and then…there were words!!
Almost 1 year ago today, I met a three year old who walked into my office with his mother. He had been receiving speech therapy since he was in early intervention. He had also been receiving private speech therapy from another office. Despite having no other co-morbid issues, he only had four words: Mama, O, Daddy, More.
This child was probably one of the best and most adept mimes I have ever met! He had a ton of nonverbal sounds, a lot of jargon, and the most complex gesture system I have ever seen. He was obviously very smart with no receptive language concerns whatsoever. I diagnosed him with Childhood Apraxia of Speech that day and we started on a new path for this special little boy.
Mom or Dad attended each session, and mom kept a target word list in her phone. Grandma, a caretaker for this boy, came to one session to also learn and observe.
Almost 7 months of intense therapy, this boy reached a point of therapy where I usually start to see carryover into spontaneous speech. I waited for a month, but he still refused to try without a model or cues from me first. He largely remained nonverbal.
I started to get worried. He has NO other problems aside from verbal apraxia. Why wasn’t he transferring what he could do?? Maybe I should refer him on. I’m not sure I’m helping him.
I waited another month. This was in December and I remember because I told mom I was sure we would start to see carryover soon, and I remember her saying it would be “the best Christmas gift ever.”
Christmas came and went. He still wouldn’t talk outside my room. My heart was sad. I wasn’t helping him.
I waited another month. He could imitate everything I said. Actually, he could independently say most of his target words. Yet he wasn’t. I was so sad I didn’t make good on her Christmas wish. Why wasn’t he doing it anywhere else?? Another month came and went.
I decided to give him some real “counseling” sessions. I was talking to a 3, almost 4 year old, and it’s hard to gauge what they understand, especially if they are nonverbal; but I decided to try.
“Alex. You have to take a risk. Do you know what that means? It means you have to try even though it’s scary. Even though you think you’re going to get it wrong, you have to try….and Alex, if you JUST try, I promise, I promise, I will be here to help you if you say it wrong. Okay buddy? Listen, I can’t be with you all day and help you talk. I can only do it here. The rest is up to you. You have to be brave. You have to go out there and try to talk and you might mess up, but that’s okay, okay? Sometimes we mess up. It’s okay to mess up, but I need you to try!”
I said something like this, or the equivalent to this for three sessions straight. It seemed to be going nowhere…..
One day…. it did!
His mom came in with new words he had said on his own that she had saved on her phone.
“He was at his brother’s soccer game and said, Go Matthew!”
I smiled so big. Oh man. In my profession, it doesn’t get ANY better than that. He FINALLY took a risk. He finally transferred all the blood, sweat, and tears he had been practicing with me.
I shook him. I praised him. I probably even danced a rain dance.
“Alex!!! You TOOK a risk!! You tried to talk without me and LOOK! You did it! I KNEW you could do it. You’re so brave. I’m so proud of you.”
The words have kept pouring in after that. Every session now is something new. New words and phrases on mom’s phone. Reports of
“He’s imitating more”
“He’s trying to say everything we say”
“He argued with his brother for the first time ever”
I live for that moment. I live for those reports. One week there were no words, and then one week, all the therapy paid off!
That doesn’t mean he’s exited from speech. He isn’t. There are more sound and sound sequences left to go, but it’s different now. He and I both know he will achieve them now, and he goes out and tries to say them all without me. He won’t earn an award for this achievement. Everyone will just see a boy who is talking. What’s the big deal?
I’m lucky because I’m also the walk coordinator and I will be able to call his name and put that medal around his neck and award him for all of his hard work. I will be able to personally tell him I SEE him, I RESPECT him, and I’m PROUD of him for doing the one thing everyone takes for granted:
Every Child Deserves a Voice