By: Jill Klatt
One of the many benefits of the WonderBus is that it can go almost anywhere, allowing Mrs. O to bring her office right along with her when she visits her students for individual speech therapy sessions. Just the other day, Mrs. O parked her bus right outside a preschool and signed a student out for their session. This way, the student’s parents do not have to worry about transporting their child from school to speech therapy or adding time to their schedule to get the student to their sessions. When a speech therapy session is over, Mrs. O just brings the student right back into school to continue with their day! This is a totally hands-off and convenient way for parents to ensure their child receives the services they need without all the mess of running around to different places throughout the day.
The student Mrs. O worked with here is a 2.5-year-old with childhood apraxia of speech (CAS). Childhood apraxia of speech is a neurological motor coordination disorder where the individual knows what they want to say, but their brain can’t get the information all the way to their speech structures to form the words properly. Mrs. O described the frustrating disorder with a baseball analogy, saying, “imagine you are trying to swing into left field, but the ball always ends up going right.” For more information about CAS, I recommend checking out the American Speech-Language-Hearing Association’s page on the disorder.
A typical 2.5-year-old should have around 300 words in their vocabulary and be forming those words into two-word phrases. Take a look at the Rainbow Rehabilitation Centers’ website for a chart with more speech and language developmental milestones. This student only has about 40 words in their vocabulary and rarely uses two-word phrases. He also exhibits some inconsistencies between the way he articulates words, he may pronounce a word properly one time and miss the mark another time. Differences within the articulation of words, like saying “cot” and later saying “kit” when trying to say “cat,” as well as within single speech sounds between different words, like pronouncing an “l” sound properly in one word and incorrectly in another word, is a hallmark of CAS. To combat both of these issues, this session involved working on increasing this student’s use of words and sharpening his articulation of the words he already uses. Today’s theme was food and eating. Mrs. O wants this student to use phrases like “eat cookie” and “drink milk” more spontaneously, meaning he will say them on his own and not just when repeating a model. One key to keeping students excited about speech therapy is to incorporate the student’s interests as well as icons that are familiar to them into the activities. This student’s favorite TV show is Bubble Guppies, so Mrs. O began the session with a game where the student used a tablet to feed Mr. Grouper. For every food item the student tapped, Mr. Grouper said the word out loud and Mrs. O had the student repeat him. Pairing pictures with words helps the student build a mental representation of the word, while hearing and repeating the word is good articulation practice!
Mrs. O had a variety of other activities planned for the session. When working with younger students, it is important to have enough options to keep the student engaged for the whole session, as many younger kids have short attention spans. When this student became bored of Mr. Grouper, Mrs. O quickly switched over to a pair of puppets she had ready to play with. The student set up a plate with printed pictures of food for the puppets, then “fed” the puppets by stating the foods he had picked out! The session was also structured around words that the student already has in their vocabulary, this makes it easier for Mrs. O to build up the student’s vocabulary from a solid foundation. Mrs. O knew this student could pronounce “ducky” and “puppy,” so she used ducky and puppy puppets. By doing this, the student did not have to waste extra energy learning those words and could better focus on learning the food words from the day’s lesson. Efficiency is key when working with energetic children!
Some of the other activities Mrs. O did with this student were unplanned. At one point, she asked the student if he wanted to read a book, to which he replied “no!” quite emphatically. Instead of forcing the student to sit through an activity he was not interested in—risking the student spacing out and retaining nothing from it—Mrs. O had to improvise. She showed the student her sensory table which had kinetic sand and many molds to play with, and maintained the food theme by making icecream cones and other foods out of the sand. Pediatric speech pathologists often have to be savvy in changing up the activities they had planned in order to follow the activities that their students gravitate towards while keeping with the lesson. Mrs. O definitely had her creativity cap on for this therapy session!