Home Speech-Language Pathology Using a Child’s Interests to Teach Goals in Early Intervention

Using a Child’s Interests to Teach Goals in Early Intervention

by Julie Erdmann
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As speech-language pathologists, we use specific activities with our early-intervention clients to address each goal. Even if we bring a variety of items into the session, we still control the activity. However, if you’ve spent time with a toddler, you know this kind of structure isn’t really their thing.

Child-directed treatment allows the child to play as he normally would, and SLPs join in with goal-oriented tasks. You let the child’s interests dictate the activities during your session.

Below, I share reasons why I find this a good way to approach treatment.

Children often feel more involved when they choose an activity. Just like adults, toddlers remember more when they enjoy something. Start by observing the child to learn not only what she plays with, but how she plays. Gather information from caregivers and try short interactions to see how she responds to you.

Ask yourself these questions:

  • Does she enjoy sitting, constructing/deconstructing toys, make-believe?
  • Does she prefer running, jumping, tossing items?
  • Does she like a mixture of low and high energy play?
  • Does she spend a long time with an activity or bounce among them?

This information helps you insert yourself into the client’s play more easily, so you can shift between goals throughout the session by mimicking natural interactions. For example, if the child plays with a toy kitchen set, you can prompt him to:

  • Label items: “What are you making?”
  • Match items: “Can I have a cup like yours?”
  • Follow directions: “Please hand me a spoon.”

Children often learn a skill faster by changing one aspect of an already familiar activity. By joining the child in normal play, you add layers onto what she does naturally, rather than creating a new, separate experience she only completes in your setting. When children learn new skills as part of their daily activities, those skills become more relevant and clients get practice beyond treatment sessions.

Do I encounter challenges in child-directed intervention? You bet! I must adapt session plans quickly and frequently to match clients’ changing interests. I stay focused by using long-term goals to direct treatment. I still shape the activity to some degree without deterring the child.

Here’s an example:

The long-term goal is following two-step directions independently. I use activities initiated by my client to teach goal-related skills:

  • Trains: “Put the man in the train, then push the train up the hill.”
  • Snack: “Get a banana, then give it to me.”

Child-directed intervention doesn’t give you a pass on planning, and in some ways it involves more work. I constantly think about where the activity might lead us, and how or when to insert cues in a natural way. Over time, you will probably find similar play and learning styles among various children on your caseload.

Do you use child-directed treatment techniques? If so, share your favorite activity examples in the comment section below.


Julie Erdmann, MS, CCC-SLP, treats clients as a contractor for TinyEYE. She has more than 10 years of experience working in early intervention in her clients’ natural environments. Erdmann is building a mobile app on language strategies for parents. She also treats children on the autism spectrum and provides caregiver coaching. julie.erdmann@gmail.com

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Kevin L. Boyd February 14, 2017 - 12:19 pm

I think this article is marvelously written and, while seemingly not a specific objective of its content, implies that intrinsic to the training and demonstrable expertise of Speech and Language Pathologists, is competence in truly understanding how to anticipate and appropriately manage a child’s age-appropriate fear/anxiety when exposed to novel environments and situations (e.g., medical, dental and SLP clinical settings, etc.). For example, unless the author indeed possessed the aforementioned pediatric ‘clinical anxiety management’ skill set, she would not have been able to effectively and so eloquently develop her working title, ‘Using a Child’s Interests to Teach Goals in Early Intervention’….or in other words, it would not have been worth reading in my opinion.

As a pediatric dentist who is very successful at preventing tooth decay in our patient population, mostly what we prevent and treat on a daily basis are children with malocclusion-related sleep disordered breathing problems (e.g., OSA, ADD/ADHD, etc.); and most of these children are under the age of six so it must be obvious why I am so impressed with this author’s behavior management skills.

Not until the orthodontic profession embraces (sorry) this type of pediatric behavior management talent, will children with LTS (Less Than Six…years of age and/or number of erupted permanent teeth) cease to be ignored and be offered appropriately timed and applied ‘pre-orthodontic’ intervention.

Nice job Julie….Thank you!

Kevin Boyd, DDS

Julie Erdmann February 15, 2017 - 7:14 pm

Thanks. I feel pretty confident in saying that most pediatric professionals I know have spent a lot of time and effort learning how to develop trust with young children who are anxious in new situations.

Kevin L. Boyd February 16, 2017 - 1:11 pm

Yes indeed, that’s the key….I agree with you entirely that most ‘pediatric professionals’ are well prepared to manage intrinsic and normal anxiety behaviors that are commonly associated with being in healthcare settings.

However, pertaining to the discipline of orthodontics, most orthodontists lack training and experience in this area as the training curriculum in Orthodontics (from Am Dent Assoc.) does not require demonstrable competence of post-graduate trainees. Of course most would agree that orthodontists do not necessarily fit into the category of ‘pediatric professionals’, but for now at least, orthodontists are pretty much the gatekeepers for whom/whom does not receive accurate malocclusion diagnosis and indicated intervention in childhood/early childhood. This has likely resulted in multitudes of children over recent decades having been denied the possibility of receiving orthodontic intervention strategies (e.g., palatal expansion, etc.) that might’ve conferred systemic health benefits to children at risk for malocclusion-related airway disease (e.g., OSA, ADD/ADHD, etc.).

lshea3 February 15, 2017 - 9:12 am

Following a toddler’s interest is imperative to effective early intervention. However there is something glaringly absent from this article, the parent. Our understanding of infant/toddler development has pointed to parent/caregiver mediated intervention in Ei for the past 10 years, from the federal level down. Simply observing the important people in the child’s life interacting in both play and caregiving routines followed by the joint development of intervention strategies will provide far more information and benefits than via provider interaction with the child.?

Julie Erdmann February 15, 2017 - 11:54 am

Hi lshea3, thanks for your comment. I agree 100% that success with early intervention relies heavily on caregiver coaching and follow through. The research proves it and therapy outcomes are clearly better when parents are involved. Parent coaching is a crucial part of EI and is addressed in other articles on this blog.

The focus of this article, however, was simply to provide information to therapists on how to shift from a “medical model” delivery system to a more natural play-based format when they are new to this therapy style.

Kevin L. Boyd February 15, 2017 - 12:11 pm

Per your, ‘Our understanding of infant/toddler development has pointed to parent/caregiver mediated intervention in Ei for the past 10 years’, first of all I’d like to suggest that, at least in the area of orthodontics, specifically by how ‘traditionally’ practicing orthodontists essentially ignore infant/toddler Dx/Tx of malocclusion, the dental profession is way behind in this area. Secondly, I’d like to know what occurred about ten years ago to prompt this change in your profession.

Jennifer M. February 15, 2017 - 3:52 pm

I love using pretend play items in clients’ homes (food, tools, farm, dollhouse, etc.). So many ways to incorporate vocabulary, expand utterances and follow directions. I made the switch to EI in the natural environment and our agency uses the coaching interaction style. Using the child’s interests in their home environment really has helped caregivers learn to play effectively with their children and in turn progress their skills!

Julie Erdmann February 15, 2017 - 7:17 pm

The agency I worked with sounds very similar to yours! The outcomes were great when the caregivers learned with their children, in their own homes so they could make therapy goals a natural part of their day.

smtv24x7 February 17, 2017 - 5:41 am

Great post. That is really the topic I needed advice on right now. Thanks for getting specific and mentioning so many different services.
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Full Spectrum Mama February 27, 2017 - 10:56 am

Incredible article and interesting comment thread. As a parent (and professor) I was going to comment solely that joining my autistic son in his pokemon activities has been a bond and learning experience for us both going on 13 years now. He’s learned spelling, math, geography, pronunciation, fine motor skills…

But i should also note, following this thread, that dental care is a nightmare for us and I am touched by the above orthodontist’s care and thoughtfulness!!!

Full Spectrum Mama

Julie Erdmann March 1, 2017 - 12:13 am

Hi Full Spectrum Mama. I love hearing stories about using what some consider unconventional activities to motivate progress! It sounds like you and your son have a great relationship!

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