An Expression of Perseverance
As a speech and language pathologist, I’ve worked in a number of settings, including hospital, public school, and private clinic. I’ve also worked with adults as well as children. Although I enjoy working with people of all ages with varying speech and language issues, I find that working with children is especially enriching and rewarding. Children who have limited communication skills are typically identified and treated for their speech or language delays between the ages of two and eight; this is usually due to having difficulty expressing themselves effectively and/or having limited understanding of language. Children who have delayed speech and language skills may also demonstrate challenging behaviors, such as, tantrums, hitting, and biting.
In my opinion, behavior IS communication; and, for many children without effective communication skills, it’s their only method of expressing themselves. After all, not being able to tell someone we’re hungry or really need to use the bathroom may just evoke a kicking and screaming fit from us as well. It is my job to help these students by providing opportunities to learn speech and language in a meaningful way. This may include instruction on sound, syllable, and word production as well as language treatment, including sign language and other forms of augmentative communication. This is sometimes easier said than done; as I mentioned earlier, there may be challenging behaviors to overcome.
When I first began working in this profession, I would sometimes feel overwhelmed by the complexity of a child’s needs, including dealing with those behaviors. I am a conscientious person and a worrier by nature. So, this meant that I was always over prepared, spending hours planning, preparing, and visualizing a treatment session. Sometimes, though, it didn’t matter how prepared I was for treatment, because a student may have other ideas– running around the room, rolling on the floor, or playing with a toy. When this happened, I learned to let go of my plans. However, I did this while still being mindful of my purpose. I realized that creating a meaningful context out of an activity that was child-directed was key to gaining joint-attention and ultimately helping a student to communicate. It didn’t matter how fantastic my treatment plan was if my student’s attention wasn’t on the lesson. I was most successful when I was able to meet a child where he or she was engaged at the moment, embrace their interests, and give meaning to their activities through interaction, verbal and nonverbal language, and positive reinforcement. What I learned was this: By generating a genuine affection and respect for my students and their interests as well as an empathy and compassion for their challenges, I was almost always able to address their therapy goals in a way that was productive and enjoyable for both of us.
Over the years, I’ve worked with many students who have autism, but one in particular comes to mind; I’ll call him Matthew (not his real name). Matthew was about six years old and nonverbal, except for using some sign language. He was not able to vocalize and sequence sounds to produce speech. Although Matthew had difficulty with speech production, he appeared to understand everything. Because of this difficulty expressing himself, he was very frustrated. We often heard Matthew coming before we saw him, and it wasn’t unusual to spend the first few minutes of therapy getting him up from the floor and onto a chair or otherwise engaged in a task. Our treatment goals, among other things, included working on producing and sequencing vowel and consonant sounds and combinations. This was challenging for Matthew as he had a disorder that caused the signal from his brain to his articulators (e.g. tongue, teeth, lips) to get jumbled en route. This meant that he would grope at trying to put his tongue, teeth, and lips in the right place at the right time to produce a sound or word.
Making a sound or saying a word seems like a fairly straight-forward thing to do, but it’s actually an extremely complex fine motor skill. Articulating a word happens in a split second, but there’s a lot going on in the background. Take the word “Twinkle” for example: Our tongues start on the alveolar ridge or bone behind our front teeth to articulate /t/, while our lips are simultaneously rounding for the bilabial /w/. Then our tongues begin to retract for the vowel /i/ in the middle of our mouths and then continue retracting all the way back for a velar /k/. Finally, the tongue shoots forward and upward to form the liquid /l/. That’s just the articulatory aspect of speech production. And, I haven’t even discussed the phonatory part, yet: voiced sounds, voiceless sounds, and how the vocal cords vibrate for /w, i, l/ but not for /t, k/. The brain coordinates the articulatory, phonatory, and respiratory systems in order to produce speech in a fraction of a second. If there is any problem in the area of the brain that’s in charge of all of this, then it can be quite difficult and frustrating for a child like Matthew to speak with ease.
Matthew’s challenging behaviors had become much worse. He was extremely frustrated and angry and not very interested in my agenda. But he WAS interested in toy cars and airplanes as well as a little, stuffed worm from The Very Hungry Caterpillar book. I incorporated these toys into our treatment plan; one of his favorite activities was moving the toy airplane in rhythm with his vocalizations. He was also allowed to play with these toys after a few good-hearted attempts at a particular treatment objective. This worked most of the time, but there were times when it didn’t. Occasionally, Matthew would slide out of his chair onto the floor, vocalizing loudly, crying, and shaking his head “no.” At these moments, I would sit quietly until he was mostly finished expressing himself. And, then I would say: “Matthew, I know this is really hard, and you feel mad. I’m sorry this is so hard for you, but I know that you can do this.” I said these words deliberately and sincerely. Most of the time, after sitting there for a few minutes, he’d blink his watery eyes and then hand me the toy airplane that we had been using to practice his vocalizations. These moments were always an inspiration, and we kept on going.
While we continued to address Matthew’s overall communication goals, we also worked to improve his speech production. We worked on producing vowels and consonants, and then we worked to sequence vowel-consonant, consonant-vowel, and consonant-vowel-consonant combinations. We used melody and movement to support these endeavors and a whole lot of positive reinforcement. And, after days and months of hard work, Matthew finally said his name…. for the first time. While it wasn’t a perfect production, it was a very close approximation. As he finished saying his name, we looked at one another and smiled—-jubilation! “You did it!” I exclaimed. And he cracked a rarely seen smile back at me. “You did it,” I quietly said.
Here’s the thing: I realized that when I looked past the complexity of a child’s communication disorder as well as any challenging behaviors they may be exhibiting at the moment, what I always saw was their humanity. It was this sense of compassion that encouraged patience and perseverance for both of us. I came to understand that when I looked from another’s perspective, not only did I become a more effective therapist, but I clearly saw the person before me.