Q: I have a 3-year-old student with Joubert’s syndrome. Currently we are using sign and an AAC device for communication. She can move her mouth, grunt, say “buh”, and blow a whistle. She grunts more when we model the grunts back to her. Should this continue? And do you have any ideas on improving vowel phonation?

This child is not making vowels because she is not using her voice. Her grunts and productions of periodic “buh” mean that she is just beginning to get the voice to work. Her use of the whistle means that she has some voluntary use of exhalation. But she does not have full command and control of her own voice.

Producing grunts back-and-forth will be good for her. It will teach her to use the little voice she has in playful communication routines. This will act as a foundation for all the rest of her communication. But you have to do something to develop her voice.

The kazoo is the best tool for developing the voice. The kazoo only sounds when the child produces voice into it. There are lots of different kazoos available – some plastic ones are cheep and make almost no sound at all. Some plastic ones cost a few more pennies and make a beautiful resounding sound when voice is produced.

There are more “drastic” measures that can be taken to encourage voice, but see how the kazoo goes first. Get a good plastic kazoo that makes a good sound and teach her to use it. Use the kazoo for a few minutes at a time several times throughout a therapy session. Send one home, or encourage the parents to buy one, so she can practice with it here and there throughout every day.

Teach the child to make voice into the kazoo. Teach her to listen to her voice in it, to play with her voice with it, and to enjoy this play. Teach her to prolong her voice into it. Ultimately teach her to “sing” songs with it, to “count to ten” through it, and so forth.