Your course work is over. Your campus supervision went well but now you are out in the “real world.” You know about normal development. You have read up on various language and speech disorders but now what?
During my more than four decades of work, I have found that the answers to the questions I get asked are not in textbooks. They are in the trenches of experience. Clinicians do not want to know when children eliminate fronting or when irregular past tense develops; they can look up things like that. They want to know about the nitty-gritty of conducting a session.
Today an extern was asking a child to say, “I want the bus,” and he would not respond. I stopped her and asked her what it was she wanted him to do. She looked perplexed because this sounded like an odd question when it was so obvious that she wanted him to repeat the sentence. Noticing her look, I then asked her what she was trying to “accomplish.” She said she wanted the child to request. Well, if the child could repeat her sentence, he obviously had the structure, “I want the train,” and if he was whining, reaching for the train and saying “train,” then he had mastered requesting. So what was it that she really wanted him to do? What was it that she thought he couldn’t do?
When questioned about the child’s skills, the extern said that the child could say, “I want….” in various contexts and that he could label “train,” so she wanted him to use the structure of “I want the train” to get the train. What she was trying to accomplish, without knowing it, was having the child use the skills he already had. She was not teaching him to request. She wanted him to “use his words.”
Carryover is an integral part of therapy, but you cannot force a child to speak or to “use his words.” This is a battle you will not win. You can continue to ask him to repeat, withholding the toy until he says what you asked him to say. But what purpose does that serve other than frustrating everyone?
To aid compliance, we set up a scenario in which there were two different toys in close proximity—so close that the child’s pointing did not make clear which toy he wanted. Taking the toy he wanted was acceptable, but the extern continued to ask, “What do you want?” even when the child just took the toy. As he took the toy, the extern would say, “Oh, you want the train.” The extern then requested a toy she wanted by saying, “I want the ….” and taking it from her pile of toys. She continued to arrange toys in such a way that pointing did not help the child get what he wanted, and when he whined, she ignored it. She just requested the toy she wanted and took it.
The extern set up play situations where she was able to ask, “What do you need now?” The child began to say the name of the toy he wanted. With continued modeling, he said a reasonable approximation of, “I want the train” by the end of the session. Exuberant praise and the acquisition of the toy were very reinforcing, and the child used the “I want” approximation a few more times during the session. It did not become a “talk or else” situation. It was a situation where speaking made it easier for the child to get what he wanted. The intervention was given context and the end product was the child’s obtaining what he wanted by requesting it.
The main point here is to know what you are doing, what you are trying to accomplish, and what is that you are doing that is at cross purposes to what you actually want. And to not make speaking a challenge for the child or a condition for playing, but to demonstrate that speaking facilitates communication.
I was a beginning SLP once, know the frustrations, and want to help. If you have other not-in-the-textbook questions you’d like answered, pose them below in the comment spaces so that I might address them in future blog posts.
Irene Gilbert Torres, MS, CCC-SLP, chair of ASHA’s Multicultural Issues Board, is a clinician in New York City. She concentrates primarily on infant and preschool evaluations and supervision of graduate students. She is an affiliate of ASHA Special Interest Groups 11, Administration and Supervision; 14, Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations; 16, School-Based Issues; and 17, Global Issues in Communication Sciences and Related Disorders.