In this last part of the speech series, I decided to write about using Music Therapy in word retrieval problems, something I am finding myself running across frequently lately. This is for the children who already have some controlled speech. Some of the children can speak in one to three word sentences, but not at all fluently or when upset. Because the emotion is too overwhelming, they cannot retrieve the words they already have. In these cases, the lack of fluency is serious because it takes so long and so much work to get the words they want that in an emergency, there are no words to grab quick enough. The children know the consequences and tantrum instead. In these cases, the element of rhythm comes into play in retraining the brain to run smoother.
Other cases I have found are really more of an auditory processing problem. In these cases, upon first glance, the child may appear to look autistic, using repetitive or close to no language and possibly not socializing with others. Some of these children do have sensory difficulties also, but the communication problem does not root itself in autism. It’s root is in an auditory processing difficulty. The children understand generally but not completely. Newer words often come out switched around (example – “chicken” may come out as “kitchen”). These children then, knowing it is not right, just stop attempting. Then, in efforts to be understood, only use the short phrases they do have control over repetitively. I also find these children watch my expression closely, to see if they get it right – if they have been understood. Lastly, these children tend to thrive on the repetitive do-over practice of a language skill. Once it is almost mastered, they then move on themselves. There is a constructive purpose for the repetitiveness. In these cases, visual and repetitive melody seem to be the clues the brain needs to get the motor running more smoothly.
Back to word retrieval and rhythm… Using visuals as a prompt is a given here. However, I also employ using rhythm as a key ingredient also. Many of the children with whom I work love Eric Carl’s “Brown Bear” series. I always start with what is easy and fun. As I play and sing the repetitive phrase, I allow the child to fill in the animal, and as this gets easy, fill in the color. (We always begin with Brown Bear, then usually by the child’s request go on to others; Polar Bear, Panda Bear and Baby Bear). This is not a new technique. However, in the process of the repetition, I go from giving the child the time he needs from the initial word retrieval to picking up the tempo slowly. This seems to help with the fluency tremendously. When I think of retraining the brain, I imagine it being like a casino wheel. Instead of starting and stopping, it picks up a slow continuous tempo, giving the wheel (brain) the momentum to continue. Then the child is ready to move on to two-word phrases in the same manner. In fact, if I am just singing and not playing an instrument, I will use my arm in a circular motion and point to the child when it is his or her turn, not stopping the motion. This gives the child a visual rhythm also.
In children with auditory processing issues, I tend to rely on melody as my aid. Melody seems to be even a quicker cue to the brain to help retrieve a word. I basically use the same processes as above, but when the child gets stuck, there are sounds and visuals (pictures) that help (the motion or sound of my lips with the beginning of the word), but I get the most immediate response when I simply play the note on which the song is sung to “unstick” the word. This melodic note seems to give the quickest response consistently from child to child with this difficulty. Also, singing tends to be a more age appropriate form of “mother-ease” (The pitched elongated talk that mothers use with their infants). Giving the word a pitch and a rhythm not only gives the brain a little more time to accurately process the sound it is hearing, but also the differentiated pitch accompanying the sound gives the brain an extra cue which helps clarify.
These types of Music Therapy sessions are some of my favorite sessions. Children with these difficulties who enjoy working are motivated and automatically know when to move on to something else. They almost always come in knowing what they want to do – picking up from the last session without my assistance. I am truly just a facilitator here. Most of my work is done outside the session, reflecting and determining on what has happened and where things needs to go next. Even then, sometimes the child will unknowingly let me know “not that direction; this one.”