Q: My four-year-old client is essentially non-verbal. He can say “momma.” He also babbles a little and says a few vowels. I am a first-year therapist and don’t really know how far he can go. And I don’t know what to tell the parents.

We all start out as you are by making guesses from the seat of our pants.

There is no way to know where this client will go at this point.  What I know and what I tell parents: Time will tell.  Perhaps he will fix all this up and be just fine, but perhaps not.  It is his response to therapy that determines how well he will do.

Now, having said that, we must face the fact that he is nonverbal and already four years of age.  That is not a good sign.  My guess is that he is facing a lifetime of speech-language problems.

The best you can do is to try to get a handle on his cognitive skills. His cognitive skills will help determine his future.  If he thinks like a four-year-old, then his potential is much better than if he thinks like a toddler or an infant.  Have the members of his team join information together in order to pinpoint his cognitive age equivalency.  Teach the parents and the team the following: He only can speak as well as he thinks.  Your goal will be to get him to speak as well as he thinks.

In the meantime, I would hit him with every way of stimulating communication that I could.  Use sounds, words, gestures, signs, pictures, objects, and computers.

A child like this often needs multiple means of communication.  Maybe he will say “mamma,” sign “potty,” nod his head to mean “yes,” pick up his cup to request “juice,” and use the computer to name pictures.  None of these should interfere with the others as long as you keep all channels of communication means open.