Imagine if every time you spoke to people they replied, "What?"
Imagine if you repeated what you said, and they still didn't understand you.
How long would it take for you to become frustrated, depressed or simply tune everyone else out?
A child who has difficulties communicating thinks of himself as a "bad talker." He feels isolated. He may feel jealous that a younger child speaks better than he does. He may have accepted the fact that he only has a few good words, and must use pushing, pulling, gestures or signs to help others understand what he wants or what he needs. He may have decided that trying to speak is a waste of time.
A year and a half ago, I met a boy who was in a public special education preschool program. He had severe Apraxia of Speech.
This boy could say "ma" and "da," but not much else. He was taught sign language in school, and when his parents requested that he be taught to speak, the school staff replied what they had come to believe, "Signing is his preferred method of communication."
His parents did not want to believe that.
His parents were given my name by both an occupational therapist who knew me, and a pediatric neuro-developmental specialist. His father called me in June of 2011. He was 3 years and 10 months old; soon he would be 4, and he couldn't use speech to communicate his thoughts or ideas.
When I arrived at his home I entered the living room and saw him. He was on the floor on his back, watching TV. He looked bored, sucking his thumb and covering and uncovering his head with a blanket. He glanced my way, but just didn't seem interested in me (even though I was carrying a big bag of toys).
Now, I had been told that he had been through early intervention, so I knew that he had some experience with women showing up to play. His lack of interest seemed like a deficit in social engagement, and I wondered if he might be on the Autism spectrum.
That first visit I sat on the couch and he sat on a chair, with a small plastic table between us. It was slow going. He was very hesitant. He seemed confused why I would be trying to get him to say things, when everyone knew that he communicated using sign language.
On the second visit, his mother decided that we should work in the bedroom. So, we took the table and chair into that room. He did not seem pleased, so I quickly began to pull things out of my bag.
I grabbed Lah-Lah (the yellow Teletubbie) and moved Lah-Lah up and down to make her "dance" on the table while I sang a "la-la-la" dancing song.
Within minutes he opened his mouth and I saw him groping/struggling to move his tongue tip up (without success) in an effort to sing along.
We went through the bag of toys, as I learned and noted down which toys would amp up his engagement with me, and get him motivated to work on speech. He stopped acting disconnected, and I began to see the "real" him.
It took only 1 or 2 visits until I saw happiness and anticipation on his face whenever I walked into the apartment. For weeks he did a lot of screeching and jumping around to express his unbridled joy.
He also screeched loudly and made funny faces as he tried to make others laugh. He was acting silly, but in a really, really LOUD and irritating way (I have sensitive hearing).
It occurred to me that he was a budding comedian (Jerry Lewis-style), and so I made it a goal for him to eventually make others laugh by using speech (telling jokes, silly stories, etc.).
I decided to use my DOUGH SHOW technique, with him during the next session. He and I manipulated Play-Doh and said words as we did it.
DOUGH SHOW is a routine that leads from one activity (pulling pieces off of a big piece while saying, "PULL") to another (taking those pieces and making each into a ball...[sing] "round and round and round and round...that's how we make a _____"... "BALL").
Using DOUGH SHOW, we kept physically active and cognitively stimulated. We were busy deciding if the balls would be transformed into pancakes, and then stacked, or if the balls should be made into snowmen. Snowmen? Okay, then let's add 2 eyes, 1 nose and a happy mouth! We used a pencil point to carve faces and poke in buttons, and always took pictures of our creations!
We worked together, transforming our creations from one thing to another, speaking the whole time, and benefiting from the fine motor movements' stimulation of speech production (just as signing MORE often helps to get the word "more" to pop out).
In just a few sessions, this little one was learning to imitate me fairly consistently, and I pushed him to imitate phrases and sentences, syllable by syllable; only backing down to sound by sound, if necessary.
I modeled things slowly and clearly (in my slightly louder REPEAT-ME VOICE), so that he would say things directly to his parents ("I - MADE - A - SNOW - MAN!").
I was so glad that I was videotaping so many of his sessions. The feelings of pride demonstrated on his beaming face were evident, as he heard his parents saying, "Good job!" with each successful utterance.
That little boy was grinning from ear to ear and wiggling around as he did a seated dance of joy.
It took 7 weeks (about 20 visits) until I heard something from his parents that I had been waiting to hear.
His father told me that, the day before, his son had gone over to a much older boy at the bus stop, and had spoken something to him, in an attempt to start a conversation.
YES! I was psyched.
It was official. He now perceived of himself as a TALKER! And, (drum roll, please) he had enough confidence to speak in a public place to a much older child! We were on our way!
Signing was NO LONGER his preferred method of communication. Mom and Dad, your gut feelings were right!
Imagine the shock of the school staff when he walked in the first day of school in September and was TALKING! Imagine that scene.
Well, I have to say, that this little boy is in a great school district with thoroughly professional staff members.
His speech therapist was so surprised (and pleased) that she recommended me to her supervisor, who then invited me to do a training for the district's 11 speech therapists, during a professional development day.
The therapists listened to my explanations, and saw me using my techniques with children on DVDs. The district even paid for the 11 speech therapists and the supervisor to get a copy of my VERBAL APRAXIA book.
This little boy is now 5 years and 6 months old, and I presently see him only 3 or 4 times per month. He is mainstreamed at school, is learning to read and is working on /l/ and /r/ blends in speech therapy. Since he is a natural performer, we make videos of his little performances.
I'll never forget the day when he spontaneously stumbled through his out-of-the-blue announcement, "Ladies and gentlemen, I give you, Miss Noelle!" He came up with it and we worked on it for 2 sessions, until he could say it fairly clearly. Then we worked on him introducing all the different members of his family. He's a great emcee!
Sometimes he leaves out articles or other non-content words, when he speaks in longer sentences, but he is always willing to repeat my corrections. All-in-all he is a fairly intelligible communicator who has come a L - O - N - G way.
* Remember, 18 months ago he was almost 4 years old, signing to communicate, crying to express sadness and screeching to express joy.
With my encouragement, he is now learning to use speech to refuse, explain and share both negative and positive feelings.
I focus on expressing feelings because, if this is not done then regression to lower levels of communication (screeching, screaming or crying), during stressful or exciting times, can occur.
Verbal Apraxia doesn't always look the same, and the therapy is slightly different for each child. The types of targets and how you present the therapy techniques must also change as the child grows, gains skills and ages.
It often feels like 3 steps forward and 1 step back, but keep the faith! Each time a child
reaches for a higher level of communication he struggles and his speech often becomes less intelligible, but then he moves
The FIRST STEP in the journey is for the child to believe in himself; seeing himself as a talker is key (i.e., getting positive responses when he talks).
The SECOND STEP is for the child to get some uplifting experiences in error-free communication (e.g., SPEECH STORIES)...[that blog entry is coming soon].
These 2 steps build and strengthen the child's confidence.
Children with Verbal Apraxia need LOTS of confidence, in order to have the emotional stamina to make mistakes and still continue to try.
I'm Noelle Michaels, speech and learning specialist.
I always make it my business to advocate for children with Verbal Apraxia, and I truly love my job!
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Noelle Michaels, MA, CCC-SLP, LDT-C
Bilingual Speech Language Pathologist
Special Educator & Learning Specialist