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The lowdown on Speech Therapy

I think Speech Therapists (also known as SLPs) are basically just a gift from heaven. OK, so maybe not everyone is going to agree with that statement and certainly, not all SLPs are created equally and some are better than others. Speech therapists when they are on their game; are inventive, exciting for kids to play with, and can teach you a ton of information. The trick is to find one that ‘fits’ your child’s style. This is the case for any kind of therapist. Finding one that clicks with your child is the goal. This can take some trial and error. Unfortunately though, some rural areas in this country are overrun with children needing therapy and not enough therapists to go around. In this case you may be stuck with what’s available but that still doesn’t mean all is lost. Speech therapy is usually only for a matter of hours in a given week or month, the everyday work has to be done with parents and grandparent and caregivers. This means that you have to be involved in the whole therapeutic process. Knowing what your therapist and child are working on is VITAL. Watching your child’s sessions and integrating the goals your child’s therapist is working on into everyday life is where progress can be made. Speech therapy, or any therapy for that matter, doesn’t end the minute your walk out the clinic door—it begins the minute you walk in and it doesn’t end. 
 
So how do you know your child needs speech therapy? 
 
First of all, there are developmental guidelines that can tell you when your child should be reaching certain milestones. Your pediatrician and Early Intervention services can provide you with accurate descriptions of what children should be doing at what age. Please, please don’t let your Aunt Mildred tell you that everyone in your family didn’t speak until they were six and they all turned out fine. Late speaking children with NO other issues often do turn out OK but that’s NOT always the case and it’s better to be safe (and start early) than the alternative. It doesn’t hurt anything or anyone to just have an evaluation. Speech therapy is FUN and most young kids enjoy going because they get to play without knowing they are really working and doing therapy. Parents and caregivers can also learn a thing or two. 
 
Secondly, some children have particular speech issues starting with no speech at all. If your child is not developing any speech or very few words—now is the time to get help. If your infant is not babbling, cooing, and experimenting with sounds now is the time to talk to your pediatrician or to have an evaluation through early intervention. If your toddler is not saying mama, dada, pointing to objects of interest, or not understanding what you are saying to him, now is the time to call for help. If your child has reached speech milestones and then lost speech (regressed) now is the time to call for an evaluation. 
 
There are other ‘clues’ to abnormal speech development such as echolalia and difficulty with prosody. These are two unusual terms here that most people are not generally familiar with. First of all, echolalia is a natural part of speech development. So if this is the ONLY thing your young toddler is doing and is labeling and interacting than it’s probably OK. Echolalia is just when your child repeats what you said back to you. It’s a little like that game you used to play as a kid—where you just repeat everything your brother said just to annoy the crap out of him. So if you ask your child, ‘Do you want some milk?’ and your child responds back, ‘Do you want some milk’ and seems to approach language from this perspective it’s time to seek professional help. 
As annoying as echolalia can be, it turns out that it sometimes serves a purpose for the child on the Autism spectrum. Echolalia can be a way for your child to understand and process what you and others are saying to him or her. Sometimes though, echolalia is not functional and is really more of a way for the child to ‘self-stim’. Echolalia can occur immediately as in the milk example but it can also occur long after your child has heard something. Your child may have heard some dialogue from a movie or a commercial and recalls that information and repeats it over and over several days to weeks after first hearing it. These types of echolalia are termed either immediate echolalia or delayed echolalia. My son had and still has on occasion both types of echolalia. He now does it in situations that are new and maybe even a little stressful or hard for him to read. I look at it from the perspective that he is trying to process what everyone is saying and when he is able to answer he will, but his answers may lag behind the conversation.
 
The hard part though is getting your child to say ‘I want some milk’. Because you are going to say, ‘Do you want some milk’ and you hear back, ‘Do you want some milk’ and then you are going to say ‘No, no, say I want some milk’ and then your child says, ‘No, no say I want some milk’ and…well you get the point. Basically after a few rounds of that, it’s time for a giant Advil. There are ways to work with echolalia and to help your child turn it into something functional but it takes a lot of patience, hard work, and perseverance. Getting professional guidance on dealing with echolalia is key though, and the earlier the better. 
 
Prosody is another topic that often comes up with children on the Autism Spectrum. Prosody is basically just the regular intonation that most people have in their voice. In other words, the ups and downs of the tones you use when you speak. If you have a monotone voice, there are no ups and downs, it’s just one tone all the time, excited or bored, it all sounds the same. Some children will not use prosody in their speech and will sound monotone. Other children will only respond or respond better when spoken to with an exaggerated prosody. That means that you have to alter the pitch of your voice up and down as you speak (almost a sing-song type of speech) to really get their attention. Right now, you are saying to yourself, ‘I am going to sound like an idiot if I go around talking to my child like this’. Yep, you are—I know because I’ve done it and still do it occasionally. But, what’s more important than looking goofy, is that your child may respond to this and actually get something out of it. It may be a way to engage your child, especially if you say, ‘well, my child is just not interested in anything, certainly not anything I’m doing, but when you put Laurie Berkner on, he perks right up’. The reason your child responds to the wonderfully talented Laurie and not you could have something to do with prosody and music. 
 
I found this out a little bit by accident. When Ewan was a little over two we decided to get a new speech therapist to get a little better ‘fit’. When the new therapist came, well—to be honest, she was just silly and goofy and we just weren’t sure what was going to happen. Ewan instantly took to this therapist and he started making some really good progress with her. She was able to engage him in ways other people weren’t and I started to wonder why? Then one day, and I have to be honest here, we were in the car and I was poking a bit of fun at the way this therapist talked to Ewan and played with him and I pretended to be her. Ewan immediately perked up and was interested in what I was doing and saying. That’s when it hit me like a ton a bricks; she does it because it works! 
 
I spoke to her about it at the next visit and she explained that it was a little like when she worked with adult stroke patients. Those patients responded to the singsong voice and it was just something that she picked up and used often with the young children on her caseload. From that point on, we have made it a priority to exaggerate emotions, exaggerate the way we spoke to Ewan, and played with him—always raising the ante when it came to being excited, sad, happy, mad, or surprised. This was something that Ewan could understand. He still had not mastered his own feelings at that point, but he was starting to respond with more than just the average disinterest (or fleeting interest). Of course, the drawback now is that he is excited like that all the time. Everything, and I mean everything, is exciting and interesting. So if the waiter brings a blue napkin to the table, guess what Ewan’s response is, ‘Wow, it’s a blue one mom, it’s a blue one,’ at the top of his lungs so that everyone in the restaurant knows all about it. Now we are trying to strike a balance between being too excited and loud and not being interested and engaged—it’s definitely a balancing act!
 
However, all people need a way to communicate effectively or else the behaviors can hit the roof. Behavior is the only form of communication some people have. For the family who has a child who is not developing speech at all, or it seems to be happening at an extremely slow pace, you may want to consider alternative forms of communication. Check out our AAC section to learn more about the exciting and always interesting field of Augmentative and Alternative Communication (or AAC).