Happy Brain Speech and Language Therapy
Just great therapy.
"Different is not a failed version of normal."
- Cindy Goldrich, EdM, ACAC
my approach
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Commitment to ongoing continuing education
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Narrow treatment focus within scope
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Rotating free, extra research hour: dedicated extra hour a week of research on rotating scale to prevent any bias in time dedicated to clients on caseload (as a former "easy kid," I'm not letting any kids slip through the cracks!)
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Caseload cap of 25
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Wide and current assessment battery
-Thom Hartmann, "ADHD: A Hunter in a Farmer’s World"
First things first: your brain is not broken. Your brain was made for surviving.
I can help you or your child use those “hunter” strengths, handle the frustrations and very real difficulties (it is absolutely hard to have a different brain than most), and understand what’s going to feel easy and what’s going to feel hard.
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Let me help you decide whether ADHD coaching or executive functioning treatment will best meet your needs.
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ADHD coaching is different than executive functioning treatment in a few ways. Primarily, coaching focuses on reducing impact of symptoms, while treatment is focused on reducing severity of symptoms.
My coaching clients are typically adults with ADHD who are looking for a boost in order to successfully meet a meaningful goal or navigate a big life change. They have lovely people around them offering tons of support and advice, but keeping a calendar or packing your bag the night before is making them annoyed just thinking about it. They’d love some help designed for an ADHD brain.
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Coaching is probably right for you if any of the following applies, in addition to having an ADHD diagnosis:
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Finding and starting physical therapy or mental health therapy
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Setting up & carrying out study plan for a credentialing exam, driver’s test, SAT/ACT or GRE
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Submitting applications for jobs, loans, small business grants, etc.
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Moving in with a partner (woohoo!)
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Navigating being a mom or dad with ADHD (planning summer, new baby in house)
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New grads
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Experiencing depressive episode
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Medication shortage/discontinuing meds
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Due to rarity of insurance covering ADHD coaching, these sessions are private pay only. Coaching does not take place on a weekly basis, but rather in pairs (we’ll schedule 2 sessions) or bursts (we’ll schedule 3)!
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"Executive functioning" refers to how someone manages themselves and the resources in their environment to accomplish daily tasks. Executive functioning treatment is designed to help those whose current executive functioning skill set is not meeting the expectations or demands of their environment and whose executive functioning testing performance is significantly below the average range. While the majority of executive functioning treatment clients have ADHD, executive functioning treatment is also appropriate for children, teens or adults who are...
1- unable or waiting for official ADHD diagnosis
2- learning to thrive in multiple-household families
3- autistic or otherwise neurodivergent
4- in recovery (go you!)
5- healing from traumatic brain injury and/or effects of radiation
6- adjusting to new medication for mood disorders like depression
7- born prematurely and/or have fetal alcohol spectrum disorder (FASD).
Executive functioning treatment includes coaching, but will always be geared towards directly increasing your capacity to perform daily activities and responsibilities. Executive functioning treatment is typically covered by insurance, takes place weekly, and aims to directly increase executive functioning capacity through elements such as working memory training (Rowe et al., 2019), systematic instruction, use of metacognitive strategies, environmental arrangement and management, visual cues, and interoceptive knowledge.
I’ll set quantifiable treatment goals to share with your doctor or pediatrician right away and take data on those goals every session. Our goal is independence with skills targeted and performance in typical range upon re-assessment.
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My process looks like this:
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Evaluation
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We’ll meet at my office or over my HIPAA-compliant telehealth platform. I’ll gather all the information I need to select the most appropriate standardized assessment to administer. I’ll also gather some informal baselines and get clear on the family’s treatment priorities. I have completed over 200 evaluations and will keep this developmentally appropriate!
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Treatment Planning
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I’ll score the assessment (every clinician’s favorite part!) and synthesize results with your family’s priorities and my own observations and clinical knowledge. I’ll write this all up so you can add it to your files. I’ll then write individualized goals to target areas of need, send it to you to look over, and share the whole packet with you and any other providers or teachers you and your child would like me to include once you’re happy with my plan.
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Treatment
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The rubber meets the road! I’ll be taking quantitative and qualitative data every single session to share with you at the drop of a hat. I’ll be using that data to guide clinical decision-making as I gradually reduce supports and increase complexity as we work towards total independence with targeted skills. Depending on your child’s executive functioning profile, any or all of these core components of executive functioning treatment will be included:
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Working memory training (Rowe et al., 2019) to help with things like following directions, social success in conversations, listening and reading comprehension, and organization
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Metacognitive skills training (Nakonezny & Hughes, 2012) to build attention and self-regulation skills by increasing the child’s ability to self-monitor and self-evaluate
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Cognitive flexibility treatment (Sohlberg & Mateer) to help a child sustain or shift attention in response to different demands, or apply different rules in different settings (ex., classroom rules changing during state testing, adjusting to a substitute teacher)
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Task initiation treatment via systematic instruction, self-knowledge and advocacy skills, interoceptive skills, and increasing self-efficacy​​
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My Guiding Principles of Executive Functioning Treatment:
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Recruit resilience - identify & incorporate the client’s values into therapy, and promote self-efficacy. “What helps you when things are difficult?”
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Cultivate the therapeutic alliance - resist the urge to be the expert, listen carefully to the client, form a strong partnership - it’s foundational!
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Acknowledge multifactorial complexities - cognition is complex and can be impacted by depression, anxiety, pain, sleep disturbance, etc. Move beyond cause to help the patient function
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Use the team - involve and collaborate with family members, teachers, coworkers, others who can serve as a natural support
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Focus on function - overarching goal is to help people resume real-life activities. Best accomplished when therapy is integration-focused and directed at relevant, functional activities
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Promote positive expectations for recovery - provide education, demonstrate strategies
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Re-assessment
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I’ll be re-assessing your child every 6 months to help us measure progress in addition to my data. This will of course be shared with you and anyone else you’d like me to keep in the loop! Depending on the results of re-assessment, we might tweak current treatment goals, change treatment dosage, or start planning for “graduation”!
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Fluency disorders interrupt the ability for a person to speak fluidly, or without interruption. Stuttering is well-known, but another fluency disorder that can occur by itself or in combination with stuttering is called “cluttering.” Cluttering shares many characteristics with stuttering and is much less common. For more information on cluttering, drop me an email at sarah@happybrainspeech.com.
Most families who seek me out are looking for more than just “fewer bumps in speech.” What they’re responding to is the fear, discomfort, and/or embarrassment they see their child experiencing due to their disfluency. As someone who went through tons of stuttering treatment as a child, I relate!
My evaluation and treatment processes are guided by these tenants:
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Your child sounding like themselves is a non-negotiable!
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Your child has a gorgeous voice
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It is up to your child when they want to use the strategies I teach
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My goal is for your child to get to the point where they can focus on things way more fun than speech strategies!
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I have never met a parent of a child who stutters who is not trying their best to help. You have been beside your child every step of the way. You deserve kindness, respect and honesty too!
Evaluation
We will chat via email before the evaluation to discuss terminology you use with your child related to disfluency. I will use a standardized assessment to collect baseline data points such as rate of disfluency and types of disfluency (blocks, repetitions, avoidance (“what was it called again? Oh, yeah! Art class…”), and/or prolongations).
I’ll measure tension in your child’s speech. I’ll be getting answers to the following questions:
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Does your child need speech therapy, or is this typical disfluency for their age? (Applies to mostly preschoolers)
Is your child’s disfluency stuttering, cluttering, or co-occuring stuttering and cluttering? -
As stuttering tends to run in families, would you or another family member also like speech therapy with me or another provider I can refer you to? The field has changed so much over the past 10 years especially, and it’s always worth a shot even if you didn’t have a great experience as a child!
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How does your child feel about their disfluencies? Are they aware? Do they notice?
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Cause of stuttering: if your child is older (example, 8 and up), just started stuttering, and there is no history of stuttering in your family, I might share my evaluation with you to bring to another medical professional to be evaluated for silent concussion, adverse response to medication, etc.
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Am I seeing signs of statistically likely co-occurring disorders (e.g., dyslexia, ADHD, depression)?
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Besides a standardized assessment, I’ll also get speech samples when I’m being a “bad listener” by interrupting, acting distracted, and making environmental noise. I’ll have your child tell me about something exciting, observe your child explaining something to you, and potentially send you home with a task to complete with your child while recording to send back to me. All of this is to help me get a picture of your child’s typical speech.
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Treatment
Based on the results of the evaluation, I may or may not recommend treatment with me. If we’re a fit (woohoo!), treatment will look different for each and every situation. We might focus on decreasing your child’s fear of stuttering, which can have the added benefit of rapidly decreasing rate of disfluencies. We will probably begin with a few fluency strategies that your child is the most appropriate for at the time. You and your child will be the ones choosing which combination of these components (desensitization and direct speech strategies) will best meet your child’s needs. My job is to design the most effective way to target whatever combination you decide upon in a way that is culturally appropriate, emotionally supportive and safe, and sustainable for your family.
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Re-Assessment
My re-assessment will collect updated levels of rate and type of disfluency. I’ll interview you and your child on changes in feelings about disfluency and observations related to disfluency beyond the therapy room. I’ll collect speech samples from your child using any strategies we’ve focused on in treatment so far. I’ll have your child fill in a pie chart with what they’d like us to be focusing on over the next 6 months to allow your child to be honest with me (nothing could be scarier to a child than an adult asking them “do you feel like this is working??”). I’ll write this all up and send it to you and your child if appropriate. Based on the results of this re-evaluation, we’ll either make necessary adjustments to the treatment plan or enter the maintenance/discharge phase of therapy!
As this type of work is so specific, I would love to discuss treatment options with you directly. If I'm not the right fit, I'll give you some ideas and recommendations for who to reach out to next. In short, I see a massive need for trauma-informed speech therapy for children who (a) survived trauma, and (b) who also have speech and language disorders unrelated to trauma (e.g., articulation delay/disorder).
For the past two years, around ¼ of my clinical population has been elementary-age children who (a) have experienced an emotional trauma such as loss, and (b) who also have speech and language disorders unrelated to trauma (e.g., articulation delay/disorder). I utilize trauma-informed treatment modalities and approaches, including trauma-informed clinic design, family-centered therapy, child-led play-based treatment, and child-led session duration (e.g., 15-minute sessions 2x/week using modified 5 Minute Kids™ program). If they're done, they're done sometimes! Caregivers are always welcome in sessions. Our treatment design will be customized, and I am always happy to share my notes with you and other related professionals upon request.
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I believe strongly in evidence-based care. This methodology is ingrained into how I treat every patient (child or adult). I offer a variety of services through this lens, and I am committed to providing quality care for each and every case.
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As a clinician, I deliver evidence-based care with:
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ADHD Coaching
“People with ADHD are the descendants of hunters!...
They’d have to be constantly scanning their environment, looking for food and for threats to them: that’s distractibility.
They’d have to make instant decisions and act on them without a second’s thought when they’re chasing or being chased through the forest or jungle, which is impulsivity.
And they’d have to love the high stimulation and risk-filled environment of the hunting field.”
Executive Functioning Treatment
Stuttering & Other Fluency Disorders
