Voice Unearthed (eBook)

1

How The Voice

Got Buried:

The Speech Therapy

Journey Begins

Our son Eli was 2 ½ when we first noticed that sometimes his mouth opened and nothing came out. The veins on his tiny neck would bulge and his face would turn red before we heard a peep.

Although we were concerned, at first we didn’t react, hoping it was something he would grow out of. Then others began to comment – a day-care provider who had been in the business for 30 years said she had never heard anything like it. A friend who was also an elementary school teacher encouraged us to take Eli to a speech therapist. We had adequate financial and medical resources, so we did what so many other parents do when their children are struggling – we turned to the experts.

Our first trip to a speech therapist was for an initial assessment, and just like when you take your car to the mechanic, Eli displayed no tension or struggle during our visit. She decided that his behavior was most likely developmental and advised us to hold off on therapy, assuming whatever he was doing would fade away.

Over the next six months, Eli’s struggle waxed more than waned. On his good days we would breathe a sigh of relief, hoping this was the end of it. On his bad days we would talk more about getting him into speech therapy. When Eli was three and still struggling, we decided it was time.

I remember kneeling down to his eye level and explaining that we thought talking seemed sort of hard and we were going to get him some help. I’ll never forget the confused look on his face. He clearly had no idea what I was talking about…and I felt like I had just crossed over a threshold that I maybe should not have crossed over.

Crossing that threshold took us into a world of treatment options that evolved around the following standard therapy components; fluency enhancement, fluency shaping, stuttering modification, and an integration of those therapies:

• Fluency enhancement relies on indirect strategies that focus on changing the external environment in order to support natural speech and/or spontaneous recovery. This is the approach most often used with preschoolers and its goal is fluent speech.

• Fluency shaping often enlists speech techniques such as prolonged speech, soft starts, choral speaking, rhythmic stimulus, and mechanical devices. The goal of fluency shaping is fluent speech with minimal errors. (Shapiro, 1999)

• Stuttering modification utilizes techniques focusing on modifying the moments of stuttering and reducing fear and avoidance behaviors associated with stuttering. This is often the next step taken if fluency enhancement and fluency shaping efforts don’t work. Moments of stuttering are modified by using voluntary stuttering, stopping and starting over, easy onsets, intentional bounces, and slowing down. The goal is to decrease anxiety around speaking and to have less tension during the stuttering moment. (Guitar, 1998) Therapy terminology is often changed to be more palatable and accessible for children. For example, intentional bounces are referred to as “Tigger Talk,” slowed speech becomes “turtle talk,” and so on.

• Integration of therapies is used by many speech therapists who combine components from all three approaches into one plan of action.

Until he was five, Eli’s therapy was the more indirect approach referred to as fluency enhancement, the type used most often for preschoolers who are exhibiting repetitions and speech tension. I would join Eli in the room with the therapist and she would assess his speech by interacting with him using toys and games. She would model the slower speech style she encouraged me to use and she instructed me to make good eye contact, ask fewer questions, avoid stressful situations, and not address the concerns directly with Eli. (Unfortunately I had already blown that when I informed him why we were going to speech therapy.) He was never directly told to change the way he talked. Yet his struggle persisted, even after several rounds of therapy at our local clinic. He would improve for awhile, enough for us to be hopeful, and then the struggle would again surface.

Shortly after Eli turned five, and after a break from therapy, I discovered through my newly acquired access to the Internet that some therapists actually held a Board Recognized Specialty in Fluency Disorders (BRS-FD), given out by the American Speech-Language-Hearing Association (ASHA). I wasn’t sure what this meant, but at the same time I was a little miffed that no one had told us this before. I contacted the University of Minnesota for a referral and since they were closing down shop for the summer, they directed me to a clinic about 40 minutes from our home. I assumed that since I had asked the U of M for a therapist with this certification, that this clinic had such a therapist. I didn’t realize until years later that at the time, there were only three therapists with that certification in the state of Minnesota, and none of them were at this clinic.

Nevertheless, we began a twice-a-week trek into St. Paul, and since I was homeschooling, I often brought Eli’s nine-year-old twin brothers along.

Alberta, the new therapist, explained that, because of Eli’s age, the window for spontaneous recovery was closing and it was time to pull out the big guns – direct therapy. The persistence of his struggle was considered an indicator that the tension could very well be turning into a chronic issue. This was hard for us to hear, but at the same time, she didn’t say the window was entirely closed. Maybe this more direct approach would be the boost he needed to get on track. At the time I didn’t fully understand all the terminology, but looking back at his records, I can see that she was using the “integration of therapies” approach.

I asked if I could be involved in therapy and she agreed to let me observe on occasion, but discouraged me from doing therapy with him at home, except for short practice sessions each day where he was encouraged to use his speech tools. We were told to not push the use of speech tools outside of our home sessions. This didn’t make sense to me. In order for Eli to use speech tools naturally outside the clinic setting, I felt it would take more practice than what occurred during two ½ hour sessions each week and 10 minutes a day at home. At the same time, I remember thinking that this level of intervention must be effective or why would anyone bother? I decided I just needed to have more patience and faith in the guidance we were getting.

Over the next six months, Eli didn’t get any better - in fact, he seemed to be getting worse. He had more blocks and he continually drew out the vowel sounds in the first syllables of words, especially those near the beginning of a sentence. I occasionally sat in on his therapy observing Alberta’s techniques and how Eli responded. He used his speech tools quite well while with her and this gave me hope. We were told that many children found these techniques very helpful in managing their speech. We were doing our 10 –15 minutes of “special time” each day during which he would describe pictures and practice easy bounces, stretchy talk, turtle talk, and so on. Oh, and he was instructed to think about his breathing too. He did sometimes seem to run out of air…

I blamed his lack of progress on the challenging and anxious circumstances during this period. His first day of therapy was on September 11, 2001, and over the next six months, we experienced a death in the family and moved to a new home. My concerns about his being able to use these techniques in real life were heightening, as were my concerns for his overall wellbeing. He was showing more resistance to our “special time” and was growing quieter and quieter around friends, even around his brothers. If he blocked, he would just stop trying rather than push through and say what he had to say.

I now felt an even stronger urgency to find more intensive intervention. I started looking for a new therapist, one who would give me a bigger role by training me to do therapy with Eli at home.

Our next therapist did indeed have her BRS-FD, about 20 years more experience, and a much larger base of clients who stuttered. The drive to her office was even further - over an hour away - but she agreed to train me to do therapy at home. We brought Eli to her office once a week for a half-hour session. She told me that she wanted to start with fluency shaping strategies, but if that didn’t seem to work, she would move on to stuttering modification techniques. Again, we had high hopes.

Our “special time” increased as I tried to get Eli to use easy, relaxed onsets, and smooth and easy speech. We practiced half an hour to 45 minutes each day. In order to make it more palatable to him, we were given handouts with cute little pictures on them: kids playing in a sandbox, a kid making a peanut butter and jelly sandwich, or kids dressed up like spacemen playing volleyball. These were meant to inspire conversation. Eli thought they were stupid, and that attitude did not inspire conversation. We also played board and card games (which resulted in an aversion to these activities that Eli still has today). While talking, Eli was to self-monitor, practice easy bounces, use stretchy words, breath deliberately, and stop and start over when he made a speech mistake. He was also supposed to monitor my speech and point out when I stuttered, as I had been instructed to throw in intentional bumps.