197. Ten Predictors of Poor Progress in Speech Therapy—and How to Turn It Around

If you treat speech sound disorders (SSD) and you’re not seeing the gains you expect, this episode is your playbook. We cut through the noise and name the 10 research-informed predictors of slower progress—attention/self-monitoring limits, sensitive temperament, co-occurring language/working-memory load, hearing impairment (fricatives/affricates), motor speech factors, structural constraints (e.g., open bite), low stimulability, later start to intervention, low therapy intensity/irregular attendance, and environmental barriers. Then we pivot hard into the three levers that consistently move outcomes: choosing complex, maximally distinct targets (e.g., SW-blends), delivering dynamic temporal tactile cueing (DTTC-style), and holding the ~80% challenge point to avoid reinforcing error patterns. Concrete therapy examples, parent carryover, and generalization strategies included. What you’ll learn: 📈How attention and self-monitoring mask progress until generalization “pops” 📈Why a sensitive temperament demands predictability and a responsive start 📈How co-occurring language and limited verbal working memory can look like CAS—but aren’t 📈What hearing loss really means for fricatives/affricates and consonant deletion patterns 📈Practical expectations for motor speech and structural constraints (e.g., open bite) 📈How stimulability with maximal cueing informs prognosis 📈Why start age and habit strength matter for entrenched /r/ and /s/ errors 📈Why frequency > duration for home practice, and how to embed one daily rep 📈The “no-data-during-DTTC” mindset: probe quickly, cue deeply, fade fast The 3 levers (non-negotiables): 📈Target selection: Complex, maximally distinct clusters (SW > ST/SP/SK) to drive system-wide change. 📈Delivery: DTTC-style, moment-to-moment cueing (choral → fade), with brief probes to verify learning. 📈Challenge point: Keep accuracy near ~80%—high enough to learn, low enough to adapt. If you’re reinforcing errors, pivot. 00:00 Why progress “flatlines” then explodes 03:10 Predictor #1: Attention/self-monitoring 06:20 #2: Sensitive temperament & predictable routines 10:00 #3: Language/working memory vs. “looks like CAS” 14:15 #4: Hearing impairment (HF cues, fricatives/affricates) 17:10 #5: Motor speech considerations 20:05 #6: Structural constraints (open bite, dental) 22:40 #7: Stimulability with maximal cueing 25:00 #8: Older start age, entrenched habits 27:10 #9: Intensity/attendance 28:45 #10: Environmental barriers 30:45 The 3 levers: complex targets, DTTC, 80% challenge point 38:00 One-rep-a-day home carryover that actually sticks Call to action: Stop reinventing materials. Make your work easy with effective, educationally-rich SSD tools at your fingertips—complex target sentence strips, paragraphs, and movement-literacy activities ready so you can focus on cueing, not prep. 👉 Join the SIS Membership: https://www.kellyvess.com/sis

If you work with children with autism who are minimally speaking, this episode is a must-listen. We’re breaking down why the “Look at” sentence strip has been a total game-changer in my therapy room—and why it consistently helps children begin to speak, connect, and comment on the world around them. After 25 years of practice, I can tell you this tool does more than encourage speech—it builds neurological pathways for speech to flow. You’ll learn: ✅ The neuroscience behind why repetition and motor consistency matter ✅ How DTTC and “look at” work hand-in-hand to build automaticity ✅ Why “look at” is far more powerful than “I want” for developing joint attention ✅ How to pair high-tech AAC with low-tech sentence strips for best outcomes ✅ The 10 reasons this strip transforms therapy for children with autism. This episode is full of practical insight, real-world examples from my SIS members’ “back porches,” and evidence-based strategies that rewire how we think about early speech intervention. 🎧 Tune in, and then grab your own Look at sentence strip and watch your minimally speaking students light up the room. 💫 Join the SIS Membership today for access to the weekly movement- and literacy-based therapy materials that pair perfectly with this episode—complete with parent emails and ready-to-go Google Slides for your whole group sessions. 👉 https://www.kellyvess.com/sis Thanks for joining me at today’s drawing board for a better tomorrow, 💚Kelly

Discover how a 2025 Nature autism study transforms early intervention in speech language pathology. Learn how family history, genetics, and executive function shape assessment, therapy planning, and lifelong communication outcomes. If you work with children with autism, this episode will change how you think about early intervention forever. A major 2025 study published in Nature titled Polygenic and developmental profiles of autism differ by age of diagnosis has revealed that early onset autism and later developing autism are not the same. This is one of the largest autism studies ever conducted, examining more than 47,000 individuals around the world. The results reshape how we understand autism heritability, family psychiatric history, and executive function development. In this episode, you will learn: ✅ Why early autism diagnosed before age three is genetically distinct from later developing autism that emerges in middle childhood or adolescence ✅ How family psychiatric history, including ADHD, anxiety, depression, bipolar disorder, and substance use predicts later developing autism ✅ Why the DSM 5 removal of the age three cutoff was not only progressive but empirically supported ✅ How this research should change your parent input forms and follow up recommendations ✅ Why executive function including attention, cognitive flexibility, and self regulation is the bridge between prevention and intervention This study confirms that autism can emerge at any point in development when social and academic demands exceed a child’s executive function capacity. That finding changes everything about how we evaluate, how we plan early intervention, and how we empower families. If you are ready to move beyond reactive labels toward proactive, capacity-building intervention, this episode will show you how to do exactly that. 💡 Join the SIS Membership at https://www.kellyvess.com/sis to access weekly movement-based literacy and language activities that build executive function, the foundation for lifelong communication, learning, and independence. Source: Zhang, Y., et al. (2025). Polygenic and developmental profiles of autism differ by age of diagnosis. Nature, 631(8046), 455–468. https://pubmed.ncbi.nlm.nih.gov/41034588/ Note: The diagnosis of Autism is an interdisciplinary process. In the U.S. public school system, a psychologist, social worker, and SLP are minimally required. In private settings, most insurers require a psychologist, MD, or psychiatrist with an allied health professional, such as an SLP.   

If you work with minimally speaking children or children with autism, this episode is a must-listen. Speech-language pathologist Kelly Vess takes on the five biggest myths about high-tech AAC (augmentative and alternative communication)—and backs every point with current peer-reviewed research. Learn why high-tech AAC devices: ✅ Do not require self-regulation or joint attention first ✅ Are not too complex for preschoolers ✅ Increase social interaction rather than limit it ✅ Should not be constantly customized ✅ Must be provided—and supported—by public schools under IDEA and ADA Kelly breaks down each misconception, explains how to blend high-tech and low-tech AAC for multimodal communication, and challenges you to D.S.D.—Do Something Different—instead of waiting 17 years for “research-to-practice.” It’s time to empower our minimally speaking students with robust, research-driven voices. Whether you’re an SLP, special educator, or early-childhood professional, you’ll walk away ready to advocate for access, staff training, and parent coaching in AAC implementation. 👉 Join today at www.kellyvess.com/sis

Today’s episode is a can’t-miss if you work with children with developmental language disorder (DLD) or developmental language delays. I’m sharing my #1 most powerful responsive language strategy—one that works with every child on your caseload, regardless of temperament. We’re going beyond basic expansions and simple recasts. Instead, I’ll show you how to transform simple sentences into complex ones by adding finite clauses—what I like to call “clausing.” You’ll hear about peer-reviewed research from: Gillian Steel et al. (2016) – demonstrating how complex sentence deficits persist in DLD. Amanda Owen Van Horne et al. (2023) – showing how targeting complex sentences drives broader language gains, including grammatical morphology. You’ll also learn practical ways to apply “clausing” during play, art, snack time, and book reading without memorizing verb lists or forcing structure—just natural, responsive modeling that works. 🎯 Key Takeaways: The higher you aim, the higher the gains. Responsive modeling of finite clauses builds both sentence complexity and verbal working memory. Simple to implement. Powerful results.  💚 Ready to take this strategy further?If you love helping your students use bigger, bolder sentences, you’ll love the SIS Membership. Each week, you’ll get:✅ Research-based language activities focused on complex syntax, literacy, and movement.✅ Parent carryover visuals and whole-class Google Slides decks.✅ Ready-to-use therapy tools that align with current research—so you can make an impact today, not 17 years from now. Join at https://www.kellyvess.com/sis and start building complex sentences that stick. Sources: Owen Van Horne, A. J., Curran, M. K., Fey, M. E., & Tomblin, J. B. (2023). Teaching little kids big sentences: A randomized controlled trial of complex sentence intervention embedded in science instruction. International Journal of Language and Communication Disorders, 58(5):1551-1569.  Steel, G., Rose, M., & Eadie, P. (2016). The production of complement clauses in children with language impairment. Journal of Speech Language Hearing Research, 59(2):330-41. 

If you work with children with speech sound disorders, this episode is a must-listen. We’re diving into cutting-edge research on final consonant clusters—a treatment target that has been largely overlooked but may unlock powerful generalization gains. For decades, evidence has shown that choosing complex targets leads to greater overall progress. Now, new research suggests that working on final 3-element clusters may be just as effective—and possibly more efficient—than the traditional initial cluster approach. In this episode, I’ll break down: ✅ Why marked forms (like /skr/) accelerate progress more than unmarked forms ✅ What makes final clusters uniquely complex (morphological load, rarity, later acquisition) ✅ Key takeaways from a 2025 study on final clusters in intervention (8 children, 6 weeks, medium effect sizes) ✅ Practical strategies you can implement tomorrow on your back porch ✅ Why efficiency matters: getting gains in speech and language when time is limited. I’ll also share how to structure practice (limited exemplars, high repetitions, removing models for self-driven motor planning) so you can maximize impact. Don’t wait 17 years for research to trickle into practice—try this approach now. 🎁FREE Resource: Download your Final Cluster Homework Flip Book here: 👉 http://www.kellyvess.com/finalcluster ✨ Want weekly ready-to-go resources? Join the SIS Membership today and get instant access to: Theme-based movement + literacy activities Weekly treatment targets (including complex clusters + paragraphs) Parent + teletherapy Google Slides decks A full treatment target library 👉 https://www.kellyvess.com/sis Source: Potapova, I., John, A., Pruitt-Lord, S., & Barlow, J. (2025). Extending complexity to word-final position via telepractice: Intervention effects for English-speaking children with speech sound disorder. Language, Speech, and Hearing Services in Schools, 56(1), 42–57. https://doi.org/10.1044/2024_lshss-24-00020

If you work with preschool or early elementary students, this episode is a must-listen. We’re diving into decontextualized language—a skill that’s rarely discussed but critical for literacy and academic success. Decontextualized language is when children talk about things outside the here and now—past events, future plans, ideas, feelings, and abstract thinking. Why does it matter? Research spanning over 20 years shows that children with strong decontextualized language skills in preschool perform better in reading and academics throughout elementary school. Yet, most SLPs and educators aren’t taught how to target it. In this episode, you’ll discover: -What decontextualized language is and why it’s the foundation of complex thinking. -Four powerful, evidence-based strategies to build this skill in fun, natural ways. -How to use Halloween excitement to scaffold conversations about past and future events. -Practical tips for using visuals, gestures, role-play, and parent collaboration. 💡 These strategies don’t just work for Halloween—they can be used for birthdays, field trips, and any special event to make language learning stick. 💚 Join the SIS Membership: Want ready-to-go therapy materials that build decontextualized language every week? Join the SIS Membership and get: -A Google Slides deck each week packed with educationally rich, movement-based literacy activities, Home resources to bridge school and family communication, -Evidence-based materials to target speech, language, and AAC in fun, engaging ways. 👉 Join here: https://www.kellyvess.com/sis 🎃Happy Halloween: Click here to download a 100% FREE Halloween-themed Google Slides deck to kickstart decontextualized conversations in therapy and at home!: https://www.kellyvess.com/halloween

Are you ready to go digital the right way in your therapy sessions? Today, we’re diving into the latest systematic review research on using digital tools to improve preschoolers’ language and literacy outcomes. The evidence is clear: digital media can be a powerful tool — when it’s used intentionally. In this episode, you’ll discover five key strategies that work, including: Why children should never be left alone with a device How to make digital activities multimodal and engaging The language modeling strategies that matter most Ways to make alphabet knowledge meaningful and connected to stories How to coach families and teachers for lasting impact Want to skip the overwhelm and have ready-to-go resources at your fingertips? Join my SIS Membership, where every week you’ll receive: A Google Slides deck filled with educationally rich activities Movement-based literacy ideas to target speech, language, and AAC goals Parent-friendly materials to bridge home and school learning Make therapy easier, more engaging, and research-based — all while saving hours of prep time. ✨ Join the SIS Membership today: https://www.kellyvess.com/sis Source: Liu, S., Reynolds, B., Thomas, N., & Soyoof, A. (2024). The use of digital technologies to develop young children’s language and literacy skills: A systematic review. Sage Open, 14(1).   

If you work with minimally speaking children using low-tech or high-tech AAC, this episode is for you. A brand-new systematic review has just been published, but the underlying research is sparse, messy, and often mislabeled. Today, we’ll dig through the “recycle bin” of studies to uncover what actually works, why commenting is more powerful than requesting, and how to take action on Monday morning. You’ll learn: -Why are many so-called “commenting interventions” really prompted responses to labeling questions, not true initiations -The pivotal role of combining words in AAC for speech development and generative language -Why modeling and scaffolding work and what research says about prompting hierarchies -How to apply the triangle of evidence-based practice when published protocols don’t exist -Download my free 30 Minute M.O.D.E.L. workshop to share with colleagues and caregivers: https://www.kellyvess.com/aac 💡 Ready-to-Go Tools: Don’t waste hours planning therapy. Get empirically-based, literacy-rich, movement-based activities delivered to you every week inside the SIS Membership. You’ll get: -Weekly theme-based Google Slides decks for individual, group, and teletherapy sessions -Engaging multisensory activities that target speech, language, and literacy, all ready to use Join now at https://www.kellyvess.com/sis and transform your therapy sessions with tools backed by research and designed for real-world success. Spencer, T. D., Tönsing, K., & Dada, S. (2025). Augmentative and alternative communication (AAC) interventions that promote commenting: A systematic review. Augmentative and Alternative Communication, 1–14.

Is telepractice just as effective as in-person therapy for treating speech sound disorders? In this episode, we take a realistic, research-driven look at what the evidence really says about speech telepractice—and what factors determine whether it works. You’ll discover: The exact client profiles that are NOT a good fit for telepractice. The active ingredients that make telepractice sessions as effective as in-person therapy. Why dose isn’t just about reps—and how complex targets create massive gains. Brand-new research on final clusters and how to apply it in therapy. The key role of caregivers as co-therapists in virtual sessions. If you’re a school-based SLP, private practitioner, or just considering telepractice, this episode will help you deliver high-impact, evidence-based therapy online—while avoiding the pitfalls. 💛 Get ready-to-go therapy plans every week inside the SIS Membership:https://www.kellyvess.com/sisYou’ll get theme-based movement activities, literacy-rich speech therapy materials, and a home-to-school 'Google Slides Deck' bridge that’s ready for immediate use. Potapova, I., John, A., Pruitt-Lord, S., & Barlow, J. (2025). Extending complexity to word-final position via telepractice: Intervention effects for English-speaking children with speech sound disorder. Language, Speech, and Hearing Services in Schools, 56(1), 42–57. https://doi.org/10.1044/2024_lshss-24-00020 P.S. A gift for SLPs & Educators: I’m giving away a FREE Digital Articulation Screener to make speech assessments easy and engaging—for both in-person and teletherapy sessions. Here’s what you’ll get for free when you join The Preschool SLP Facebook group: 🗂 A ready-to-go digital speech screener + protocol 📝 5 pages of goal-writing cheat sheets to write strong, measurable IEP goals 🎥 A live workshop to walk you step-by-step through the process ✨ Download by pressing the pinned link here → facebook.com/groups/thepreschoolslp