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                                           When It's Hard to Find Your Voice!
                                                                 Helping Your Child with
                                                                               Dyspraxia, Part 2

In the previous issue, we presented the first in a two-part series on speech development in ASD kids who have dyspraxia.  (See Finding the Words, January 2006).  Often considered “non-verbal,” this group of kids makes up the 40% of children with ASD diagnoses who we used to think could never talk.  Now we know better!  We know there is a systematic way to support our kids’ speech, and we have presented our successful hierarchy of supports in an earlier series (See When Speech Gets Stuck, Sept-Oct and Nov-Dec 2005; or visit the author’s website, www.communicationdevelopmentcenter.com , to download a copy.)

To further refresh your memory, please note some of the key points we’ve covered about dyspraxia: 

(1) Speech is movement…movement of muscles.  And, speech is more than making “speech sounds.” It is a multi-layered process, starting with deep breathing, and making that exhalation audible, like a whisper.  At higher levels, it involves “voice,” or making vocal sound. At a still-higher level, it involves coordination of breathing, producing voice, and “articulation” (finally, making speech sounds!).

(2) Dyspraxia affects new motor “plans,” not automatic muscle sequences. So, learning any new combination of muscle movements is challenging. It is easier to stick with what is well-practiced…and, conversely, harder to try out new patterns. This is part of the “stuckedness” that is dyspraxia!

(3) Using the hierarchy of supports means using the level of support below the one where the child is developing skill! So, if a child is starting to develop some intonation, for example, we want to support him at the levels of deep breathing and voice production.

(4) Supports for dyspraxia address the foundational pieces of speech…from the bottom up.  Each level of support is added only after a child is consistently-supported by the current level.

(5) The Hierarchy has been kid-tested in our clinic for ten years, and has proven to be a highly-successful approach for supporting our kids with dyspraxia. It works!


With this introduction, let’s now turn to Jake, the toddler we featured in our last column. Jake was (and is) significantly dyspraxic.  Except for crying, he was nearly silent when he was one and half years old. But over the course of a year, Jake became a true speaker…one whom everyone acknowledged was talking and communicating!  When we started working with Jake, we began at the “bottom,” giving him lots of gross motor support, to promote deep breathing, prolonged exhalation, and his voice! 

Once Jake’s voice was no longer “stuck” on silent mode, he “found” his voice more and more often, and became very vocal! Jake loved his own voice, and kept it going for as long as he could at a stretch!  He didn’t want to “lose” it, and have to start it all over again! Starting one’s voice is really a Level 4 skill, and it’s a lot easier to just keep laughing and giggling than to have to emerge from silence again and again!

We, too, wanted to avoid Jake having to start his voice “from scratch” every time, so everything we did with Jake for a year or so came in the “backdoor.” We created fun and laughter in physically-supportive ways, and tried to make it last.  We wanted Jake to log in as many hours of laughing and happy vocalizing as possible, so that some aspects of this powerful voicing would become automatic.  If Jake could spontaneously vocalize whenever something was just so funny, or just so much fun, he could take this voice with him wherever he went! 

To reiterate, we supported at Level 1 (deep breathing and exhalation) so that Jake would develop at Level 2.  When there was sufficient Level 2 success, voicing per se could become the support for Level 3 (intonation).  We could just start laughing and Jake would be supported to laugh too…which, in turn, supported Level 3. In fact, Level 3 tone changes developed nicely once Jake could “find his voice” for longer and longer periods of time, and he had something to work with!

Over time, Jake developed more and more confidence with his voice. He could stop and start his voice fairly fluently (Level 4), and he then had sound strings that sounded like sentences!  Jake was then able to demonstrate what he knew about language…and we were delighted to hear him say things that sounded almost like, “I did it!” and “I got it!” but without the individual speech sounds.

Additionally, now that Jake could maintain sound long enough, he began to develop some sound shifts, too, the result of changes in the shape of the lips and the mouth cavity as vocal sound passes through it.  These are the vowels!  Thus, Level 4 led directly to Level 5, the level of articulation of vowel sounds! This was a far as we got in Jake’s story last time.

So, now let’s continue...  Between the ages of 2;6 (2 years, 6 months) and 3, Jake learned articulation of speech sounds!  While most people consider “articulation” to be synonymous with “speech,” you, dear reader, know that it is just “level 5 and higher,” and that a child like Jake was talking once he could make his exhalation audible (Level 1 or 2)!

At age 2;6, Jake was “working on” vowel sounds, and had developed an open-mouth sounds (“ah” and “aw”), some small-mouth sounds (“uu” and “oh”), and some tight, retracted-mouth sounds (“ee,”  “aa”), and a few others along the way. Carried by his intonational contours, Jake’s vowels made his vocalizations sound like “real” speech!  It truly sounded like Jake was talking now!

Of course, Jake had a few consonant sounds too. But, these were just inadvertent side effects of vocalizing.  He had an “m” sound, because he sometimes kept his voice going while his mouth was closed!  And, when he opened his mouth while he was vocalizing, he might just make a “b” sound.  Consonants just happen…at least some of the time!

Thus, by the time Jake had success with intonationally-supported vowel sounds, he was already developing some consonant sounds.  Of course, the universal first consonant, “m” came in early, and soon thereafter came “Mama.”  Because Jake is dyspraxic, however, “Mommy” did not come naturally to him, and Jake worked long and hard to get his mouth into the two different vowel shapes to say it.  This word became his pride and joy at age 2;8, and, even at age 2;11, it seemed like a near miracle every time we heard it! 

Other consonants (Level 6) did not come so readily, however.  The “b” and “p” sounds were a natural shoe-in, as they just “happen” when mouths open and voice is already turned on.  Jake was able to say, “Bah,” for “bye,” and “B” (the letter name) fairly early in his Level 6 work.  But tongue sounds like k, g, t, d, n, r, l, s, sh, etc. require a strong, independent tongue.  And this, in turn, requires a strong, independent jaw…which requires a strong, independently-mobile neck!

So, the way we supported Jake in developing tongue sounds started at the torso and neck! (Remember: dyspraxia is a movement disorder!)  We had to make sure Jake’s torso was strong, and that he could support his shoulders, which, in turn, supported his neck.  Truth be known, we were working on this all along, as Jake had an OT who was paying attention to this! Then we had to make sure Jake’s neck was strong, and that it moved flexibly in all directions. We did this by making sure he got lots of opportunity to lift up his head at all kinds of angles while he was playing on the floor.

Next, we had to make sure Jake’s lower jaw was strong, and that he could move it without moving his head. Jake’s family made sure Jake was chewing lots of different foods, including meat, and we watched whether his jaw acted independently, and moved in a nice rotary circle when he chewed. All this jaw work was important to give Jake’s tongue a good base of support…because, eventually, we wanted Jake to be able to lift his tongue independently of his jaw!

Jake began moving his tongue well, and he developed nice “k” and “g” sounds (“Cat,” “Gordon” and “Go” are some of his favorite words) and “d,” “t,” and “n” sounds (“D,” “T,” “train,” and “N” are others of his favorite words!). Jake was on his way to developing consonants!

Level 7 (Sequencing Sounds) remained challenging for Jake at 2;11, as he could sequence two repeating syllables, two syllables where the middle sound could be ignored (“Gordon” was said as “Gawn”), and two or more syllables without consonants at all. (“I don’t want it” was said as “Ah oh wah ih”). The latter type of phrase has been dubbed an “intonational utterance,” and is actually a Level 5 phrase with good intonation and vowels, but no consonants.

Level 8 (Purposeful Speaking) works for Jake, but only if the fun and playfulness quotient is high enough.  Jake cannot speak “on demand,” but if he is physically set-up, feels safe and comfortable, and has understanding partners, Jake can spontaneously engage in back-and-forth turns and spontaneous imitation.  If Jake is hungry, however, he still resorts to crying. Recalling what you know about dyspraxia, that it is a disorder of purposeful speech, you will understand why! If Jake’s “purpose” becomes more powerful than his ability to support it, his Level 6-8 ability is reduced to Level 2 screaming or Level 1 silent, deep breathing!  Jake is still dyspraxic, and significantly so. 

But, Jake has come a long way, quite quickly, making his progress easy to see and understand.  These qualities make Jake is a great “case study,” to illustrate the general course of progress we see in all children with dyspraxia. No other child is just like Jake, but the progression he went through is similar in others, even when the “typical” timeline is much longer. Jake’s lessons are clear because his progress came so quickly. For this reason, they have the power to teach us about all children with dyspraxia! 

In summary, let’s look at some of the lessons learned from Jake about “speech therapy”: 

 Make speech support fun!  If it isn’t fun, it isn’t “support.”  If it’s “work,” there is too much “trying,” and trying is the nemesis of good progress with dyspraxia!  Granted, providing fun for a toddler is a lot easier than providing fun for an older child.  With older (and bigger) kids, the equipment needs to be bigger, and the challenge needs to be greater.  But that’s why we can learn our lessons from toddlers…and then find ways (and bigger trampolines!) to make them work with older kids!

 When thinking of support, think general rather than specific.  Think “levels of support” rather than particular “target” sounds or words. We can trick a child into saying a particular target word a bazillion times (e.g. withholding something so he will request it over and over), and, a child will “learn” it.  In the parlance of dyspraxia, however, that word will become automatic, but this will not support saying any other words.  The child will still need a “plan” for that!  Better to use a whole level of support that will make everything your child says easier!!   

 Support your child’s own intentions when you decide when and how to do “speech therapy.”  In other words, follow your child’s lead! If he is supported while talking about what he cares about, then there is no problem generalizing!

As we come to a close of this column and this topic, we’ll leave you with a hint at the topic to come…“Finding the Words…when they are pictures!”  As you can guess, we will venture into the world where our kids are often truly gifted, thinking in pictures. We will examine what Temple Grandin and others have taught us, and look at how best to help our kids “find the words.”

Until then, all the best to you and your children!
 

                                                                                                                     
Marge Blanc founded the Communication Development Center, in Madison, WI 10 years ago.  Specializing in physically-supported speech and language services for children with ASD diagnoses, CDC has successfully helped scores of children as they moved through the stages of language acquisition.  Contact Marge and her associates at:
Communication Development Center
700 Rayovac Drive, Suite 200
Madison, WI 53711

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