"Don't teach my child sign language. No need for pictures or symbols either. Just teach her to speak!"
Parent-Teacher Meetings came by twice a year at the Centre I worked in. There was one right after the IEPs for the year were made and another towards the close of the year. When most parents were happy with their child's progress and eager to know what the next steps were, there was one particular couple that had something very different to say.
'S' was a little girl, 5 years of age. She was on the Autism spectrum and was non-verbal. When she first joined the Centre, S had poor eye contact, a decreased attention span, poor recognition of common objects, and poor comprehension of facial expressions & environmental cues. By the end of one academic year, S was by then able to identify her school bag, could point to the picture of a glass to ask for water, and signal for 'toilet'. She would recognize the names of the most common things she carried in her snack box, like banana and sandwich. S could also eye-point to the identify her teacher and the class helper, when named. She had come really far, but still had a very long way to go.
S's parents sat patiently listening to all the good words each professional spoke about her performance in the last year. They were happy with the progress their little daughter was making, until it was the speech therapist's turn to give her feedback. They did not sound impressed at all with all the improvements she had to tell them about, so much that they interrupted the therapist midway with, "Don't teach my child sign language. No need for pictures or symbols either. Just teach her to speak!"
After a brief half minute of trying to digest what we all just heard at the most unexpected time, the speech therapist (ST) continued. "We use a Total-Communication approach here, Sir."
What is this 'Total Communication' and how does it apply to our daily life?
When we speak, we use gestures, voice modulations, signs, etc. Even when we write a message to someone or signal to indicate something, we are still communicating, in spite of not using our voices. A smile, a frown, a dropped jaw and a stern look all send the message across loud and clear, without a sound!
Communication is not always verbal, and speech therapy is not a classroom where you are taught to 'speak'.
Total Communication is a holistic approach where the use of other communication methods, like signs, gestures, pictures, voice output devices, etc are encouraged to support a child's or an adult's understanding and use of language.
Imagine a policeman on the highway, signaling you to pull up. If you did see him, you would definitely slow down, park on the side and probably get down and ask him, "What's the matter, Sir?" What if you thought he was just shooing off a fly or shaking his tired arm?
You are driving on a new route and there is nobody in sight to ask for directions. How would you follow road signs and arrows if you didn't know what they meant?
You are in a new country on holiday and do not know the language. How do you ask for something? You signal, or use pictures, gestures, etc. right?
You want to get on the bus. There is no point standing on the roadside and saying 'stop', to the approaching bus. You either wave or signal the bus to stop.
How do you understand what each of these emoticons stand for?
I can go on forever, but what I mean to convey here is that, what helps you get through these situations is the way you communicate, not necessarily 'speak'.
If Speech Therapy won't help somebody 'speak', then what is the use of me sending my child to you?
'Speaking' is not a one way thing. In order to 'speak' we first need to know the what, why and how to it. We need to 'understand' before we learn to 'speak'. Unless your child knows what 'water' looks and feels like, and that it comes in a glass or a bottle. and it is called 'water', how is she going to ask for it?
The act of 'speaking' itself is not as easy as it may seem, especially for children like S. It is a very complex process that involves auditory processing (the ability to interpret the sounds that one has heard), motor planning (the ability to plan and carry out a skilled, motor act in the correct sequence from beginning to end, while relying on sensory feedback from the body and the environment, as well as on language, memory and thinking skills), and speech coordination (coordinated movements of the lower lip, jaw, and larynx to achieve sound production). Pictures, signs and symbols are some of the many different modes of communication that help speed up the development of verbal language.
S had poor attention skills. We worked on that first, so she could focus when we taught her things she didn't know. We used real items, toys and pictures of the same item (in stages) to help her learn that they were all different forms of the same thing. We are not silent through the process, instead we keep repeating the word, in this case, 'water', multiple times so that she gets to connect the sound of the word to the image/ form of the word.
For the parents of S, speaking was priority, but she had a lot of steps to complete before she could be ready to speak fluently. "It may take her much longer than it did for your other children, but we should not prevent her from expressing herself effectively while she gets there", we continued to explain.
"Moreover, these methods of learning to understand 'communication' helps build her cognitive skills and improve her visual perception which are all part of her intellectual development. By learning to express herself in socially appropriate ways, she is gaining confidence which in turn boosts her emotional development. I hope I have been successful in trying to make you understand how total communication is holistic and transdisciplinary, and why it is important especially with non-verbal children."
S's parents seemed to be (somewhat) convinced with all that we had to say and they (quite reluctantly) agreed to let their daughter be taught to use a voice output device in the Centre. S slowly picked up on common words, and by the end of another academic year she was able to express her basic needs (water, toilet, food) verbally, as well as say 'Mama', 'Baba' and her own name. However, it took her parents some time (and sadly, a shift from the Centre to two other centres, one after the other) to fully accept that their daughter may not speak in long sentences like their other children.
My take: Success is not at the other end of that one, big, lucky step. Rather, it's along each of those tiresome, endless, tiny, consistent steps. All you need is the strength to pursue till you reach your child's goal.
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