Q: I am serving a student with moderate acquired dysarthria impacting speech intelligibility due to impaired respiration, phonation, coordination, speech rate and articulatory precision. She is six-years old and her accident was 2 years ago. She can follow directions well and is aware that she sounds different than her peers. The most obvious speech quality is the slow rate, pausing, and unnatural phrasing. Her peers tend to ignore her when she is speaking because these qualities make her sound so different. I would really like to make an impact on improving her speech and so would appreciate any advice you have to give in treating this.

Thank you for serving this student. These stories make my heart break…

If I am reading your email correctly, it sounds like slow rate is the main issue that interferes with general communication. I doubt that that will change very much for a while.

We could look at this from a speech movement perspective, but this time let’s look at it from a communication perspective. The thing to do, in my view, would be to rotate “normal” kids into therapy with her.  Teach THEM how to listen to her and how to listen patiently. Teach them to tolerate and even enjoy and celebrate her differences.

Say things to them in very straightforward ways (and you will have to get permission to do this from the client’s parents…).  Say things to the models over time like:

• You can talk really well, can’t you?… And really fast…  But Susie is just learning to talk again. Did you know that? Did you know that she had an accident and is learning how to talk all over again?
•  That’s right. She is learning all over again.  And because of that she talks very slowly… Did you notice that?  Did you notice that she talks really slowly?
• Yea… I noticed that too. … I find it hard to wait for her to speak…. Do you?…Do you find it hard to wait for her to get the whole thing out?… What do you do to help you wait?…. What else could you do?…
• Do you think you could help me teach other kids to do this?… Because Susie wants to talk to you guys, but she is just learning how to again…

That would be my approach with peers and siblings. Develop compassion and teach them how to do this––how to take a breath in order to wait, how to zipper their own lips closed while waiting, how to try not to think about what they want to say and listen to what she is saying instead, etc.

Communication is a two-way street and sometimes we have to work with the other side.