Tagged "Drooling Remediation Program"

Ask A Therapist: Straw Length

Posted by Deborah Grauzam on

Hi Guys!


I have a couple of questions. First of all, I am utilizing Sara Rosenfeld-Johnson's Drooling Remediation Program and OPT on a 2.2 year old for drooling. Dad is a dentist and is totally on board. Their little guy is a twin and has three other siblings. The little guy has progressed to straw #5 and although he struggled with horn #4, he has now successfully moved on to horn #5. Mom is very unhappy with the length/height of the straws ... I have explained 'calibration' of each straw to her. Is there anything else I can say to appease this busy mom? We are also needing some help writing up the report for insurance purposes. I purchased the "Forms for Oral Placement and Treatment" CD, thinking that it would contain that type of helpful information. Insurance can be so persnickety!


I am also trying to get insurance to cover services for a 10 month old with Down Syndrome that I have screened for services. He is being seen through ECI, has not feeding issues currently but would benefit from OPT!


I have been working with a 27 year old with Down Syndrome very successfully! Her parents are amazed and thrilled!


Thank you for any information you can provide that will assist me in helping my clients!






Hi Kellie,

It sounds like you have done a great job explaining the straws and how to use them to this mom. The only other idea I have would be to encourage her to put the straw in the large TalkTools cup with lid and have the curly part of the straw under the lid. That sometimes helps if it is tipping or they are playing with it. I just try to explain that the straw is working on tongue retraction in the mouth at different levels. It is important that they are that particular length because that is what makes them more difficult and requires more work for the tongue and lips.

As far as the insurance billing, I personally do not bill insurance but there is a CD called "OPT Goals & Objectives for IEPs and Insurance Reimbursement" that will help with goals and objectives for insurance reimbursement and IEPs. It does not include coding but it should help with what you are talking about. It sounded like it was more of what you were looking for than the CD you mentioned.

Good luck with the mom you are working with and please let me know if you have any other questions.





Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 10 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy. She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

Read more →

Ask A Therapist: Client with Autism and Apraxia of Speech

Posted by Deborah Grauzam on

Hello TalkTools,


I am an SLP working with a four year old boy with autism and apraxia of speech. He has some significant drooling and is non-verbal. I completed the "Three-Part Treatment Plan for Oral Placement Therapy" on-demand course, but was hoping for some guidance from your Instructors.


He is the first child I've used Oral Placement Therapy (OPT) with, and we're working on the Drooling Remediation Program. He's progressing really well with the Chewy Tubes and the Straw Hierarchy but is not able to volitionally blow on Step 3 of the Bubble Blowing Hierarchy, nor is he able to blow for Horn #1 or hold a tongue depressor between his lips for any length of time.


He is able to produce the /m/ and /b/ sounds, but often not on command. He just recently began to show some lip rounding while producing a /w/ sound.


I did purchase the Pre-Hierarchy Horn and have been working on the ball/exhalation activities. Is there anything else I can/should be doing to help him with blowing?


Also, when he eats, he sometimes will chew the food, remove the bolus from his mouth, rest for a few seconds and then place the food back in his mouth and finish chewing/swallowing. Do you have suggestions on how to address this?


Thank you in advance,




Hi Amber,

I'm Robyn, a TalkTools® Instructor, and I will answer your questions the best I can without knowing the child.

I will start with the feeding issue first. This sounds like a self-stimulatory associated with the autism or an issue of bolus mobility. He certainly could have chewing fatigue, or perhaps cannot lateralize the bolus to where it needs to go to swallow it. You will need to assess this, and if needed, implement a pre-feeding program such as, Feeding Therapy: A Sensory-Motor Approach. If all is assessed and nothing is wrong from an oral motor perspective, I would work with the child's behaviorist on a regimented plan to keep his hands down and away from the mouth during feedings.

On to your OPT questions... Phonatory control and volitional blowing can be a very big problem with apraxia. The sounds the child is making can be reflexive in nature but not achievable on command. This is also a defining trait of apraxia. I would consult with OT/PT to start working on rib cage expansion, trunk stability, and core strength as prerequisites for blowing. For now, expose him to the Bubble Program staying on step 2 of the Bubble Hierarchy and practice placing Horn #1 in the mouth and taking it out for the lip closure motor plan. You may also model it for him with your own horn. I often sing, "If you are happy and you know it blow a horn toot toot" and place the horn in the lips when I say 'toot'. I also place children in a prone position on an OT wedge during this task. Immediately after drilling the horn, use the Apraxia Bilabial Shapes to practice the bilabials.

Good luck!


Robyn Merkel Walsh, MA, CCC-SLP

Read more →