How to Save Your Sanity with a Tough Caseload

How to Save Your Sanity with a Caseload of Tough Teens

5 tips for working with tough kids

Years of working with difficult students who couldn’t make it in a regular school setting taught me how to save your sanity with a tough caseload. There’s nothing like a difficult teen who is determined to ignore you. Or worse, act out!

Tough teens are not at all like a difficult young kid who can be enticed with fun toys. With tough teens, you have to be the connection. Yup, just you! You have to find a way to connect with your students using your own personality traits.  Funny, quirky, down to earth, you name it. Find something that works for you.

But, whatever you do, be sure to :

  • Be real– teens can spot it a mile away if you are faking it.
  • Show your humanity. Admit to your mistakes and talk about what happened, Apologize if your mistake happened with one of your students.
  • Care. Ask your teen students how you can support them if something seems wrong. But do it privately.

Tips for Engaging Tough Teens

1. Include your teens’ interests!

Incorporate your students’ interests into the therapy session when possible.  This helps difficult teens to engage. One way is to use YouTube links and video clips. Since teens usually have much more time to spend surfing the net than we do, try putting them in charge of finding something interesting to do!

  • Maybe they can choose a video clip to watch at the end of the session. 
  • Use a topic that they have to learn more about in one of their classes.
  • Find out about a hobby or interest they have and incorporate that.
  • Tie your work into a hands-on activity that interests them.
  • Read the lyrics to a song from their favorite artist as you would use a story.

Of course, it makes sense to get this information from them and plan to use it in a later session. At least until they have proven themselves to be reliable about choosing school appropriate materials.

Goals that are fairly easy to work into any of these activities include:

  • answering questions.
  • having a conversation.
  • retelling or summarizing the video’s story.
  • sequencing the events.
  • coming up with alternative solutions to the problem the character faced.
  • eliciting specific grammar or speech sounds during a discussion. 
speech therapy, difficult caseload

2. Make a connection with your tough teens!

Many students with significant difficulties in their lives may not respond to you at all until they feel like they have a connection with you.  Getting this connection can make it difficult to address your therapy goals at first. Be patient as it can pay off in the long run. And sometimes your most difficult student can turn out to be the one you are most attached to!

3. Use many different formats to work on a skill!

Do your students need a significant amount of practice, using specific strategies, in order to make gains? Maybe they don’t have long attention spans and don’t like to do the same activities every day (unless they are on the spectrum, and that’s another post!) This is the reason why most of my products include multiple activities for the same skills, as well as ways to vary the difficulty levels. 

Giving students choices about their work, even if it is as simple as offering a spinner, discussion cards, an internet activity, or a game can help motivate students to work. Since they have made the choice, they are more willing to engage.

speech therapy choices

4. Provide tough teens with choices!

Choices are a big option, and this includes the student’s behavior. Try telling your students that you can’t make them work, but you hope that they will think about their choices and make a good decision. While the students are contemplating taking off their hoods and looking like they might interact, keep busy with doing attendance.

Or get out some easy, hopefully, more engaging work choices than the one you originally hoped to do that day. Make it a point to have varied options for each IEP goal, and lots of games, available at all times for just this reason.

5. Use Incentives that your Tough Teens Will Work for!

Incentives to work are so important! While we love our jobs, would we do it without a paycheck? Teens dealing with tough situations in their lives are living in the moment. They are not likely to be motivated by thoughts of a vague future job.

Negative consequences, such as notifying the teacher or parents, may work in the short term but are not ideal for helping students to make better choices for themselves.  Games, contests, something fun to do at the end of the session, and point systems all can help. Prizes for older students can include:

  • no homework passes.
  • extra game or computer time passes.
  • items from the dollar store that interest them.
  • something special from the cafeteria.
  • points toward a school store item.
  • an end of year speech pizza party.

Best of all, just ask each student directly what they will be willing to work toward. And still expect to have those rough days!


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I’m Linda, an SLP who loves helping you build effective communication skills for your students using strategies and visuals. Pictures are time consuming, so let me make your life easier!

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