BY MARGE BLANC, M.A., CCC-SLP THE STORY THAT FOLLOWS HAPPENED EXACTLY THIS WAY... IT'S ALL TRUE, EXCEPT FOR THE NAMES. I walked through Eddie's backyard, where I had gone for a first home visit. I had just met Eddie and his sister, his mom and his dad. Eddie imitated my name quietly, almost in a whisper, saying "Mah" as we ran along. Without any signs of obvious enthusiasm, he went over to his swing set, whispering a short syllable. It was such a quiet voice that I almost missed it. But his quiet "sih" (for "swing") was unmistakable to ears that have become acutely tuned to such fleeting, subtle pronouncements. "I hope you can teach Eddie to talk," said Eddie's mother; and his father echoed an equally fervent plea. How was I going to tell them that Eddie already did talk? I had been in this situation many times before, and knew that an instant retort would be ill-timed, and seem lacking in credibility. I knew I'd have to wait until I knew Eddie, and his parents, better. Parents are clearly not to blame for not "hearing" Eddie and others like him. In fact, we are all "programmed" to think that talking comes in a certain form, with a certain loudness, with a certain rapidity, and, of course, with accompanying eye contact and referencing (pointing, gesturing, etc.). We think this is always true because it almost always is! Our phone systems expect that we will pause no longer than two seconds. If we do, they cut us off. Our voice mail systems expect us to never talk at a high frequency, or too loudly, or too softly. If we do, they cut us off. It is just "not done." And, we are programmed as parents and teachers to expect that kids will make eye contact and gesture long before they begin talking...a handy order-of-events for us, so we'll know that they are talking, that they're talking to us, what they're talking about, and that they want us to listen and to respond. But, those of us who know and love at least one child on the spectrum know we don't have the benefit of this "expected" order of events. Rather, out-of-the-blue one day, we may hear a sound, a word, even a phrase or sound contour...and never again. We think our ears have deceived us...and we are sure that we should not take it seriously. We think we can't afford to delude ourselves into thinking our child actually talked, or has the ability to use the language it would have required. We are, somehow, "bound" by our child's diagnosis to think that our child's language must be "disordered," and that since his speech doesn't sound like real words to us, that it is "babbling". Back to Eddie... Unlike his parents, I didn't have to worry about being deluded. I had heard dozens of children like Eddie say things that were later validated by repeated, clear productions, and/or other signs of communicative intent, like independent typing. Waiting for that next time a child said a particular word or phrase, though, sometimes seemed to take forever. Usually it did not, however. I learned that if the people surrounding a child believed his words to be real, they would reappear sooner. That was the key! What if Eddie really didn't say my name, though...or didn't tell me what he wanted to do? Would it do him any harm if I thought he had and responded accordingly? Does it do infants any harm when moms hear "mamamama,"and presume [read: "hope"] it means, "Mama?" No, of course not. It is this delighted parental reaction to sound that teaches kids that speech has meaning. It is how children learn to talk! Shouldn't our "non-verbal" ASD kids have the same opportunity? Of course they should! And it should be delivered with even greater regularity and "benefit of the doubt." I've witnessed, first hand, the positive results that can be achieved with our kids when we presume their communicative intent and respond accordingly. (Blanc, 2004.) We have all read that, historically, nearly half the individuals with Autism Spectrum diagnoses have failed to develop useful oral language. They have been known as "non-verbal." And we have all known that motor coordination problems are prevalent across the spectrum, with Occupational Therapy leading the way towards understanding the complexity of "praxis" or motor planning. But it was not until 1997 that Speech-Language Pathologist Gail Richard reported in her book, The Source for Autism, that the 40% or so on the spectrum who are significantly challenged with Apraxia of Speech (Verbal Dyspraxia) are the same 40% who have not developed useful speech. Looking at Eddie, one can understand why. Eddie's voice was extremely quiet...not just because his confidence in being understood was so limited. His muscle tone was low, making all his movements slower and weaker, and the timing of his verbalizations seemed "random," so no one knew when to listen. Essentially, no one could hear him. Without some encouragement and feedback, Eddie was not going to become a competentspeaker on his own. But kids like Eddie are not alone any more. Our kids with apraxia now stand an excellent chance of defying the odds of the past and becoming verbal! How? The rest of this article will address that. First of all, know that there are now excellent resources and many trained SLP's, OT's, and PT's to help. If your child's therapist is trained in Sensory Integration, your child will have a good start. Why? Because we now know that the sensory/motor "pieces" that challenge your child in his overall sensory and motor learning affect "praxis" as well. And what is praxis, you ask, and how does this translate into speech? Praxis, as defined by OT's (after the pioneering work of Jean Ayres), and now used by the rest of us, refers to motor plans...that is, formulating an idea, or an "intention" to do something unique with one's body, initiating
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