Freeing the tongue

Mak started in speech therapy in March of 2010. I clearly remember his first appointment. 

His wonderful SLP (speech-language pathologist for the uninitiated) asked him to pick a blue ball out of a group of objects. He knew his colours at that age, which I knew because I watched him play games on the computer. He did not, however, understand her question. In frustration, he threw the toys and ran to hide in the corner. 

While I apologized profusely, she calmly replaced the toys on the table, called him back, and asked again. The hour we were there consisted of the same pattern of behaviour repeatedly expressed, and no apparent gains. We left, after booking next week's appointment, wondering whether we would ever be able to get through to our son.

He could talk, unlike many autistic children. His verbal acquisition had, in fact, been entirely normal, even precocious. I go back occasionally and read posts on my 'birthday club' at a parenting website where I bragged about his advanced skills. By fifteen months, I described him as a child who used words first and requested items he wanted using his considerable vocabulary. 

By eighteen months, that description was no longer true. His precociousness had devolved into what some refer to as 'block' speech. He would use memorized sequences of words in situations that might possibly apply, but had no concept of the meaning of the individual words. "Bye thanks for supper" was a block he used for every parting. The vast majority of his speech was gleaned from Thomas the Tank Engine. 

Even though he did have several blocks, his use was both inconsistent and often inappropriate. The few times he did use spontaneous speech, it was often in ways that most people would not understand. Any spontaneous speech was often symbolic - toddler metaphors, if you will - and only made sense if you were familiar enough with his activities to be aware of the connections he would make. And even then, much of it still baffled me. 

For the first six or so months of speech therapy, much of it was giving him more blocks to use so he had some form of functional communication. He easily understands "in situation a, say b." We worked on giving him an entire lexicon of such terms. Eventually, he started putting them together,but he still struggled to understand what to say if "situation a" was not the exact scenario that had been laid out. For example, I told him "say 'excuse me'" to get around someone in a store. In the next aisle, he was saying it to a shelf. I clarified he should only say it to people. Problem solved. 

Similarly, if a question were phrased differently, he wouldn't understand it. It took us about six months for him to reply to "What is your name?" But he still would just cover his ears or ignore the inquiry if someone asked "can you tell me your name?" Asking "what is your age?" due to the similarity of the question, would result in him giving his name. 

For over a year, asking "what did you do today?" resulted in this response: "Kick blocks." It evolved to "I kicked blocks" when he learned to use I. Then "I kicked blocks hardly" when he learned adverbs. 

If you think about it, there are millions of potential situations one can run into every day. It is impossible for us to give him the words for every possible situation, or to teach him how to respond to every possible inquiry. We needed to teach him how to understand the individual words and put them together himself. 

That proved to be an enormous undertaking.