209. DTTC for AAC: The 5-Step Prompting Framework That Builds Independence Fast The Preschool SLP

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.

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

If you work with children who are minimally speaking with autism or you love a child who is minimally speaking, today’s episode matters. Over the past year, I’ve been doing something deeply intentional. I’ve been having long, honest conversations with speech pathologists and special education teachers who are truly effective with high-tech AAC. These weren’t quick chats. Each interview ran over an hour. I asked open-ended questions. I pushed for specifics. I wanted to know what is actually working for robust AAC systems with thousands of words. What I found surprised me. There was no magic training. No perfect certification. No secret setting hidden inside the device. What these highly effective professionals shared was something much more human. They believed in themselves enough to try. To fail. To troubleshoot. To look clumsy. To learn alongside the child. In this episode, I talk about why vulnerability is the real needle mover in AAC implementation. I share why modeling uncertainty, curiosity, and joy matters more than appearing fluent. Showing a child how you search for a word, celebrate finding it, or flexibly choose an alternative builds far more communication power than perfection ever could. We discuss treating AAC as play, not performance. About using devices the way we use books with young children as interactive tools meant to spark connection, not test correctness. I also connect what I’m seeing in my dissertation research to real-life practice. Across hours of transcripts and coding, the same theme kept surfacing. Fluency doesn’t come from training. It comes from hands-on experience. Repetition. Messy, imperfect action. This episode will challenge you to rethink comfort zones, to stop waiting until you feel ready, and to remember that communication growth begins when adults are willing to learn out loud. If AAC has ever felt overwhelming, intimidating, or like something you were supposed to already have mastered, this conversation is for you. And if you want ready-to-use, engaging, and effective activities that make AAC implementation doable in real sessions, join the SIS Membership. Weekly resources arrive in your inbox so you can spend less time prepping and more time modeling, exploring, and connecting with your kids. You can learn more and join at https://www.kellyvess.com/sis Thank you for being part of this work. Roll up your sleeves. Be vulnerable. And keep changing lives one child at a time.

If you work with children who have complex communication needs, you already know this truth: You cannot pour from an empty cup. In this episode, I share six realistic self-care swaps I use from morning to night to support energy, focus, and emotional regulation in the work we do. These are not trends. They are practical, research-informed adjustments that help me show up fully present in therapy sessions, even during long, demanding days. As winter approaches and energy dips, comfort-food cravings rise. Instead of relying on willpower, I build better systems. In this episode, I walk you through: • A caffeine swap that supports focus without crashes • A protein-rich breakfast that stabilizes blood sugar • A comfort-food lunch that doesn’t derail energy • A 4 p.m. strategy for end-of-day slumps • A clean popcorn hack that actually works • A dessert and sleep routine that supports recovery, not burnout Self-care isn’t indulgence. It’s infrastructure. When your body and brain are supported, you can stay responsive, regulated, and fully present with the children and families you serve. A note for SIS Members and those considering joining Inside the SIS Membership, I design therapy the same way I design my self-care: with systems that remove friction. Members receive weekly, done-for-you, research-informed activities so they can spend their energy where it matters most: interaction, responsiveness, and connection. No scrambling. No reinventing the wheel. Just showing up ready. If you are ready to reduce decision fatigue, protect your energy, and innovate your practice alongside a community of practitioners doing the work in real classrooms and therapy rooms, you can join us here: 👉 https://www.kellyvess.com/sis You deserve support that actually supports you. Thank you for joining me at today’s drawing board for a better tomorrow, 💚 Kelly

If you work with parents of children with special needs, this episode is non-negotiable. Instead of diving into research, we’re heading straight into a film that delivers the kind of uncomfortable clarity our field rarely gets. Today, we break down If I Had Legs, I’d Kick You—Mary Bronstein’s raw, emotionally accurate look into the lived experience of parenting a neurodivergent child—and why every SLP, special educator, and early-intervention professional needs to watch it. This movie exposes a blind spot in our practice: how we show up for families. And more importantly, how often we get it wrong. In this episode, you’ll learn: • Why judging parents instantly destroys trust • How our “professional persona” blocks genuine connection • The simple shift that makes parents feel heard instead of dismissed • When your “support” becomes a burden—and how to stop doing it • Why burnout in families is invisible until it explodes • How to rebuild capacity for parents and for yourself This is not a feel-good conversation. It’s a necessary recalibration for anyone who works with families navigating neurodivergence, chronic medical needs, and overwhelming daily demands. If you want to do better for the families you serve, start here. Feeling your own burnout creeping in? Stop white-knuckling it. The SIS Membership provides weekly, ready-to-use, universally designed literacy-movement activities that dramatically reduce your planning time while increasing engagement for every child on your caseload. Protect your capacity. Strengthen your practice. Join today at https://www.kellyvess.com/sis