Tuesday, May 31, 2011

Communication Update

I think if Alanna had the "talk" picture in her communication book she would probably give me these two pictures on a sentence strip.

Alanna has made some good progress these last few months.  She is in regular speech therapy with a talented speech-language pathologist (SLP) and she works directly with Alanna's IBI team to ensure the therapists are incorporating her techniques.  This seems to confirm our previous suspicion of a motor planning disorder (speech apraxia).  She can say roughly ten words, mostly prompted, but sometimes spontaneously.  This in itself is a miracle, since we were at zero words before, and any words is a step in the right direction!  The SLP has said that once she can say 50 words, her learning may accelerate because in typical development this is when children get the base to practice enough sounds to learn new words more easily.

Interestingly, although ABA has proven very effective to teach Alanna most things, it was less effective for vocal imitation.  Many early vocal programs encourage children to echo sounds, and then these sounds are built up to form words.  This has never really worked with Alanna because the sounds (phonemes) were meaningless.  Once she attached the words to meaning, she was much more successful.  However, now that she has words, we can use ABA principles to get her to use them appropriately.  And her PECS language has been taught successfully using ABA principles.

While we're on the subject of PECS, we are starting to see a spike in some behaviours.  I suspect this is because as she is getting older (she is 3 1/2 now, where does the time go?) she is realizing that not everything she wants to say is in her communication book.  She has, several times, gone to her book and looked at the pictures and then became very frustrated because she could not express want she wanted to say.  Once she started a sentence with "Alanna..." and then couldn't find the words to finish.  We are bringing in more complex requesting programs to try to reduce frustration, but I really think her cognitive ability has exceeded her expressive language so much that this will continue to be a huge issue for her.  Thankfully she has started using the sentence "I want outside" to mean either (1) I want to go outside and play, or (2) I want to leave now.  I am really trying to understand the root of her communication because I think half the time what we think is a "simple" request is simply the best she can do.  For example, "I want blanket" (her comfort object) might be, "I am afraid", but she has no pictures to say that yet.  She feels it, perhaps she can label it given the pictures but you can only teach so much at once!

I believe she is very much aware of her inability to speak and she is very frustrated by this fact.  She tries very, very hard in speech sessions to make words, and even tries to prompt her own mouth to make sounds.  On the one hand, it's a good sign that cognitively she is understanding more of her world.  On the other hand, she is also lacking the ability to express herself, and that is incredibly difficult for her to deal with.

I expect more behaviours as she tries to communicate.  But I don't believe this is "bad" - I think it's evidence of something good.  We just have to try to find ways to help her tell us what she is thinking and feeling.


  1. "but I really think her cognitive ability has exceeded her expressive language so much that this will continue to be a huge issue for her"

    This my friend, is the story of our lives. And what a painful story it is seriously. Even though Khaled is now quite verbal, putting together his own sentences and script-derived language, he is no where near his cognitive abilities and I am now watching this boy become depressed, and give up on so many things (in social situations). Its very hard.

  2. Your comments about "I want blanket" were (and sometimes now) the same experience our son had at the same age as your daughter, our son is now seven. We see the frustration in our son when he cannot express what he intends. While he is significantly more verbal now (but not yet conversational) he still has issues with verbal "expression". We keep data and it is clear behaviour occurs due to inability to communicate. We also found this development stage not to be bad as you say but very challenging to make positive so as not to demotivate attempts to communicate. The hard part for us is that our son is very social/affectionate but has significant challenges engaging peers. He wants to join in but does not know how. We have specific programs in place and these have helped but as social reality is not all interaction can be "staged".