Monday, August 26, 2013

Our Experience with Speech and Communications Delays

I have mentioned several times on this blog and on Something Swanky that Emma has struggled with speech and communication delays. Consequently, I get a lot of questions from friends and readers about what we've been doing to work on it and if we've found any success.

So I thought I'd jot down a few notes here for my friends to read about our experience with all of this, and hopefully someone will find it helpful! (And for anyone who doesn't have a personal concern with this, it'll just be a nice update on Emma's progress ;)

Somewhere between 12-18 months my mom started expressing a concern that Emma didn't engage very well with other people. That was our first red flag.

At her 18 month appointment, her doctor affirmed the concern and referred us to our local Early Childhood Development Services (RAISE). When we started with RAISE, Emma's only form of communication was coming to take my hand and pulling me to her point of interest (a toy, the TV, the refrigerator for food or drink, etc...). She didn't make many sounds outside of crying and laughing. She was often too distracted by her surroundings to focus on a person.

(At this point, we had Emma's hearing tested and everything checked out as normal)

RAISE started speech services right away. It was slow (if any) progress for about 4 months. When I expressed frustration about this, our service coordinator suggested we bring on another counselor who could provide "communication"/behavioral therapy. Apparently there's a difference between speech and communication-- I had no idea.

The object of communication therapy was to elicit ANY form of verbal or physical communication from Emma. Our job was to make sure that she understood that communication (be it grunts, whines, gesturing, or signs) would result in us giving her attention.

This part was a ton of work. Because Emma was, in general, a pretty content toddler. She didn't ask for much. So we had to find ways to create needs and wants by putting her toys away up high, not giving her a drink or utensils with her meal, not taking her out of the bath right away when the water was gone, not picking her up out of the crib when we walked in the room in the morning, etc... we had to "deprive" her of things so that she would ask for us to fulfill the needs. Sometimes she would be confused (or just not care) and wouldn't respond. So we would have to act out what we expected her to do (for example, Chris might ask for a drink-- using sign and words-- at dinner, and I would respond to him first when he asked, hopefully prompting Emma to copy him).

As Emma caught on to this system, we were able to introduce more "sophisticated" forms of communication, like sign. Signing Time (which teaches ASL in conjunction with speech) was possibly the most instrumental tool in the process for us. The shows do a FABULOUS job of repeating language over and over again, as well as provide a physical action to go with the word (super helpful to a child like Emma whose motor skills were much more developed than her communication skills). And we absolutely found that the speech developed right along with the signs. Having the signs in addition to the words simply gave her an added confidence that we would understand what she was trying to tell us and in no way stunted her speech development.

If I could only make one suggestion to parents who are trying to help their child with a speech delay, it would absolutely be recommending the Signing Time videos. We'll be starting our next child on Signing Time first thing!

 Once we had the foundation of sign and about 50-80 solid words, we were able to start up with speech therapy again, and we alternated speech therapy with communication therapy weekly for the rest of our time with RAISE.

Some of the things we've found productive in working with Emma have been:
  • Commanding eye contact. She's in a constant state of distraction, so we try to always kneel down to her level and make sure we make eye contact. Sometimes I would put both of her hands on my face. It was a way to physically command her attention, and it worked well for along time. Nowadays, I have to put my hands on her face and turn it towards me if she won't look at me.
  • Making sure there was a "reward" for correctly giving or asking for attention. We do a lot of tickles, high fives, and big hugs. Sometimes we call for her attention and then just give her tickles and hugs. It's supposed to demonstrate that I'm not always putting a demand on her when I say her name-- which is supposed to help her respond to me when I do put a demand on her.
  • Working with her on her terms... but still slipping in what we needed her to learn. For example, Emma L-O-V-E-S colors. For many, many months, the primary topic of all therapy sessions was the color of things. And we would slowly incorporate other words and concepts. Like... opposites. We would say "Oh, this BLUE dot is up high. And this BLUE dot is down low." Or when she was really into animals, we learned "big" and "little" by calling everything "mama" or "baby," because that's how she identified animals. One time, I just tried teaching her "big" and "little" without any disguise, and she actually said "no opposites, Mom." That's when I knew... she's smart-- and she's super stubborn.
  • Repeating everything she says... but correctly. Even if I'm just guessing at what she's saying, and even if I'm not even right. The therapists both said it was beneficial to repeat anything she said correctly and emphatically. This way, she either heard the correct way to say what she was trying to say, or she could have the opportunity to disagree with me (verbally hopefully) if I was incorrect in guessing what she said.
  • Role playing. We do a TON of role playing. If we think she's trying to express something, or if we want her to express something, Chris and I will act it out. We used to do it with basic things like, "can I have a cracker? -- Yes, Dad, you can have a cracker." or "I want that toy. -- Okay, Dad, here's the toy." But now we even do it to show her manners or how to control her emotions by expressing with words. If she's upset that I'm not giving her a cookie (for no other reason than I don't want her to eat a cookie), we try to turn it into a speech lesson to end the tantrum (it's a way for us to give in but without her knowing we're giving in-- it just looks like we were trying to teach her a lesson from the start). So Chris will say, "Mom, can I have a cookie please?" And Emma thinks we're just trying to teach her to say "please," so she mimics him and I give her a cookie. Double whammy: she learns some speech and manners, and it doesn't look like we're rewarding the tantrum. It looks like we're rewarding speech and emotion control. 

As we've done all these things (and instructed EVERYONE she interacts with to do the same), we've seen a TON of progress.

She still needs a lot of speech therapy, but at this point it's mostly to just to work on HOW she says the words. But to anyone who can understand her language, she's speaking in full sentences, and even using some pretty big words. She's learned most of the alphabet, and most of the numbers 1-10 (anyone with a speech/communication delayed kid will understand what a feat that is).

Some of our favorite recent sentences have been,

"Dad, this is the best movie EVER!"

"MMMM-mmmm, this is DELICIOUS!"

"Hey look! It's a Chrysalis!" (Thanks to Dinosaur Train for that one)

"Mom, this needs more sugar."

"Oh, yeah! Oh, yeah! I love the Target store! Oh, yeah!"

"Oh, L is soooooooo beautiful."

"My haircut is so beautiful."

"I'm a pretty princess."

Of course, we're still working through some issues. She's developed certain habits and sentences as distress coping methods, and we still haven't deciphered some of them. Like...

"I heard sound!" She says this a lot when she's extremely upset. We have no idea why.

or... "my tummy hurts." We think she's just learned that this gets a fast response from us, and uses it to get attention when she doesn't know how to express what the actual problem is.

She's also started asking for a blanket when she's in distress, but I think what she really wants is some sort of pressure on her skin, because she'll accept anything that we can lay on top of her-- a pillow, a jacket, a towel... This is some sort of sensory issue, and we haven't really identified how to work through it with speech.

Anyway. That's where we are! We had to end RAISE services on her third birthday, because that's the age limit. But she'll begin Speech services through the public school system  in the next week or so.

We're very proud of the progress she's made, and we appreciate being able to communicate with her even more for going through this challenge with her. One of the great joys in our every day is getting to hear the thoughts going through her mind :)


1 comment:

Katie Clark said...

I think it's great that you were able to get her into speech and communication therapy so early on. My little brother had some severe speech delays, and he got into early intervention programs and you would never know. Forrest had a lot of speech delays as well. She sure is a beautiful little girl, though! And some of those things she says are hilarious. It sounds like you guys are doing all the right things :)