The Survival Guide for the Beginning Speech-Language CIinician By

Susan Moon Meyer

Aspen Publishers, Inc., 1998
Chapter 7: Enhancing Performance

22 Considerations to Avoid Common Mistakes Made by Beginning Clinicians

1. Seating Arrangement
a.Record Keeping — taking data (rt vs. left handed); therapy materials, etc.
b.Client Access — can an overactive child escape easily?
2. Use of Reinforcement
a. Accidental/Inappropriate ("OK" problem; unrelated "good")
b. Continuous Reinforcement (varied comments after each correct response)
i. Use for new skills
c. Intermittent Reinforcement (intermittently varied reinforcement; every 4 correct, for example) i.
Use when a new skill is established
d. Specific and Varied
i. "Great Sound!"; "Good pointing!"; "Super! You said `cats'!" vs. "Good!"; "OK!";
"Good!"
e. Tangible Reinforcement — reinforce goal directed behaviors
i.Fill a cup — earn a sticker
ii.X # of correct responses — color a picture
iii.here are 4 chips — lose a chip if get out of chair; if you have chips at the end, you
get a sticker
f. Natural vs. Artificial
i. Use natural reinforcers when you can – actual bubbles blown when client says "bubbles"
rather than just verbal reinforcer
g. Testing Reinforcement is different!
i. Don't make clients aware of correctness of responses; instead reinforce with: "You're
working hard!", for example
3. Verbal Models:
a. The "OK" Syndrome – 5 functions/situations to avoid
i.Conversational filler — Ok, let's get started.
ii.Tag questions — say it again, ok?
iii.Providing feedback — (incorrect response) OK. This time, with your teeth closed.
Say /s/. (does not distinguish correct/incorrect)
iv.Positive reinforcer — Ok. Say it again.
v.Answering questions — let's work on /s/, ok (tag)? Ok.
vi.AVOID EXCESSIVE USE OF "OK"!
b. Unnatural Production — AVOID THEM
i. E.g., "but-tons" vs. "buttons"; teaching/modeling unnatural speech
c. Ungrammatical Utterances — Know and USE proper grammar!
i.Bad: "you listened good"; "listen close"; "You're pointing so nice today"
ii.Good: "you listened well"; "listen closely"; "you're pointing so nicely today"
4. Loquaciousness (excessive talking!-who me?)
a. Client's don't talk/respond when they can't and YOU are talking! Power of pause/silence!
5. Smothering: using language above their linguistic ability
a. Non verbal child — "doll....fell" vs. "The doll fell off the table!"
6. Foster Dependency — Avoid "our lesson"; "say it for me"; "I want you to listen"
7. Choice Constancy —Keep # of choices constant
8. Reading Sequence — Client's perspective — not yours (English is L-R / Top — bottom)
9. Elicitation techniques
a. Language — beware client responses to your questions that may be natural but not reflect your
target — be creative
 i. Working on pronouns: show picture of a cookie and ask "what did the boy drop?"; client
answers "a cookie" (appropriate response — find a better way to elicit the target); perhaps
using puppets and having the child tell a story of the puppets doing a task
b. Articulation — hierarchy
i. Manipulation; placement; visual/tactile imagery; prosodic emphasis; frequency of stimulus
presentation; model; phonetic context; minimal pairs/contrasts
10. Use Questions Sparingly
a. Don't ask questions that you won't accept a response to (Do you want to...); give choices
11. Do not appear to be a fool — be creative; not condescending
a. Avoid questions like "what color is this block"; client knows you know the answer; rather hold all
blocks ask what color they want, pull one out-"is this the right color?"
12. Avoid being overpowering — Be aware of body positioning; be on their level
13. Directions — simplify, simplify, simplify! Do not over-explain
14. Receptive Tasks
a. Make sure they measure what they are designed to measure
i.Show 2 pictures — a boy playing and a girl cooking
ii.Avoid "Show me "The boy is playing" because he may not differentiate "play-cook", but
he can differentiate "boy-girl"
iii.Instead, only have one variable (both pictures with boys) or give a different
command ("Show me "play")
15. Group Therapy vs. Therapy in Group
a. Avoid "therapy in group"; have all participants interact
i.Avoid turn taking for working on targets (therapy in group)
ii.Play games with different targets for each player (Group therapy) e.g . Targets: Client 1:
articulation target-move a space vs. Client 2: complete sentence-move a space
16. Bad Habits to Avoid —beware misinterpretation!
a. Boredom or nervousness may be mistakenly conveyed by leg swinging, twisting hair, resting chin on
hand, etc. You are constantly being observed!
17. The Game "Mirage" — What did you do in therapy? We played games......
a.Games are a means to an end; emphasis must remain on the goals!
b.Be creative in game play so that goals are constantly remembered and targeted (e.g., move spaces
per # /s/ sounds produced, rather than produce /s/ sound and move according to a dice roll)
18. Carryover / Generalization
a.Monitoring — should always be encouraged; may be time consuming to teach, but very important
i. In therapy, have them constantly self-evaluate with you so they will do it out of therapy
b.Assignments / Homework — make it appropriate, specific, measurable; be sure to review at start of
the next session with client so they know you think it is an important part of therapy
19. Avoid doing too much work
a. Have clients and families help you select target words — be creative!
i.HW — make a list of X words beginning with Y
ii.Here is a paper bag — collect X objects from your house that begin with the letter Y
and bring them in next time
20. Sign Language
a. Don't forget receptive language if the client plans to use sign language to communicate! They will
need to understand / "read" signs. Need to make sure you sign everything you say and work on
receptive goals, too, as you would in any other spoken language
21. Session Opening
a. Aside from the "hello's", start each session with goal recap; ask the client to tell you what they are
working on; review homework
22. Session Closing
a. Warning: Be sure to give warning at the level of the client as to the closing of the session — "five
more sentences, then it is time to go"; "Two more minutes, then we're done"
b. Wrap up: End on a positive note and recap the goals again ("What did you work on today?");
assign and discuss homework