I’d love to tell you that every licensed speech–language pathologist is equally good, and that whichever therapist you pick will be able to play Annie Sullivan to your child’s Hellen Keller and have him or her speaking fluently and using language appropriate to their age within a short period of time. But it’s not true. I do think that every speech-language pathologist who chooses to work with children genuinely wants to be the best therapist the he or she can be, and to get the best possible results for your child. But speech-language pathologists have a wide range of experience, expertise, training, and even talent. Some speech-language pathologists specialize in conducting research or teaching, while others are better clinicians. As a society, we need both kinds of therapists, but you probably want your therapist to be more oriented towards the clinical. You want someone who enjoys, and is good at, working directly with children in a clinical setting. However, you also want a therapist who reads the literature and takes classes to stay current on the latest research and techniques, and then implements what they’ve learned into their therapy sessions.
Generally speaking, speech-language pathologists with more experience are better than those who have recently graduated and who don’t have much experience. That’s probably not surprising to you – whether you’re choosing a doctor or a lawyer or any other professional, experience counts. You want someone who has seen a large number of children with different deficits and different personalities.
So things you may want to ask include how often the speech-language pathologist takes the time to attend seminars and continuing education classes, and which techniques the therapist has been exposed to (good), trained in (better) or certified in (best). Some classes and techniques that I think therapists who work with children with developmental disabilities should at least be familiar with include PROMPT, Social Thinking (by Michelle Garcia Winner), Relational Development Intervention (RDI), some variety of play therapy, Verbal Behavior, Applied Behavior Analysis (ABA), Pivotal Response Treatment (PRT), and Links to Language. These techniques, all of which have a somewhat different approach, focus on different deficits which your child may or may not have. For example, PROMPT is an effective technique for children with apraxia, while play therapy focuses on deficits in play skills. And ABA may be better for the younger ones with fewer skills, while a more RDI oriented approach might be more appropriate for an older, higher-functioning child.
The more training your therapist has, the better. One way to think of these various techniques are as tools in your therapist’s toolbox. Some tools can be used to address a variety of different deficits, while others are more specialized. Also, some tools are going to work better on your child (based on his or her age, abilities, personality and temperament) than others. Of course, there is a limit to how much training any therapist can have, and some techniques in which your therapist is trained may be great for more typically developing children, but not as effective for a child on the spectrum or with an apraxia of speech. But generally, the more tools your therapist has in their toolbox, the more flexible he or she can be when conducting therapy. On the same theory, you may not want a therapist who is wedded to one particular technique. Flexibility is almost always a good thing, unless you’re really sure that the therapist’s approach is going to be best for your child, both now and down the road. I would recommend caution if a therapist indicates that they exclusively or primarily use one approach in their therapy regardless of their client. You might be surprised to find that some therapists insist that they’ve found the “holy grail” approach to speech and language therapy, and that all the other approaches not only aren’t as good, but are likely be harmful or damaging to your child. I certainly feel strongly that some of the techniques in which I have been trained are better than others, but in my opinion a “one size fits all” policy for speech and language therapy would work as well as a “one-size fits all dress” – way too much coverage in the wrong places for some, way too little for others. I prefer to keep an open mind and to adapt my therapy sessions to my clients, rather than to try to force my clients to adapt to my preferred methodologies, and I’m too humble to think I’ve figured it all out – my clients teach me something new every day.