Saturday, 26 April 2014

Great expectations

During a recent extended family get-together, I had many conversations with various individuals "what is it you do again?!", "how are things at work?" Etc. a few conversations went further, leading me to explain the nature of the client group I work with, and that some of the children would never be expected to develop speech.

That needed a bit of explaining! 

How does a speech therapist not work on speech?! Well, I've often wondered whether we should be called communication therapists really as my job involves looking at a child's communication, whether it is intentional or not...

Explaining non-intentional communication, and then describing how we can set targets and develop it into intentional communication can be difficult.  Even to a parent of a very special little one, who is functionning at the level expected for a child of a few days or weeks old.  

In very simple terms non-intentional communication is when a baby or child makes a sound or movement (or even goes rigid/tenses) accidentally.  As adults and carers for that child, we respond and by responding in the same way every time, and the littlie develops an understanding and expectation for the response to occur again.  This in turn develops into an intentional communication where the littlie makes the sound or movement on purpose to get a reaction!  How many have experienced a 7ish month old who throws their cup from their chair again and again, thinking its a fun game?! How many have found themselves wondering why they are babbling back to babies of a few weeks old in a high pitched coo that they had never before uttered?! 

These activities are great when doing them with tiny babies who do not have additional needs.  But, how about when a child cannot hear? Or see? Or both? What then? How do we make them understand firstly that there is a world around them, and secondly how they can have an impact on that world?

Initially I would speak to the OTs or the specialist advisory teachers for advice!!!

Actually, I'm only partly joking!  I know that joint working is crucial for these children for their best possible outcomes and I'm very fortunate to be based in a child development centre where other health professionals are just along the corridor. 

Perhaps the starting point for these very special littlies should be to have great expectations.  I once had a conversation with a parent of a 14-month old child [with epilepsy, visual impairment, feeding difficulties and low muscle tone] who had not yet considered future education for her.  I was able to describe a sensory curriculum in a special education school, where the child could learn about her own preferences and this could help her become as independent as possible in making her own choices for certain things or activities.  The family have since referred to that conversation, saying that it helped them think about her world in a different way, and to realise that she would learn and respond in a different way.  Now, they recognise her every move as an interaction and can therefore respond to her.  

Often, parents need time and encouragement to acknowledge the developmental level their child is at.  When working with a very special 2 or 3 year old with very complex needs, it can be helpful to think, for example - his social awareness is at the same level as a 6 week old baby. Let's target this and get him to respond to mum, dad, familiar adult consistently and achieve his equivalent of a social smile. These tiny targets and achievements may be hugely significant for that child's family who may have thought he would never respond to them.  

All children respond to the world around them, and have likes and dislikes that they can communicate.  Some children I know go rigid when they hear something they don't like, whereas other go rigid in anticipation for something they do like.  An observant parent will usually be able to interpret these tiny movements and responses and together we can start to generalise that vocalisation; that reach; that stiffness to be a consistent response to a range of activities. 

All children respond to high expectations, just some have a response which is not what we expect, but that in itself, can make it more of an achievement!

Have you had any experiences of a 'breakthrough' moment with your child that you weren't expecting?  Or have you found that your therapy brought results you didn't expect, after lowering the targets to the appropriate level?  Leave a comment and let me know below!