Global Delays and SL Expectations

By Pam Marshalla

3-year-old-boyI get questions all the time about children with global delays and severe speech-language impairment. The current trend is to call these children “apraxic” and to treat them like other children with motor speech disorders. But this is an incorrect approach that results in confusion over the purpose and direction of therapy. For example, here is a letter I received lately:

I started working with a boy (who is now 3 yrs.) about a year ago. He has delays “across the board”. On average he can follow single-step directions with a direct context in front of him. He randomly produces 2 vowels and 2 consonants. He cannot make any oral or facial movements on command.

I’ve thoroughly enjoyed your book, Becoming Verbal with Childhood Apraxia! Your insights and expertise have truly altered my theories and therapy. In September, I changed my strategy and began using most of the vocal play activities suggested in your book. For the first time he vocalized vowels loudly and giggled.

But now we’ve reached a stalemate. We even took a break from therapy for a month but it didn’t help. I haven’t heard a sound out of him in weeks. The family says that he is making noises and single words at home. You used the word “stagnant” in your book, and I think that’s where we’re at. Do you have any suggestions as to where I might go from here?

If he has delays “across the board,” then he has cognitive impairment and this is not just apraxia. If he is functioning essentially like a one-year-old, then he will only talk as well as a one-year-old. This means that he may have only a few sounds and a word or two that he produces haphazardly.

Although you learned the methods of vocal play in my book on apraxia, don’t think of a child like this as apraxic. Think of him as cognitively impaired.

We have to face the fact that a child cannot speak better than he can comprehend. We have to help parents understand this too. He is talking like a young one-year-old because he functions like a young one-year-old.

The goal is not to “fix” him. The goal is to help him be as communicative as he can be given his cognitive impairment. The goal is to get him to communicate like a young one-year-old. And how does a young one year old communicate? With a few sounds and words and gestures. That’s all he should be able to do right now 🙂

He doesn’t need breaks from therapy because he is stalemating. He needs good consistent therapy over the long haul so he can learn a gradually increasing repertoire of sounds, words, gestures, and other augmentative symbols within his scope of cognition.

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