Friday, April 29, 2011
Take a look at this paper. What kind of information does it tell you? Right off the bat you can see that this child, my son Josh, has difficulty with writing tasks. His letters stay on the lines pretty well and he is doing a good job of leaving spaces between words. Margins are still a bit challenging. He remembers to capitalize the first letter at the beginning of a sentence. His spelling needs to develop. But look how hard he is working just to get the ideas out of his head, through his hand and onto his paper. Some of the letters are darker from the force of his pencil on the paper. Others are lighter, indicating an inconsistency in his ability to grade the force of pressure he uses when putting pencil to paper. Sometimes the letters or entire words have been traced multiple times. Why would he trace some letters several times but not others? Could this be indicative of a neurological issue? Is he even aware that he is perseverating on some of the letters? If you could observe him during the process of writing you would see that he does not form the letters consistently from one word to the next. Sometimes his "i" starts at the top and is drawn in a downward motion. Other times he starts on the line and writes with an upward motion. When he is in tracing mode, he might write it both ways several times. Imagine if you were writing and had to stop and think how to form the letters because you didn't have an established pattern. Josh was dealing with multiple challenges just to get a few of his thoughts down on paper. Here's how I tried to help him. I did some of the Brain Gym activities to help information flow more easily between his right and left brain hemispheres. I had him use mechanical pencils, which kept the degree of sharpness more stable than other types of pencils. He tried different pencil grips to see if they would help his hand to relax so the writing could flow more easily. I made sure Josh had adequate arm support and was using his non-dominant hand to stabilize the paper. He tried writing with a slant board. I wondered if his letter and number tracing could be due to anxiety or OCD, but that was ruled out. Eventually, Josh was able to tell me that he was processing and trying to internally organize himself as he traced. I stopped trying so hard to get him to write in cursive, and decided to be satisfied if he was able to sign his name easily and could write in cursive if it became necessary. I also wrote him occasional notes in cursive writing to be sure he was able to read them. For the most part, though, we concentrated on printing. With all of these interventions, I did see improvement in his writing. It became more fluid and automatic, but if he concentrated too much on making his printing very neat his writing became laboriously slow. When I introduced keyboarding, he greatly preferred it to paper and pencil writing. Although I tried multiple typing programs to help Josh learn touch typing, he resisted them all and has his own method of typing. It works for him, and today as a young adult he is a prolific writer. He is planning to start a blog, and I hope to be able to share that with you soon so that you can be encouraged by the growth of this previously-struggling writer.
Saturday, April 09, 2011
When I heard the words "My ball died" coming out of the mouth of a preschool boy I was seeing for speech therapy, I tried not to show alarm. "Tommy" didn't seem to be too upset, but he was clearly trying to tell me about something that mattered to him. I had not heard of any recent loss in this boy's life, but then again I only saw him once a week for speech therapy and didn't know about every single person in his life. I wanted to be compassionate and allow him to talk about what was on his mind. Tommy already had a very hard time expressing himself due to speech articulation (pronunciation) errors. Even to those familiar with Tommy's speech patterns, his speech intelligibility was poor. When I repeated his words back to him for clarification, he responded vigorously with head shakes and repeated insistently, "No. My ball died." Some children, when hearing their incorrect speech production repeated back to them, will recognize that what they are saying does not match the message they are trying to convey. As a result, some children will alter how they are pronouncing words in order to increase their intelligibility. Tommy was not one of those children. He kept saying the same thing in exactly the same way, over and over again with no change. Tommy still did not appear distressed, but was making eye contact and eagerly awaiting my response. As a speech therapist, I have been asked how to respond when you just don't understand what a child is trying to say. I think the correct response is usually dependent on the situation. If the child is just chatting to make a connection with another person, then it may be more critical to be responsive and caring than to determine exactly what has been said. Sometimes asking the child "Can you show me?" helps them use nonverbal means to get their meaning across. This is limited to messages that can actually be pointed out or demonstrated, though, so much of the time it isn't a very effective strategy. The strategy of pretending to understand the child can backfire, because you may be consenting to something you don't intend to or the child may try to continue the conversation and sooner or later the fact that you are faking comprehension will become obvious. Could this affect your relationship with the child? Another option when a child is clearly trying to convey a message to you is to begin asking questions to see if you can narrow down the possible topics the child is talking about. Even with barely intelligible children, knowing the context of what they are talking about makes it easier to discern what they are attempting to say. In Tommy's case, I started by asking him if someone in his family had died. Tommy looked uncertain, so I started naming possibilities by using yes/no questions since Tommy was able to respond accurately to them. "Did your grandpa die?" "Did your dog die?" and so on. Tommy continued to shake his head "no". When this line of questioning lead nowhere, I tried asking about his toys. "Did you lose a ball?" "Did something happen to your ball?" Again I was met with repeated head shakes and the verbal assertion, always pronounced exactly the same way, "My ball died." Tommy wasn't giving up on me, but continued to make eye contact with a hopeful expression on his face. I was feeling more and more inadequate to help this sweet child who apparently had some kind of loss to grieve. Through the open window of the room we were using for speech therapy, we could hear the sounds of children playing. Following a particularly loud vocal outburst from one of the children outside, Tommy cocked his head, grinned, and happily pronounced, "My ball died!" He certainly didn't look upset about a death, but instead looked at me in triumph as if he had just proven a point. Given the context, the words, and Tommy's speech sound error pattern, things began to fall into place. Hesitantly, I asked another question, "Is your brother outside?" Tommy responded with enthusiastic head nods, repeating once again with a look of utter satisfaction, "My ball died." Okay. So no one died and nothing was lost or irreparably damaged. What a relief! For whatever reason, it was very important to Tommy that I acknowledged that his brother was outside. Although it had to be frustrating for him when he couldn't quickly or easily convey his message, he was eventually rewarded for his persistence and I was relieved to discover that in fact, no ball had actually died.