212. Stop Waiting for Joint Attention. You’re Delaying Language.

If you work with children who have autism, minimal joint attention, and limited expressive language, this episode challenges what you’ve been taught and replaces it with something far more useful. This is not a “wait and see” conversation. This is a rethink-everything conversation. Drawing from a powerful systematic review and the lens of dynamic systems theory, this episode breaks down why language development in autism does not follow a predictable path and why that actually changes how we should intervene starting today. You will walk away with a clearer understanding of how language can emerge in unexpected ways, why inconsistency is often a sign of growth, and how to respond in the moment so you do not accidentally shut down emerging communication. This is about seeing the child differently and adjusting your intervention accordingly. What You’ll Learn... Why joint attention is not a prerequisite for language The reality that some children develop language without following typical developmental sequences? How children may learn language visually, through patterns, reading, or AAC rather than through listening? Why “inconsistency” in communication is often a sign that a new skill is emerging How dynamic systems theory explains variability in language development? Because the child in front of you is not broken. They are showing you their pathway. You just have to be willing to take it? 3 Clinical Takeaways You Can Use Immediately: There is no single pathway to language Children may not follow a linear progression from babbling to words to sentences. Some may start with scripts, reading, or full phrases. Your job is to identify the pathway and build from it. Variability is not a problem When a child says a word once and then “loses it,” that is not regression. That is emergence. Do not punish inconsistency. Support it. Be dynamic in your response You cannot use a fixed script with a variable system. Adjust moment by moment. Increase support, then fade it. Follow attention, motivation, and engagement in real time. Referenced in This Episode Kissine, M., Saint-Denis, A., & Mottron, L. (2023). Language acquisition can be truly atypical in autism: Beyond joint attention. Neuroscience & Biobehavioral Reviews, 153, 105384. https://doi.org/10.1016/j.neubiorev.2023.105384 Spencer, J. P., Perone, S., & Buss, A. T. (2011). Twenty years and going strong: A dynamic systems revolution in motor and cognitive development. Child Development Perspectives, 5(4), 260–266. https://doi.org/10.1111/j.1750-8606.2011.00194.x Your Next Step If this episode is hitting something for you, if you’re realizing that your therapy needs to shift from linear to dynamic, then you need tools that actually match that approach. Because insight without application does not change outcomes. Inside the SIS Membership, you get weekly, ready-to-use, literacy-based movement activities that are built for exactly this kind of work. You are not guessing what to do next You are not piecing together random strategies You are walking into your sessions with a clear, research-informed plan that supports real language growth This is where theory meets practice in a way that actually works. 👉 Join today: https://www.kellyvess.com/sis Roll up your sleeves and meet me at the intervention drawing board.

If you work with four, five, or six-year-olds with speech sound disorders, this episode was made for you and this research will change how you document, advocate, and make eligibility decisions for your students. In this episode, we break down a brand-new 2026 open-access study that every school-based SLP, early childhood SLP, and preschool speech-language pathologist needs to save, cite, and have ready to go. Whether you're navigating a negative 2.0 standard deviation eligibility criteria, writing IEP goals for preschoolers with speech sound disorders, or advocating for a child who doesn't yet "qualify" on paper, this research is your clinical ammunition. This landmark study examined peer perceptions of children with speech sound disorders across ages four, five, and six: At age 4: Neurotypical peers already rate children with severe speech sound disorders lower across domains of intelligence, friendliness, and likability compared to typically developing talkers. At age 5: Children with moderate-to-severe speech sound disorders are rated lower across all social domains by their neurotypical peers. At age 6: Even children with mild speech sound disorders are rated lower and are seen as less desirable friendship candidates compared to neurotypical peers. The bottom line? Severity matters. Age matters. And the social stakes get higher every single year. Use this research study to support eligibility decisions when standardized scores alone don't tell the full story. Cite it alongside teacher observations, parent input, direct observation of socialization, and connected speech samples. Document the educational and social impact of the speech sound disorder, not just the score Know your state's eligibility criteria: some states require -2.0 SD, others -1.0 SD, and others rely on professional judgment of adverse educational impact Advocate proactively: a wait-and-see approach has real social consequences for your students Henry, M., & Bent, T. (2026). Let's be friends: Peer perceptions of disordered speech in preschool and early school-aged children. American Journal of Speech-Language Pathology, 35(1). 🔓 FREE Open Access Article: https://pubs.asha.org/doi/10.1044/2025_AJSLP-25-00093 Download it. Save it. Cite it. Your students are counting on you. 📖 RECOMMENDED RESOURCE: 'Speech Sound Disorders: Comprehensive Evaluation and Treatment' by Kelly Vess. This is written to support SLPs at every level, from graduate students to seasoned clinicians. 👉 Grab your copy on Amazon  Here's what we know: earlier is better. Neuro-plasticity is at its highest level in the preschool years. Are you using the most effective treatment targets to capitalize on that window? The SIS Membership gives you access to complex treatment targets — the evidence-based approach that leverages the power of neuroplasticity to drive maximum speech sound gains in minimal time. If you are working with preschoolers and early elementary students, complex targets are the clinical game-changer you need in your toolkit right now. This episode just showed you the social urgency. The SIS Membership gives you the clinical tools to act on it. 👉 Join the SIS Membership today and start using complex treatment targets with your students. Because we're not treating a mouth. We're treating a child, and every session counts: https://www.kellyvess.com/sis  

If you work with children with autism, developmental delays, or complex communication needs, this episode is a must-listen. Today, we’re talking about cerebral visual impairment, or CVI, and why it may be one of the most overlooked reasons children struggle with communication, attention, social interaction, AAC use, and motor-based learning. This episode is not about whether a child can see an item on an eye chart. It is about how the brain processes visual information and how that affects language, participation, and learning. In this episode, I share 10 practical strategies from the literature that speech-language pathologists and speech-language pathology assistants can use right now to better support children with visual processing challenges. We discuss why reducing clutter matters, how to make materials more visually accessible, why movement activates learning, and how active task-based therapy can improve visual-motor integration. You’ll learn: -Why is cortical visual impairment increasingly referred to as cerebral visual impairment -How CVI affects communication and social development -What visual complexity does to learning -Why movement is critical for visual engagement -How to adjust therapy and AAC supports for better outcomes Join the SIS Membership for ready-to-use literacy-based, movement-based activities that help you put these ideas into practice right away: https://www.kellyvess.com/sis Featured article: Wilkinson, K. M., Elko, L. R., Elko, E., McCarty, T. V., Sowers, D. J., Blackstone, S., & Roman-Lantzy, C. (2023). An evidence-based approach to augmentative and alternative communication design for individuals with cortical visual impairment. American Journal of Speech-Language Pathology, 32, 1939–1960. https://doi.org/10.1044/2023_AJSLP-22-00397 Thank you for being with me at today’s intervention drawing board for a better tomorrow,💚Kelly

Many clinicians are told there is a right way to prompt AAC users. You may have heard that you should always use least-to-most prompting. Others insist most-to-least prompting is best. But what does the research actually say? In this episode, we look at findings from a scoping review of 29 AAC intervention studies examining the prompting strategies used with children with autism who use speech-generating devices. Here’s the surprising truth: The research does not show that one prompting hierarchy is universally superior. Instead, effective AAC intervention is multimodal, flexible, and individualized. Successful clinicians use a toolbox approach, drawing from multiple evidence-based strategies depending on the child in front of them. In this episode, I walk you through a DTTC-inspired prompting hierarchy adapted for AAC that moves children from high levels of support toward full independence. I also share a real therapy example from this week using a St. Patrick’s Day literacy activity with a puppet and AAC device, so you can see exactly how this process works in practice. This is not a theory. This is something you can try tomorrow. Why This Matters for AAC Intervention? Children with autism are developing across multiple domains simultaneously: • language • motor planning • executive function • symbolic representation • social interaction Because autism is multifaceted, intervention cannot rely on a single rigid strategy. The most effective clinicians adopt an “all of the above” mindset and use prompting dynamically depending on: • the child • the task • the novelty of vocabulary • the motor planning demands • the learning context This episode will show you how to do exactly that. Want Ready-to-Use Activities That Apply This Framework? Inside the SIS Membership, I provide ready-to-use activities designed specifically for: • AAC users • speech sound disorders • language development • motor planning • executive function Every week, you receive literacy-based movement activities that allow you to apply frameworks like the DTTC-for-AAC hierarchy immediately with the children on your caseload. These activities are designed to address multiple developmental domains simultaneously while keeping therapy engaging and efficient. You also get access to the Speech-Language Treatment Target Library, giving you structured targets across speech, language, AAC, and literacy. Instead of spending hours planning therapy, you can walk into your session with activities that are already designed to produce meaningful communication gains. Start Using DTTC for AAC Today If you want structured activities that help you implement these strategies immediately: 👉 Join the SIS Membership today https://www.kellyvess.com/sis You’ll receive: • weekly ready-to-use therapy activities • weekly Google Slides Deck • treatment target library • practical strategies you can implement tomorrow Because when we reduce clinician workload and increase engagement, every child wins. Reference the research:  Wandin, H., Tegler, H., et al. (2023). A Scoping Review of Aided AAC Modeling for Individuals With Developmental Disabilities and Emergent Communication. Current Developmental Disorders Reports, 10(2), 123–131.                                                       

Feeling overwhelmed by a caseload that includes autism, childhood apraxia of speech, developmental language disorder, articulation, fluency, and AAC users… all back-to-back? You are not alone. Many speech-language pathologists walk into therapy sessions with a stack of different activities for every child. One game for articulation. Another for language. Another for fluency. Another for AAC. Before long, therapy starts to feel like running a fast-food counter. But what if you could run one powerful therapy routine that works for every child on your caseload? In this episode of The Preschool SLP Podcast, Kelly Vess shares the five-step therapy routine she uses every single day to deliver educationally rich, engaging sessions that treat the whole child while producing powerful gains across: • Speech sound production • Language development • Literacy skills • AAC use • Executive function • Motor planning and coordination Instead of pulling ten different activities from behind the therapy table, this routine uses one structured activity and simply changes the treatment target to match each child’s goals. Built on principles from Universal Design for Learning, motor learning, and executive function research, this approach allows clinicians to work smarter, not harder. You will learn: • The five predictable therapy steps Kelly uses with every child • How to use one activity to treat speech, language, AAC, literacy, and fluency • Why predictable routines help children feel safe, regulated, and ready to learn • How task-oriented movement improves executive function and engagement • Why treating the whole child instead of just the mouth produces stronger outcomes When therapy is predictable, engaging, and multimodal, both the clinician and the child can be fully present. And that is when the magic happens. Join the SIS Membership If you love practical therapy frameworks like this, the SIS Membership was built for you. Each week inside SIS you receive: • Ready-to-use movement-based therapy activities • Powerful complex speech and language treatment targets • A growing treatment target library you can use with any caseload • A full literacy, language, and movement Google Slides deck for therapy, classrooms, or teletherapy Everything is designed to help busy SLPs deliver high-impact therapy without spending hours planning. Many members prep their entire week of therapy in less than one hour. Join today and receive the entire Treatment Target Library immediately: https://www.kellyvess.com/sis with you in this,💚 Kelly

What do Gustav Eiffel and dynamic, tactile, temporal cueing have in common? Scaffolding, vision, and the courage to aim higher than anyone else. In this episode, I break down why Dynamic, Tactile, Temporal Cueing (DTTC) is not just for childhood apraxia of speech. It is a practical, high-impact framework that can upgrade how you treat: • Speech sound disorders • Language delays • Literacy skills • Fluency • AAC users • Autism and complex communication needs If you want maximal gains in minimal time, this episode is your blueprint. After standing beneath the Eiffel Tower and speaking at a packed state conference, one message hit me hard: the higher you aim, the bigger the cascade. When you treat at a complex level with the right scaffolds, earlier developing skills often come along for the ride. Inside this episode, we unpack: • Why fewer targets with higher reps build automaticity faster • How simultaneous production jump starts planning and reduces breakdowns • Why slowing time increases accuracy across speech, language, fluency, and AAC navigation • How to use most to least prompting without letting the tower fall • Why errorless learning and the 80 percent sweet spot matter • How multimodal cueing accelerates learning for every child • Why you build automaticity first and generalize later This is not business-as-usual therapy. This is challenge point therapy. This is how you stop grinding and start seeing real progress. Join SIS and get the complex targets done for you If you want powerful complex speech and language targets ready to pull into sessions immediately, join SIS Membership today. You will get access to high impact therapy materials designed to help you scaffold fast progress across speech, language, literacy, and AAC, without reinventing the wheel every week. Join here and get started today: https://www.kellyvess.com/sis Roll up your sleeves. Make the world better, one child at a time. With you in this,💚Kelly

If you work with children who drool, this episode is for you. I’m pulling back the curtain on an approach I’ve used for over 15 years that has consistently reduced—and often eliminated—drooling in preschoolers. Not in theory. Not in a lab. In real therapy rooms, with real kids, on real caseloads. Here’s the uncomfortable truth: There is very little direct research on speech intervention and drooling. And instead of grappling with that complexity, our field often defaults to dogmatic thinking—blindly applying principles from other populations and calling it “evidence-based.” In this episode, I challenge that thinking. You’ll hear why: Motor learning principles do not transfer cleanly to preschoolers Bottom-up oral motor logic fails when the task is speech Single sounds don’t recruit the same neuromuscular systems as 3-element consonant clusters Then I walk you through four precise reasons why targeting three-element clusters (like /spr/, /skr/, /skw/) uniquely impacts drooling: Jaw stability driven by sustained /s/ with a closed mandibular posture Differentiation of tongue and lips from the jaw, mirroring swallowing mechanics Enhanced proprioceptive feedback through Dynamic Temporal Tactile Cueing Endurance and motor control built through slow, continuous, high-load speech tasks I also share a practical “back-porch” way to test this yourself—no fancy equipment, no new evals, just systematic observation and honest comparison. This isn’t about abandoning evidence-based practice. It’s about doing it better—with nuance, skepticism, and attention to detail. Because real progress doesn’t come from swinging between extremes. It comes from asking better questions and working at the right level of complexity. What You’ll Learn Why drooling is a neuromuscular control issue—not a hygiene issue How 3-element clusters recruit swallowing-relevant motor systems Why preschoolers need more, not less, feedback How to get speech gains and drool reduction at the same time Where the limits of this approach actually are (and why that matters) Call to Action If you want to apply this Monday morning, don’t guess. When you join the SIS Membership, you’ll immediately receive: Ready-to-use 3-element cluster treatment targets Weekly task-oriented movement activities that support posture, endurance, and executive function Research-to-practice tools designed for real caseloads—not perfect conditions You don’t need more time. You need higher-yield targets. 👉 Join here: https://www.kellyvess.com/sis Because when you work at the right level of complexity, the easier skills take care of themselves.

If you work with preschoolers with autism and you care about spoken language outcomes, this episode matters. A lot. In today’s episode of The Preschool SLP Podcast, we unpack the largest study to date examining why some autistic children do not develop spoken language, even after receiving high-quality, evidence-based early intervention. The takeaway is blunt: Motor imitation doesn’t matter a little. It matters a lot. Inside this episode, we cover: Why one-third of autistic preschoolers in a large, multi-site study did not advance in spoken language despite receiving ~10 hours/week of evidence-based intervention How motor imitation emerged as a key distinguishing factor between children who advanced in speech and those who did not What neuroscience tells us about mirror neurons, empathy, perspective-taking, and speech development Why speech develops from the inside out: core → proximal → distal → speech. And, what happens when we skip the body and go straight to the mouth How motor imitation supports: Entry into peer play Social communication Speech motor planning and execution Prefrontal–cerebellar connectivity Why this research gives us a “crystal ball”—not to maintain the status quo, but to do something different earlier  You can’t build speech on a system that can’t yet support posture, movement, imitation, and motor planning. If motor imitation is weak, speech outcomes are at risk, pretending otherwise doesn’t help children. Clinical bottom line: If a child presents with: Severe autism presentation Limited or absent spoken language Poor motor imitation Then motor imitation must be intentionally built into intervention, alongside AAC, multimodal cueing, movement-based learning, and robust communication supports. This episode challenges us to stop treating mouths—and start treating children. 🎧 Want practical ways to integrate motor imitation, movement, AAC, and literacy? Join the SIS Membership for ready-to-use, movement-based, evidence-informed activities designed for real preschoolers in real settings: 👉 https://www.kellyvess.com/sis Vivanti, G.L, et al. (2025). Proportion and profile of autistic children not acquiring spoken language despite receiving evidence-based early interventions. Journal of Clinical Child & Adolescent Psychology. https://doi.org/10.1080/15374416.2025.2579286      

What if the problem with treating the R sound isn’t the child—but the way we train it? In today’s episode, we step outside the field of speech-language pathology and borrow powerful, evidence-based principles from exercise science and kinesiology to rethink how we treat speech sound disorders. Why? Because exercise science has done what our field largely hasn’t: isolated what actually works using controlled trials, precision, and specificity. Speech is a complex neuromuscular skill. Treating it like flashcards and passive listening don’t make sense—and they don’t produce durable change. In this episode, you’ll learn how five core principles from exercise science directly apply to improving the R sound efficiently: • Why “practice makes permanent” and how the 80% challenge point prevents habituating errors • How progressive overload explains why complex clusters outperform isolated sounds • Why auditory bombardment is passive and inefficient when therapy time is limited • How compound training (paragraphs, clusters, movement, literacy) creates system-wide linguistic change • Why specificity matters—and why speech therapy must look like real speech to generalize This episode challenges the status quo in therapy and makes the case for treating speech as the neuromuscular endurance task it actually is. If you’re tired of plateaus, endless cueing, and R programs that don’t generalize, this conversation will change how you think about treatment starting Monday morning. 👉 Ready to treat the R sound more efficiently—without guessing? Inside the SIS Membership, you’ll find high-impact treatment targets, complex R clusters, and ready-to-use paragraphs designed to apply these principles immediately—so you can stop planning and start seeing change. Get access to efficient, evidence-informed R targets at https://www.kellyvess.com/sis Train smarter. Challenge appropriately. Create real change.

Are consonant clusters really “too complex” for kids with severe speech sound disorders—or have we been aiming too low? This episode tackles one of the most persistent myths in speech therapy: that children with childhood apraxia of speech, autism, or severe speech delay aren’t ready for clusters. I’m unpacking the real science behind complexity, coarticulation, and system-wide change—and why waiting for “readiness” often slows progress rather than supporting it. Let's break down three common myths that are not evidence-based: • Myth 1: Children must master single sounds before clusters • Myth 2: Clusters should always come later in treatment • Myth 3: Consonant deletion must be fixed first You’ll hear why speech doesn’t develop like a geyser, how the waterfall effect actually works, and why starting with complex targets can accelerate gains across the entire sound system—even in preschoolers. This episode also walks through how to do this in therapy: using dynamic tactile-temporal cueing, maintaining an 80% challenge point, and choosing treatment targets that improve motor planning, programming, and verbal working memory simultaneously. If clusters feel uncomfortable, slow, or messy—that’s the point. Challenge creates change. Want treatment targets that already do this work for you—without reinventing the wheel every week? Join the SIS Membership for ready-to-use, research-informed activities designed to create real speech change while protecting your time and energy. https://www.kellyvess.com/sis