Role of Augmentative and Alternative Communication in Speech Development

Should this be a controversial topic I don't think so. The opinion is that if you provide other avenues to communicate then the child will resist the opportunity to communicate, basically stating that augmentative communication is a hindrance not a tool. Surprisingly I have heard this opinion on more than one occasion and it has caused issues with trying to help my son navigate his non verbal world.

My question is, should it be ok for children to be locked in silence without any form of communication. Should it be ok for them to spend all day at school completely silent unable to express themselves their ideas or their needs and wants. This should not be a situation that exists however sadly it does. This is the dilemna of any parent of a child who has issues with their communication regardless if they are Selectively Mute or not.

What are the consequences of these attitudes? From my point of view, the issue with lack of communication is an acceptable place for them to express themselves. Being non verbal I would imagine would be extremely stressful and anxiety provoking. We want children and for that matter clients of ours to be independant and self empowered, self directing and motivating. How can they do this in a world that can't hear what they need and what they want to say.

The second issue is that if a child does not get the opportunity to communicate when they can and if they want to it causes secondary effects, first of all if a child has a speech delay in any form not being able to talk and hear feedback and have people talk back to them, delays their development. There is a lot of stress and pressure put on parents to get their child to work on their speech, but this issue is happening. Secondly which is also important is we act surprised when our children behave in a non acceptable manner, for example at school in the shopping centre. Yet they are frustrated because they can't communicate. They are screaming in their heads trying to say something and we are there with NO idea.

Now don't get me wrong I don't think for a second that a child should use AAC without any verbal attempts at communication that is not correct. But I don't believe for a second that it inhibits their speech development. Please have a read of this document on the scale of communicate and how we progress to verbal communication I think this clearly shows how we can move through to verbal communication.

Stages of Social Communication Comfort Scale

Speech therapy: assessment

As a child and my husband as well we both had hearing issues as kids and even as adults so we knew that we needed to monitor our children to ensure that we would know if there were any issues. So once you decide that there is an issue, then the process of assessment and diagnosis begins.

There are two aspects for speech issues that need to be addressed in the process of assessment:

• A comprehensive audiology assessment needs to be carried out first rule out or recognise any areas of hearing loss, difficulties or ear issues such as glue ear.
• An assessment of your child's language skills will need to be carried out by a Speech Pathologist

The biggest issues in this process unfortunately is the wait lists necessary to access these services through the public system. This has been my experience but once in the system it is easier access reviews for audiology. However be prepared for a waitlist and make sure that you let the services know of your concerns. What is ideal is to before you think you need it then put your child's name down.

First up they will ask for a hearing test to be done so if you get that under way it is one less thing to do. In the assessment they will listen to what your child can say ask you questions about how many words they say, what words do they say, how many word sentences do they use and so on. We had problems in this area because our son couldn't even respond to the speech therapist as he was so overwhelmed with fear we didn't know what Selective Mutism was at that time.

Once this is done then you will have an idea of where your child stands. When I finally got a assessment done (after two years of fighting for one) I was quite shocked at how far behind they believed my child to be, so it was a tough moment, we had done EVERYTHING that was needed to be done yet he still struggled. Hopefully you will find that there isn't an issue and he/she is jsut fine! If not please check out my next post on treatment.

Moments of doubt that can control

Today I have been thinking about everything. There are days where I cruise along in auto pilot, keeping up with the demands of a child with Selective Mutism, Speech Delays and Sensory Processing Issues. Every now and again a sense of panic can seize, one that asks many questions such as; when will this end? I am not sure I can cope with this all of the time? what are we missing? I can't think any more how to solve this problem? is my son going to fall behind because those around him can't hear what is going on in his mind? are we going to run out of money? how do we afford all of this? are we doing enough? why does it feel like I have two sons one that lives with me and one that only comes out when others are around? Am I doing enough? have the right therapist?. Moments of doubt can threaten to take control.

The reality is we all get tired, over it, some days we just wish that things were normal and we didn't have to think all the time, work all the time. I realise that I have a son that has needs that are invisible can be misinterpreted and misunderstood. However I am grateful that I have a child who is healthy, well and does not have any other complex needs like some other brave parents and children I know. The reality is that we don't always know if what we are doing is the right thing or if it will help, if we are making mistakes. It is a little like navigation once we have everything in place, then we need to sit tight and stay on course, making space for changes along the way. We just need to keep going.

All of this is a gentle reminder to me, there are other important questions I need to ask myself that are more important than the questions of doubt; what is the goal we are trying to achieve with this, what is it going to look like when my son is no longer bound by fear and then secondly how am I? self care is one of the most important things we can do for our children yet the hardest and most neglected. It is amazing how often we can find ourselves in the same place, some principles are more effective when we practice them regularly, self care can be just like maintenance. If we maintain ourselves well then the little issues that pop up aren't so devastating, if we neglect ourselves then chances are then we can have a complete break down, which do we prefer? The answer should be easy!

Speech therapy - home is where it starts

For my son, speech therapy has been a component of our life for quite some time now, as he had hearing issues mainly associated with a glue ear up until really recently. Consequently it meant that his speech was delayed because of his hearing and the lack of reinforcement and practice that was a by product of his Selective Mutism. My youngest son had a few issues more so being up to scratch with where he should be in his development of speech with also the added bonus of waxy ears.

For us the added complication of the speech delay meant that he would have increased anxiety around the fact that he wasn't at the same level and would not know how to speak even if he wanted to. So to cover this properly there are many different levels of assistance/therapy that we can give our children in regards to speech that can be helpful so I am going to divide this up into a few different posts to cover the different areas.

Home is where it all starts. The reality of anything we do for our children is that we are the drivers of the things we do with our children. Whether or not we believe that our children need speech therapy, do they have an issue or are we too busy to even attempt to address what is happening. Everything starts and ends with us. So the first step is acknowledging is there an issue and secondly how bad is the issue. We will cover diagnosis, assesment and so on in the next post.

So once we have realised that there could be an issue these are the things we can do that are simple, that can really help our children.

• Whenever we speak to our children (especially instructions) get down to their level, or bring them up and speak to them face to face, not behind them. Use clear uncomplicated instructions and if they are able ask them what you are telling them if you believe they didn't understand you.
• Reduce background noise whenever possible, when speaking even if it means pressing pause on the tv or turning down music it does make a different.
• Talk to your children, be attentive when they approach you to talk, this really builds their self esteem and confidence in speaking. Speak back to them, rephrase what they said to show you understand. Such as labelling the items they are talking about in terms of colours identifying factors such as fast slow, soft, hard, cold, hot. Talk about what interests them, what they are looking or pointing and and copy by pointing and use your most enthusiastic voice.
• Use familar phrases regularly in their routines, they will start copying and repeating what you say in no time at all (this is a big part of the Hanen Program which I will discuss later).
• Read books as often as possible, not only just read the books talk about the pictures what the characters are doing.
• Take notice of cold, ear aches, hearing loss during colds and treat them immediately. Lots of issues are resolved by prompt treatment of any underlying issues such as ear infections it is common for children not to be able to hear you when they are have a cold.
• Regurarly monitor your child's hearing ability, I do the check of talking behind them sometimes, I go into another room and talk to them from there, I tell my sons that I am going to ask them about a lolly but I am testing them. I found, for children that if you ask them if they want a lolly (or another treat) without hesitation if their hearing is ok the majority of the time you will get their attention immediately, this can give a better indication of how they are hearing. Unfortunatley we can be easy to ignore at times!
• Play with your child, talk to them during this play time even five minutes makes a difference

This is where it all starts with us at the home. Next up we will look at diagnosis, assessment and the medical part of speech therapy.