Speech Series, Part 2; Where to Start: Control of Oral Movements

How does one go about exercising getting a child to exercise those oral muscles? Like everything else, start where the child is. The first response one may say is,”Where he is? He doesn’t do anything. He doesn’t even look at me.” As mentioned in the last blog https://backmountainmusictherapy.com/2012/11/5-part-series-music-and-speech/), precursors to speech are attentiveness, eye contact, and joint tension. Reflect back to the client whatever he or she gives. I do this musically. For example, if he rocks (with no eye contact), I would play two back-and-forth notes repeatedly (ostinato). As a parent, possibly with little musical ability, sing two tones back and forth, or rhythmically (to his or her rocking) name his action (ex: rock-ing, rock-ing). If the child makes a sound, terrific. He has given you specific tones with which you can sing and work. What is needed next is patience and a willingness to let a child move at his own pace. After all, you may not be aware of how many other areas the simplistic structure may be helping to organize. When you sing the two tones repeatedly, taking a breath with approximately the same distance, you set an predictably achievable structure to join and understand. The therapist or parent must carefully watch what the child gives back. Slightly altering movement and change in posture, expression, or breathing may be a sign. Notate any small change, then remember: this is the material the child gives you with which to work: this is response and success! Sometimes it is not the child who is inattentive or not alert, but may be our own set of expectations that blinds us to the attempts of the child (conscious or not) to join in activity with another. When we support what a child already has, no matter how minute, we also help to inspire confidence, trust, and success.  Support any change. Confidence and trust can be more powerful than we realize. I am even humbled to see verbal children, who initially give an appearance of low-cognitive function, blossom and respond instantly, creatively, and intelligently once they have gained some trust and confidence. Before thinking about what developmental steps should be gaining, watch the child. This should also help you to understand what primarily is blocking speech. The child will show you. One example is a little boy who began to mouth things in Music Therapy. As he did this, instead of removing or derailing the self-stim, I chose to work with it in a more appropriate manner. Every time he mouthed something inappropriate, I exchanged in with a recorder (if mouthing is harsh, like biting, I use a harmonica for safety reasons). He demonstrated an inability to blow air into a recorder, suggesting apraxia. I also paired this with “my turn”, demonstrating blowing into the recorder first, and then following with “your turn.” If the boy produced sound, it was accidental, usually from pulling in air. However, repeated accidental success is practice for success. Although it took three years to purposely blow air into a recorder and produce sound, it was reported by his parents that Music Therapy was the only therapy that could get this little boy to work on control of his oral muscles. In the meantime, turn-taking had been established, as had certainty of whom “me” and “you” were. As he quickly began to transfer this skill to a harmonica, he also gained the confidence and enjoyment to try to vocalize and babble purposefully. He enjoyed using his harmonica at home to initiate babble. The repeated musical pattern of “me” and “you”, paired with learning to control those oral muscles, was also part of the process that led to his first controlled words and sounds. Eventually, “oo” and “ee” became “you” and “me.”

I would love to give a formula on how to elicit and control speech; however, each child is different, and each disability or neurological difficulty behaves differently. Always follow the child, and attend to the most minute of change.

Antoinette Morrison MT-BC