Speech Therapy Helps Teen Express Herself: “Her Personality Is Shining Through”
Alexis Irazoque, M.S., CCC-SLP
Maddie is a 16-year-old girl who loves painting, paper crafts, cooking, and animals. She enjoys visiting parks and walking on nature trails. But it hasn’t always been easy for Maddie to share who she is with the world. She is autistic and nonspeaking, and over the years, she’s tried a variety of methods for communicating. AAC, or augmentative and alternative communication, can include everything from picture boards to speech-generating devices. While some methods were helpful, Maddie was often frustrated when trying to express her wants and needs. After she started speech therapy with Expressable in March 2025, something clicked. Now, Maddie’s communication has taken off. She’s participating in conversations and expressing her thoughts in a way she couldn’t before. It’s a life-changing development for both Maddie and her family. Here’s how it happened.
Switching from in-person to online speech therapy
Maddie’s mom, Vanessa, recalls that when Maddie was 18 months old, she was only saying a couple of words here and there. “She also began to rock back and forth a lot and hum, so I registered her for speech, physical, and occupational therapy,” Vanessa says. “Later, she began to regress back into not saying anything at all.”
Maddie had many years of speech therapy, but attending sessions at a clinic wasn’t a good fit. “The waiting time and the crowded, noisy lobby were beginning to be too much for her, so I started searching for the alternative of online therapy to help ease her stress and anxiety,” Vanessa says. She found Expressable through a Google search, and Maddie was matched with speech-language pathologist Ciara Smith-Vazquez, M.S., CCC-SLP.
Ciara collaborated with Vanessa and Maddie to set goals for speech therapy. They focused on helping Maddie use AAC to comment, protest, or make requests. Maddie’s care plan also included calming techniques for better self-regulation, which is closely linked to communication. “When it comes to regulating herself, as soon as Maddie can communicate something, she’s good,” Ciara notes.
Trial and error leads to the right AAC device
Maddie had tried high-tech AAC devices in the past, but they hadn’t been a good match for her needs. She then tried using picture cards to communicate. But she’d get frustrated when visual communication didn’t work–for example, she’d be riding in the car with her mom, trying to communicate from the backseat. She also didn’t often use the picture cards to initiate communication; she had to be prompted to use them.
Maddie tried a “mid-tech” speech-generating device called MiniTalk, which helped her express basic needs such as feeling tired or needing to use the bathroom. “We realized then that Maddie is very capable of communication,” Ciara says. She began introducing high-tech AAC apps for Maddie to try.
It took a few false starts before Maddie tried ChatterBoards, an AAC app for iPads. “Within just two weeks, her communication had taken off,” Ciara says. “Maddie gravitated toward it, her mom was comfortable using it, and it just really worked for their family.”
She’s communicating completely on her own. That is huge.
Ciara remembers one moment during a therapy session when everything seemed to click. She and Maddie were watching a video together, and Ciara paused the video to talk to Maddie. “She used her device to tell me to ‘stop talking’ so we could resume the video, which I loved!” Ciara says.
Now, Maddie often tells Ciara how she’s feeling–sleepy, hungry, excited. “I like that she’s doing it completely on her own,” Ciara notes. “That is huge.”
Horses, crafts, and ice cream: Client-led sessions make the difference
Vanessa reports that Maddie looks forward to her speech therapy sessions. “She is a lot calmer and less stressed being able to attend her sessions virtually as opposed to waiting in a lobby. As soon as I tell her it's time for speech and she sees the laptop, she sits in her favorite chair and patiently waits for us to join,” Vanessa says. “Maddie responds well to Ciara’s instructions and is more attentive to her online sessions than the ones that were in-person.
“Ciara is very engaging, personable, and accommodating,” Vanessa adds. “Her approach encourages Maddie to be more responsive and makes her feel included.”
She is a lot calmer and less stressed being able to attend her sessions virtually as opposed to waiting in a lobby.
Speech therapy that’s “client led,” or focused on the client’s interests, tends to get the best results. Ciara makes it a point to choose topics and activities that Maddie enjoys. They often make crafts, cook or bake together, or watch videos about animals (Maddie especially loves horses) and talk about them. Throughout the session, Ciara models how to use the AAC device during whatever activity they’re doing.
In one session, Maddie and Vanessa made homemade ice cream while Ciara guided Maddie’s communication. Ciara recalls how Vanessa was shaking the ice cream to help it harden, and Maddie seemed to love watching her. “I said, ‘Maddie, you really like watching Mom do that.’ And then she went to her AAC and hit ‘I like’ several times in a row! She participated in a conversation without any prompting at all. That hadn’t been happening just a few weeks before.
“Maddie’s personality is shining through, and it’s amazing to see,” Ciara says. “She can even be a little sassy, like when she tells me she’s ready to be done with a session! I listen to her and switch to talking with her mom.”
Home practice + teamwork = success
At Expressable, parent coaching is an essential part of speech therapy. Every session includes times for Ciara to connect with Vanessa, explain aspects of the AAC device, and offer tips for helping Maddie communicate at home.
“I love that the online sessions get me more involved and require more of my participation, as opposed to the in-person therapies where parents wait in the lobby,” Vanessa says. “From Ciara, I ‘relearned’ the importance of consistency, repetition, and quickly and properly implementing the techniques and advice she gives me.”
Vanessa uses the Expressable client portal to view Maddie’s progress, as well as Ciara’s notes and home practice assignments after each session. “I love the ability to upload files or videos directly to my therapist. The home practice activities, and the ability to practice them as many times as needed, provide a unique opportunity to reiterate core principles learned during the sessions.” Ciara is grateful for the teamwork she and Vanessa have developed to support Maddie. “Vanessa is so good about doing the home practice and prepping for sessions with me. We couldn’t do these kinds of sessions without her involvement."
Becoming a more confident communicator
Vanessa has seen a big difference in Maddie since she started speech therapy with Expressable. “As she gets better at expressing her needs and wants, she’s less frustrated. When she can choose the method of communication that she’s most comfortable with, she’s more likely to sit down during speech sessions. She makes more of an effort to listen and takes an active part in her sessions.”
“Client-led therapy and having options has been really good for Maddie,” Ciara adds. “The fact that she’s communicating spontaneously is huge.”
As Maddie becomes more confident using AAC, Ciara will continue to help her build her independence, so she can easily communicate with people outside her family. Thanks to her mom’s support and the right therapy, Maddie’s on her way to being able to share her thoughts, needs, and personality with anyone she meets.
How Expressable Can Help
Concerned your child isn't reaching age-expected milestones? Looking for communication support from a professional? Expressable is a national online speech therapy practice serving children and adults. We treat all major areas of communication and feeding, offer flexible hours including evenings and weekends, and accept most major health insurance plans. We’re proud to have earned more than 3,000 5-star reviews from our clients (4.9/5 average).
Our therapy model is centered on parent and caregiver involvement. Research proves that empowering caregivers to participate in their loved one’s therapy leads to better outcomes. That’s why we combine live, 1-on-1 speech therapy with personalized education and home practice activities for faster progress.
Communication is more than words. It’s how we share how we feel and show who we are. We’re here to help you or your child do just that.
