Maximizing participation in speech therapy: An “in-the-moment” toolbox of behavior management strategies for preschool and early elementary school-aged children

By Shannon De Almo

Behavior and participation in speech and language therapy for younger children can be unpredictable. There are many outside factors which impact a child’s ability to work to his full potential for an entire speech session: Did he get enough sleep last night? Does he need a snack? Is he SO excited for his birthday? These outside factors often continue to impact a child’s participation when he enters your treatment room. Some children continue to walk away from the table and run around, or say “no” and laugh when you ask them to produce a speech or language target. It sometimes feels as if none of your games or activities is fun enough. Every child is different and it is important that you read the child you are working with to determine which tools work best for him. Here are several very simple behavior management strategies that can be used in the moment which I have found help to maximize my clients’ participation:

Modulate your voice.
Have you been speaking energetically and enthusiastically? Try taking it down a notch, lowering your voice and speaking quietly for several seconds. Have you been speaking sternly or quietly? Add some energy and volume to your voice. Often, the change in vocal energy in volume helps the child change his own behavior and energy.


Change the expectation for work. Some children benefit from a high workload to reinforcement ratio to keep them on track. For example, this could be producing 20 targets prior to a turn in a game or activity. Other children work best with a lower ratio, such as 5 targets prior to their turn. Consider what works best for the child you are working with; in the end, the productivity level will be the same, as the child will be working to his fullest potential. If something is not working, don’t be afraid to change the expectation partway through the activity. By decreasing the ratio of workload to reinforcement over several turns and getting the child invested in an exciting activity, you may be able increase the expectations again after a few minutes.


Change the timing of the structured work. Some children will request to complete an activity as soon as it is time to produce their targets. Try changing the timing of completing structured speech and language targets; you could complete the structured targets during the transitions between activities (such as when you are handing out game pieces or opening a box for a pretend play set), before the highlight of an activity (such as making the child laugh through a funny voice or joke), or on a regular schedule (such as after every turn).


Establish the format of choice-making. Some children work best with a visual schedule in which they get to choose the sessions’ activities. Other children are more motivated by choosing their own activities at their own pace as they go. Still others prefer to play one highly desirable activity for an entire session. Consider changing the format of choice-making to suit each child’s needs.


Play by yourself. Ideally, each child enjoys his time with you and wants you to participate in each activity with him. If a child is off-task or refuses to participate, I sometimes enthusiastically continue the activity by myself (whether it is a game on the iPad, trains on the floor, or taking my turn in a board game). Many children will be willing to complete structured work as soon as they see that you are having so much fun and they are missing out!



Use a concrete earning system. Stars, points, happy faces – use what it takes. Some children are highly motivated to earn something at the end of their session, including a “free choice” activity, praise from the clinician, or a special sticker. Keep the behaviors required to earn this few, concrete, and consistent (such as sitting in his chair), and “catch” the child when he is on task. If he earns 7 “stars” throughout his session, he can earn something special.


Incorporate a gross motor activity. When a child is highly active, excited about something else, or when he seems tired of structured activities, I often incorporate gross motor activities. The best choices are those which require your help to complete – such as obstacle courses, jumping rope, or racing from one side of the room to the other. Children are often willing to attempt their speech and language targets when the reward is jumping or running!


Incorporate pretend play. Everything is more fun with props, right? Incorporate structured work into pretend play, such as with a baby doll, a Little People set, or pretending to be animals together. The props used can be the speech and language targets themselves, or you can wait to complete your part of the play until the child produces the specific targets.

Consider the best type of praise for the child.
Some children are very proud when they accurately produce their speech and language targets. Others, especially if they are having difficulty with their targets, might require praise for other things to boost their confidence. Several skills which are critical to treatment but do not involve accuracy include participating, listening, working hard, and trying – these can be praised as well. Additionally, try praising smaller behaviors that will be components of a larger target to keep confidence high, such as a sound in isolation as opposed to in a word. Establishing the best type of praise for each child allows him to feel successful, have confidence, and build a foundation for actively participating in building more challenging skills.


Take a break! Sometimes, spending 2-3 minutes without working on anything can make for a much more productive session in the long run. Allowing the child to relax and participate in his very own choice of activity for a few minutes can make going back to the structured work more productive. There are several important factors to keeping these breaks successful. First, it is important that the breaks are established preemptively by the clinician. You can do this in the middle of a session if you notice that the child is “zoning out,” or you can include breaks on a visual schedule and allow the child to choose the time at which they are used. Secondly, keep the expectations clear; you can say something like, “Two minutes of the iPad for a break, and then we’ll get back to our work.” If you maintain control over breaks, they can be extremely useful for increasing participation and productivity.


Every child is different, and different strategies are effective with different children. Keep these in mind to try the next time you are having a difficult time managing a child’s behavior!