. And then, yeah, whenever they come in, we use that in their own words when we... talk about their stuttering, once we do a narrative therapy like that naming the stutter, I don't call their stuttering anything else. You know, like, how was Mr. Unicorn today? Did he visit you? When did he come around? How did you, you know, handle that? What did other people do when Mr. Unicorn came around? It's like a nice little way to separate them from talking about it directly for those kids who are a little more shy. and things like that, gives them just a little bit of space. know, like it's not the stuttering is me. It's Mr. Unicorn who comes and he lives in my brain and these are the things he does. And somehow it's easier to then like talk about it and, you know, come up with ways to, you know, cope or adjust or just tolerate, you know, be, just let it be what it is. SLPs are wanting to learn more about narrative therapy. Do you have any favorite resources for that? Well, I can definitely share that, I have some, there's some articles about that. But yeah, it's very similar to how I just described that I get pretty vivid. Like I would take an entire session to do this. And most kiddos, when you all have art supplies and things ready, you know, say, this is weird. you today we're going to talk about something weird, okay? I'm going to ask you to, you you stutter and we've been talking about your stuttering and I would just like to talk to it sometimes, but the trouble is I don't know what it looks like, you know, and only you know what it looks like. So can you help me understand? And they'll kind of look at me like, I don't know what you want me to do, lady. You know, like what is this? I'll say, your stutter have eyes? You know, does it have eyes? And you know, sometimes it does, sometimes it doesn't. Sometimes people pick a fog and it doesn't have eyeballs. But somehow asking that question, does it have eyes, like leads them to get going. And then you start commenting on, oh, I noticed you picked, you know, yellow and blue crayons here for this color. he's wearing, it looks like he's wearing a cape. What is that cape all about? And it looks like there's stars in the sky. I'm just curious what's happening there. You get them to kind of describe it like vividly, like a movie. And you ask a lot of details about, you know, when does it come around and how does it make you talk differently? And what do you do because you don't stutter all the time. So. You sometimes have them create a second character that is them, that is stronger than the stutterer. And then so what is it that you do? He tries to kick me in the throat and I have this lightsaber that I use to push him away and say, no, I'm going to say it the way that I want to or whatever it is. It's just like a nice. It's very vivid and detailed. And then I always refer to their stuttering by that character name after that. Some of them have created entire comic strips. And, you know, some of those did make it to the Stuttering Foundation newsletter. So, yeah, we try and get as detailed as possible. I love it. I love it as a strategy. Yeah. Yeah, that's great. And then we'll add the... articles that you mentioned in the show notes. think that'll be a great resource. Okay, so just a quick recap. So we're going through the three components of stuttering awareness. So we just chatted about personal and then we have community and society. And for the personal, we talked about like noticing what's going on with our stuttering or the client's stuttering and like the types of stuttering, like the speech machine, where they. where we feel it, incorporating narrative therapy, the Joyful Scale. So that's just a quick recap of some of the things that we went over. So what does the community starting awareness look like? Yeah. So for the individual in the community, I start to have the kiddos talk about, and this is from Vivian Siskin and the avoidance reduction therapy, who I'll talk about a lot because she's my... She and Barry to me are like the people that I would do literally anything they say. But so one activity you can do is called who's in your box. So you have the kiddo identify like who are the people right now that you feel safe and comfortable stuttering openly with. I can have them actually, you know, draw it in a box and put their names and then who are the people just outside the box that you might consider letting in. And then who are the people that are like, wait, nope, not interested in letting them in my box right now. And so part of therapy could be some of their goals, could be creating easy, medium, and hard goals, using that as your framework. So all right, your mom is a person who's in your box. What are you willing to practice with your speech? this week, are you willing to stutter openly with her a few times at breakfast? And you get them to be very specific. Okay, there's a medium person who's just outside the box. Are you willing to talk to them for one five second hello, you know, just to get you a little bit closer to bringing them in your box? And for the outside people, like, or if they have something really high up their hierarchy, they would get like an A plus just for even doing that thing. Like, oh, I never want to give a presentation, but they're willing to do that with their teacher as a starting point. Just because they did it and they were willing to take this risk, that is kind of redefined what their success is. you know, what difference would it make if you were to bring more people into your box or your community? So, I mean, the other people in the community are, of course, their parents and their close family and how they respond to their stuttering. And, you know, there's tons out there with Palin, parent-child interaction and patient listening and low-pressure environment, talking to siblings about interruptions, things like that. But the parents need community, too. So I often will try and connect them with other parents whose child stutters, you know, they have a lot of valid things that they're thinking about. You know, even with a two-year-old, they're like, I don't know if they're going to be able to ask somebody to prom. It's like, okay, this is important to them. They're thinking way into the future. So I ask them their best hopes as well. That's another good cognitive behavioral therapy kind of. discussion where I might even meet with them separately from the child if I see that they're very anxious and I give them a list of or I ask them to say, you know, what's good enough for the outcome of their stuttering? And to kind of rank that from one to 10. If one means it's, you know, not affecting them at all and a 10, like where are you okay? And then Asking them the child's best hopes for their life in general. Oh, I want them to be a good friend and parent and have a job they love, all of those things. And then you can ask them to rate, where are they on their scale to meeting all those best hopes? And if they say, well, he's a four-year-old, so he's like a three, it's like, okay, that's fine, yeah. But what makes him not a zero? and they list all the, he's very clever and creative and independent and funny and smart. And, you know, I have them read that list back. I read it back to them and I say, what does that say about you as a parent? You know, and it's kind of a, and then I asked them again, what is your good enough after that discussion to see if it's changed? And we have seen some dramatic things where they're like, I absolutely want negative five stuttering, don't want it to happen at all. And then after we have this discussion, they realize they've got a great, amazing kid on their hands, it's going to be fine no matter whether they stutter or not. Then they normally adjust that. So that's another really awesome activity for parents that I've found to be successful. And then teachers or other people in the community, of course, I know a lot of SLPs are working in the schools. I encourage my clients to write letters to their teacher and there's a little, you know, there are some templates out there, but mostly it's about to say, you know, these are the kinds of things that I like and this is what my stuttering is like and this is what helps me. And also if they want to talk to them about how presentations might go or. how I choose to kind of raise, I will participate, but please call on me when I raise my hand rather than just like cold calling me. And another member of the community, of course, is teachers. So I work with my kiddos to write a letter to the teacher. So that could say things like, you know, these are the kinds of things that I like. This is what my stuttering sounds like. This is what helps me in the classroom so that you can... so I can participate fully. And then I work with the family to decide, does the kiddo give it to the teacher themselves? Do the parents, are they involved at all? I basically let that be the kiddo's choice, what their comfort is. And then they might have a conversation about, oh, I prefer to raise my hand before you call on me, as opposed to just being cold called, those kinds of things. And so many people may not know. I know a lot of people feel like, They're going through their stuttering alone, but there is a huge, we call it the Stamily. So the stuttering family is enormous and very enthusiastic and supportive. So we have the National Stuttering Association chapter. I've been to the conference like five times. Every time you like vibrate from the energy, I never want it to stop. I totally encourage people to connect with those groups. We allow people to join our group by Zoom. So if anybody doesn't have a chapter and you wanna join our chapter, please just contact me. Friends has great groups that meet. There's lots of camps. I would recommend any way that you can connect anybody to anybody else who stutters because you're definitely not alone. There's this amazing group called Sisters Who Stutter for teens, specifically girls. I love them. Really great advocacy. I highly recommend them. And so, you know, part of this is you're an individual in a community, so you have to also learn to cope with people's responses, which sometimes are going to be rude or not nice. And so part of therapy too is like helping them tolerate that and, you know, get some mantras in your head like, let them think what they think, I can't control how other people react. You know, so we do build in some cognitive messaging around that. I do some predicting and checking the evidence because there's a lot of anticipation anxiety that goes into, they're going to give me the evil eye or I just am guessing that they're going to be rude. We say, okay, yeah, make your prediction and then see what actually happened. If they did give you the stink eye, what else could that have been? It could have been about your speech, but it could be because they ate a weird burrito and they don't feel good. they're late to class or somebody in their family, something happened. And so we just don't wanna always assume it might be about their stuttering. So one activity I do when I leave the clinic with clients is we have this big at University of Vermont, we have this big student center. And so I'll go down to where the people are and I have the person who stutters up on the stairs so they cannot hear me. And I say, okay, you tell me whether I stuttered. just by the reaction of the person that I talk to, right? So they can't hear me, they can't hear if I'm stuttering, they're just looking at the person I'm talking to. And then I'll go up and say, okay, what do you think? Did I stutter or not? They're like, oh, you definitely stuttered because they looked uncomfortable and they ran away from you. And I was like, okay, all right. On that one, I did not stutter. So what else could have been going on? know, oh, they were late for class. We come up with a bunch of different reasons. So anyway, I like that. That's called predicting and checking the evidence, basically, to help learn to undo some assumptions that might be happening. So yeah, that's my community box, I would say. Yeah, I love that. And I love the approach of thinking about, OK, what can we do to educate parents and teachers, but then also helping the clients come up with strategies of because we can't run like, of course, the goal of stuttering awareness would be for everyone to be accepting and all that. But that's likely not going to be the case. So I love incorporating those strategies of just coping with those rude responses, because I think unfortunately, that's just it's life no matter whether we stutter or whatever, whether we have like brown hair, pink hair, whatever it is, there's always going to be that. So I love that. Okay, should we dive into the society piece? Oh yeah, okay, sure. Okay, this is the big one. I know, well, this is a good one in the sense that I think the tide is turning. There's more and more awareness and more people having their voices be heard. So yes, that is the driving force of the normalized stuttering movement. And I've asked people who stutter, you know, when will we know when stuttering is normalized? What is the day where we can be like, okay, we kind of, made it. And so people have said, you know, when there's a person who stutters on a TV show and it's not a big deal, right? And I just heard a podcast because Mark Winsky consulted on the Penguin series. And there is an actor there who does not stutter who he consulted with to help stutter authentically. And I'm like, that is a good baby step because a major production company decided very intentionally to have a character who stutters and they were very good about consulting people who stutter to make it honor and align with what their, as best they could, their real experiences are. So I think that's a good first step, but... you know, where is that actor that's just in a show that, you know, you don't make a big deal, he just stutters and he's just, you know, going about life. And another person said that stuttering will be normalized when we could say that we stutter just as easily as we say our pronouns. You know, and pronouns haven't, that was a relatively recent shift where this is, you know, just what we do. And wouldn't that be great if you could just say, Hi, I'm Dan Rye Stutterer and I use she her pronouns. So to me in the society side of things, there's strength in numbers too. So there's like 81 million people who stutter on the earth. You literally can make the largest nicest street gang ever. Like if you really banded together, you have the power of numbers. And so literally every stuttered voice that comes out chips away at that. So the more the better. So every voice is a baby step to that kind of change of normalizing. So I encourage people to take up space, put your authentic self forward. Don't feel like you have to hide it. You know, do the opposite to the degree that you're comfortable and just step into your full power and stutter. I think that's the actual change. Change making is the actual voices of people stutter and other allies, you know, supporting that and giving that platform to them. So that's why I'm trying to make a dent in that process myself. But yeah, the normalized stuttering challenge was a part of that. So I told you before that we lost a child who stutters to suicide. And so he was 12 years old, devastating, right? This is the kind of thing that like permanently changes your life. And I had worked with him for seven years, and I wasn't working with him at the time. And, you know, there's just so much wrapped up in that that is painful. And I was really motivated because of that. And more recently, an article came out in People Magazine about his death, because his mom is advocating for rights at the state level to protect people from that. And the article came out, so I'm seeing pictures of Ryan, you know, in a magazine that I got off the shelf, you know, from a grocery store. And on that same day, Trump had made fun of Biden's stutter. And so something like changed inside of myself, like this needs to stop, right? Like we need to, as a society, not laugh at these things. Like it's of grave importance. And so the normalized stuttering challenge was for people to take a video of themselves. And if they stutter, they say, stutter and I'm worth listening to. And for allies do say, if you stutter, I'm listening. so I helped spread this out with some colleagues from stutterology, Ezra, Mackenzie from Talking Town Books, who's a kiddo who stutters and she wrote a book. which I'll recommend too, and Martha's speech, who's now from Young Stutters. So we helped spread that and it was amazing. I think on day two, I heard from somebody in Africa who made the video. I mean, it went really fast and so exciting to see people be like, this was really hard for me. I didn't want to do it. I'm never on social media. And those are the voices that stand up. And then the people who love them also making the videos. Anyway, so that I'm kind of like wanting to do more of to keep bringing in, making the community wider in those ways. And I was pleasantly surprised because I think we're all like, oh, if you go on social media, people are going to troll you and be meanies, right, to the people that you care about. And I literally read every message of anybody who did a video because every time they came in, I was like, ah, so excited. No negative messages. anywhere, like literally none. And so I think it was nice to see that if you're brave and you show your authentic self, people respond positively. So I'm trying to come up with something else like that to do the next round of Stuttering Awareness Week. I'm thinking something like, I won't shut up, something like that. You I won't shut up until stuttering is normalized, something like that. But anyway. Yeah, to me, those are the global things that are happening and that people are responding to and willing to do at this point, which is a good sign for society's change, I think. Yeah, I think that's so incredibly powerful. And I don't have personal experience with the stuttering side of things in terms of that being my lived experience, but I've had experiences with other things that I've struggled with and just getting to see I think not feeling alone is the big thing. And then just seeing people navigate it in a positive way, like, oh, this doesn't have to be like a horrible thing. I think that can be really powerful. And I just love your creativity and navigating that. That's great. And then I'll put your Instagram account in the show notes too. So for anyone listening, if you're curious kind of what this looks like. And yeah. Like if they follow you, then they can join in next time you do the challenge and all of that. This is really cool. Okay, so the majority of speech therapists who listen to this podcast are in the schools. So do you have any, and a lot of what you shared is absolutely applicable and can be used, but do you have any like other ideas or suggestions? Cause I feel like, Being in the school community, we have the opportunity to have our own stuttering challenge as one example. But have you come up with any other ideas or anything else you want to speak to in terms of SLPs in the schools navigating this? Yeah, sure. So I'd say number one is first getting them access to the services, right? I know we hear from a lot of people who say, I know they stutter. They do not meet the criteria to be on my caseload. These are smart kiddos who fly under the radar. They're not standing out in any other way. So we talk a bit about adverse effect and going beyond just academics too. That can be sometimes a way to get students in. So for example, there's a questionnaire that we use called the TASCC. So T-A-S-C-C, I'll link it, but the Teacher Assessment of Student Communicative Competence. So that's for kiddos grades one to five. I sometimes give that to the teacher because it helps identify if there are other participation things that are affected at school that could count for adverse effect if needed. So like participation in field trips, after school activities, it's not just the sitting down in class parts. It's anything to do with their day. And we definitely want to help catch that before avoidance behaviors become habits. So anyway, once we get kiddos on the caseload, if you make it that far, which is great, I do everything that we talked about before. So like the speech machine, the awareness, helping them learn about stuttering and expanding their community. being mindful of their readiness levels and toxic positivity. You know, that part, don't, you know, I may come off as rah-rah, but I'm very delicate about those early stages with the kiddos. They need time. And don't underestimate the power and importance of developing a trusting relationship first. You know, they need to, if you're going to ask them to walk naked through a minefield, they're going to need to trust you first. If you want them to be honest with you and raw about their real experiences, you need to validate where they're at and not try and push them too far too fast. So I don't make assumptions about where people are. I need to ask and listen. And generally, tools are annoying and unsustainable. If you're talking about things that the old set of tools like fluency shaping and things like that and do this, do that, it's just not effective in terms of these are little kiddos self-monitoring certain things constantly. It's just not feasible, not for adults. Like I say, think about if I asked you how many times that you blink during a day, it's like, okay, I've made it 12 seconds and now I'm done. Right? So instead, we need that relationship built and start doing these things to help take risks and accept themselves fully as people who stutter. So counseling skills really come into that. And I think that's where student clinicians get very uncomfortable. They're worried about saying the wrong thing. So even though we're speech people, I definitely listen more than I talk. And some of the strategies that are just full proof would be waiting a full 30 seconds after you say something or ask them a question. And that's good for introverts and for any person who stutters because you're giving them the chance to be their own expert. I really resist the expert role. You know, they'll say directly to me, like, well, what do you think? And I like to just boomerang it right back to them and like, this sounds important to you. What was your take on it? I just kind of refuse and give them the autonomy because we want them to be their own clinicians. We don't want them to overly rely on us. And so if you've got a kiddo who's kind of like, you wait the full 30 seconds and they're like, I don't know. I say, well, if you did know, what would you say? And amazingly, most kids answer that second part question. So I just kind of relentlessly put them in the driver's seat, I guess is how I would describe that. I'm also very aware of the language that I use. like instead of how was this week? Because many people would be like, well, I had a bad day on this day and I, you know, whatever happened. So instead I like to frame it as what are you proud of this week? And similar to what that other student said, you know, for him it was what did you do that would make your younger self proud? So I do recommend if people are interested in counseling, they learn a bit about motivational interviewing. There's quite a lot of that in other medical professions. There's a lot of resources. I'm happy to share some of the ones that I have. But it's a way to listen to the core message and reflect back to them and kind of tag it with their values as well. So like if a kiddo says, I want to be fluent before next year, before next school year. you could say, hey, great, and what would be different if that happened? You can turn it into like a discussion point. So they have to verbalize like what all the things that would be different if that happened. And then they might say, oh, I'd walk with my head up high and talk to everybody. And so you've just learned that their value is confidence, right? Right now they're not doing those things, they're hiding away. So that would bring them confidence. And then you can always attach what you're doing and make goals related to that. In schools, I know this is hard, but if you can work closely with the family, I think it's the most effective to not work in a vacuum. That one hour with you a week, ideally, or whatever you're able to do is just, it's gonna be so much better supported if the family's involved. When I was in a school, I met after school at lunch breaks. That would be something that you would have to decide your willingness to do. but I found it to be far more effective. So, and then you can do a lot of the classic kind of supports like the iceberg, know, what's above the surface, what's below the surface. If there's another kid who stutters in the school, even if they're older, I would put them together, you know, as a little mentor relationship. The older one will like supporting the little, the little will be like, wow, look at this cool older person. You know, I'm a middle-aged lady who does not stutter. I am not the cool person in the room, right? So I'm very intentional about if there isn't anybody who stutters in the school. The National Stuttering Association used to have a mentorship program where they will pair you by interest, you know, like a person who loves basketball. And they don't have that anymore formally, but... I know that if you wrote them and said, I'm looking for somebody in Phoenix who likes fishing, I'm sure that they would find a way to put them person together with them. I would really encourage that. SLPs come to our National Stuttering Association meetings with them, and some kids are really shy. And so we say, you don't even have to have your camera on. You know, talk to us in the chat. We just want you to be there and to listen, and it's totally fine. And then eventually they normally kind of get in. there's also lots of really good books for kids who stutter, like I mentioned before, Talking Town book. Daniel the Digger, very cute. I read that with my niece. And she said, oh, I talk like Daniel sometimes too. I'm like, yes. You know, that's so true. So stuttering, you just have to find what motivates them. So sometimes we'll do a stuttering project. That would be good at a school. You know, maybe they want to make a Jeopardy game. You can make that on Jeopardy Labs. Some kids like to make little flyers about how to listen to people stutter. We've had kids make movies or board games, all kinds of things. And if kids are brave enough, they might do a school presentation, you know, so you could definitely facilitate that. They can participate to the degree they want. Some kids like to plan it but not participate. Other kids like to be right up front there. Sometimes I'll bring in a cool older person who stutters to help with that. We have done a Jeopardy game, the finger traps, just like when you're blocking. There's this what would you do video where there's, I think it was, Well, Mark Winsky, the person who helped on the Penguin movie, he was the actor in that and he was being made fun of at a restaurant. And we kind of talked with the kids, what would you do in this case kind of thing. So anyway, I'm a big proponent of focusing goals, even if you're in a school, on the avoidance reduction kind of values, which would be more about joy, sincerity, authenticity, confidence, spontaneity. connection, efficiency, effortlessness. And there's a really great article, Syskin and Goldstein, 2022, which I can share, that has a lot of really good, very practical ideas for how to do these things, which would totally be easy in a school. Yeah. That's amazing. So many incredible resources. Yeah, the show notes are going to be full. And no, but this is amazing because I feel like you did such a nice job of breaking it down and giving really practical examples of what this could actually look like. Because sometimes in presentations, they'll talk about incorporating counseling and it's like, but what does it look like? And I feel like you just gave us a million different examples, which is so empowering. And you did it in such a beautiful way. So before we close out, do you have any last things you wanted to share? Well, I have a few other resources if that helps the SLPs out there. So I mentioned a couple of times ART, so that stands for avoidance reduction therapy. So Vivian Siskin, she has a, it's called openstuttering.org on YouTube and she's done some beautiful videos there. There's also real people. there who have gone through the program. I really encourage people to just go there and listen. She's doing Coffee with Sarah McIntyre. Awesome. I could listen to them all day. Obviously, the National Stuttering Association, totally life changing for many people. You can find them at westutter.org. I know you interviewed Nina Reeves and Scott Yarris. they have stuttering therapy resources and this great verbal diversity movement, which is really in alignment with these things that we've been talking about. And it has a structured way to talk about these things with kids who stutter. And if they're really into art or however they want to express themselves, they can make it however they want. but it gives a nice structure. And then at Sparrow, they have a really excellent video about, families, that I think is good really for anybody to watch, but that's something else that I can link. Talked a lot about readiness. Naomi Rogers from Iowa, great article about that. I can share it as well. And the 8,000 things we're sharing in the show notes. Definitely follow people who stutter who are on Instagram. I like people like Caitlin Cohen who's, you know, a regular person who stutters who just talks openly about it. Sisters who stutter, all kinds of people. Mark Winski's out there, stutterology. There's just a million. I would encourage you to listen. And when you're doing the famous people who stutter, I know that we asked a lot of people who actually don't stutter anymore. And we're kind of moving away from that, right? So there are people like Michael Crest and, know, Emily Blunt, did hear she still, I heard an interview with her. She still does sometimes stutter. George Springer, who's a baseball player. You know, Elvis stuttered his whole life. So I try and find more people who continue to stutter. when we're talking about famous people. So I guess my message too that I hope people who stutter would take from this and maybe you can carry this forward in your work as SLPs is that fluency is overrated. We're encouraging our students to take back their power, be big, make sure they know that their stuttered voice has value. We're listening to them. They deserve to be heard. They're not alone and do not shut up. I think those are my final messages. I love that. Thank you so much for being so generous with your time and expertise. This was incredible podcast. Again, chock full of resources. So thank you. And yeah, thank you to everyone for listening to you. And that's a wrap.

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Marisha

Why Basic Concepts Matter

1. Keep Instruction Clear and Focused

2. Embed Concepts in Meaningful Contexts

3. Use Multiple Exemplars—Strategically

4. Pair Words with Gestures or Visuals

5. Collaborate Whenever You Can

Bringing It All Together with Zoe Gets Ready

Key Takeaways

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Why MLU Goals Matter

1️⃣ Identify Targets Using a Language Sample

2️⃣ Embed Targets in Play, Books, Songs, and Routines

3️⃣ Model Just Above the Child’s Level

4️⃣ Use Sentence Frames and Visual Supports

5️⃣ Use Contingent Responses and Time Delay

🛻 Therapy Plan in Action: Little Blue Truck

✨ Final Takeaways

🔗 Resources Mentioned

🧠 References

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Why Syntax Matters (Even for Kindergarteners)

Step 1: Start With a Thorough Syntax Assessment

Step 2: Make Syntax Explicit, Then Contextualize It

Step 3: Evidence-Based Syntax Intervention Strategies

1. Focused Stimulation

2. Directed Questioning

3. Visual Supports and Picture Sequencing

4. Sentence Combining

5. Sentence Decomposition

Step 4: Embed Syntax in Meaningful Contexts

Bringing It All Together

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1️⃣ Start with clear visuals.

2️⃣ Teach sentence combining explicitly.

3️⃣ Use sentence expansion and reduction.

4️⃣ Add movement for meaning.

5️⃣ Plan for generalization.

Why This Matters

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1. Start with a Thorough Following Directions Assessment

2. Incorporate Movement to Support Language Learning

3. Teach and Model Strategies Explicitly

4. Share Strategies with Teachers to Increase Carryover

5. Plan for Generalization from the Start

📦 Resource Spotlight: The Following Directions Skill Pack

References

✅ Takeaway

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Why WH Questions Matter for Kids

WH Questions Skill Pack

What Are WH Questions? (and Why They’re Important for Kids)

Complex WH Questions (and How They Differ from Early WH Questions)

Functional WH Questions in Everyday Routines

WH Questions by Age and Skill Level

WH Questions for Preschoolers

WH Questions for Early Elementary Students

WH Questions for Students with Autism

WH Questions Skill Pack

WH Question Examples and Lists (Free Preview)

What Questions for Speech Therapy

Where Questions for Speech Therapy

Who Questions for Speech Therapy

When Questions for Speech Therapy

Why Questions for Kids

How Questions Examples

Teaching WH Questions in Speech Therapy (6 Evidence-Based Strategies)

1. Assess — Find the Starting Point

2. Teach — Use Explicit Instruction and Visuals

3. Scaffold — Move From Simple to More Complex WH Questions