speech therapy

iPad Grant for kids with autism

When it comes to technology, I have way more ambition than skill. Getting an iPhone a couple years ago helped me see how even a novice user could find and use great apps. Diving further into the utility of technology for my personal enjoyment as well as my speech therapy practice, I was drawn to the iPad2.

Last spring my wonderful husband bought me an iPad2 (I may have given him a few helpful hints) and I dove into technology and apps with the aforementioned ambition. In addition to educational apps and therapy tools, I am impressed with the potential of the iPad2 to be used as a communication device. 

One big drawback with most communication devices is that they are bulky and heavy, therefore the children may not drag their devices with them wherever they go. I’ve also seen devices that are used primarily by adults who know the child well and can “read” them enough to select the page or icon needed. Basically when this happens, the child is communicating to an adult who then communicates with the augmentative communication device.

The iPad2, I think, will be (and already is for some of us) the Augmentative Communication device of the future. Thin and lightweight, it’s already ideal for portability. There are more communication apps becoming available daily, and they can be customized for individual needs. iPads are significantly less expensive than traditional devices and some insurance companies are catching on and starting to cover some of the costs.

Then there’s the cool factor (spoken like a true nerd still longing for coolness) that the iPad offers. LOTS of people have iPads or would like to, and children using them have devices that don’t look like “tools” but are appealing and versatile, and, well, just plain cool. On the spot, pictures can be taken and added to a communication app. Aides will not need extensive training for iPad use, because it is so user-friendly even a novice with technology (ahem, like myself) can easily learn to implement apps.

I came across a site, iTaalk.org, and saw that the iTaalk Autism Foundation is giving away an iPad a day until December 31, 2011 for children diagnosed with autism. There is an application online at their website, along with more information about iTaalk.org. Check out the resources and training for parents and professionals after you read about the grant at the link below.


“My Ball Died”

When I heard the words “My ball died” coming out of the mouth of a preschool boy I was seeing for speech therapy, I tried not to show alarm. “Tommy” didn’t seem to be too upset, but he was clearly trying to tell me about something that mattered to him. I had not heard of any recent loss in this boy’s life, but then again I only saw him once a week for speech therapy and didn’t know about every single person in his life. I wanted to be compassionate and allow him to talk about what was on his mind. Tommy already had a very hard time expressing himself due to speech articulation (pronunciation) errors. Even to those familiar with Tommy’s speech patterns, his speech intelligibility was poor. When I repeated his words back to him for clarification, he responded vigorously with head shakes and repeated insistently, “No. My ball died.”

Some children, when hearing their incorrect speech production repeated back to them, will recognize that what they are saying does not match the message they are trying to convey. As a result, some children will alter how they are pronouncing words in order to increase their intelligibility. Tommy was not one of those children. He kept saying the same thing in exactly the same way, over and over again with no change. Tommy still did not appear distressed, but was making eye contact and eagerly awaiting my response.

As a speech therapist, I have been asked how to respond when you just don’t understand what a child is trying to say. I think the correct response is usually dependent on the situation. If the child is just chatting to make a connection with another person, then it may be more critical to be responsive and caring than to determine exactly what has been said. Sometimes asking the child “Can you show me?” helps them use nonverbal means to get their meaning across. This is limited to messages that can actually be pointed out or demonstrated, though, so much of the time it isn’t a very effective strategy.

The strategy of pretending to understand the child can backfire, because you may be consenting to something you don’t intend to or the child may try to continue the conversation and sooner or later the fact that you are faking comprehension will become obvious. Could this affect your relationship with the child? Another option when a child is clearly trying to convey a message to you is to begin asking questions to see if you can narrow down the possible topics the child is talking about. Even with barely intelligible children, knowing the context of what they are talking about makes it easier to discern what they are attempting to say.

In Tommy’s case, I started by asking him if someone in his family had died. Tommy looked uncertain, so I started naming possibilities by using yes/no questions since Tommy was able to respond accurately to them. “Did your grandpa die?” “Did your dog die?” and so on. Tommy continued to shake his head “no”. When this line of questioning lead nowhere, I tried asking about his toys. “Did you lose a ball?” “Did something happen to your ball?” Again I was met with repeated head shakes and the verbal assertion, always pronounced exactly the same way, “My ball died.” Tommy wasn’t giving up on me, but continued to make eye contact with a hopeful expression on his face. I was feeling more and more inadequate to help this sweet child who apparently had some kind of loss to grieve.

Through the open window of the room we were using for speech therapy, we could hear the sounds of children playing. Following a particularly loud vocal outburst from one of the children outside, Tommy cocked his head, grinned, and happily pronounced, “My ball died!” He certainly didn’t look upset about a death, but instead looked at me in triumph as if he had just proven a point. Given the context, the words, and Tommy’s speech sound error pattern, things began to fall into place. Hesitantly, I asked another question, “Is your brother outside?” Tommy responded with enthusiastic head nods, repeating once again with a look of utter satisfaction, “My ball died.” Okay. So no one died and nothing was lost or irreparably damaged. What a relief! For whatever reason, it was very important to Tommy that I acknowledged that his brother was outside.

Although it had to be frustrating for him when he couldn’t quickly or easily convey his message, he was eventually rewarded for his persistence and I was relieved to discover that in fact, no ball had actually died.

Say What?

I love talking with my son, Josh. He has such interesting perspectives and the way he verbally expresses himself gives me insight into how he thinks and processes information. When he was young, Josh had some difficulty remembering words so he would use descriptions to get his point across. He once described his ankle as “you know, that part that’s like the wrist of your leg”. He tended to use vague words such as “thing” and “that” rather than specific word labels. Despite the circumlocutions, I could always tell what Josh was talking about. Since Josh struggled to recognize many nonverbal signals and had to be taught how to use appropriate body language when he interacted, I could never take it for granted that Josh would just pick up on social cues and be able to express himself adequately. He could learn how to interact with other people, but he had to be taught specific discrete skills for social interactions. For my daughters, social skills came naturally and they just seemed to intuitively know how to relate to others. For Josh, it was like being in a foreign land where everyone else seemed to know the language but he struggled to learn basic communication and was vulnerable to being frequently misunderstood. I did speech therapy with Josh to work on conversational turn-taking, topic maintenance, and nonverbal ways to let a listener know he was interested. Unfortunately, Josh often was not interested in what others wanted to talk about, so then I had to teach him about being polite and a good friend by sometimes letting someone else take the conversational lead. Once Josh had some of the basic skills for social interaction and was able to express himself more effectively, he continued to practice and fine tune his communication exchanges. I noticed that Josh often did not respond when given a compliment. Outside of the family, Josh didn’t get many positive comments so he didn’t really know how to respond when it happened. I talked to Josh about possible responses and we role-played several situations together. After our practice session I reminded Josh that he had lots of strengths worthy of compliments so it was good that he was learning how to respond to them. Josh informed me that “Vanity was never my strongest weakness.” Say what? After some probing (they don’t call me the Momster for nothing) I was able to help Josh expand his message so that I could understand what he meant. His intention was to indicate that although he was aware that he had many significant challenges, being vain was not one of them. Therefore, he needed some help in learning how to respond to compliments. Even today, Josh comes up with some unique responses that catch me by surprise. Just this morning our dogs were playing and one of them ran over and stood next to me. I said, “Look, Josh, she’s on base.” After a brief pause, Josh jokingly said, “Then I’ll be lead guitar.” Say what? Translation: “base” sounds like “bass” as in a type of guitar. What’s a band without both bass and lead guitars? Josh was making a play on words, and at least now he understands what I say and makes a deliberate choice to joke and say funny things.

Speech Sound Production

I was recently contacted by a mom who had a speech therapy question for me.  Her teenage son had a lisp and although they had tried a few different things to correct it in the past nothing seemed to work.  Her question for me was to ask if her son might be able to correct his speech or if it was too late.  While it is true that children should be able to produce all speech sounds correctly by the age of 8 years, the good news is that speech articulation can be improved at any age given that the necessary physical structures and functions are adequate.  It takes practice, motivation, and cooperation.  When you can correct speech at a young age, it is often easier because the incorrect patterns are not as established as when a child has been pronouncing sounds incorrectly for years.  An older child, teenager, or adult  has a harder habit to break in addition to learning a new way to say speech sounds.  When there are multiple sounds in error, a speech/language pathologist can help determine which errors are developmentally acceptable and which are beyond the expected age for the sound to develop.  Working on developmentally earlier sounds increases the likelihood of success and lessens frustration.  The teenager whose mom had contacted me had been asked to do a reading at a wedding and as a result was very motivated to improve his speech prior to his public speaking engagement.  This motivation, along with strong parental support, was the strongest prognostic factor for improved speech sound production for this young man.  Although he could have corrected his speech earlier, without the motivation to work on it and practice he didn’t experience much change in his speech and it didn’t bother him since his speech was understandable despite the lisp.  But now he had a goal and was motivated to make the necessary changes to bring his speech up to par.  It just so happened that this family lived only a few miles from me, so I agreed to work with them for a few weeks to see if I could help the boy meet his goal of speaking clearly.  Being a busy teenager, his time for practicing his speech had to fit in with all his other activities.  With that in mind, we discussed practicing for 5-10 minutes each day rather than an occasional longer session.  This was not only reasonable for his schedule, but the short yet frequent practice sessions helped him be more aware of his speech and generalize his new skill.  After seeing this motivated teenager for just four speech therapy sessions, he is able to speak and read aloud without lisping.  He is practicing good speech sound productions on his own and the result is carrying over into his everyday conversations now.  He is ready to do his public reading and is a good example of what motivation and practice can accomplish.  His speech articulation will never hold him back now that he knows what to do and is willing to work to make it happen.  I am thrilled for him and his family and I’m very proud of what he has accomplished in a short period of time.