Wednesday, July 25, 2007

Speech suggestions to live by

SPEECH CLARITY-
How to help your child be understood more.

A Guide for Apraxia, Down syndrome, and other Late talking conditions.

Dr. James D. Macdonald Communicating Partners Center
www.jamesdmacdonald.org

What is it? Children usually begin to speak in ways that
are at first understandable to no one but very familiar persons. Such
performances are not "mistakes"; they are normal steps in the
difficult process of coordinating many muscles. This process is often
very difficult for children with language delays or ones with little
practice talking. Until the child is a habitual communicator with
words, it is very important not to discourage the child from saying
words in any ways he can.
Consequently, unclear speech should not be seen as "error' but rather
as natural developmental steps that you can support by showing the
child the next step. Unclear speech is an attempt to do what the child
physically can do at the moment. Unclear speech is like a missed
attempt at a basket in basketball-and as Michael Jordan says, " I'd
never be as good as I am if I had not missed over a million baskets.
Speech clarity takes a great deal of motor practice, more for some
children than for others. It is critical to accept any attempts at
speech at first and to not discourage a child from speaking with
negative feedback or attempts to get him to do things he is not ready
to do.

Unclear speech is not a mistake: it is a development.
It is essential that you do not consider your child doing something
wrong when he speaks in unclear ways. Every skill develops in baby
steps not in ' perfect" performance. Rather than think that your
child is doing something wrong when he says "irainou ai" in stead of
"It's raining outside", tell your self he is not acting like an
adult...yet. He is doing what his biology, history and current
environment has him do. Your job is to be the kind of partner who
shows him how next to talk.

Why is it important? While it is eventually important for a child to
speak in ways that most people understand, it is equally important not
to expect or pressure the child to speak in ways he is currently not
able to do. Children develop speech in three general stages.
Three Stages of Speech Development
First, the child has "self-talk" in which he makes sounds as he
plays and practices muscle co ordinations mainly for the sensation
value. These sounds may or may not refer to real words and they may or
may not be used to communicate with others. It is important for
partners to respond to these early sounds so that the child does more
of them and so that he learns that sounds will be the most effective
way to communicate.
Second, the child has "family or idiosyncratic speech" which includes
attempts to communicate that usually only his family understands.
This speech can be considered the child's own "language" and the
family's main job are to translate the child's language into theirs.
This is done by simply giving the child a word in the mother tongue in
response to his idiosyncratic production. In this way the child hears
a new way to talk without feeling that he had done something wrong.
Third, the child then develops "conventional" speech, which are words
that most of the community can understand. For language- delayed
children, this stage may take years. The key is to realize that each
child speaks as he can at the moment, and if partners want different
speech, it is up to them to show the child what to say next and not to
respond in ways that often discourage the child from talking.

What can you do? The most important thing to help a child develop
clear speech is to respond to all of his speech attempts, however
unclear, so that he keeps talking. If we make talking hard work for
the child by asking him to repeats or by not responding, he is likely
to talk less and then get less of the practice he needs to speak more
clearly. The more your child interacts with people who act like him,
the clearer his speech will become.
Use the following approaches to build your child's speech clarity.

1. First, understand that your child's speech will come from hearing
you and others talk in daily interactions. The recommendations below
depend on this understanding. You and your family have hundreds of
times more opportunities to help your child speak and do it more
clearly than any professional can.

1. Constant social sounding: Before you worry about speech and push
for words, help your child become a constant social sounder. We
frequently find children making sounds more alone than with people.
Why? Perhaps because we do not respond to just those little sounds
that they need to practice greatly before words will emerge. Be sure
to respond, imitate and play with your child's sounds so that he has
frequent little sounding conversations with you.

2. Responding. Respond to all of your child's speech attempts, even
if it means imitating unusual productions. Many partners find it
awkward at first to imitate a child's unclear sounds, but many have
found that imitation keeps the child talking more so that he has more
practice. If a child stops talking all opportunity to improve speech
ends. The more a child speaks interactively, regardless of the
clarity, the clearer his speech will become.
3..Translating. Consider every sound or unclear word your child
makes as an important word in his unique language. Regardless of
how your child pronounces a word, it is an important accomplishment
for him and should be supported with a word that translates his
language into yours. If he says "akaba" when entering the bathtub,
simply say "bathtub " clearly. Keep reminding yourself that, if your
child's name is Amy, then she will speak "Amy" first. Your job is to
translate it into English, or whatever your language is.

4. Matching. The more you talk with your child in ways he can try to
do, the more he will talk and the more he will learn to speak as you
do. Many children face so much adult language that they do not have
the kinds of models they can learn from. Get into the habit of asking
your self: can my child talk in the way I am doing? If, not , then
reduce your speech to models he can do.

5. Being playful with sounds. Adults often take talking so seriously
with language delayed children that children do not enjoy the process.
Consequently, they stay away and talk less when it is seen as failure
and work. Many parents have found that children talk more clearly
when they treat sounds as the child's most important toy that can be
exchanges back and forth as balls are exchanged when a child wants to
play ball. The more you think of sounds and words as playthings, the
more the child will participate and practice his speech.

5. Balancing and waiting. When you make sure that you take turns
with your child and not do much more talking than he does, you will
find he will learn to speak more like you. Often children will talk
in the easiest and unclear ways, but when you wait silently you will
find that he will speak more clearly. As long as his unclear speech
gets your response, he will have no reason to say things in more
difficult but possible ways.

Measurable outcomes: ( for use at home and in intervention plans)

1. The child will make new sounds and combinations of sounds.
2. The child will direct his sounds more to people than to himself
and things.
3. The child will change his sounds to be closer to his partner's
productions.
4. The child's speech will be clearer to his family.
5. The child's speech will be clearer to strangers.
6. The child will imitate the speech of others more closely.

Conclusions:
You will understandably be frustrated and anxious when you do not
understand your child. This often results in judgments and pressures
to speak in ways his is not ready. This discourages the child from
speaking at all and results in not enough practice for speaking more
clearly.
Another problem is the belief that oral motor exercises outside of
speech acts themselves can prepare a child to have clear speech. In
over 30 years, I have not seen evidence to support this assumption.
However, it is clear that the best exercise for clearer speech is
highly frequent sounding practice in interactions where they are
hearing partners communicate with sounds and words the child is able
to do. Speech is the best practice for speech just as playing tennis
is the best practice for tennis, even though some may think muscle
training is necessary for both.
Another common problem occurs when we speak in long strings because a
child shows he understands us-if we want a child to speak more
clearly, it is necessary that he hears speech that he can do.
Regardless of whether he can understand us, he will not learn to talk
like us unless he frequently hears speech in pieces he can do.

The bottom line, folks, is that your child will learn to talk and
learn to talk more clearly when he frequently interacts with you when
you are sounding and talking in ways he can do. You are the answer.
For more information on over 30 years of clinical research with late
talking children , see our website at: www.jamesdmacdonald.org.

Dr. James MacDonald . Professor emeritus, Ohio State University
Director Communicating Partners Center, Columbus, Ohio.

Friday, July 20, 2007

Monday, July 16, 2007

Love, trust, and little brown pills

First, let me get the bragging out of the way.

SHE DID IT! Ciarra learned how to swallow a PILL!

Ok, I feel better now. But yes, my darling little girl has finally learned to swallow a PILL! Meaning the awful battle her mommy has been having with herself regarding sneaking liquid-nastiest-taste-in-the-world Ginkgo Biloba into her is OVER. That stuff is VILE! So, on to greener pastures.

Ciarra is an easy child. If I really want her to do something, and she knows that it is important to me, she will usually try her best. She and I have a trust between us that I feel very lucky to have. But it hasnt just happened, it has been cultivated and nurtured over 9 years. She is not afraid of Doctors. She loves the dentist. She says thank you when she gets her blood drawn. And she will sit and watch as I try to teach her exactly HOW to swallow a fat little brown pill and not choke to death.

Tonight, I went into her room intending to show her how it is done, because I am DETERMINED to get her back on the GB. You never would have convinced me that I would use any kind of "drug" on my child. But the science behind GB convinced me. There is something to it, and I am not easily convinced. Ciarra's reaction time, her speech, and mostly her memory, are all impacted for the better when she is on GB. Having the option of a single pill/capsule versus mixing a nasty concoction and hoping she didnt gag too much as she struggled to down it...for ME...is a relief.

I have always been honest with Ciarra. Including with the liquid. I am not one to lie to my children. I figure she is plenty smart to know if I try to trick her, and I dont want to violate the trust she has in me. So I just told her, "Hey, this stuff is brain food. It helps you learn better." And that was that. Her mommy wanted her to take it, so she fought it down, every night, for months. And I stood watching, knowing it was good for her, but aching to grab that nasty little cup away and make it better.

I argued with myself, even though she didnt fight me, it was almost her willingness to suffer through it that made me most sad to hand it to her every night before bed. Maybe I am too soft. But that is not how I envisioned our night time together. Ciarra, being Ciarra, does what her Mommy asks of her. Mom, being Mom, doesnt want to ask her to drink something that mom herself would gag on, in the interest of "brain food". DS is not that big a deal, and this, while good, needed to be easy and unassailing, in order to fit in with my wishes for total acceptance. If she had to suffer, even for a minute, in the chase for "better", then it wasnt for us. But it does stay in your mind, when you know there is something...out there...that can make their lives easier. You want it for them. But you weigh the cost versus the benefit, and that cost changes daily. For me, the cost of watching her gag and retch to please me was too high.

And so, the GB liquid hit the road about 2 months ago, and hasnt been back. Today she told me that she calls Danny Phantom "Danny Handsome" because it is easier to remember, and "I have Down syndrome, it is hard to remember." :) Funny kid. She wasnt making an excuse. She just knows the truth, DS does make it harder for her to remember things. And I have no doubt she has heard me have discussions about GB and memory. In any event, I was motivated to try again. So I mixed up a batch of the liquid GB, srrong strong grape koolaid doesnt really mask the taste. I took a sip, just to remind myself HOW awful it was, and wasn't disappointed. And then I dumped the entire concoction, and the remainder of the bottle, down the drain.

I decided to give it one more shot. Try to teach her to swallow pills, to make this easier on both of us. I want the benefit of GB for her. Heck, I want her to learn how to swallow pills in general. And so I grabbed a handful, and headed for her room. Sat down beside her bed and admired her coloring. And told her that I thought maybe she was big enough to try swallowing a pill. She tried, but despite several reminders, had to fight the urge to bite into it...not a good idea. I never want to make this a battle, or her to feel she cant do something. And so she spit out the melting capsule into my hand. And I told her nice try, and tucked her into bed. Another day, maybe...

Ten minutes later, she came trailing a Groovy Girls doll and her baby balnket (yes, she still has one) into the living room. And told me she was ready. Big smile on her face. I knew she really was ready, and so we went into the kitchen and got a glass of orange juice, 2 capsules, and headed back to her room. Sat down and watched as she practiced holding a drink in her mouth, gargling to show me she could. Then in goes one pill, 2 drinks later, down it went. And out came the BIGGEST most beautiful proud smile. "I did it!" Yes you did, baby girl. Yes you did. She wanted to try one more time, and since the pills are half the daily amount she needs, I let her. Down it went. "That was easy!" she says. She trusted me. I trusted her enough to know she would do it when she was ready. And that trust paid off. And I, the mommy, am on cloud nine.

Love, trust, and little brown pills

First, let me get the bragging out of the way.

SHE DID IT! Ciarra learned how to swallow a PILL!

Ok, I feel better now. But yes, my darling little girl has finally learned to swallow a PILL! Meaning the awful battle her mommy has been having with herself regarding sneaking liquid-nastiest-taste-in-the-world Ginkgo Biloba into her is OVER. That stuff is VILE! So, on to greener pastures.

Ciarra is an easy child. If I really want her to do something, and she knows that it is important to me, she will usually try her best. She and I have a trust between us that I feel very lucky to have. But it hasnt just happened, it has been cultivated and nurtured over 9 years. She is not afraid of Doctors. She loves the dentist. She says thank you when she gets her blood drawn. And she will sit and watch as I try to teach her exactly HOW to swallow a fat little brown pill and not choke to death.

Tonight, I went into her room intending to show her how it is done, because I am DETERMINED to get her back on the GB. You never would have convinced me that I would use any kind of "drug" on my child. But the science behind GB convinced me. There is something to it, and I am not easily convinced. Ciarra's reaction time, her speech, and mostly her memory, are all impacted for the better when she is on GB. Having the option of a single pill/capsule versus mixing a nasty concoction and hoping she didnt gag too much as she struggled to down it...for ME...is a relief.

I have always been honest with Ciarra. Including with the liquid. I am not one to lie to my children. I figure she is plenty smart to know if I try to trick her, and I dont want to violate the trust she has in me. So I just told her, "Hey, this stuff is brain food. It helps you learn better." And that was that. Her mommy wanted her to take it, so she fought it down, every night, for months. And I stood watching, knowing it was good for her, but aching to grab that nasty little cup away and make it better.

I argued with myself, even though she didnt fight me, it was almost her willingness to suffer through it that made me most sad to hand it to her every night before bed. Maybe I am too soft. But that is not how I envisioned our night time together. Ciarra, being Ciarra, does what her Mommy asks of her. Mom, being Mom, doesnt want to ask her to drink something that mom herself would gag on, in the interest of "brain food". DS is not that big a deal, and this, while good, needed to be easy and unassailing, in order to fit in with my wishes for total acceptance. If she had to suffer, even for a minute, in the chase for "better", then it wasnt for us. But it does stay in your mind, when you know there is something...out there...that can make their lives easier. You want it for them. But you weigh the cost versus the benefit, and that cost changes daily. For me, the cost of watching her gag and retch to please me was too high.

And so, the GB liquid hit the road about 2 months ago, and hasnt been back. Today she told me that she calls Danny Phantom "Danny Handsome" because it is easier to remember, and "I have Down syndrome, it is hard to remember." :) Funny kid. She wasnt making an excuse. She just knows the truth, DS does make it harder for her to remember things. And I have no doubt she has heard me have discussions about GB and memory. In any event, I was motivated to try again. So I mixed up a batch of the liquid GB, srrong strong grape koolaid doesnt really mask the taste. I took a sip, just to remind myself HOW awful it was, and wasn't disappointed. And then I dumped the entire concoction, and the remainder of the bottle, down the drain.

I decided to give it one more shot. Try to teach her to swallow pills, to make this easier on both of us. I want the benefit of GB for her. Heck, I want her to learn how to swallow pills in general. And so I grabbed a handful, and headed for her room. Sat down beside her bed and admired her coloring. And told her that I thought maybe she was big enough to try swallowing a pill. She tried, but despite several reminders, had to fight the urge to bite into it...not a good idea. I never want to make this a battle, or her to feel she cant do something. And so she spit out the melting capsule into my hand. And I told her nice try, and tucked her into bed. Another day, maybe...

Ten minutes later, she came trailing a Groovy Girls doll and her baby balnket (yes, she still has one) into the living room. And told me she was ready. Big smile on her face. I knew she really was ready, and so we went into the kitchen and got a glass of orange juice, 2 capsules, and headed back to her room. Sat down and watched as she practiced holding a drink in her mouth, gargling to show me she could. Then in goes one pill, 2 drinks later, down it went. And out came the BIGGEST most beautiful proud smile. "I did it!" Yes you did, baby girl. Yes you did. She wanted to try one more time, and since the pills are half the daily amount she needs, I let her. Down it went. "That was easy!" she says. She trusted me. I trusted her enough to know she would do it when she was ready. And that trust paid off. And I, the mommy, am on cloud nine.