Karen was a cute and bright eight-year-old girl. I needed a calm and predictable environment. Frustration manifested itself in emotional tantrums: falling to the ground, screaming and crying. His distress was most often related to his lack of spontaneous language. Karen relied on visual cues to access her words.
Karen loved to draw. One day he made a picture of a girl with tears in her eyes. A zipper was pulled from the top of his head to the middle of his body. He unzipped across his torso. With her limited communication skills, it was difficult to discuss her feelings about the image; however, I couldn’t help but wonder if that haunting image represented her own inner world.
Karen learned sight words with ease. Since he loved to draw, I wrote sentences about what he drew; then I asked him to read them to me. Using the images as visual cues, I often asked him to help me generate the sentences. For example, he drew a picture of a girl with a clock on her head. While pointing to the image of the girl’s head, I said, “The girl has a watch on her__________.” Karen replied “head”. As I pointed to the image of the clock, and then to the head, I said, “The girl has a ________ on her_________.” Karen completed the words “watch” and “head.” Then I said, “Who has a clock on his head?” Now I would point to the photos of the girl, the watch, the clock and the head respectively. I said, “The________ has a ________ in his _________.”
Overall, Karen made great strides emotionally and academically. In spring, tantrums rarely occurred. Towards the end of the year, the diagnostic teacher administered a standardized test and informed me that Karen’s academic progress had gone from a kindergarten to a third grade level. However, the test did not measure his deepest deficit, spontaneous speech. Third grade reading level or not was still significantly impaired. He still couldn’t request what he wanted, answer questions, comment, or share his feelings with no visual cues available.
The school year had passed and Karen was now in my class for summer school. He had a community-based program. Each day one of the children chose where they wanted to go that day. Non-verbal children or those like Karen, who had difficulty accessing their words, chose from a menu of options. I encourage you to use your verbal language, written words and / or pictures to help me generate a short story on the board. The simple stories told who was going, where we were going, when we were going, how we were going to get there, what we were going to do, and why. The activity was followed with related language activities relevant to each child’s level.
In this little story generated by a child, the children referred to a pizzeria with a candy machine that scatters small candies in the shape of apples, oranges and bananas.
I want to walk to the pizzeria.
I want to buy sweet food.
I want twenty-five cents, please.
A few weeks after writing the above story and doing the activity, with a blank slate in front of her, Karen spoke spontaneously in sentences for the first time with no visible visual cues. He did this by mentally recreating the sentences from the previous story that he had seen on the board several weeks earlier. I marveled as he created his own self-determined imaginary visual cues. Moving his eyes from left to right and pointing to each word, he slowly read each invisible word. At the end of each sentence, he turned his head to the left again to read the next remembered imaginary sentence.
There were only a few weeks left of summer school and our time together when he stumbled upon this strategy. Karen used it a few more times before we parted. He was at the zoo once. He visualized a phrase he memorized from the board that morning about riding the merry-go-round. Using the same technique, as he did with the pizzeria, he pointed to each imaginary word in the sky and read: “I want to ride the merry-go-round.” He knew he needed money to ride the merry-go-round and again, pointing into the air, he added his memorized phrase from the history of pizza: “I want a quarter, please,” as he held out his hand. It goes without saying that we all ride happily on the merry-go-round.
It was the last day of summer school and it was Karen’s birthday. When he got off the bus I wished him a happy birthday. To my surprise, she spontaneously said, “Not happy. No more Mary Ann,” while dramatically wrapping her arms around my waist. For the first and only time, he agreed to her words without showing any visual or imaginary stimuli. I couldn’t have asked for a more wonderful goodbye!
Lessons I learned from Karen:
1. Use the strength and interest of the child to compensate for weak areas. Reading and drawing was his interest. He made her speak with the use of the written word.
2. Make sure the activities are motivating enough to stimulate the formation of cues that work for them. (Karen really liked sweet food.)
3. If a child can read, but cannot initiate speech, it may be helpful to write a series of useful generic sentences that he or she can select and use in a variety of situations.