The good news is things no matter how dire the current moment, things almost always improve. How do I know that? It’s lesson the people I’ve helped over the years have taught me. It’s something a two year with a developmental language delay who at three could say at best five words and today speaks volumes. The child classified within the autism spectrum, who six months later is off the spectrum. The little girl with Cerebral Palsy mastery over sign language. It’s the success stories of these individuals and the many many others who have collectively taught me the role of patience.
Not every case is cut and dry and as a therapist I offered a forecast for how things may turn out, but I didn’t always know exact moment when the tide would turn.
So does patience automatically appear when told your child has a language or speech delay? No… simply knowing its importance may not make the process any easier. It’s reasonable to want solutions to come about quicker. The attribute of patience is having the vision to understand and see the accomplishments your child makes over the course of their speech therapy program. It’s pushing aside the worry of the moment in favor of a developing confidence that things will be better than what’s happening in a particular moment. The ability to appreciate and see the little steps a child takes toward a therapy goal.
Lately, I’ve witnessed that sometimes my 6 month year old grandson “Jack” is quiet and sometimes he talks a ton. I noticed also there are times when I want him to babble and he won’t make a peep. There appears a window of sorts that suddenly opens and sounds come forth.
The cool part of this window is that it can open at any time . Often it catches me by surprise. I’m working writing this blog, or in the kitchen cooking and out of the quiet comes an array of sounds – “ah, ga. eeee. iiii ” with an occasional “h,m or even a “ba”.
These windows to vocal play can occur unannounced and quite randomly. Babbling just happens. As a therapist, I see such windows as having particular value to Jack’s overall speech and language development. It’s here Jack begins to explore and play with sounds. It’s in this place, using random sounds, Jack initiates some of the first conversations of his young life.
Yet given the suddenness and random nature of the window, it’s easy to miss or even misunderstand the teaching opportunity presented. So when for no apparent reason the window opens, put down the computer, move away from the kitchen and join the fun! There’s some speech a brewing…
Three words that make so much sense it’s a wonder they’ve take this much time to become part of the main street conversation in speech therapy. Having completed an online course by Sarah Baar at SpeechPathology.com it’s clear Person Centered Care will be a centerpiece of neurogenic disorders therapy moving forward. Sarah Baar is both an authority and advocate for PCC and her work presents a passion and a sense of inevitability with respect to the direction neurogenic disorders therapy must now follow.
In her course Sarah defines the role of a therapist as one of a teammate where patient and therapist work in tandem on agreed upon goals. Within this model therapy activities and goals are defined by the life experience and personal interests of the patient. Sample goals might center around;
Operating a coffee maker
Responding to a phone call
Organizing a grocery list
Making a date to play golf
Alerting a friend you may have an issue with speech
Going through the steps of writing an email
Re-learning a work task
The current medical model of treatment bases it’s therapy in universal teaching contexts which may or not be relevant to a patient’s life. In this model therapy success is defined by results on a standardized test or a predetermined performance standard. In contrast Person Centered Care breaks from this more traditional model the therapy to structure goals around the functional needs and interests of the patient. If you need groceries – how might you order groceries online or by phone. If using a phone is problematic practicing phone conversations in real life contexts may be in order with possibly the first goal alerting the listener you may have a problem with speech.
Therapy is suddenly personal, meaningful and pertinent. Therapy materials which filled closets for in some cases decades are out the window. ST’s longer work to improve numbers measured by a standardized test but performance on an everyday task.
Therapy materials are formed around the everyday interests and needs of the patient which in turn powers ST’s to be creative. This approach to therapy presents a unique therapy challenge. It’s not as much about thinking outside the box – but understanding the box sitting in front of you and that’s the real fun. In a very real sense we’re helping a person find and be themselves.
Sarah Baar cites studies by (Hinckley & Yones, 2014) (Rutherford & Childs, 2015) which finds PCC patients;
Are less likely to be readmitted
Show more trust and motivation
Are more likely to adhere to treatment regimens
Show better recovery, quicker rates of generalization, improved self-awareness
Demonstrate better emotional health at follow-up
Require fewer diagnostic tests and referrals
Sarah goes on to indicate insurance companies are very much on board with PCC and that Medicare actually now includes PCC as part of their annual goal and five year centered vision plan.
This approach to therapy makes so much sense it’s surprising it has taken this long to become a thing in speech therapy. If you are Speech-Language Pathologist, or person concerned with the topic of speech therapy for neurogenic disorders, we strongly suggest a visit to: HoneyCompSpeechTherapy.com and the words and works of Sarah Baar to learn more.
Realizing your child has a developmental issue that may require speech therapy can be a difficult experience. Just my presence on the scene means a family is no longer alone and that a professional has arrived to help. I often feel the concerns which led to the call for help as I walk in the door
One of the first questions I’m asked is the length of time it will take till everything is ok. As a therapist my role is to assure those concerned I am clinically competent with respect to their child’s issue and that over time things will improve – the key phrase is “over time”.
The dictionary defines patience as:
“The capacity to accept or tolerate delay, trouble, or suffering without getting angry or upset.”
When discussing speech therapy programs with families, I liked discussing not getting frustrated, or discouraged by the events of the present. The acquisition of speech and language is a an evolving process. It entails both the formation of cognitive, neurological, and physiological processes. For a word to be said, all the above processes (which by the way are invisible) have to act and coordinate in a manner they may have never done before. Given this multifaceted nature of speech, one of the most important elements for its acquisition s patience.
At a speech therapy seminar several years ago a presenter said, “If a child thinks they cannot say a sound or word, chances are they won’t”. After many years in speech therapy I’ve come to appreciate the wisdom of these words. Children speak words they know and feel comfortable saying. For example, if I know a toddler says the word “car” and I ask them to repeat my model or identify a “car”, most often they say “car”. If I ask that same child to say a word or sound they have not said before said, most times my request will be met with silence.
For a spoken word or sound to occur, cognitive and physical connections must be in place first. Often with respect to first speech, we’re asking a child to something new. There is a first time for every sound or word and for something new to be spoken a surprising number of things must work in unison. Things we have no way of seeing, acting in conjunction with processes we can only imagine. And even if everything’s wired the way it’s supposed to, there must be a certain confidence level in place before a child will even try to say something new.
A Story About Confidence — Speech Therapy
Michael was an adorable 2 ½ year old with a pronounced speech delay. He could say only a few bilabial sounds but had no voiceless sounds e.g. /H/, /S/, /P/ and /F/. My goal this particular day was to help Michael build air-flow skills through horn play. It may seem like a simple task, but this was something Michael had never done before. Sitting in a circle with his mother’s help, the plan was for each of us to take a turn blowing the horn. The first time through I blew my horn, then his mother, and then Michael. He just held it while looking for someone else (anyone else) to blow theirs. After a couple of minutes of this, Michael appeared content to just watch the mom and I.
Then, just as I was having thoughts of moving away from this activity, something surprising happened. On a subsequent turn, Michael stood up and took his horn downstairs (we were on the top floor of a bi-level). Neither the Mom nor I said anything because Michael seemed to be a toddler on a mission. He reached the lower level, and after a brief moment of silence Michael began to toot the horn. After a few seconds, to our continued surprise, Michael ran up the stairs holding his horn with a wonderful smile on his face. When asked if he had blown his horn, Michael ran downstairs and blew a second time; this time even louder. I remember telling the mom the goal was for Michael blow on the horn, not that we had to actually see him do it.
For Michael it was just a matter of finding the confidence to try, and in this case he needed some space. There’s a first time for everything!
It’s starts with observation, my child is not talking. This is followed by the thought something may be wrong with their language development. Then the questions; will this just go away? How long will it take for speech to happen? Will my child ever speak? These are trying times for a parent. There are no instant solutions, only the realization my child’s development of speech and language may be at risk.
For many parents this is a new place. There may be some denial or a wanting for this to go away. Yet as time goes by and comparisons to other children occur, there’s the growing concern: the so called normal acquisition of speech and language is not yet happening. There is a need to act, a need to better understand what is going on. My child is at a developmental impasse.
What Can I Do?
So something has to done, some calls have to be made, but to who, to where. The good news; there’s a network of professionals concerned and experienced in treating your child’s exact issue with language development. The situation you face is by no means unique. Many and I mean thousands have gone before to find relief from a worry that seems so now encompassing. Places to reach out might include your pediatrician, your local school district, and if your child is under three early intervention center(s) for your area.
Prior to calling it’s a good idea to organize your concerns. You could note; how many sounds and words your child says. The general clarity of speech, missing sounds, misarticulations. Your child’s overall interest in talking, eye contact, ability to follow directions, identify pictures. How your child interacts with family and children their own age, and other concerns.
There’s a community of caring professionals just waiting to help.
For more information on help to find the right therapist for your situation click here.
I remember one of my earliest speech therapy seminars when the instructor Suzanne Evans Morris – laid down the tenet – that one of the prime roles of a therapist was to teach children to “love their mouth.” The more I practiced the more I came to understand the importance her words during speech therapy sessions.
Since speech is comes from a child’s mouth – it’s important to consider the mouth from the perspective of child. Away from a mirror, it’s not that visible. It’s also a source of discomfort, it’s the place where teething occurs. A place, with respect to speech, a lot of things are expected and maybe not a whole is happening. A child cannot see their own speech. Unlike a toy, they can’t hold it, push it or bang on it. And if you’re having problems it’s kind of like being at a tennis match where everyone around you is playing but you. Its easy for a little one to be frustrated and take a step back from expected speech goals.
The mouth and it’s speech is a phenomena that must be discovered. Children by nature, learn through play and adults act as facilitators of knowledge. We can guide and put things in the path a child to learn, but when all is said and done a child learns through a process of discovery.
Play Is fun – Discovery Is Fun – Learning Is Fun – Make Speech Fun
Children don’t play by the same rules as adults – they don’t yet think the way we do. I read an article suggesting that young children are faster to fix a computer problem than adults. Not because these digital natives are naturally better at technology (although they might be), but because they keep trying different things until they have success. They discover a solution while an adult will keep trying the same thing several times.
Children learn because they attend and are curious about something immediately in their path. They learn because something has caught their attention and sparked their inherent curiosity. As facilitators of learning, adults can place things in their path, but when all is said and done we can only hope it triggers an interest.
If a child is having fun it means that whatever is going on around them has the power to draw their attention and curiosity. And when in this state their mind is more open for learning.
Proper credentials Master’s degree in speech and language, state license (in states that require), Certificate of Clinical Competence CCC from the American Speech and Hearing Association (ASHA). Therapist schooling takes two years beyond college and can include a 9 month clinical fellowship.
Experience Has experience working with your child’s particular problem.
Initial Assessment Everything starts with the initial assessment ; one written competently defines the problem and sets up everything that follows. It’s a critical document. It’s content provides useful information to other professionals working with your child.
Rapport Your child likes and feels comfortable with your therapist. There is an obvious level of trust. Your child looks forward to the therapy session.
You feel good about them You believe your child is in competent hands.
Communication Skills Therapist communicates regularly with you. They make a point to talk with you after the session. Their documentation is timely, readable and helpful.
Inclusive Your are part of the therapy process. There is a home program.
Team Player Therapy often occurs with other disciplines. Therapist reaches out and communicates consistently with other professionals e.g. OT, PT, doctor, nurse, teacher, social worker.
Blends with your child’s world Therapist integrates interests and things of importance to your child in therapy.
Achieves goals Is therapy on target with initial goals? Are goals achieved? Were achievable goals set in the first place?
Documentation Proper and timely documentation is paramount. Poor or missing documentation stops funding.
These are nice things to have too
Current Therapist is up to date with new things happening in the field. Familiar with trends going on in the field.
Creative/Thoughtful Thinks outside the box. Sometimes obstacles to progress require creative solutions.
Generous Goes beyond the minimum expected. Spends extra time with you or e.g. makes therapy materials, coordinates with a teacher. Does things you might not expect.
The numbers vary but by age two a spoken vocabulary of at least 50 words is the average. Some children say upwards of 150 which is great, while others with a vocabulary of 25 words or less is considered a “late talker”.
Aside from the numbers, other things to consider include:
The clarity of speech
Are your child’s words clear or lacking mis-articulations, omissions, or substitutions. How clear is his/her speech to peers, or non-family members.
Does your child exhibit good eye contact when speaking? Is eye contact sporadic, or non-existent?
Comfort level when speaking
How comfortable is your child when speaking? Do they avoid speech tasks, or prefer other means of communication e.g. will just go get an item vs. asking for it. Do they look away and remain quiet when asked to name an object or respond to a simple question. Do they appear frustrated?
How well does your child respond to spoken directions. If you ask “please get me your shoes?”, “Do you want milk or juice?” Do they act appropriately.
How speech and language gains trend over a period weeks and months. Are their more sounds, words, phrases being produced? Do gains appear few and far between, or do things appear to be just staying the same.
If anything pointed out here raises a concern, discussing the matter with your pediatrician, early intervention center, local speech therapist, or school district may prove to be a good idea.
Kids differ widely in the way they acquire speech and language. The good news is there are many avenues available which can help and often a little push may be all that’s needed. Two is the age when the foundation for speech and language is built. It’s a time about becoming the person your meant to be.