How do you know wen expressive language (speech) is too far off of a goal? I do not believe that when after a child can point, that is when they are motivated to speak. None of the young people I have worked with have ever reacted by gesturing, pointing, or signing first when at the extreme of emotions (fright frustration, happiness). It is always sound that comes out, and sometimes unexpected language.
This blog was one that was hard to know quite where to start. Kids with neurological difficulties and developmental delays so often come in anywhere on the language spectrum. Some of the children whom I had never thought would be working in this direction have shown me differently. If the children don’t give up in this area, why should we? If the child shows me any sign of sound at all, there is the possibility. The little boy I spoke of on the last blog (http://backmountainmusictherapy.com/2012/12/part-2-eliciting-speech/) who took three years to learn how to get sound out of a recorder initially demonstrated to me only a throat-clearing type of sound. I’m not even sure when I actually heard his real voice.
I have often found that children who usually appear silent can lose themselves in the music and will clearly babble, which several steps up the scale from silence towards speech. Often children are reluctant to imitate or produce what we are asking because they can’t on demand, yet. So they don’t even attempt. Sometimes the children have not yet had the opportunity to let go enough to play with sound unconditionally, like infants do. The following are some signs that I have worked with that have shown me that speech is still possible:
- any attempt at making vocal sounds
- sound that just happens vocally
- crying with sound
- crying that changes pitch
- vocal sounds that are similar to vowel sounds
- accidental sounds that occur in the same range in which the therapist is singing or playing
- pop-out words
- vocal glissando’s
- singing or attempts at singing
If a child exhibits any of these, I have found that it is possible to move beyond these steps and for the child to gain more control. All the nonverbal children with whom I have worked have gained more control of purposeful sound, but most have gained some purposeful, functional speech. We have to work with whatever a child gives us instead of switching to matching. Matching demonstrates what the child understands and that the child has enough control to carry that out. For a child to be able to have enough control to cognitively contemplate and carry through is part of the picture, but all things need to work together.
Most of my clients have gone through periods, from days to weeks to months, where their vocalizing may have disappeared. I have learned not to worry about this. We all gain control of ourselves in different ways. It is also not uncommon to see behavioral difficulties at these times due to the level of understanding being higher than what thy can control to produce. When the vocalization reappears, it has usually progressed while the silent process of organizing, understanding, and gaining control was happening. Quite often, if you watch carefully, other areas are developing during this silence.
A mother of a client once said to me that she tried it. She tried going an entire day without speech. She said it was incredibly frustrating. Every human needs to have a voice. Those who can express themselves well are usually seen as having a high degree of intelligence, and are treated as such. Those who do not express so well are seen and treated differently. Imagine having thoughts, opinions, impressions, and not being able to express anything. Imagine having a high degree of intelligence with a body that doesn’t obey and no voice. Imagine having the world treat you like you don’t understand, and not being able to let them know that you do. How incredibly frustrating this must be. Each and every one of us yearns to be connected at some level, and heard. Not everyone has the tools to do so is motivated when given the opportunity and belief that they can.
Antoinette Morrison MT-BC