Ever struggled to get – or keep – a child’s attention in speech therapy? Of course you have! We’ve all been there.

In motor speech therapy, we ask so much of our young clients.

We ask them to repeat the same words over and over within each activity. We ask them to manage their frustration while persisting at difficult tasks, switch their visual attention back and forth between our face and the materials, and wait and watch while we model  what to say and how to say it.

No wonder so many children struggle to pay attention when we are working on motor speech together! Here are 10 things you can do to help:

ADJUST EXPECTATIONS

10. Make sure your expectations are fair.

Some children – at any age – might need to work on “therapy readiness” skills before it’s developmentally appropriate to expect them to focus on and adjust their speech movements.

For example, they might need to work on turn taking, participating in stop-look-listen-imitate routines with adults, inhibition, and/or following first-then contingencies.

While you are working on these skills, you can also work on motor speech development indirectly by giving the child many opportunities to see and hear words with speech movements that are motorically ‘easier’ for them. But the focus would be on developing the therapy readiness skills first, not on speech production. At this stage, you would praise any of the child’s attempts at speech imitation – accurate, or not – because the focus is on establishing attention and participation.

9. Offer early wins.

When you do start asking a child to produce speech movements a specific way, help them feel like a speech therapy superstar: start with something they can already say. Keep that first task easy and offer lots of specific praise for the speech accuracy as well as for their  attention and persistence.

SET UP FOR SUCCESS

8. Harness the power of routines.

Routines help free up a child’s attention and energy so that they can focus more on you and on learning new speech movements, and less on trying to figure out where they are supposed to be and what they are supposed to be doing.

Help your clients understand expectations by setting up and following some simple therapy routines in your session. For example, you could have them ‘sign in’ by putting their name on the board, begin with reviewing the visual schedule (see below) at the start of your visit, have a designated place (such as a bin or shelf) for the child to put materials after each activity, and have a simple goodbye/cleanup routine.

7. Use visual schedules for any age.

Help build predictability and clarify expectations by showing the child ‘the plan’ for the session in a format that they understand, that can show their progress as they complete each task, and that they can look at whenever they want throughout the session.

Most of us are familiar with picture-based visual schedules, often laminated and put together with velcro.

Others may have used digital picture-based visual schedules (such as the Choiceworks app) that allow for quick customization.

Children who need practice deferring their favourite activity until completing an adult-directed one might do best to start with a simple ‘first-then’ schedule.

Children who are readers may appreciate a simple plan written out by hand on a whiteboard or piece of paper, crossing off each step as it is completed.

Whatever format you choose, be sure to follow through with the plan as best you can. Sometimes, things will come up and you will need to make changes. So it is a good idea to practice making changes to the schedule throughout your therapy program so the child understands how changes work.

For example, to practice, you could use a different colour of marker to indicate a change on a written plan, or add a special “change” sticky note to a picture schedule. Practice by using a change that the child might enjoy, such as bringing back a favourite game they layed before.

6. Offer choices.

Look for opportunities to provide the child with choices. For example, have them choose from two stories or games, or have them select what they would like to do for a movement break.

Make sure to include their choice on their visual schedule (see above).

5. Include the child’s interests.

Find out what the child already focuses on best – their main interests.

Adding a picture of a favourite character or animal to an activity or having a toy figurine participate in the therapy session can go a long way to grabbing and holding their attention! Or try holding that picture or figurine next to your mouth to help them focus on your speech model.

4. Engineer the environment.

Set up the therapy environment so that it doesn’t compete with you for the child’s attention. Some things to consider:

  • Decrease background noise.
  • Ensure comfortable, stable seating (the child’s feet should be supported, on the floor or on a stool).
  • Simplify the visual information in front of the child (keep the table clear; put unused toys out of sight).
  • Have the child sit facing away from the rest of the room and looking towards you. It helps if you can have your back to a neutral background such as a wall so that your face stands out.

RESPOND IN THE MOMENT

3. Reward effort

To help children who struggle to attend in speech therapy, be sure to offer specific praise for the child’s attention and attempts, even if they are not fully accurate.

For example, try “I like how you were looking at my face that time”, “Great job waiting for me to say the word”, “I like how you tried that tricky word”.

2. Include what they are already focused on

To help a child whose attention is focused on something other than you, try to figure out what it is, and then use it in the session, if possible.

If they are focused on a favourite toy, try using it to help model the word (for example, by sliding it across the table to show smooth movement transitions between sounds). If that is too difficult, try putting the toy in a special place (such as a box) and then put it on their visual schedule (see above) so they know when they will see it again.

If they are focused on an activity that they are looking forward to after your session, add it to the end of the visual schedule to affirm that it is going to happen, and to clarify what they need to do first.

KEEP IT FUN

1. Have fun together!

The most important thing you can do to capture and hold a child’s attention for speech therapy is to be FUN!

Notice what each child enjoys. And then build as much of that into the session plan as you can!