Online Speech Therapy: Our Experience During the Covid-19 Pandemic

Since March of 2020, all of our clients have been seen virtually. Up till that time, I had seen just a few clients in my over 40 years of practice through telepractice, and was unsure as to how effective it would be.

As it has turned out, any concerns I had were unfounded, as most of the children I have seen have done extremely well, and in a fair number of cases, seemingly better than in person.

Comparing in-person to online, the reasons for this appear to be twofold: heightened caregiver involvement, and convenience of therapy.

When working in my office, parents, for the most part, would wait in the waiting room, and I would take their child into my office for the therapy session. When the session was over, the parent or caregiver would come in and I would explain what we had done and give the parent or caregiver some things to work on until our next session.

When working online, however, parents need to be involved during the therapy session, and the younger the child, the more the parent typically needs to be involved. And so the largest difference in provision of therapy has been with the younger children, particularly toddlers, ages 1 – 3 years.

With this age group, therapy (whether in-person or online) is largely mediated through play activities of the child’s choosing. We have a saying “A child’s work is play.” Play is how they learn about the world. Play is how they develop vocabulary. Play is how they learn how words go together. Play is how they learn how we change the meaning of words by adding a prefix or a suffix such as “re” as a prefix meaning “again” or “s” as a suffix making the word into a plural or a possessive. We teach these through play as the child interacts with a toy and we formulate our utterances to demonstrate their meaning.

And with remote therapy, this play is facilitated by the parent, who is needed to help the child stay focused on both the activity and the computer screen. And they also have the sometimes-difficult job of keeping the child visible on the screen so I can see what the child is doing.

We operate as a team, and that teamwork accelerates the child’s progress. Some of our language delayed toddlers were at age level in a matter of months. Parents and caregivers are learning how to best help their child learn to both comprehend and use language.

Additionally, remote therapy allows us to see kids who are away on a prolonged vacation, or feeling a little bit under the weather or uncomfortable traveling into our office when the weather is inclement. No need to travel in the snow! Or when having the sniffles! And improvements are happening way faster than I could have predicted.

With respect to older clients, most of whom were receiving therapy for oral motor difficulty (which almost always includes difficulty with sound production, often times /r/, /l/ and /s/ sounds), many parents and caregivers have been involved here as well.

They are up close doing the work with their children. They can see and hear what their child should be doing, and can see and hear what I’m doing, and model themselves accordingly.

As it turns out, my personal conclusions are supported by many others as well. The American Speech-Language-Hearing Association (ASHA) has a video which was actually posted in 2015 which discusses telepractice as a service delivery method.

Telepractice: Providing Audiology and SLP Services at a Distance

And in an online blog in DYKnow, their October, 2020 issue deals with this same question. The author, a private practitioner named Lenne Sherred, posted an article entitled How Online Speech Therapy Can Accelerate Your Child’s Progress, and she maintains that children can actually perform better with virtual therapy. For similar reasons as we noted here, Ms. Sherred reports that parent involvement, and lack of need to commute to therapy has resulted in a treatment modality that is more effective.

In the International Journal of Telerehabilitation, a review of studies entitled The Efficacy of Telehealth-Delivered Speech and Language Intervention for Primary School-Age Children: A Systematic Review was published in 2016. It evaluated children being seen for speech and language therapy, of all categories. The included studies came from a number of countries. The children were between the ages of 4 and 12 years old. Findings indicated that there really was no difference in results between in-person a nd tele-therapy sessions.

Aside from the fact that we speech language therapists love to be on the floor or sitting at a table doing our work (or our work that is often play!), whether you call it tele-therapy, remote therapy or online therapy, I have seen first-hand its effectiveness.