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For many years I’ve worked with many autistic children who have severe speech apraxia. During that time I’ve been able to help many of them achieve language and understanding, even when all hope was gone. Through these wonderful children and their dedicated parents, my approach to speech apraxia was transformed, and I want to share one story with you.
Following is the story of Hank. When Hank’s parents brought him to my speech therapy practice when he was six years old, he was a mentally challenged, non-verbal, severely apraxic young child. Displaying the classic behavior of children with autism and speech apraxia, he struggled to communicate even his most basic needs.
Hank’s parents, try as they might, were having a terrible time coping with his challenging behavior. They felt helpless. They couldn’t tell when he was hungry or if he was in pain because he did not have a name to call on them for help.
Hank’s story represents just one child’s journey from silence to sound – but he embodies elements of many children who, as I like to say, have been my teachers over the years.
It’s generally believed that if a child doesn’t speak by the time he is six- or seven-years-old, he or she never will. However, I detected a certain brightness in Hank’s eyes now and then, and my intuition told me that he might be able to speak one day. I became determined to address Hank’s underlying listening deficits to try to help him to attain some measure of communication.
In my work, my approach had always been multi-faceted. I used movement, object/picture matching, postural support, tactile stimulation, cognitive attention/focus, and primitive reflexes. Working with Hank, however, I was forced to look at speech apraxia through a new and different lens.
At that time, I discovered research that uncovered the fact that a large percentage of children on the autism spectrum have difficulties with auditory processing. In other words, many, if not most, of their problems were tied to an inability to process sound the way other children do. I was so fascinated by the research that I set out to discover to what extent Hank’s listening problems were affecting his behavior, learning, and communication.
This was my new lens.
First, I referred Hank’s parents to an ear, nose and throat doctor who specializes in autism and auditory processing. Indeed, the doctor detected an underlying condition that could be a contributing factor to his behavior problems. He prescribed a course of therapy that lasted for two years.
Then I got to work.
Through neuro-development listening programs that combine music with interactive rhythms, I was able to retrain Hank’s ear. He began to be able to tune in to pitch ranges that were previously tuned out. He started to have a new awareness and understanding of the world around him and where sounds originate.
Miracle of miracles…the training was so successful that, although he did not use speech-like sounds, Hank finally began vocalizing. His parents were ecstatic – and so was I!
Over the next year, Hank’s progress was just astounding. This boy, whom everyone had given up on, was starting to understand the world—and attempting to communicate for the first time!
Next, I introduced Hank to a tablet application that displayed pictures of objects and “said” each of their names at the same time. He began to understand that sounds coming out of the tablet were similar to the sounds that people make when they open their mouths. Suddenly Hank recognized that sounds and things are connected and that everything in the world has a sound to accompany it.
Hank realized that he has the power to influence his world. It was a huge breakthrough!
One day Hank’s mother called me crying tears of joy. Hank was making “mmmm” sounds to get her attention. Hank had finally connected a sound to a request!
Over the years, each new skill brought Hank closer to real verbal communication. In one particular session, he lowered his tongue and uttered the first “speech-like” vowel sound he’d ever produced. He tried to mimic my facial expressions, too. Sometimes those facial expressions had a sound that went with them. The better he became at mimicking my facial expressions, the better he got at making consonants and vowel sounds.
Soon, Hank was shrieking the open vowel “uh” and using the “ă” sound to request objects. He was on the verge of becoming a verbal communicator.
I continued to work with him. Using a drum, I demonstrated how sounds blend in a sequence and the rhythmic patterns that Hank was imitating. In this way, I bridged the gap between the cognitive (understanding) and the auditory (making sounds). As Hanks verbal imitation abilities improved, he also got better at following directions.
Finally, Hank made the connection between the verbal and the auditory. In a meaningful way, he began to use sounds to name pictures of everyday things. He wanted to learn to speak!
From then on Hank rapidly responded to every new idea. I introduced more and more tools, such as software videos focused on facial expressions paired with sounds and words. He began making a clear long “a” sound. Another tremendous breakthrough.
As Hank progressed, my approach to speech apraxia changed. It was amazing—five years ago a mentally challenged, non-verbal, and severely apraxic child walked into my office. The same boy was now using speech to communicate his wants and needs. He is calm. He tries new things. He even plays with other children.
The bottom line: It is highly unusual, if not almost unheard of, for a six or seven-year-old non-verbal child to begin talking. But, by looking through a new lens at his auditory processing deficits, I was able to help Hank make enormous breakthroughs.
His parents, once desolate about their son’s future, now understand that their son is quite bright!
Hank’s journey has been my inspiration to continue to test innovative strategies in new ways with children who have similar challenges. I feel blessed to have the opportunity to guide Hank and children like him in their journey from darkness into light.
1) During the years I worked with Hank, he had biomedical treatment, biofeedback, and occupational therapy—all of which enabled him to get better at listening and following directions.
2) Hank’s parents granted me permission to tell his story.
There will always be more to learn about auditory processing and executive function. However, the knowledge we have combined with the passion of creative professionals and the determination of everyone involved, more and more children like Hank will be able to live normal lives.
To sign up for auditory processing and executive function skills online classes, please click the link below:
“Listen UP” is a 2-hour presentation on principles of how auditory processing affects behavior and performance with practical strategies to enhance those underlying skills.
“The Brain Awake Program” is a class designed to explain underlying sensory motor perceptual skills that higher level thinking, reasoning, and performance is dependent.