Speech Therapy Works

As a Speech and Language Therapist it shouldn’t really be a revelation to me that speech and language therapy works. Obviously I have always believed in it otherwise I wouldn’t have stayed with it as a career for over 14 years. It’s just that trusting something works because you understand the theory behind it and actually experiencing something on a practical level, within your own home, with your child, is quite different.

Obviously I have experienced success in my professional life, but that has been within the confines of a large caseload and various time and resource pressures. In the latter part of my NHS career, as a more senior clinician, my main role was assessment and report-writing. I rarely did any therapy as we had a structure where skilled assistants carried out care plans under our supervision. It meant I didn’t get to know children as well as I’d have liked and I didn’t get to share in their small steps of progress week by week. I re-assessed and reviewed progress, seeing improved assessment scores but that isn’t the same as cultivating progression yourself.

Now that I’m an independent therapist I’m really enjoying being able to properly get to know the children I work with. I’m completely invested in their therapy and am just as pleased when they move forwards or overcome something as I am when Little Bear does. I do see (and feel) therapy working now.

However, what we have experienced at home has taken my belief in speech and language therapy to a whole other level.

I was recently running a communication workshop (for adopters, prospective adopters & professionals) when somebody asked me a question that made me realise the examples I talk about in it, from Little Bear’s communication profile, paint a bleak picture. The picture is totally accurate and reflective of his communication skills when we first met him, aged 3 and a half. The picture, detailing significant difficulties with attention and listening, comprehension, expressive language and speech sound disorder was bleak. At the time I was fairly overwhelmed by his level of need and the magnitude of the task ahead of us.

Here is a very brief summary of Little Bear’s presentation then:

Little Bear was not tuned into language at all and did not respond to verbal instruction, including his own name. His comprehension was better than it appeared but significantly delayed for his age. Little Bear had a very small vocabulary that didn’t meet his needs. He did not have words for common, everyday objects such as cow, train, television, food items etc. Little Bear couldn’t answer ‘what’s your name’, his only size word was ‘big’, he couldn’t name colours or count and he couldn’t put more than about 3 or 4 words together. The words that Little Bear did have were unintelligible. Little Bear was extremely frustrated and he was often left with no other option but to express himself with his behaviour.

I quickly realised this wasn’t a straightforward language delay and that Little Bear’s needs met the criteria for Developmental Language Disorder

At the time I had no idea what the prognosis would be but I suspected it wasn’t rosy and that speech and language therapy would be a big part of our lives for years to come. It was hard to know where to start and easy to become overwhelmed by priorities. There were times I really questioned my faith in what I was doing and wondered if we’d ever get to where we were hoping to go.

I did not expect, in my wildest dreams, that 2 and a half years later a speech and language therapist would observe Little Bear in his mainstream classroom and say there was no discernible difference in language skills between himself and his peers and deem him ready for discharge. Yes, his attention and listening skills still mark him out and there are some minor speech errors but his comprehension and expressive language skills are now within the expected range for his age.

This near miraculous improvement is due wholly to one thing: speech and language therapy.

Admittedly our circumstances are unusual: most children with DLD do not have a parent who is a speech and language therapist and able to provide targeted intervention on tap 24/7. Little Bear has essentially undergone an intensive 2 and a half year block of therapy. Strategies have been used by the whole family and are an automatic part of the way we talk with Little Bear, not something we use for just a couple of minutes each day. The key strategies have included: using environmental sounds to capture Little Bear’s interest as a way in to listening to language; reducing our language; modelling of vocabulary, sentence structures and sound patterns; repetition; showing, explaining & checking understanding of complex concepts or new words as well as seizing every possible communication opportunity. We have done some direct work on auditory memory, phonological awareness (initial sounds, syllables, rhyme, blending sounds together) and speech sounds.

I suppose at any one time I have always had a current communication aim in mind, whether it has been a specific language concept or speech sound and I have found ways to weave this into play or our usual day to day lives. I have very rarely, if at all, asked Little Bear to sit at a table and ‘do speech therapy’, it has been a much more holistic and inbuilt approach than that.

Little Bear has also been seen by an NHS speech and language therapist throughout the past 10 months or so. She has taken the lead on sorting out Little Bear’s disordered vowels which have been complex to assess and set goals for. Generally she has started us off with a sound or activity and we have carried it on between sessions.

The NHS therapist has also set language goals for school and has provided them with programmes to carry out, which they have done.

All of these strategies, techniques and approaches have worked. Their effectiveness is inarguable. Yes, the sum total of the input Little Bear has had is massive and yes, me being a speech and language therapist does make things different. However, I truly believe that a similar impact could be gained by providing parents with good quality, strategy based communication training alongside regular sessions with a speech and language therapist, who could do the assessing and target setting bits, as well as providing resources and guidance. Similarly, if speech and language techniques can be embedded into teaching and used holistically as part of the curriculum (not here and there for 10 minutes) that too can be highly effective and impactful.

Little Bear is living and breathing proof of the efficacy of speech and language intervention. Prior to treatment when I’m almost certain that no strategies were in place, he made negligible progress. In fact, on entering pre-school shortly after coming home, Little Bear was assessed as having a delay of more than 2 years in all areas of his development, with speech and language and numeracy being the most delayed areas. Within 2.5 years of therapy, that gap has closed (meaning that Little Bear has essentially made 4.5 years’ worth of progress) and his comprehension and expression now measure within age expectations on standardised assessment.

Speech and Language Therapy works.

Whilst his progress has been phenomenal, I should point out that speech therapy is not a panacea. Little Bear still has DLD and I suspect it will impact him to a greater or lesser degree into adulthood but what therapy has done for him is allowed him to reach his communication potential, despite having DLD. Little Bear still finds it difficult to learn new vocabulary and to figure out the sound patterns in new words but we know what to do and the strategies work. The approaches that we have built into our daily lives will continue as Little Bear is still going to need them and it is imperative we continue to strive for that meeting of full potential. As the demands of the curriculum increase, we might find we need to access formal therapy again and that would be okay too.

I feel extremely proud of Little Bear’s progress and find myself constantly marvelling at the things he can say now. Last week he took part in his second school assembly. He learned more than double the words he managed last time and was able to recite them in front of the school without any prompts at all. The naughty streak in me did notice that other children in his class had to read their lines or forgot them completely (I don’t mean that badly, it’s just he has never been able to keep up with them before, let alone outshine anyone and he’s more than earned his moment of glory). Not only that but he sat really well throughout, no teacher attached to his side like previously, and he spoke loudly and clearly. Several people came to me afterwards to comment on how well he had done, the difference being so stark in comparison to previous public appearances.

I am truly grateful to speech and language therapy for not only giving me a career I love but for unlocking my son.

 

 

I think I had better make some changes to my workshop too. Although people need to see the bleak picture, they also need to see the sunshine over the rainbow picture that can be gained by using the strategies and applying them diligently. Little Bear’s prognosis appeared extremely poor so his progress really is a beacon of hope.

 

 

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Speech Therapy Works

Football: A Yardstick for Progress?

Back in the summer of ’15 (no, I am not re-inventing a song) Little Bear had just arrived. It was both a blessing and a curse that this momentous event had taken place during the summer holidays. It was great because it answered the question of how we were going to possibly manage meeting our youngest son a couple of hundred miles away whilst also managing the needs of our elder school-age child.

However, once we were back, the days stretched out interminably ahead of us. Grizzly and I were both on leave and there was no school or pre-school to give some much-needed structure to our days. There was just us and a very unruly seeming energetic mass of a child who at the very minimum needed to be kept out of immediate danger all the livelong day. With the benefit of hindsight I can say that he was traumatised and emotionally at sea. At the time I don’t think we quite knew what had hit us and I’m pretty sure we had barely a second to think about it.

We discovered, within the first hour of his arrival, that being inside the house with Little Bear was kind of difficult. He could not be contained in one room and wandered, nay prowled about, seemingly looking for the most dangerous or unwanted (by adults) tasks to engage in. He was everywhere: up shelves, in cupboards, under furniture. Little Bear was not in any way tuned into language so didn’t respond to any verbal means of trying to shape his behaviour. We spent the first weeks trailing after him, like a Police dog trailing a criminal, trying to anticipate what he might do next, trying to keep up with him, trying to offer distraction. We had to physically remove him from dangerous situations, which triggered his fight response and we were often bitten, scratched, hit or kicked.

It quickly became apparent that we might fair slightly better outside. Wide open spaces were good because there weren’t many things you couldn’t touch and Little Bear could be freer. Obviously the not responding to language thing was tricky, especially when you wanted him to come back. There was many an occasion when Grizzly had to sprint after him but notwithstanding that, things were easier.

You cannot actually live your life in a field though so we did have to try to make do with our small-ish back garden some of the time.

Left to his own devices, Little Bear would have spent the whole day watering the garden with the hose until a flood came and we would have needed Noah on speed-dial. We did of course allow Little Bear some hose time but it was essential we introduced some parameters if we were ever going to gain a modicum of order. As an aside, on one occasion of supervised hosing, Little Bear accidentally caught the sunlight at just the perfect angle to create a rainbow. It was one of the first times he responded to my communication to “look” and together we shared the same reference point and together marvelled at the amazing rainbow. I remember feeling more happy than you might think about that because I had actually reached him. After that we often tried to make a rainbow collaboratively and he began to see the point of me in an interaction. He also learned the word “rainbow” which was a big deal in his otherwise depleted vocabulary.

While the rainbow moment was a mini-turning point, I still did not want a flooded garden and knew that Little Bear needed help to engage with other outdoor activities too. Big Bear was 6 at this point and had recently got very into football. He was keen to be outdoors and was never far from a ball. Little Bear was also interested in the ball and generally ran straight though the middle of a kick-about with the sole purpose of nicking said ball. This was incredibly annoying from Big Bear’s point of view.

We tried to explain that Little Bear was little and didn’t understand games yet or that there were rules and he was really just trying to play. Big Bear could entertain this type of reasoning and would try to follow Little Bear’s lead. Little Bear would pick up the ball and run off, saying ‘catch me’ and looking for you to chase him. Big Bear or one of us would oblige. As he was shouting ‘catch me, catch me’ that’s what we tried to do. Only, when we did catch him, all hell would break loose. I guess because when the catching actually happened he decided he didn’t want it after all. I suppose being grabbed by people you aren’t sure if you trust yet is pretty frightening.

Little Bear would cry, we would be scratched. We would try some reasoning but Little Bear couldn’t process it. Five minutes later Little Bear would be running off with the ball shouting ‘catch me, catch me’ and the whole merry-go-round would begin again.

It was very difficult to manage or to see how to manage it a different way. All we knew was, it was a very inauspicious start to a footballing career and we probably had not just adopted the future David Beckham.

In the summer of 2016, things had developed a little. Big Bear was now getting good at football and wanted to practice properly. Little Bear had fallen totally in love with his brother and wanted to do whatever he was doing. If Big Bear was playing football, Little Bear was close by. Unfortunately he still had a penchant for ball-snatching and though Big Bear is extremely patient with him, it really did push his patience to breaking point. Most football games ended in one or the other or both in tears or storming off.

By this point Big Bear was pretty knowledgeable about the rules of the beautiful game and both he and Grizzly did their utmost to teach the basics to Little Bear. There were a few problems. One was that Little Bear could be (and still can be at times) rather oppositional so rules were like a red rag to a bull. If you told him he wasn’t allowed to pick up the ball, his first urge was to pick up the ball. Another problem is that Little Bear had very poor resilience then and the smallest knock or comment or his own perception that he had done something bad would be enough to cause him to purposefully kick the ball out of play or boot it at someone or call someone a name or hit them. Football continued to be a source of stress, distress and very little enjoyment for anyone involved.

Thankfully for Big Bear, he played football at an after-school club and he joined a club outside of school so he could get his fix somewhere. Interestingly, he had had a rough time because he didn’t like football when he was younger and it had really impacted on his ability to be accepted by the other boys. We had been reluctant about allowing him to join a club as it can be so competitive and the last thing we wanted was for his confidence to take a further knock, for example by being kept on the bench if he wasn’t perceived to be good enough.

Grizzly researched all the options and found a club with an inclusive ethos where all children get an equal go, irrespective of how good they are. Despite our reservations, it was a fantastic experience for Big Bear and did wonders for his confidence, both inside and outside of school. He continues to play for them now and apart from a recent appearance of nerves (a whole other tale, there is always something!) he loves it.

By the summer of 2017 a glimmer of football-related hope began to appear. Little Bear was beginning to tolerate the rules. He accepted they were there but was often in conflict with himself over sticking to them. He was still easily upset and something like the other team scoring a goal could be enough to cause a bit of a situation. However, the situation was generally less dramatic than before and mostly involved him stropping off to a corner of the garden for five minutes.

Alongside this, Little Bear’s language skills had now developed unrecognisably. We could start to talk about how he was feeling and what might be causing his behaviour. We could say things like “I think you are feeling a bit frustrated because the other team scored. That’s ok. Sit there for five minutes then join in again when you’re ready”. We generally didn’t make too much of a fuss and often if we ignored the outburst he would just join in again a few seconds later by himself. We always praised the good decision he had made to come back. We also tried some other techniques like bringing a squidgy stress toy outside with us and Little Bear would go and squeeze that if he was getting annoyed, rather than shouting at somebody or running off with the ball.

Football still had its moments but as the summer wore on I realised that the boys were starting to have a kick-about on their own after tea, while I did the washing up (handily positioned in front of the back window where I could keep a watchful eye). More often than not, the game would go without hitch and I would silently count my blessings when they came back in. They even started to set each other up for specific bits of play e.g. Little Bear would throw the ball so Big Bear could volley it in. Maybe football could be fun in the Bear household after all?

Not long after term started again, Little Bear began asking to join the after school football club that Big Bear attended. I had a lot of concerns. He is extremely tired after school, making listening harder than usual. We were having a very rough phase in the classroom and Little Bear was frequently in trouble for being disruptive. The guy who runs the football is lovely but not especially firm and I’d always rather suspected the children ran amok. Little Bear is not a child who should be allowed to run amok. It is not wise. It could be extremely detrimental.

Little Bear clearly wanted to go though and I had to listen. I decided this was a rare time that a sticker chart might work. I was clear with Little Bear that I couldn’t let him go to the club if he wasn’t going to listen to what he was told because that could be dangerous. The rules would be there to keep him and his friends safe. He gained stickers by doing what he was asked in school, at home and if he was with others like his grandparents. If he didn’t manage to do as he was asked, nothing happened. If he did manage to, a big fuss was made about his ability to make good decisions and he got a sticker.

By October half term the chart was full and I kept to my word and signed him up. I did speak with the football coach about Little Bear’s needs; that rules need to be clear and consistent for him and that he needs to know that the coach and I will talk and if things are not going well, the coach will tell me.

I knew I had to let him try but I was worried.

Last week, out of the blue, I received this message:

Just a quick one, I know you were unsure about signing Little Bear up for football but he has been amazing! I love coaching him, football or PE, just wanted to drop you a message to let you know. And then Big Bear is something else, great kid that doesn’t get the credit he deserves, he’s fantastic.

And my heart melted.

How lovely of the coach to take the time to send me that? I wonder if he really knows how much that means?

I couldn’t possibly have predicted, back in 2005, mid back garden flood, that my little dude would be able to overcome so many hurdles that he would be able to not just cope but flourish in a football club only 2 years later. He’s a phenomenon.

Maybe we did adopt the future David Beckham after all?!

 

And as for Big Bear, he is an extremely patient and lovely big brother and I hope that I at least give him the credit he deserves.

Football: A Yardstick for Progress?