Ariana's Posts

Celebrating 2 Years of Telehealth Speech Therapy Being More Successful Than The In Person Sessions :)

Posted on by Ariana
Tony getting ready to answer a question for Jenny during a speech therapy session online, all photos by Ariana unless indicated

Tony has always, always hated speech therapy. For many years this was his least favorite therapy type, as every speech therapist who has ever worked with him can attest. Our little man understands a great deal more than most people realize (in both English and Spanish), but he still usually doesn’t want to communicate unless it is guaranteed to benefit him. He will only indicate the number of something if he’s telling you how many he wants, that sort of thing.

We’ve discussed this before, but nobody on Tony’s therapy team thought he was a good candidate for telehealth two years ago. But the pandemic turned doing everything we could to make it work into a necessity, and I’m not going to lie: I dreaded most teletherapy sessions regardless of the therapy type. Adverse behaviors were up during them, and all of the hands on management of this fell to me.

We didn’t really see a whole lot of smiles in speech therapy before it became based around answering questions about videos he likes.

Except for speech, interestingly enough. Chris, his former therapist, had asked me what I thought would be most likely to hold Tony’s attention and encourage any sort of cooperation. I indicated that if he could play some of Tony’s favorite simple songs from YouTube and ask him questions about those over zoom, we might be able to get this thing to work. That’s what happened, and within a short period of time, Chris and I both were in full agreement that at least with speech therapy, Tony’s enthusiasm and cooperation dramatically improved with telehealth. In fact, speech is the only service I still want to keep on telehealth because of the extent to which this manner of delivery has improved his cooperation and behaviors during that therapy type.

Tony loved Chris, and he didn’t really take it well when we suddenly lost him as part of his therapy team. For those of you who have been reading with us for a while, you might remember the really nasty sprain I got last year right before I went into anaphylaxis…I got it by slipping on Tony’s Ipad while I was chasing him up and down the stairs because he was running up them and self-harming when his new speech therapist took over. He also did a whole lot of running up and hiding in the linen closet, trying to get out of working during these early teletherapy sessions with Jenny. I’d sit up there with him keeping him safe and text her, letting her know what was going on if I couldn’t get him safely down for several minutes- and that happened a lot during our first few weeks with her.

A screenshot of one of the social stories she created for our son. Chris and Jenny pictured.

Once he got used to working with Miss Jenny, speech went back to being one of the easier therapy types for me to assist with- either in person or telehealth. And while Tony wasn’t thrilled at first and it took him a couple of months to really warm up to working with her, so many of the harder things I was going through in the first couple of months she was working with us were eased and improved by the social stories she made for us to use with Tony. Social stories that explained the change in therapists and that explained some of the differences he might experience in what I could and could not do when I developed POTS, what could happen if I had to go back into the ER for more visits.

The basic process we are using is pretty simple. She opens each session saying “hi” to Tony, and he greets her back on his AAC. She asks him what song he wants to pick, and then for each song he requests she has either actions she wants him to imitate or questions she wants him to answer. Sometimes he’ll ask for a book during session, and Jenny will pull up a copy of someone reading it on YouTube to go along with him flipping the pages in real life. Really we are working on building the habit of and encouraging him to communicate even when he’d rather not. Which is most of the time. Sometimes he will get a mischievous or determined look on his face and pick every single item on the page except the correct answer. Even with that, you can tell he knows what he should have said, he just really doesn’t want to some times. We close with them saying goodbye to each other, but sometimes (like today) he tells her “I want goodbye” while she’s still trying to get him to answer the last few questions. All I can do is laugh about that one, really.

But, we keep plugging away at it. Jenny has an insane amount of patience with him, and I am so grateful for that. The rest of this post is just pictures of some of what’s happening in session. Most of the pictures and screenshots were taken by me, some of them were taken by Hannah and I will label those accordingly.

Saying “hi”. Sometimes he starts out with great eye contact, others not…and that’s OK.
Tony responds to her greeting, he insists on asking every person’s name even if he knows them right now because I told him he shouldn’t ask if he knows who they are. That’s one way his ODD manifests I think. But then he goes in and selects their name on his own right after he asks it.
Saying “hi” on a different day…
Jenny’s pulled up a book he requested on YouTube…Hannah’s in the background taking pictures.
We read it a couple of times that day, the first time he went through it himself and looked at her and the screen. Then we read it again with him on my lap and me reading it out loud. Jenny on the computer in the background on the last picture. Photos by Hannah
Tony looking at Jenny/the computer and thinking about which song he wants to request. He will tap the surface of his device with the backs of his fingers while he’s thinking about it. He still chews on a lot of different things during sessions. At this time, we were trying to prompt him to grab his own device to answer questions, instead of me giving it to him. First two photos of this trio by Hannah.

Jenny will freeze on a point and ask him to imitate an action, in this case he’s using his hands to make the turning around motion.

Sometimes we do a lot of waiting for him to respond or pick a song. Jenny’s demonstrating her flexibility below by showing him the body part she’d like him to touch for this song, and sometimes he struggles with touching his legs, and he’ll land on his tummy instead.
She’ll circle or use arrows to indicate what she’d like to talk about. Here we’re working on using the correct gender and describing looking.

The expression says it all in the firs pic…sometimes, there’s not always a lot of enthusiasm for describing things even in videos he loves.

Sometimes he still gets off task and runs off to do something he shouldn’t, like raiding the cereal. I direct him back to task and prompt him to ask permission.

Sometimes he has to describe what a person is eating. For this particular song, he knows it’s a chocolate chip cookie and he asks for one to eat before he answers the question about what is happening on the screen in terms of a cookie being eaten.

We work on a lot of different things: size descriptors, what animal he’s hearing, what action is happening…sometimes he looks at me, sometimes Jenny, and sometimes neither of us.
Imitating and responding and he’s not looking unhappy…I’ll take it! 🙂

Ariana