Thursday, July 17, 2014

Summer of AAC or No More Speech in Speech Therapy

In early May of this year I had a realization; Elanor was not making progress in speech. At that point she had been in therapy with the county and a private therapy clinic for most of the last year, since she was about 18 months old. In that time she had made little to no progress in speech besides being able to make a few more consonants. Think "duh" and not "dog." Her vowel repertoire was sparse and her verbal word inventory was even sparser.

Although we already had the talker at that point, we weren't putting much of an emphasis on it. Instead, we were putting most of our eggs in the ASL basket. Elanor's signing ability was somewhat impressive. She could sign 2-3 word sentences and had a pretty good variety of signs. However, no one but my husband or I could ever tell what she was saying, not only because not everyone knows ASL, but also because her neurological disorder makes it hard for her to correctly plan movements. Even someone fluent in ASL would not always understand what she was saying, and she was unable to make signs for letters of the alphabet or numbers, although she was clearly interested in both. Bottom line, ASL wasn't the amazing saving grace I thought it was going to be. 

So the information I had at the time was: 

                    a. speech therapy isn't working
                    b. signing isn't good enough
                    c. we've got this communication device

So, we started putting an emphasis on the device, using some of the strategies found here to encourage her to use her talker. I also spoke to the county therapist about it. She was immediately on board and began using the talker exclusively in her sessions. As in, no eliciting speech at all. Only the talker. The idea at the time was that the county therapist would do that and they would keep using the regular approach in private so we would have all our bases covered. 

What we saw in those first two weeks was nothing short of amazing. She began to use her talker quickly and intelligently, but that wasn't all. She started talking. With her mouth. 

Here is a snippet of a post I made in the Speak for Yourself user's group at the beginning of June:                
   Her EI therapist has been solely working with her on her talker (no repeat after me or direct speech work at all) for the last 3 weeks and we have had an explosion. She makes a b sound now, but not to say "buh" but rather "ball" with the L at the end and everything. She says "all done" and "balloon" and "cat" and all kinds of crazy things.
This is a child who had never made a "b" sound before in her life. She'd gone to speech therapy twice a week where they had done nothing but tried to get her to make b and p sounds. Suddenly, with no pressure on her at all, this child was not only making "b" sounds, but whole "b" words. So I had an idea. What if there wasn't any more "repeat after me?" What if all we did was work on functional language? Maybe just for the summer? What if, for three months, all we do is AAC (alternative/augmentative communication)?

The very notion was crazy. The Childhood Apraxia of Speech group exclusively pushes two speech therapy methods: the PROMPT method, and the Kaufman method. Above all, they push repetition. Speaking the same words over and over and over again. We were completely turning away from the party line,  doing something I'd never heard of anyone doing before. Sure, the general scientific consensus was that AAC helps to increase verbal output, but no speaking in speech therapy? Unheard of.

I brought this idea to Elanor's private speech therapist. I asked if we could hold off on trying to get her to talk for awhile and just work on the talker. She seemed confused by this idea. "Well, by using the device," she said, "we are encouraging her to speak." Yeah, I know. I've won the jackpot on speech therapists here.

So the summer of AAC has been going on ever since. No speech in speech therapy. It's been a whirlwind of a summer so far. It's been 1.5 months since we stopped eliciting speech, and I have never heard her say more.

This was my non-verbal, speech-impaired child last night:

What's so amazing to me is that the things she says are the words she has on the talker. She makes the same kind of utterances out loud that she makes with her device. There is no doubt in my mind that she is speaking now as a result of our emphasis on the device. We are using AAC as our only therapy, and it is working better than anyone had hoped. 

Our summer of AAC will likely be extending into the fall (and the winter and the spring...) and I'm excited to see the changes it brings. 

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