Regulation or Speech Therapy? What to Do When Sessions Stall
Spending whole sessions on regulation in speech therapy? Here's why that's still communication work, plus one question that changes what you do next.
Have you ever walked out of a session and thought, "Did I even do speech therapy today?" I have. Your client spent the hour pacing, touching everything, turning
away from you, or throwing things. Whatever you planned never happened.
You didn't want to force compliance. You wanted to follow their lead and build trust. But you're also their speech therapist, and you're supposed to be working on communication.
Here's the short answer: regulation in speech therapy is not time taken away from communication. When you name what a client's body needs, join what they're doing, and solve problems with them, you are teaching language and self-advocacy. That's the core of the "Neuro-Strengths Based Support for Autism (NSBSA) Framework" that Susan Golubock and I use.
Susan is the founder of Making Sense of Autism. She's an autistic, retired occupational therapist, and she changed how I understand autism. Below is the framework we talked through. The video holds the moments that are better heard than read.
Is regulation work actually part of speech therapy?
Yes. Regulation support is communication, because every time you name what you see, you hand your client the words for it. Saying "I see you're frustrated, let's work on this together" is language input, delivered at the moment it matters most.
Susan puts it simply: when you're interacting with someone about anything, communication is happening. Co-regulation means helping a person calm their nervous system through your own calm presence. It's also one of the richest language contexts you'll ever have.
There's research behind building body awareness, too. A 2022 study in Occupational Therapy International followed 14 autistic students, ages 9 to 19, through a 25-week interoception program. Interoception is the sense that tells you what's happening inside your body. Students showed significant gains in both interoceptive awareness and emotion regulation, "Mahler et al., 2022". Naming body states ("your body needs to move") builds the self-awareness that regulation depends on.
What is a dysregulated child communicating to you?
A client who is throwing, pacing, or touching everything is still communicating, usually "this is what my body needs" or "this is more interesting than what you're offering." Your job is to read that message, not override it.
Arousal level means how alert or activated a person's nervous system is, from shut down to overwhelmed. When it's high, Susan suggests linking your support to what the body is already asking for. If they need to push, find something safe to push. If throwing is fun, find a safe way to throw.
Then join them. "What are you touching? May I touch it, too?" Susan explains it this way: when you take an interest in what they're interested in, they take an interest in you.
I use a visual-stim app for a few clients when movement escalates them. Afterward I narrate what happened: "Are you feeling calmer? Are you ready now?"
Watch at ~3:30: Susan walks through what joining sounds like in real time, and why it turns you from a demand into a playmate.
What if I'm already child-led and it still isn't working?
When following their lead isn't enough, stop solving the problem for your client and start solving it with them. Name it as a shared problem: "Here's what you seem to need. Here's what I need.
What are we going to do?"
Most of us have tried five strategies in a row by this point. Susan's point is that the strategies weren't wrong. The client just wasn't part of choosing them.
Working through it together sounds like a short checklist of possibilities:
Is the activity too hard, or too boring?
Did something happen before the session?
Does your body need to move, or push?
Would quiet help? Music? Jumping?
Then you try a solution and check together whether it helped. You can read more on this in "why trying harder to engage rarely works" and "what to try when an autistic student won't engage".
We built Two free problem-solving tools for exactly this moment. One uses trial and error for clients with higher support needs. The other is for clients who have the language to build solutions with you.
When should you suspend a speech therapy goal?
If a client keeps making no progress because something else is getting in the way, it's legitimate to suspend that goal and target the barrier instead. Susan did this throughout her OT career, and she documented it plainly in her reports.
Barriers to learning are the things that block a person from learning what you're teaching. They include regulation, sensory needs, processing time, or a skill underneath the goal that isn't in place yet.
Two questions help here. First, is this a goal my client actually wants to work on? Second, is it written at the right level? Sometimes we aim too high on the developmental progression, and the foundation isn't there yet. Shifting a goal isn't giving up on communication. It's choosing the communication your client is ready for.
Watch at ~12:45: Susan shares the exact sentence she wrote in her reports when she suspended a goal, which you can borrow.
What's the one question to ask in a session that isn't working?
Instead of "How do I get them to do this?", ask "What might be making this hard for them to access right now?" Once you can name the barrier, you can problem-solve the support.
Instead of asking… | Try asking… |
How do I get them to participate? | What's making participation hard right now? |
Why won't they follow my plan? | Is this goal something they want to work on? |
What's the problem? (to the client) | Does your body need to move? (yes/no) |
Which strategy should I try next? | What am I actually seeing first? |
As I said in the video, and want to say again: our job is not to make an autistic person comply with our therapy plan. It's to understand what makes communication easier or harder for them, and support them from there.
Watch at ~13:50: the full question, and the list of barriers Susan and I check first.
FAQs: Regulation in Speech Therapy
Q: Is it okay to spend a whole speech therapy session on regulation? A: Yes. If your client isn't regulated, no new learning will stick. Narrating body states, offering choices, and co-regulating are all language input. Document the regulation and communication work you did, and if it keeps happening, revisit whether your current goals fit where your client is right now.
Q: How do I document regulation work as an SLP? A: Write it as communication: naming emotions and body states, teaching self-advocacy phrases like "I need to move," and modeling problem-solving language. If a goal stalls because of regulation, note that it's suspended while you address the underlying barrier, and set a goal for that barrier.
Q: What do I do when a child throws things in speech therapy? A: Treat throwing as communication first. Ask yourself whether it's sensory seeking, frustration, or fun. Then offer a safe version (soft items, a target, a bin) and narrate it: "Your body wants to throw. Let's throw these." Joining safely usually builds more connection than stopping it.
Q: What is co-regulation in speech therapy? A: Co-regulation is when your calm, predictable presence helps a client's nervous system settle. In speech therapy it pairs with language. You name what you notice, offer a body-based support, then check in ("Did that help?"), which teaches the words for self-advocacy at the same time.
Q: Why doesn't child-led therapy always work? A: Following a client's lead builds trust, but it doesn't remove every barrier. Processing load, sensory needs, a goal that's too advanced, or a mismatch in communication styles can still block participation. When that happens, solve the problem with your client using yes/no choices instead of guessing for them.
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