Last month I made plans to tag along with a speech therapist for a day, to get a sense of what her daily work routine is like. Those plans fell through when she mistook my 315 phone number for a 312 number - an honest mistake, of course, and an understandable one - 312 is local to Chicago. She came to my apartment to pick me up, but dialed the wrong number and figured that something must have come up for me. Meanwhile, I was upstairs putting the finishing touches on all the questions I was going to ask her.
Well, we finally had a chance to reschedule, and I spent a full day with A on Wednesday. We drove from home to home (and to one day care), seeing eight clients in total. A's specialty is early intervention speech therapy, so her clients are between 1 and 3 years old. It was fun to see how much she clearly loves her job. "I get paid to play with kids all day!" she said. Which is true, sort of, but there is obviously much more to it than that...
So how does one administer speech therapy to children so young? Well, one aspect of it is exercising and toning the muscles necessary for speech. Many of the children we visited have already faced serious health challenges (like heart surgery or liver transplant, or in the case of one little boy, down syndrome) in their short lives, and as a result their physical development lags behind what is considered normal for their age. Part of A's job is to get them to strengthen their chest, core, neck and face muscles, as these are all necessary to support speech.
Another key is improving the kids' ability to focus. For example, when A reads a book with one of the children, she gets them involved with pointing to and trying to name things in the book and turning pages. If the child starts to get distracted, A brings their focus back and tells them, "We have to finish the book first." She is strict about keeping the child on track, and she doesn't back down. Some of the kids were pretty irritated with her at times, but they always came back around to smiling at her. Tickling was occasionally necessary.
There is something very appealing about working with young children. For one thing, their little brains and bodies have such an astounding ability to overcome early challenges. A's expectation is that all of her Wednesday clients - except the boy with down syndrome - will fully overcome their difficulties and catch up with 'normal' developmental milestones within several years.
The case that sticks with me the most is that of a 35-month-old girl, L, who has apraxia and extremely low energy. Speech apraxia is when a person has trouble saying what she wants to say correctly and consistently. It is due not to weakness of the speech muscles, but to the muscles not receiving the correct messages from the brain. So L has difficulty putting sounds and syllables together in the correct order to form words. When asked to say "pretty, pretty, pretty," she might say something like, "tehpee, petty, beepee." She seems to understand everything being said to her, but it is very difficult for her to communicate.
Imagine being one month shy of three years old and so totally stuck in your own head like that! I am sure it is immensely frustrating. As a result, L is a very quiet child. It took A a while to warm her up to even trying to talk. Finally, it was the talking toy refrigerator that did the trick. (A brings bags and bags of her own toys and books with her to every home.) L had to say the name of each piece of food in order to play with it. I think I heard a tiny improvement in L's articulation just in the hour that we spent with her. I bet that if her family tried to engage with her and get her to talk every day, her progress would be remarkable. Sadly, that does not seem likely to happen. L's long, dirty fingernails (clip them!), really dry skin (lotion, please!) and blank stare do not paint a very pretty picture.
When I got home on Wednesday, I told K all about my interesting day. I described L and her dirty house and how her parents were home but didn't show any interest in her speech therapy. Sigh. "Should we go steal her and bring her here to live with us?" asked K. Well... that sort of sounded good, but needless to say, "No dear, we really can't do that." Nice of him to ask, though.