Hand in Hand: Small Steps in Speech Therapy

Speech therapy, the tactile way

Amelia started working with a new speech pathologist last week. Our much-loved ‘speechie’ MA had to suddenly move out of the city for family reasons, so we’ve been scrambling to find a suitable replacement.

In general, there are lots of speech pathologists to choose from, but only a handful who have extensive experience with deaf children and, in my view, that special knack of coaxing results out of complex little people.

We chose a trial appointment with PP, a pathologist we had met before but never worked with closely. She had always shown great affection for Amelia, but I had no idea if they would hit it off.

Over the last six months, Amelia has undergone a myriad of language tests at the Cochlear Implant Clinic to see if she would benefit from an implant. These appointments often lasted between one to two hours (with breaks) and the pressure to perform was felt by all.

Sometimes Amelia would happily look at the images put in front of her and respond to questions. Other times, frustrated by her lack of understanding or perhaps just from fatigue, she would run around and around in manic circles. As a defence strategy, it was terribly effective.

Mostly though, and this is Amelia’s defining modus operandi, she played the testing ‘game’ according to her rules. She would dismantle activities and set them up in the corner to play with in her own way. My steps, my way, indeed.

The environment of a language test or assessment – where it’s all about specific results on the day – is very different to a therapy session which is about building understanding in the long-term, one brick at a time.

Not one to hedge my bets, when PP came out to greet us in the foyer of her building, I just knew we were in good hands. Amelia didn’t remember her from their previous meetings, but she seemed relaxed and open to being in this strange, new place.

We were led into a medium-sized room with a little table set up in the centre, like so many we have been in before. I am used to Amelia rebelling against co-operation in these settings, but what a casual observer might call ‘naughtiness’, I have come to understand as a cover for her very real anxiety about what’s expected in these endless rooms with small tables.

But not today.

She did a routine check-in with me first, “Mummy stay?” “Yes baby, Mummy’s going to stay with you and we’re going to have some fun and play some games with PP, okay?” She took a seat and from that point on it was plain sailing with barely a hint of cloud overhead.

PP showed herself to be just the right fit for our family. She has a clear agenda for her sessions, BUT she also responds quickly and intuitively to the personality of the child, their mood on the day, their engagement with other games in the room and their stamina for each activity.

She took Amelia in hand – literally – using tactile therapy, she was constantly taking Amelia’s proffered hands into her own, getting in close to teach her what a sound feels like (the air movement created when we pronounce a p sound), to gain attention and to build trust.

It was wonderful to watch. If Amelia was desperate to play with Mr and Mrs Potato Head (it’s a Toy Story thing), then that was no problem. When PP asked if she would look at one more card and name the objects there and was given a resounding “No”, she switched promptly to the next thing.

Normally in sessions like this, I am the cajoler, the suggester (maybe we should try that game Amelia has been hungrily eyeing off for the last 10 minutes…), and the go-to person if things fall apart.

But here, I only needed to sit and watch, laugh, encourage and learn. There was a lot of high-fiving, touching for support and to regain focus (so important for communication with deaf children), and no rigidity at all.

I marvelled at PP’s ability to make swift transitions from one activity to the next with complete flexibility and a lot of well-honed instinct.

Amelia struggles with pronouns, so we did lots of practice with turn-taking and saying “I want the Potato Head eyes, “I want the mouth”, and so on. She really started to get it, and as the session went on, her speech became clearer and more confident.

And she never left her chair.

The whole time, PP was prompting and encouraging, she was writing notes and giving me snippets of feedback. We moved to a computer for one more activity and then, as quickly as it had all started, for Amelia it was time to finish.

When my girl has had enough, it really is ENOUGH. But this time, the meltdown was minor, just a little choppiness with the harbour safely in sight. Amelia sat on the floor and cried quietly for a few seconds and then gathered herself up.

I tentatively offered her my hand (she hates offers of help) and her face cleared and opened to me again with a smile. I stared in wonder at this newfound self-possession, a sign of her maturing self.

I loved PP’s approach to Amelia. She got away with being bossy, when the rest of us go home in a body bag for saying “wait” or “careful” or (heaven forbid) “not yet” or “NO”. At the same time, she was full of praise and warmth for Amelia and that meant a lot.

She found a way to guide, respond and maximise the benefits of the session while making Amelia feel like she was in control.

PP and I agreed that 30 minute appointments, once a fortnight, will be more than enough for Amelia. There’s no need to push too hard when little people are putting in such intensive effort to understand and learn.

Amelia, proud of her handy work (Speech Therapy, 2013)

That night, while we were cooking dinner, Amelia was very talkative, and unprompted, she began saying in a sing-song voice, “I cook the egg”, “I want the jam,” “I make the dinner”.

It doesn’t seem like much, but when your child has had so many barriers to speaking any words, even a single ‘I’ is a thing to cherish.

No doubt there will come a time, as it does for most parents, where it’ll be one self-centred ‘I’ too many, but for now I’m taking it to the bank.

Because it’s the smallest things, the tiniest steps that make me so proud and filled with something that feels dangerously like hope and for once it’s hard to contain.