As we stroll through this second week of discussion about speech therapy for Tony, I want you to keep something very important in mind: Ms. B deserves just as much loving picture wise as every other therapist who works with Tony.  This post however, is going to be lighter in pics than some of the other therapy updates because Tony requires a great deal more support from me to block self-harming for speech in the clinic setting.  In that setting, the best way I can honor both Ms. B and my son is to focus on helping and not photographing. 

I do realize that some autistic individuals recommend allowing attempts to bang the head, however our little man often tries to use a great deal of force because his deep pressure nerves are under responsive and he can’t feel the damage he’s doing.  Until you’ve seen a more serious attempt at repeated self-harming for yourself, nothing I say could really help you appreciate how hard these can be- on everybody. This is an area where his safety is more important than respecting his wishes on the matter and I must definitely intervene.  Because I try not to totally suck to work with, if Tony is agitated and using more force, this is something I prefer to handle so that others do not accidentally get hurt.

When we work with Tony in the clinic setting, there are other inescapable truths.  The small side rooms for speech in a clinic setting are a bit reminiscent of a doctor’s office, and our son has a deep-seated fear of those.  His behavior is dramatically less functional and cooperative in these environments, and becomes even more so if you are expecting higher levels of structure.  For him, asking him to regulate and cooperate with social communication activities when he can barely get past his raging anxiety about the setting is expecting a great deal.  

I would invite you to enter briefly into his world by imagining you’ve just been dropped into a situation you personally find terrifying and then asked to complete an exam in the subject you least understand, find most difficult, and know that people believe you to typically under-perform in.  How well do you picture that test going?

What we have been working on recently in the clinic setting is focused on expanding Tony’s ability to follow directions and describing what he sees using the PECS on his TouchChat app.  This is a very social form of communication, where participants are wanting to invite other people into their world.  Let’s just say our little man isn’t even a little bit concerned about or interested in what other people think about what he’s seeing at this time.

We also are not working on vocal imitation currently in speech, as the focus is on communication.  However, our sweet little guy actually does have some verbal approximations he uses independently.  He will say his sister’s name sometimes, he will call out for “mama” sometimes when he wakes up in the middle of the night, he will say things like “goo’ Bubba” and “goo’ job Bubba” to himself when he does something I typically complement him on if I forget to do so (Bubba is one of his nicknames).  The other day, when I got him his potty suckers he said “Goo’ mama.”  “Goo’” being his best attempt at “good.”  However, he still struggles under instructional control to put two different sounds together when requested, cannot make some important consonant sounds, and seems to be fairly aware that he is unable to produce words as clearly as others do and is therefore less willing to try.

I still work independently with him on vocal imitation, but he has a much slower rate of acquisition of skills in this area so I spend the bulk of my time focusing on communication and early literacy skills. His success as an individual isn’t contingent upon developing verbal skills.  He may remain unable to produce certain sounds, and therefore be less comfortable verbalizing.  My goal is to teach him reading and spelling skills that would allow him to ultimately use a keyboard to communicate.  As that will be a process of many years, we concentrate on increasing the efficacy with which he uses PECS and I work on these literacy skills as often as he is willing to.

The hardest truth I have had to face this month is that Tony would get a great deal more out of his speech therapy if he were able to receive these services in-home.  We had to move Tony into the clinic setting a year ago because Michael, who was working with us at home, took a job elsewhere and we weren’t able to follow him as a client.  Home-based therapists for this service in our part of town are hard to come by.  We have grown to love Ms. B, but that doesn’t change the realities we are working with. 

A couple of weeks ago, Tony’s current DDD Support Services Coordinator Ms. J unexpectedly let us know that she had received word of a therapist accepting in-home clients for speech in our area.  I am extremely grateful that she is so mindful of what is best for our son.  We asked to meet with this therapist to determine whether or not we felt that he could be a good fit for Tony, because a person really needs the levels of patience Ms. B has to work successfully with our little man. 

The outcome for us was bittersweet…I feel confident this therapist will be able to work successfully with our son. And I felt horrible having to notify Ms. B this past week of our decision because she is a lovely person to work with.  Sometimes, I have to make a decision that is based on what is best for Tony and not my emotions.  And so we are finishing our stroll heading into a different, hopefully calmer period with our little man and speech therapy.  But I cannot walk away without looking back and expressing one last time how deeply I appreciate Ms. B, her patience, and her hard work.