Sound of the Week: before we begin, consideration #1
Sunday, March 1, 2015 at 11:05AM
Vlinder CT PLLC in AAC, Letter of the Week, Sound of the Week, apraxia, communication, speech

Before we dig in to the sounds of the week, there are a couple of notes I'd like to mention; items to consider before directly targeting speech sound production with children exhibiting significant speech disorders.

Consideration #1: Functional Communication

My first order of business with every child is to ensure that they have a functional means of communicating.  While speech (verbal expression) is something we all want for all kids, the ultimate goal is that they can effectively and efficiently express their wants, needs, thoughts, feelings and stories to any communication partner.  For many kids, speech will come.  For some it does not.  When appropriate, I do work on speech sound production skills - but not at the expense of a child's developing language skills and/or their ability to functionally communicate.  Before I start directly targeting speech production skills, I ensure there is a means for the child to communicate (ideally in all places, with all people).  How this looks varies from child to child based on their strengths, weaknesses, family culture, and a host of other factors.  Let me give you three case examples.

Client #1 - let's call him Jonny.  I first started seeing Jonny shortly after his 2nd birthday, ~3.5 years ago.  At that time he had no diagnosis.  He was completely unresponsive, had no interaction or play skills, no functional communication (speech or otherwise), and extreme behaviors (such as head banging and property destruction).  A few months after my initial evaluation he had been diagnosed with Autism Spectrum Disorder and Sensory Processing Disorder.  At that time he had no interest in or engagement with people.  He was not ready to work on speech production skills. 

Client #2 - let's call him Mike.  I started seeing Mike about a year ago.  He was 7.5 years old and had a diagnosis of Autism Spectrum Disorder.  Parent focus was strictly on improving speech intelligibility.  Mike was minimally verbal.  He had some learned words and scripted phrases to make requests.  And he was highly imitative, attempting to repeat any word I said.  But he was functionally non-verbal.  He rarely initiated communication and had little interest in communication partners.  Upon examination, it was clear he had a motor speech disorder.  His jaw and lips were so tightly clenched that he was unable to accurately produce any speech sounds. 

Client #3 - let's call her Susie.  I started working with Susie this past fall.  She is 3 years old with no diagnosis other than the motor speech disorder I observed at the time of her evaluation.  She came to me for poor intelligibility which turned out to be due to poor control of her jaw, facial muscles and tongue.  She has a large vocabulary, and is usually able to make her wants, needs, thoughts, and feelings known, although with some struggle for both her and her communication partner.  Once she warms up, she eagerly engages and interacts. 

As you can see from just these three case examples, the path, timing, and needs vary greatly from child to child.  Some may be ready to jump right in and start working on specific sounds or sound sequences.  Others may have different skills that need to be addressed first.  Before you can work on speech production, the child must be interactive, take turns, and exhibit imitative behaviors.  For some children that may mean that your first goals are establishing joint attention and joint interaction (like with Jonny), and developing turn taking and imitation behaviors.  Learning to speak is all about imitating what we hear others say.  And learning to communicate is all about taking turns within dialogues or communication exchanges. 

Please, please, please!  Do not sacrifice a child's language development and ability to communicate at the altar of speech production. 

 

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