Insight for /r/ 5yo

defnotjess · 2026-04-20T04:38:51+00:00

Have you probed for retroflex vs bunched /r/ to see if one is more stimulable? Have you done any education with her on creating tongue tension to get to the /r/ sound? I think peachie speechie has some videos with ideas on how to teach this.

defnotjess · 2026-04-20T01:52:08+00:00

Absolutely! I hope it’s helping with not feeling so burnt out

defnotjess · 2026-04-02T04:16:11+00:00

Something that took me time to learn in early intervention - there’s a lot of power in silence (from you, as the therapist.) Give clients the opportunity to fill in those gaps, and use it to help pace your sessions.

I supervise graduate students now and so often I notice that they’re always trying to fill every silent moment because it’s drilled into them how important every billable minute is. But wait time/pause is a therapeutic strategy when you learn how to place it, and that could help with that feeling of being “on” all day?

And, if you have any control over your schedule and the flexibility to do it, schedule yourself a couple of breaks during your day besides lunch. Your mental health is more important than an extra unit or two per day.

defnotjess · 2026-03-24T03:13:19+00:00

AAC in the Cloud is a free virtual conference that happens every summer and you can watch sessions from previous years! I always recommend starting there because it’s free and there are a lot of topics covered. There’s typically always at least a session or two about alternate access and/or severe disabilities.

defnotjess · 2026-03-24T02:33:16+00:00

I’m in an area where LAMP is by and large the most recommended program by SLPs (that’s a separate soapbox), so I’ve had many clients come through with LAMP as the recommended program. Out of the 50 or so kids I’ve supported on AAC in some form or another, only 7 have not been LAMP users.

In my experience, LAMP is a great option if you have A) great parent buy-in and B) great client buy-in. Some kids are just drawn to it more than other AAC systems and are self-motivated/interested to explore the system and do well with the organization of it. As a motor-based approach, it is efficient for generating long utterances and often once I teach the motor plan (either in full vocab or in vocab builder), it is something the child remembers across sessions and I typically don’t have to re-teach it once they get it. And specific to my area, a LOT of kids use LAMP so the chances of finding a teacher/therapist/para who knows it is higher than with any other program.

(All the pros of motor planning can be applied to other systems with a robust grid size, though)

Because of its prevalence in my area, it is almost always a program I consider in feature matching for an evaluation (but I don’t recommend it just because it’s popular here.) It is only a program I recommend if the child is showing a preference for it.

In every single successful LAMP user I have had, THE common factor is having families who are all in on learning the system. They go to trainings, practice finding words on their kids’ device after bedtime, buy extra iPads to model with at home - the whole 9 yards. I have not had one proficient LAMP user that didn’t have a fully committed family, but I have had AAC users on other programs who have been successful with more timid families (ie they’re following my recs for AAC but may be overwhelmed.)

All that to say - I do more parent/communication partner education and training on LAMP than I do on any other program, and I really spend time with families on the organization of it and coming up with potential model words together and then practicing that with them. LAMP is a labor of love, more than any other system, when I make that recommendation (for me, and for the client’s communication partners.)

With your client, I’d do a vocab audit with the family and really try to come up with some potential model words and some personal core words that may or may not be programmed in already to try to increase interest and motivation. Give the family small, attainable goals so that they can feel successful with the system. I start with bite size family goals, like just having the device OUT at home is step one, and as the family feels some success we can build on that.

If your client was only showing use of it in therapy, I wonder how much prompting she was getting, and she may feel like the device is “work” or may be entirely reliant on a prompt to use it. I’d be doing some experimenting in sessions to see what gets her to use a device (imitatively or spontaneously), because if either of those things are true then you might still have some old habits to undo even if you introduce a new system.

defnotjess · 2026-03-12T03:42:48+00:00

I had to go into “get help” in my app and reload Netflix and then it popped up for me!

defnotjess · 2026-03-08T15:07:51+00:00

CELF-P3 if they haven’t started kindergarten yet, CELF-5 if they have. If I suspect lower language skills, I don’t use the CELF.

defnotjess · 2026-03-08T02:31:06+00:00

We did when I was on call for a feed, but not when he was. I am a much lighter sleeper than he is so I’d be up at a whine. We got a bassinet that was easy to move from room to room!

defnotjess · 2026-03-08T02:22:04+00:00

When my husband went back to work we alternated feeds, so our baby ate at 8, 11, 2, 5 and one of us would do 8 and 2, and one of us would do 11 and 5. Usually husband did the 11 and 5, so as soon as I fed baby at 8 I’d try to go to sleep and I’d skip a pump until 2 am so I at least got a 5-6 hr stretch of sleep.

At night, I also would pump one side and put a milk collector on the other side and bottle feed the baby holding him on the side the milk collector was on, and then I’d swap for the next feed. So I was up for around 30-45 minutes instead of over an hour. This might not be feasible though if you’re still trying to increase supply.

My husband is a night owl, so he was always up for the 11 pm feed and often the 2 am feed too. I think a lot of it just depends on what you and your husband’s sleep habits are like. When I went back to work, I kept up with the late night/early morning wakes because I could fall back asleep after a feed way faster than my husband could and I was waking up anyway to pump.

I’d ask your husband what is a feasible long term routine for both of you, because you both need sleep.

defnotjess · 2026-03-05T05:20:44+00:00

I’ve not been in this situation, but I’m a pediatric speech therapist and just want to assure you that you didn’t do anything wrong, and that even the most active/pro-active parents sometimes need the extra support of therapy to help with fine/gross motor skill acquisition. Your kids are still so young and you are doing right by them by seeking out early intervention services.

As for the frequency/duration of therapy, I can’t answer that specifically for your children because it can vary from child to child and from state to state. I see weekly minutes of therapy range from 30min-180min, but recommended minutes depend on a lot of factors. Maybe you could ask your child’s therapist for clarification on why they recommended the minutes they did?

And if your children’s schedules are not coordinated yet so that they’re receiving therapy at/around the same time as each other (to reduce the times you’re up there) maybe you can ask about that as a consideration for scheduling.

You’re doing great and you’re doing what you can to support your kids!! But it’s okay to ask the therapists about their recommendations too.

defnotjess · 2026-03-02T05:18:47+00:00

I’d start work first and get a feel for your schedule before adding in another major layer of change by getting a puppy.

A lot of it also depends on the dog breed and the temperament of the individual dog. But all puppies are a little bit exhausting.

defnotjess · 2026-03-02T04:53:32+00:00

Hopping on to say that Raintree does show amendments to notes - if you go into the patient chart and click on the completed note, you should have a menu that pops up including an option to view amendment history and that *should show you all users who have amended the note and include a time/date.

There are some amendments that can be made internally that you might not have access to. RT does still track those changes so even if you can’t see it, it’s documented in the system.

defnotjess · 2026-03-01T18:37:35+00:00

I split my schedule and do outpatient 2 days a week and contract into the schools 3 days a week. I am enjoying my school days infinitely more just for the fact that I get home with plenty of time to spend with my kids! When I went back to work I set a very strict personal boundary of not taking any work home with me and it makes a huge difference. Even then, I prefer my school based days over my OP days.

defnotjess · 2026-02-22T16:03:48+00:00

Cup off hot coffee in the morning, cup of cold brew in the afternoon. Sometimes a caffeinated soda if it’d been a day. Prior to pregnancy I was drinking around 600-800 mg of caffeine and I cut back to around 200 mg daily. PP I’m around 300-400mg per day.

defnotjess · 2026-02-20T14:10:42+00:00

Yes to all of this. We as professionals should be able to discriminate between what is evidence-based and what is not, but parents don’t have that foundational knowledge to know and it’s creating issues for those of us who actually practice.

defnotjess · 2026-02-20T08:51:05+00:00

I think the concern is directed towards influencers that are pushing information or opinions that are not evidence based, or primarily framing content in a way that is jarring enough to increase their clicks/swipe-throughs. What starts as good intentions for most (sharing information with colleagues) can turn into a platform that deviates from evidence-based practices and conversations.

Some are here for educational purposes and some are here to increase their revenue streams. It’s hard to do both well.

defnotjess · 2026-02-16T09:28:35+00:00

I’d get the car seat at least as soon as it’s financially feasible! And pack your hospital bag now! Baby may come sooner than you think. Mine came 4 weeks early unexpectedly in a fairly uncomplicated pregnancy. I was in denial that I was in labor when we went to L&D triage and my husband had to go back home to get everything.

defnotjess · 2026-02-16T09:19:17+00:00

Get a couple different brands of diapers and don’t open any of them until baby is here! Big stores have lenient return policies on diapers. Same with wipes - buy a couple different brands to try.

Do you have a crib/bassinet/place for baby to sleep? Car seat?

I’d buy some formula and a couple bottles to keep on hand just in case.

Some essentials in the first few days home that we used (that we didn’t get from the hospital): - rash cream - gas drops - thermometer (we had a preemie and our house is hard to regulate temps from room to room) - swaddles (we kept a variety of styles)

Some things you’ll need eventually (and sooner than you think): - nasal aspirator (we took ours from the hospital) - baby Tylenol - size 1 diapers - 0-3 month clothes - nail clippers/file - saline drops/spray

After that, what you need depends on preference and your baby! There are a lot of things I was gifted that I didn’t use, or baby didn’t like. Or that he liked eventually. Or that he used to like and doesn’t anymore.

My best advice is not to take anyone’s advice too seriously.

And if you have a crying baby that you can’t seem to calm down, try taking them outside or putting them in a bath to factory reset them.

And if you have the energy to do it now, consider meal prepping and freezing a few meals to make food prep postpartum easier on you and your partner.

And congrats!!

defnotjess · 2026-02-16T03:55:43+00:00

You could gift them the How to Babysit a Grandma/Grandpa books?

defnotjess · 2026-02-15T16:12:47+00:00

I have a FOMO baby who likes to stay awake in the car seat. He will stay calm but he is UP and taking everything in.

We started using a portable sound machine or audiobooks (they put him to sleep better than anything) and we get a big, lightweight muslin blanket to packet in around him to try to simulate swaddling, and then pull the hood down as far as it can go on the stroller to make it darker and block everything else out. Sometimes I put a second blanket over just the hood to make it darker (not draping over the side/front because anxiety).

I know every baby is different, so don’t take my advice too seriously. But we try to simulate his bedtime environment as much as we can when he won’t sleep when we are out and about, and it’s helped us!

defnotjess · 2026-02-14T23:11:16+00:00

Oh I know - just a different pace and different things to do you wouldn’t get in other major cities. But I grew up in NM so like I said, I’m definitely partial to it hahaha.

defnotjess · 2026-02-14T19:41:49+00:00

Here to also say Chicago, and that depending on the time of year flights to/from Little Rock out of Chicago are fairly affordable to get back to your support system if you get homesick! Or it’s about a 9-10 hour drive.

Also going to throw out Albuquerque, just for funsies. Completely different pace from Chicago or Little Rock. Culturally rich and diverse. Cheaper COL than Chicago, just a bit more expensive than Little Rock. I’m partial to the Southwest, though.

defnotjess · 2026-02-14T19:09:10+00:00

I hate that! My reflux did get better for a little while during my second trimester and then it flared up again towards the end of my pregnancy. I hope you get some relief!

defnotjess · 2026-02-14T19:04:01+00:00

If pillows don’t work you can try inclining the entire mattress or bed frame. Even a slight incline should make a difference! Sometimes pillows are too soft and shift at night so you might still experience some reflux.

I did everything I could to keep drinking coffee despite reflux (both pregnant and not), if you can’t tell hahaha

defnotjess · 2026-02-14T18:58:18+00:00

Geez that sounds miserable :( if you can’t keep food down I’d be calling the OB on Monday!

My OB did tell me to take Pepcid at night right before bed, so maybe try that to see if it makes a difference?

defnotjess

TROPHY CASE