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

Jigsaws

I know this seems a slightly strange blog topic but Little Bear has taken a real interest in jigsaws recently and in doing so I have learned a lot about how he learns and how he needs to be taught.

Up until very recently Little Bear has not shown an interest in activities that require sitting still and concentrating, such as jigsaws. He has had lots of other needs in terms of developing his play skills so I haven’t been too concerned. Having a bigger brother who does sometimes (not a lot as he too doesn’t like sitting still) do these types of activity has helped Little Bear a lot though. If Big Bear is doing something, Little Bear generally wants to do it too. As I have got really strict with screen time and have been encouraging Big Bear to find other things to occupy himself one evening he did sit down and start doing a jigsaw. Of course Little Bear was in hot pursuit and got one out for himself too.

I had to intervene as I knew that the one he had chosen was too difficult. We swapped it for a very simple one with 4 large pieces. At that stage, it was too much to ask of him that he try to complete it on his own. Little Bear put the first two pieces he found together, couldn’t make them fit immediately, growled and chucked them across the room. It would have been easy to abandon ship at this point. However, I was feeling particularly resilient that day and decided to persevere. “Come on, you can do it” I cajoled, shifting the pieces about so that two that went together were close to one another. Little Bear managed to put them together with a surreptitious jiggle of the bits from me. I made a big thing of how clever he was. Could he stick another piece on I wondered aloud.

I began to get concerned because he didn’t seem at all able to see that we were making a picture and with only two pieces left there weren’t many options. He would try to put a straight edge into a hole or a corner piece into the middle. Each time he perceived himself to be failing at the task (which happened every few seconds), he would lose his temper and throw the pieces and sometimes break the ones we had already done if I wasn’t quite fast enough. Rather than losing my temper (which would be easy to do if feeling frazzled) it made me even more determined that he should feel success and complete the task. I think at one point he got up to wander off and give up. It was hard to know how far to push him but I knew that he wouldn’t think he could do jigsaws unless he actually did one so I pretty much made him come back and finish it off. I gave a lot of help and short of actually putting the pieces in place for him, heavily scaffolded the task. All the while a part of me wondered if I was placing too much pressure on him as perhaps he actually wasn’t capable of doing it?

However, jigsaw finally completed, we were able to high five, applaud and do lots of bows. Big Bear is always fabulous in these situations and spontaneously joined in with the praise. Now that the marathon of completing one 4 piece jigsaw was over I thought we could tidy up and go to bed. However, to my surprise Little Bear had other ideas. He wanted to do another jigsaw. So off we went again. It wasn’t much easier the second time and Little Bear certainly wasn’t a natural at ‘seeing’ the picture and matching bits together. I thought back to the discussions we’d had with the Educational Psychologist in which he said that Little Bear’s language scores were in advance of his visual skills, a statement that at the time I had felt must be wrong. However, was this the type of thing he meant? I had to agree that what I was seeing was concerning and that without a significant amount of adult support, Little Bear would not be able to complete even a very simple jigsaw at the age of 5.

We persevered and geed on by his previous success Little Bear was pretty determined to complete the next one. That is not to say that he didn’t lose his temper or become easily frustrated but with encouragement and a calm approach and I have to admit, an element of me refusing to allow him to fail at it, we completed another and another and about 5 more. In the end I had to call time on it and put him to bed.

I was astonished when in the morning he wanted to do more still. He got out every jigsaw we own one by one and we painstakingly completed each of them until the playroom floor was covered. I tried to teach him strategies to make it easier e.g. that one has a straight bit. It is an edge. It goes at the side. Or that was has two straight bits. It is a corner. I pointed at similarities between pieces. Look, that one has purple on it too or the cat’s tail is missing, I wonder where it is.

I repeated myself a lot. No matter how much I said it, the task didn’t seem to be getting any easier for Little Bear, not least I suspect because ‘edge’ and ‘corner’ were new words for his vocabulary. But I had to admire his persistence. I don’t think there are many children who would want to keep going and going at something they are finding so hard. I kept the praise level high and despite Little Bear repeatedly saying “I’m rubbish at jigsaws” I tried hard to re-frame that thought and help to show him otherwise. Once the floor was almost entirely covered, he began to admit that he might be The Jigsaw Master.

This was just a couple of weeks ago. Little Bear still likes to get the jigsaws out but now he can complete a 30 piece jigsaw on his own.

Nothing about this situation is as I would have predicted it and it has taught me several things:

Firstly, when Little Bear doesn’t appear to be able to do things, is it because he really can’t or because he doesn’t believe he can? I rather suspect that he often gives up at the first hint of failure as his default position is to assume that he can’t. This leads me to think that sometimes putting a bit more pressure on him to complete a task the first time he encounters it is the right thing to do to show him that he can (with a high level of support of course).

However, it is hard to know which tasks to target and whether it is realistic to expect him to achieve them. Taking a hard approach to tasks that he might not be able to complete would be really damaging.

Secondly, I do feel there was an element of Little Bear having difficulties learning the task. I don’t think he was ever going to spontaneously figure jigsaws out by himself. However, it has shown that with specific teaching he can learn and he can generalise his skills pretty quickly. He needs specific teaching of strategies e.g. he couldn’t notice the similarities between pieces so I had to verbalise things that seemed obvious. Once he has been taught these strategies and there has been a lot of repetition of them, he can apply them well. I suspect this is due to differences in his neural pathways, caused by years of neglect. However, just because he can’t learn something the usual way, doesn’t mean we can’t find a way around it and create a new neural pathway for him.

Thirdly, because of the first and second point, Little Bear can’t really be expected to try new tasks by himself. He needs a grown up by his side to keep him regulated, focused and to give him heaps of positive feedback. I really hope we get the EHCP funding we have applied for as this is the very reason why he needs it.

I have found at home that if I get the support wrong the first time we try a task that can be the end of his engagement with it forever, so good support for new tasks is essential.

I am genuinely shocked at his progress with jigsaws and at what he can do now. The fact that he was so motivated to succeed, despite all the barriers, is nothing short of inspirational. He allowed countless repetitions of the task over the course of a few days which will undoubtedly have cemented his skills much more quickly. He even sat and helped with a huge jigsaw of the world that the 4 of us were working on the other day. It was hard for grown-ups but he now believes he can do jigsaws so wasn’t unduly phased. He did brilliantly and Big Bear got bored before he did.

I am now thinking about what other tasks we could tackle in this way. We have managed it with Maxi Hama beads – we had the same “I can’t do it”, “you do it for me” situation the first time we tried those but by the end of the morning he was pushing my hand away saying “I do it myself”.

I have also noticed that once Little Bear has mastered a task his attention span suddenly increases beyond recognition. His teacher called me in the other day as she was shocked that he had sat on the rug in a corner of the classroom for a whole hour by himself doing jigsaws. They had all been muddled up and he had painstakingly sorted and completed them. She had never seen him concentrate for more than 10 minutes on anything and didn’t know that he could.

This weekend, Little Bear spent several hours making Hama bead creations until he had used every single bead and I had to make a hasty Amazon purchase.

Evidently confidence is playing a huge role in Little Bear’s ability to learn. Little Bear, you really need to believe in yourself as much as I do because what you have achieved so far is nothing short of astounding.

And thank you to the humble jigsaw, who knew I could learn so much from you?!

 

 

 

 

 

Jigsaws