I've started doing clinical observations at a clinic in the NY metro
area, where I am observing 6 children suffering from various speech
and language disorders. I will be sharing my impressions from the sessions that marked me the most.
To preserve the anonymity of all persons
involved, I will refer to the therapist as Z, and to the children as A
through F.
E's a Superman
November 15, 2010 | by Christina A.
--A--
To start this therapy session, A is working on word retrieval in a team setting, with both Z and his special education teacher (SEIT) present. The SEIT then gives him clues to guessing that she's describing a train, but A is unable to guess. Once she drew it, he quickly realized that she was talking about a train. She used this topic to reinforce the notions of "next to", "on", "with" and "first". Her method was to describe her actions as she was playing with the train, as in: "I am putting the train ON the tracks". However, this was being done so quickly, going from one description to another, that I doubt that he had enough time to process all the information that was coming his way. Might also be the reason that he was not voicing much during this leg of his session.
During Z's leg of A's session, she talks about one specific animal and some of its characteristics, then asks a subsequent question as in "Is it a bear or a dog that make the grrr sound?". He's unfortunately not able to remember that information. Z repeats the exercise with picture cards depicting each animal. This time, when asked a question about an animal, though he cannot find the word for it, he's able to point to the correct picture to show his answer. And after pointing at picture, when asked the name of that particular animal, he is able to find it. Z uses this technique for a few examples, then gradually removes some picture cards. When asked a question about the animal corresponding to the missing card, he is able to find its name. Great job A!
This demonstrate that issues with word retrieval doesn't mean that the child does not know the answer, but that it is the task of finding the word itself that presents a challenge.
--B--
B loves to run and jump, so Z is integrating a hopskotch game to work on his /l/ and /n/ sounds. He has to find the hidden picture cards, name the object that is depicted on them- all of which start with "l" or "n"- leaps on the mat, then puts them on the other side of the makeshift river. How else would they be saved from the "thieves" who are trying to steal these objects?
Some of the words that he has the opportunity to work on are: leap, lion, lemon, leap, napkin,necklace, knitting, nose and nurse. When a word is said with poor articulation, Z repeats the word while B looks on, modeling the word for him. He is then able to say those words with better articulation.
--C--
C is the cute little diva who always knows exactly what game she wants to play and when she should move to another.
To begin her session, she has chosen the supermarket game. A 2-sided magnet board deDpicting a supermarket scene stands between C and Z. C picks articles from a box and places them on the board. These articles all contain the /s/ sound. As she does so, she has to tell Z which article she picked and where she placed them so Z can do the same on her side. As she picks those articles, Z works on her /s/ sounds, correcting her when needed with modeling (saying the word herself so C can see how Z's articulators move) and prompts.
All subsequent games have a short life span as she moves quickly from one to another.
--D--
To ease his hypersensitivity, Z is using a few techniques: First D plays with an airplane-shaped whistle, to blow balls out of a ball pit. Then a vibratin brush is placed in specific areas of his mouth to further desensitize those muscles.
Once in the swinging canoe, D takes the opportunity to work on his /ch/ sounds, as he has to ask her to "push" the canoe. This time around, more prompts and less modeling is used. To work on his /b/ sounds, Z sits on an oversized ball, bouncing around while saying "boing". D soon follows suit, grabbing his own ball and saying the words "bounce" and "boing", which Z corrects when necessary.
D was definitely the envy of the other kids at the sensory gym, who were all looking on as he and Z bounced everywhere.
--E--
E is extremely hypersensitive and is non-verbal. During this session, Z focusses on phonemes rather then words.
To practice the "mmm" sound, she places the vibrating brush on his lips, and he automatically rounds them around the brush. Following her directives, he then pushes air through his vocal folds, and since it is trapped inside his mouth from his lips being closed around the brush, he is able to make the "mmm" sound.
Then suddenly, Z takes the brush away and quickly inserts a lollipop in his mouth. Contrary to previous days, he does not fight it, what a victory! He actually sucks on the lollipop and is ok with it staying in his mouth. To our bigger astonishment, he takes the handle from Z, and continues to eat it, sometimes taking it out to observe it quizzically, then puts it back in. This continues until the lollipop is completely gone. No need to say how ecstatic Z and I are.
Z goes a massager, using it as a stimulus for the / Ʊ/ sound. And guess what, he again doesn't fight it, taking it instead from Z and holding it himself, then trying it on Z and back to himself.
When she shares this with his mom at the end of the session, she is overjoyed. Z advises her to buy him the same brand and flavor of lollipop, to make sure that his taste repertoire is permanently increased, and to introduce vibrating toys for him to play with.
Amazing work E!!! You deserve all the candy in the world!
--F--
To practice turn-taking, F and Z are making "candles" out of play dough. To take the candles out of the box, Z wants them to each take a turn at removing one candle. At first, he ignores her and continues to take candles out even though it is not his turn. Z has to completely block the box to get his full attention. She then explains the rules of the game, and from that point on he goes on his turn and says "Your turn" when it is Z's. The few times when he forgets this, Z issues a simple reminder that it is not yet his turn and he takes his hand out of the box to let Z go.
Now Z rolls the play dough and asks F to do the same. Although he does not look at her and seems to not even know she's next to him, he does as he's instructed. He continues to follow suit for the next directives.
When Z asks "What do you want to play now?" He starts running towards the tree house, but Z catches him and explains that he has to look at her when she asks a question so they can have a conversation. After a bit of struggle, he stays in place, looks at Z and says "tree house!". "That's good" she answers, "but why don't you try telling me with more words, starting with 'I want' for example?" He complies and properly asks to go to the tree house. After giving him a few of those directives, he catches on and starts asking for things "the longer way".
Nice progress F, keep it up!
To start this therapy session, A is working on word retrieval in a team setting, with both Z and his special education teacher (SEIT) present. The SEIT then gives him clues to guessing that she's describing a train, but A is unable to guess. Once she drew it, he quickly realized that she was talking about a train. She used this topic to reinforce the notions of "next to", "on", "with" and "first". Her method was to describe her actions as she was playing with the train, as in: "I am putting the train ON the tracks". However, this was being done so quickly, going from one description to another, that I doubt that he had enough time to process all the information that was coming his way. Might also be the reason that he was not voicing much during this leg of his session.
During Z's leg of A's session, she talks about one specific animal and some of its characteristics, then asks a subsequent question as in "Is it a bear or a dog that make the grrr sound?". He's unfortunately not able to remember that information. Z repeats the exercise with picture cards depicting each animal. This time, when asked a question about an animal, though he cannot find the word for it, he's able to point to the correct picture to show his answer. And after pointing at picture, when asked the name of that particular animal, he is able to find it. Z uses this technique for a few examples, then gradually removes some picture cards. When asked a question about the animal corresponding to the missing card, he is able to find its name. Great job A!
This demonstrate that issues with word retrieval doesn't mean that the child does not know the answer, but that it is the task of finding the word itself that presents a challenge.
--B--
B loves to run and jump, so Z is integrating a hopskotch game to work on his /l/ and /n/ sounds. He has to find the hidden picture cards, name the object that is depicted on them- all of which start with "l" or "n"- leaps on the mat, then puts them on the other side of the makeshift river. How else would they be saved from the "thieves" who are trying to steal these objects?
Some of the words that he has the opportunity to work on are: leap, lion, lemon, leap, napkin,necklace, knitting, nose and nurse. When a word is said with poor articulation, Z repeats the word while B looks on, modeling the word for him. He is then able to say those words with better articulation.
--C--
C is the cute little diva who always knows exactly what game she wants to play and when she should move to another.
To begin her session, she has chosen the supermarket game. A 2-sided magnet board deDpicting a supermarket scene stands between C and Z. C picks articles from a box and places them on the board. These articles all contain the /s/ sound. As she does so, she has to tell Z which article she picked and where she placed them so Z can do the same on her side. As she picks those articles, Z works on her /s/ sounds, correcting her when needed with modeling (saying the word herself so C can see how Z's articulators move) and prompts.
All subsequent games have a short life span as she moves quickly from one to another.
--D--
To ease his hypersensitivity, Z is using a few techniques: First D plays with an airplane-shaped whistle, to blow balls out of a ball pit. Then a vibratin brush is placed in specific areas of his mouth to further desensitize those muscles.
Once in the swinging canoe, D takes the opportunity to work on his /ch/ sounds, as he has to ask her to "push" the canoe. This time around, more prompts and less modeling is used. To work on his /b/ sounds, Z sits on an oversized ball, bouncing around while saying "boing". D soon follows suit, grabbing his own ball and saying the words "bounce" and "boing", which Z corrects when necessary.
D was definitely the envy of the other kids at the sensory gym, who were all looking on as he and Z bounced everywhere.
--E--
E is extremely hypersensitive and is non-verbal. During this session, Z focusses on phonemes rather then words.
To practice the "mmm" sound, she places the vibrating brush on his lips, and he automatically rounds them around the brush. Following her directives, he then pushes air through his vocal folds, and since it is trapped inside his mouth from his lips being closed around the brush, he is able to make the "mmm" sound.
Then suddenly, Z takes the brush away and quickly inserts a lollipop in his mouth. Contrary to previous days, he does not fight it, what a victory! He actually sucks on the lollipop and is ok with it staying in his mouth. To our bigger astonishment, he takes the handle from Z, and continues to eat it, sometimes taking it out to observe it quizzically, then puts it back in. This continues until the lollipop is completely gone. No need to say how ecstatic Z and I are.
Z goes a massager, using it as a stimulus for the / Ʊ/ sound. And guess what, he again doesn't fight it, taking it instead from Z and holding it himself, then trying it on Z and back to himself.
When she shares this with his mom at the end of the session, she is overjoyed. Z advises her to buy him the same brand and flavor of lollipop, to make sure that his taste repertoire is permanently increased, and to introduce vibrating toys for him to play with.
Amazing work E!!! You deserve all the candy in the world!
--F--
To practice turn-taking, F and Z are making "candles" out of play dough. To take the candles out of the box, Z wants them to each take a turn at removing one candle. At first, he ignores her and continues to take candles out even though it is not his turn. Z has to completely block the box to get his full attention. She then explains the rules of the game, and from that point on he goes on his turn and says "Your turn" when it is Z's. The few times when he forgets this, Z issues a simple reminder that it is not yet his turn and he takes his hand out of the box to let Z go.
Now Z rolls the play dough and asks F to do the same. Although he does not look at her and seems to not even know she's next to him, he does as he's instructed. He continues to follow suit for the next directives.
When Z asks "What do you want to play now?" He starts running towards the tree house, but Z catches him and explains that he has to look at her when she asks a question so they can have a conversation. After a bit of struggle, he stays in place, looks at Z and says "tree house!". "That's good" she answers, "but why don't you try telling me with more words, starting with 'I want' for example?" He complies and properly asks to go to the tree house. After giving him a few of those directives, he catches on and starts asking for things "the longer way".
Nice progress F, keep it up!
Nice to Meet You!
October 29, 2010 | by Christina A.
--A--
The day started with A, a boy suffering from Fragile X Syndrome, a genetic syndrome that results in an array of characteristic physical and intellectual limitations and emotional and behavioral traits ranging from severe to mild. With A, the therapist was working on 'WH' questions with the help of Curious George story book. After each passage, she asks him a series of 'WH' questions, while using firm tone coupled wit gentle direction.
Because of his ailment, A has a hard time focusing and staying put, two prominent symptoms of Fragile X. A basically doesn't feel good in his own skin, which causes him to move around a lot, as if he were trying to escape his own skin. To address those behaviors, the therapist uses a bear-toy filled with soft weight that she positions on his lap, while using an exaggerated intonation and facial expressions to capture his attention and keep it on the story.
Another symptom of Fragile X is memory issues, that A displays signs of. Sometimes, after reading him a simple line as in "George went for a ride in the car", followed by the question "Where did George go?", A would struggle to retrieve the information to answer the question correctly.
--B--
B is a typical developing child who is experiencing some issues with his articulation. In this session, Z is working on his 'L' sounds, with that letter positioned at various points within a word.
A play atmosphere that incorporates the use of such words is set up: Z creates a game with 3 levels where first, he'll pick the image of an animal and identify it, then jumps on a jumping mat to reach a jungle picture mat showing a whale, lion, elephant and gorilla. There, he places his image on one of those animals while describing his actions. And finally, he then goes over to a bucket filled with soapy water that he blows to create bubbles.
During this session, A has the opportunity to work on the 'L' sound in words such as leaf, roller-skate, balloon, squirel and umbrella, as well as the animal names previously mentioned. Also suffering from sensory issues at the mandible level, the bubble blowing side of the game helps in desensitization.
--C--
Spina Bifida is the condition that C suffers from. It s a developmental birth defect characterized by the incomplete closure of the embryonic neural tube, where some vertebrae overlying the spinal cord aren't fully formed and remain unfused and open. This explains C's inability to hold her head up and sit straight. For this session, she will work on her 'S' sounds.
To help her correctly articulate the sound, the therapist uses some prompts by squeezing her bottom lip into position to show her how her lips should be set to emit the sound. During the session, C worked on words such as dinosaur, horse, cell phone, sandwich and cereal by playing with those toys.
Unfortunately, her father and sister joined in the session and her focus was diverted back to them.
--D--
D also suffers from Fragile X Syndrome. He has oral motor and overall language developmental issues. He will be working on his 'SH' sound during this session. One symptom of Fragile X that he shows that wasn't present in A, is hand-flapping.
D is very sensitive on the interior area corresponding to his left cheek. To the sensitize the area, D and the therapist engage in a play session in a swinging boat. When catching him, Z suddenly holds his jaw and massages it. After a few turns, she introduces vibrating toys that in the midst of playing she'll insert in his mouth and positions them on the sensitive area for a few seconds. D is very cooperative. Besides his young age, he appears to understand that his time at the sensory gym helps him in the long run.
Turn-taking is another area that Z focuses on in her session with D. They move to a ball pit where D throws balls at Z, and has to wait for her to throw them back at him. D is making great improvements with the 'sh' sound, he's able to pronounce the sound correctly in some of the words he says, whereas they sounded like Ss when he first started seeing Z.
--E--
E suffers from Physical Developmental Delays (PDD), a spectrum of disorders that includes Autism and Rett Syndrome among others. E is non-verbal and is having issues with taste. He only eats yogurt, pizza and x, so the first part of the session will focus on the introduction of a new taste, using a lollipop.
The therapist has to hold him while sitting behind him and using the lollipop as an airplane. He fights tooth and nail to avoid it, but in two occasions, he actually opens up and allows Z to rub the lollipop on his tongue. That felt like victory to both Z and I. He's also making small progress with his language: he says 'hi' and is able to voice the first phoneme of some one syllable words. For example for the word 'stick' he voices 's' and for 'ball', he's able to say 'ba'. Z uses many prompts to facilitate sound production.
During this session, E also practices the notion of object permanence, because he forgets the existence of an object when not in his line of sight. Along with this, focusing skills are also stressed: Z tries to have him follow a finger or toys that they're playing with, but he is struggling a bit in this area.
--F--
Expressive language is the challenge for F. The goal for him is increasing his MLU and collaborative play.
Though play, he is showing great progress in his language and said the sentence : "Guess what, I'm digging with the shovel" while playing a beach game. However, collaborative play is a challenge for him, as he doesn't comprehend that Z would like to play with him. He's only able to grasp side by side play. The 'Operation' game proved to be a good tool for working on his turn taking skills. He struggled a bit, but a few times, he was able to wait Z's turn while staying focused on the game. Operation proved to be the better suited game for is level, since it is a game where one obligatorily has to wait another's turn.
I'm excited to see him make his way to less structured collaborative play like building sandcastles with Z.
The day started with A, a boy suffering from Fragile X Syndrome, a genetic syndrome that results in an array of characteristic physical and intellectual limitations and emotional and behavioral traits ranging from severe to mild. With A, the therapist was working on 'WH' questions with the help of Curious George story book. After each passage, she asks him a series of 'WH' questions, while using firm tone coupled wit gentle direction.
Because of his ailment, A has a hard time focusing and staying put, two prominent symptoms of Fragile X. A basically doesn't feel good in his own skin, which causes him to move around a lot, as if he were trying to escape his own skin. To address those behaviors, the therapist uses a bear-toy filled with soft weight that she positions on his lap, while using an exaggerated intonation and facial expressions to capture his attention and keep it on the story.
Another symptom of Fragile X is memory issues, that A displays signs of. Sometimes, after reading him a simple line as in "George went for a ride in the car", followed by the question "Where did George go?", A would struggle to retrieve the information to answer the question correctly.
--B--
B is a typical developing child who is experiencing some issues with his articulation. In this session, Z is working on his 'L' sounds, with that letter positioned at various points within a word.
A play atmosphere that incorporates the use of such words is set up: Z creates a game with 3 levels where first, he'll pick the image of an animal and identify it, then jumps on a jumping mat to reach a jungle picture mat showing a whale, lion, elephant and gorilla. There, he places his image on one of those animals while describing his actions. And finally, he then goes over to a bucket filled with soapy water that he blows to create bubbles.
During this session, A has the opportunity to work on the 'L' sound in words such as leaf, roller-skate, balloon, squirel and umbrella, as well as the animal names previously mentioned. Also suffering from sensory issues at the mandible level, the bubble blowing side of the game helps in desensitization.
--C--
Spina Bifida is the condition that C suffers from. It s a developmental birth defect characterized by the incomplete closure of the embryonic neural tube, where some vertebrae overlying the spinal cord aren't fully formed and remain unfused and open. This explains C's inability to hold her head up and sit straight. For this session, she will work on her 'S' sounds.
To help her correctly articulate the sound, the therapist uses some prompts by squeezing her bottom lip into position to show her how her lips should be set to emit the sound. During the session, C worked on words such as dinosaur, horse, cell phone, sandwich and cereal by playing with those toys.
Unfortunately, her father and sister joined in the session and her focus was diverted back to them.
--D--
D also suffers from Fragile X Syndrome. He has oral motor and overall language developmental issues. He will be working on his 'SH' sound during this session. One symptom of Fragile X that he shows that wasn't present in A, is hand-flapping.
D is very sensitive on the interior area corresponding to his left cheek. To the sensitize the area, D and the therapist engage in a play session in a swinging boat. When catching him, Z suddenly holds his jaw and massages it. After a few turns, she introduces vibrating toys that in the midst of playing she'll insert in his mouth and positions them on the sensitive area for a few seconds. D is very cooperative. Besides his young age, he appears to understand that his time at the sensory gym helps him in the long run.
Turn-taking is another area that Z focuses on in her session with D. They move to a ball pit where D throws balls at Z, and has to wait for her to throw them back at him. D is making great improvements with the 'sh' sound, he's able to pronounce the sound correctly in some of the words he says, whereas they sounded like Ss when he first started seeing Z.
--E--
E suffers from Physical Developmental Delays (PDD), a spectrum of disorders that includes Autism and Rett Syndrome among others. E is non-verbal and is having issues with taste. He only eats yogurt, pizza and x, so the first part of the session will focus on the introduction of a new taste, using a lollipop.
The therapist has to hold him while sitting behind him and using the lollipop as an airplane. He fights tooth and nail to avoid it, but in two occasions, he actually opens up and allows Z to rub the lollipop on his tongue. That felt like victory to both Z and I. He's also making small progress with his language: he says 'hi' and is able to voice the first phoneme of some one syllable words. For example for the word 'stick' he voices 's' and for 'ball', he's able to say 'ba'. Z uses many prompts to facilitate sound production.
During this session, E also practices the notion of object permanence, because he forgets the existence of an object when not in his line of sight. Along with this, focusing skills are also stressed: Z tries to have him follow a finger or toys that they're playing with, but he is struggling a bit in this area.
--F--
Expressive language is the challenge for F. The goal for him is increasing his MLU and collaborative play.
Though play, he is showing great progress in his language and said the sentence : "Guess what, I'm digging with the shovel" while playing a beach game. However, collaborative play is a challenge for him, as he doesn't comprehend that Z would like to play with him. He's only able to grasp side by side play. The 'Operation' game proved to be a good tool for working on his turn taking skills. He struggled a bit, but a few times, he was able to wait Z's turn while staying focused on the game. Operation proved to be the better suited game for is level, since it is a game where one obligatorily has to wait another's turn.
I'm excited to see him make his way to less structured collaborative play like building sandcastles with Z.
