What do speech therapists do?

[Malika]

I'd appreciate some input/insight about the role of speech therapists.
After many months on a waiting list, a speech therapist finally had a space free and we saw her the first time this afternoon. Rather a surreal experience. A nice, timid lady in grey who proceeded to ask J to repeat some sounds and then sentences, which he did. She then showed him some rather boring-looking cards in black and white and asked him questions about them. At which point he got bored, got up and started wandering around the room, touching this and that. We called him back but to no avail... At which point the speech therapist looked at me helplessly and said "I don't think this is going to work", saying that she thought he needed to be helped by a psychologist for his hyperactivity rather than a speech therapist... She also said she felt J didn't like her and she wasn't sure how to deal with him! I was rather taken aback by her lack of confidence and understanding that she needed to "engage" his interest and also by the fact that she was taking his moving around and not sitting talking to her personally.... I asked her if she had ever worked with hyperactive children and she said no... Anyway, after we had talked a bit and I had tried to say she might try engaging with him, she called him over in a kind voice and he accepted to come over to her and then did what she asked with her cards... (putting a story in sequence and asking questions about them). She said at the end she would give it a go for a few weeks and see whether they could work together.
It was both our medical doctor and the psychiatrist who recommended that J see a speech therapist. I am now confused as to why and how, if at all, a speech therapist can help a child with ADHD. He clearly has peculiarities in his use of language - which are a bit difficult to explain but I would say lay mainly in his lack of concrete, rational thinking (on the way to her, for example, J started shouting out of the window "Sirène! Sirène!" I asked who it was. A friend he said... A little girl? No, he said, Sirène is a crocodile who lives in the river.... his conversations are often like this...) - but is this kind of thing appropriate territory for a speech therapist. Was it just a bad fit, a lack of chemistry with this particular lady, or would I find such an approach everywhere?
All illumination gratefully received!

 

[BusynMember]

Sonic had a speech therapist, BUT he was very engaged with her. She taught him how to make different sounds and how to say various words and basically helped him learn to talk (he did not talk clearly or in sentences until age 4 1/2). My daughter Jumper also had speech to help with her Central Auditory Processing Disorder (CAPD). You do not know for a fact that J. has ADHD. It is tempting, yet best if we, the loving parents, try not to do our own diagnosing.

I think the speech therapist was less worried that J. didn't like her and more concerned with his inability to stay focused, which is why she made the suggestion. His behavior is the sort that, here in the US, they would also recommend maybe some other type of help first. If he can't sit and pay attention, there is not much he can get out of it. Does he have speech issues?

Going around and touching everything is a big symptom of sensory problems. Sonic used to do it ALL THE TIME. In fact, he still likes to tough things that he shouldn't and we still have to tell him he can't.

Good luck. I hope you find some answers. Sounds like you have an interesting yet puzzling little guy. I have a few of those

 

[InsaneCdn]

Well... to answer the later questions first... I'd say either she isn't used to working with young children, or isn't used to working with multi-diagnosis children. Not likely so much a personality mismatch, as someone "out of her territory".

I haven't seen a full job description... but I know they work with everything from deaf kids (and actually teach many of them how to speak enough that they can communicate basic needs to hearing people!) to auditory processing disorders to pronunciation difficulties (from physical issues such as cleft palate to whatever else). Its a broad enough field that no one Speech Language Pathologist (SLP) (speech-language pathologist) will cover everything...

From what you've written, I'd second the opinion that your son needs Speech Language Pathologist (SLP) - but this is probably not the right one.

 

[Malika]

Yes, Insane (not that it doesn't feel a little odd calling somone that ) - that is exactly what she said, in her words "I am out of my territory." So then are there speech therapists who work with hyperactive/ADHD (in my case° kids? I will have to do more phoning around.
I think it was perhaps a personality mismatch in that J will, as is typical, stay focused if he is INTERESTED - and her manner of speaking and presentation were not very colourful or attracting if you see what I mean... I think someone who was more of a "showman" would have caught his interest and got him to answer the questions.
As to whether it is reasonable to diagnose one's own children... well, I think it is in a way! I have lived with J day in, day out for four years. I know him better than anyone and I've also done a lot of reading and questioning... really people have been suggesting almost from day one that he may be ADHD and I've just been kind of holding out, not wanting to accept it, wanting to hope against hope that it would all "go away", he would grow out of it, etc. He checks more than enough diagnostic boxes from the DSM criteria to fulfil the diagnosis - which he certainly does not for Pervasive Developmental Disorder (PDD) or Asperger's. Je also fits almost every profile of ADHD children I've read. More than that, it's just a kind of gut instinct, a knowing... I think he also has some sensory integration problems. And possibly learning difficulties such as dyslexia but all that is to be revealed...
Really I have just been fighting the label, wanting him to be "normal", etc. I expect everyone goes through a stage of that. But now I have accepted what has really been staring me in the face for four years and actually it feels like something of a relief... now I can face facts and get appropriate help.

 

[Marguerite]

Speech therapy covers everything to do with the function of the mouth and pharynx as well as language (therefore that aspect of brain function). However, within speech therapy, they often specialise. Therefore my good friend who is also difficult child 3's speech therapist, is not sufficiently qualified, she says, to help mother in law with her swallowing problems. But she's been brilliant in working with difficult child 3's language issues as well as doing the annual assessments we need for school.

Over the years we've seen some great speech therapists and some duds. I accept you are certain your son does not have Pervasive Developmental Disorder (PDD) - that means that J is likely to be a lot easier for the therapist to work with, than difficult child 3 was at that age. Remember, difficult child 3 is Pervasive Developmental Disorder (PDD) as well as ADHD. Trying to engage difficult child 3 at age 6 was a tall order - not only was he hyperactive, he would focus only on the written word, he was all over the place fiddling with everything in the room and ignoring the people and his language delay meant that he didn't have the comprehension needed to engage with anybody. And yet - speech therapists were assessing him from age 3. So if they could do it with my son, this one you saw should have had far less trouble with J.

You say J seems to have some language issues - even if his language is within normal range, if there are oddities in any way, either to do with the mechanics of speech (such as a stammer, or other speech dysfluency) or language (either exceptionally advanced or delayed) then it needs to be carefully assessed. difficult child 1 was assessed at age 15 and the speech therapist (I know now) did not dig deep enough; she found some oddities but did not really define them. Since then I have seen what a GOOD speech therapist can do. difficult child 3's recent reports have indicated that he now scores within normal range (or exceptional) for everything. But she still dug deeper and identified gaps - speech/language splinter skills, if you will - which will always be a problem for him with word retrieval and related function.

With a good speech therapist, there is an overlap with neuropsychs in the testing methods and also in what they can find. A speech therapy assessment is important. However, for the most accurate results, the child does need to be engaged. From what you describe, I know difficult child 3's speech therapist would have no trouble with J. She often assesses challenging clients, including those with autism and ADHD. There are many tools they can use, it sounds like you struck out with this one.

When finding another, talk to the GP about the problems. We had problems (big time) when first trying to get various tests done on difficult child 3. The first main test was a hearing test which the GP tried to administer himself. Not a hope - difficult child 3 refused to have the headphones on. But when we went to a special clinic for testing young children for hearing, they were able to involve him and fully engage him, so they got really accurate results. They basically met difficult child 3 where he was, found the key to engaging him, and worked from there. A similar technique would have worked with J - asking him to engage and offering a small short-term reward. With difficult child 3, the reward was being allowed to drop a marble down a chute then watch the marble go plinky plonk all the way to the bottom through the obstacle course. Brilliant!

A kid with ADHD can also be a problem for a neuropsychologist. difficult child 1's first assessment was a dismal failure - the school tried to assess him (without my knowledge or permission, too) and he was so anxious he was unable to sit still, did not complete the testing. But they still scored it as if he had, even knowing it was inaccurate. They then tried to tell me he was "retarded" even though he was at that time working well in class, working well above the level you would expect of a child with the scores they had just found. They then tried to use that to 'prove' to me that I was a bad mother, pushing my child to achieve beyond his capability. They had an agenda (because I had been pushing them to provide for easy child with extension work) and were using difficult child 1 to beat me over the head.

difficult child 1's next assessment was private. He was much more relaxed. But he also was difficult to engage. At one point he decided he didn't want to answer. "I'm bored with this. I don't want to do this any more. Let's talk about birds instead," he told the psychologist. The psychologist had to work really hard to keep him engaged but still warned us his results were a likely under-estimate.

What I suggest you do, besides finding someone else (although you can see how therapy will go - you need a GOOD assessment, both neuropsychologist and speech) is involve J. Let him know that he is seeing these people in order to try to help him find ways to improve his experiences with school. Don't tell him it's for school performance, or to help him behave - do not let him feel that it is in any way his fault. or not. Keep it open and easy-going, but make it clear - you know he is not happy and you are trying to find ways to help him get more out of school. Never underestimate the ability of a child, even a young inattentive one, to want to engage if they feel someone is genuinely wanting to help them in an area where they are not happy. Find something that is an issue at school and let J know, "We're trying to find out what the problem might be, so we can help fix it." The problem is not him, the problem is the problem. In the same way that perhaps an ingrown toenail might be a problem when you want to wear running shoes, and treating the ingrown toenail and reducing the inflammation makes shoes comfortable again.

You need a speech therapist with some ability to engage the child and work harder to maintain his focus. Sometimes you have to give the child a little space to do his own thing, but the business with the imaginary crocodile - a good speech therapist would have got up, gone to the window and talked to the child about the crocodile. Useful information could have been gleaned from such an interaction.

Marg

 

[InsaneCdn]

Try to look for a Speech Language Pathologist (SLP) who has experience with ALL of the following:
- young children
- multiple issues
- incomplete diagnosis

While you're at it, you could ask about Central Auditory Processing Disorder (CAPD) (central auditory processing disorder) - they are able to test for or at least screen for that one, and it might be one more factor.

I agree with you - as parents, we probably have a better handle on things than the specialists do, because we're the ones that see the 24/7 picture and live with the results of various interventions - successful or not.

Hang in there. Bang on every door - its amazing which ones open!

And don't worry about calling me Insane... I used that handle partly because that's what I'm being called most days by doctors and teachers and every other professional in the book... until they actually find some test somewhere that uncovers something THEY didn't expect... and it turns out that "Insane" is actually not quite so insane after all...

 

[SRL]

A good speech therapist for children of this age will incorporate games and try to add some fun into the therapy. If you can find a therapist that will let you sit in on the sessions, it will help you considerably to learn the ropes so that you can be working on some aspects at home. The diagnosis shouldn't matter all that much--a good speech therapist will be flexible and if they don't have experience with a particular diagnosis, they'll do their homework.

Speech language pathologists may work on a very wide range of issues, depending on the needs of the child: swallowing, articulation, language processing, appropriate social speech, being able to ask and answer questions appropriately, sequencing, ironing out quirky language to be more socially appropriate, controlling volume, role playing specific situations, stuttering, auditory processing problems like having difficulty separating out oral speech from background sound, etc.

 

[TiredSoul]

I am not exactly sure what your son was referred to the speech therapist for and I have not read all of the posts yet - but I wanted to add in that my son is also 4 years old and sees a speech therapist at our neighborhood elementary school. He sees her once a week for 30 minutes. She is very good with him and completely engages him. They usually play board games. My son is seeing her for articulation and she will have him say a word before each turn in the game. They also do art type projects like gluing pictures on a paper while saying each word. They also play with toys and do puzzles involving the sounds my son needs to work on.

 

[Malika]

Thank you all for this useful help. I think the idea of explaining why we are going to see the speech therapist (in a way that doesn't blame him) is a good one - now I just have to think of something! I'm not sure if he has any difficulties HE would identify at school in terms of language. I will reflect...
It was a rather odd session, as I say, but in the little bit of "work" that we did manage to do, two things came up - does anyone know what, if anything, they might mean? The therapist asked J to repeat sentences that she said. This he did mainly without difficulty. One he just could not repeat. It was (translated from French) "The boy saw pictures in the newspaper." I am pretty certain he does not know what a newspaper is and I'm also not sure he knows the French word in this context for pictures... So presumably he could not repeat the word because he did not understand the meaning?
Secondly he had some trouble arranging the sequence of picture cards - some children building a snowman and then playing with it. He had no difficulty with the first parts of the sequence - the children waking up, seeing the snow, going out into the garden, starting the snowman, etc. However in the last three pictures, which were more similar, all with a fully built snowman, he couldn't do it... The therapist said, "No, no, that isn't logical!" I think J does have some problems with rational thought. Here is a good real-life example. Today is Wednesday, no school, I have no work so J is staying home with me. This afternoon we have gym class. Twice or three times J has asked if he can go to gym. He doesn't seem to understand, or to remember, that it is not possible to go NOW because the class is this afternoon...
I'm clutching at straws really with the bits of information that came to light in this interview. Have been waiting for it for months and turned out to be a real anti-climax! Such is life

 

[Marguerite]

Don't tell him it's about speech or language. If this is sufficiently confusing for you to need to ask us, how much less will he understand? Just keep it general. "We are doing this to try to see what we can do to help make your days at school more productive and enjoyable for you."

A lot of what she was doing was testing articulation, language and logical sequencing. These all need to be explored so she knows where best to work with him. The picture sequencing - it involves the ability to recognise and re-tell a story. Not being able to repeat a sentence when he is unfamiliar with the meaning of the words - interesting. difficult child 3 was like this. He had to learn a wood and the meaning of it, before he could say it himself. The really weird thing - he had to learn it first by reading it. Once he could read it and at the same time know its meaning, he could then use the word verbally. That is a facet of hyperlexia.

J not understanding the sequence of events - it's a maturity problem, it's also (I think) connected to theory of mind. Very young children, not just autistic children, have problems sometimes with theory of mind. It's a bit like Piaget's Conservation of Mass etc experiments. He knows it's gym day, has poor concept of sequence of time and events and is incredibly egocentric (the entire world exists only for his personal needs to be met). Again, egocentricity is normal in younger children. It persists longer in Pervasive Developmental Disorder (PDD) than for other kids, but they can eventually "get it".

Give this therapist a chance to see what she can do.

Marg

 

[Malika]

Thanks Marguerite. I will give the therapist a chance (faute de mieux, as you say in French!)
J has no trouble repeating individual words that he does not know the meaning of. With a complete sentence though... it did occur to me that we are ALL like this. If we were asked to repeat a sentence of Japanese after one hearing, for example, we would flounder (I think).

 

[Marguerite]

difficult child 3 began his journey towards language, with individual words. When he tried to say more, it sounded "blurred" and was pure mimicry, merely repetition of phonemes with no comprehension. But as he learned more words, he spoke them more clearly and with comprehension. Because of how we taught him to read, and because his thinking was very concrete, his first words were all nouns. He did NOT learn by listening, he learned by reading. So I wrote him a book about himself (something you could try - it's a fun exercise anyway and really boosts the child's self-esteem). I put in photos as well. "My name is difficult child 3. I'm a boy. [I put that in because he had trouble working out the difference]. I like to climb trees. [photo of difficult child 3 up the tree]." and so on. As we read it together, and then difficult child 3 read it on his own, he learned the whole sequence and also how to use other parts of speech (pronouns, adjectives, verbs etc). He began to use sentences well.

Your son is not in the same category, but the same technique could be worth trying, to help him become more fluent. As I said to difficult child 3 today (he wants to be a writer!) the more he reads, the more fluent he will get. And kids love to read about themselves.

Being able to repeat a sequence of nonsense words (phonemes - the individual sounds that make up speech) is something we should be able to do, for the number of phonemes we should be able to manage according to how old we are. There would be guidelines - even if you don't know the words, you should be able to repeat the word. It is how we learn a foreign language. The interesting thing for my hyperlexic kids, is they prefer to have the word written down for them first. Even now that he has a vocabulary in the superior range, difficult child 3 still prefers to watch TV or movies with subtitles on. His hearing is fine, but his comprehension is far greater when he can read it.

Does this make sense, especially with your "Japanese" analogy? I think you're on the money with that one, by the way.

Also - is J bilingual? That can seem to slow down acquisition of language, although it doesn't really.

Marg

 

[Malika]

That's interesting Marguerite. Do you have a professional background in this area or is it knowledge you have acquired along the journey, as it were? Language acquisition seems a very much more complex area than we are accustomed to thinking and personally I know little of the mechanics of it.
With your difficult child 3 (I'd like to think of him by his name but I understand why you don't put it ), is/was his preference for the written word related to autism, do you think? Where did he go to school - did you always home school him?
J hasn't started learning to read yet. They don't do this in France until the next school year and I'm very happy not to push it... all things in their time. I think they are teaching them individual letters at school, which they learn the shape of without concentrating on the name or sound at the moment. I sense that he learns best with his body - by moving and touching, for example.
It's interesting... your son was too concrete, my son is not concrete enough! You can have the most wonderful, fantastical, imaginary and rather surreal conversations with him any day of the week - but talking about what he did at school that day or anything mundane like that? Forget it. I do keep reading that ADHD kids are creative in their thinking... certainly he fits that bill.