This advice-column-style blog for SLPs was authored by Pam Marshalla from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.
Q: My toddler-age clients sometimes fuss and cry, even scream. I know this is normal behavior for a little kid, but I am a young therapist with no children of my own yet, and I simply do not know how to handle it. Do you have advice for me?
Sometimes it is the language we use that causes stubborn and uncooperative behavior. Changing our language can improve some of these situations. Let me illustrate with a story. 🙂
I was in a very busy, very visually distracting fabric/crafts store recently and a found myself listening to a screaming child somewhere on the other side of the large room. The screaming went on for at least 30 minutes. Of course I had to investigate.
There were two moms––one with twin babies who were quietly engaged, and another with a baby and a toddler. It was the toddler who was so upset, and he was really upset, the kind of upset you see in children with autism.
But this was not autism. This was a mom who had no clue how to interact with her son in ways that settled him. She used no methods to calm the child, and only kept asking him question after question after question.
“Do you want to sit down?” (She was holding him.) “Are you hungry?” “Do you want to leave the store?” “Do you want a piece of gum?” Question after question after question. He did not answer one as far as I could see, and he just kept crying and screaming.
Here’s how I saw it: Two-year-olds do not have great question comprehension to begin with, they can get overwhelmed easily, they don’t really know what they want when they get like this, and they just scream because the adult somehow is not meeting a need––whatever it is. After a certain amount of time the need is lost and there is just screaming. I have found that kids process virtually nothing when they get this worked up.
I approached them and began my conversation with the two moms by saying, “You gals know you have the hardest job in the world, don’t you?”
I never acted boldly like this in earlier days, but I am grandmother now, and I have cancer. It is too late to wait for the world to get better all by itself. Why not share my four decades of experience with young children with two moms who are just starting out?
I was prepared for the mom to ignore me or to tell me to mind my own business, but instead she said, “Well another woman just came up to us and told us we should leave.” I said, “It takes all kinds.” I put myself on her side first and foremost. Building rapport and all that…
Then I went right for the core of the problem–– the child’s unsettledness. He had to be settled down before anything else could be accomplished, so I set my sights on that. Could I, a complete stranger, settle him within a few minutes in this situation? I had to know. In the sweetest, softest, high-pitched, gentle, soft, lilting grandma voice I could muster I said to him,
“It’s okay… It’s okay… Everything’s okay… Everything’s okay… You’re okay…”
“Your mommy’s here… Your baby’s here… Mommy is holding you… Everything is okay… Everything is going to be okay… Yes… Everything is going to be okay.”
He began to stare at me and he changed his scream to a whimper so he could hear me. He wanted to stop but he needed a little time to wind down. His lips began to shake as he tried to hold it back. He was figuring out how to calm himself. This took 5 minutes.
Why did he respond? One reason is that research shows that babies and little children respond better to high, lilting, baby talk-type speech than they do regular adult speech. Even though the trend now is for adults to speak with children like they are little adults, the research shows what it shows. I simply took that one piece of research and determined if it might help me.
I repeated this process and these words until he completely calmed and began to soften and smile a little. He was distracted from his original demand and had been led from hysteria to serenity.
Of course I did not just walk away because I wanted to see if the mom absorbed any of this. She didn’t, of course. 🙁 My message was too subtle for her in a situation that was too public and too stressful. She had too far to go for her to change right away. I felt so sorry for the boy who had to deal with an excellent mom who simply did not have a clue how to use her language to alter his behavior at the store.
Interestingly I did get to confirm that this mom simply was asking too many questions of this little child, and that this might be the core of the problem. By asking him tons of questions she was asking for cognitive processing and demanding performance instead of engaging in simple conversation.
For example, a few minutes later she was at the cutting table and I was waiting my turn. She sat him on the counter where there were fastened some large numbers. He began to point to the letters and name them. When he got stuck on a letter, he asked her, “What’s that?” Instead of simply naming it, she turned the question back on him, “What’s that one?” He asked her three times in a row and never once did she answer his question. Each time she turned the question back on him as a challenge as if she were testing him. So he started to get fussy again. Wouldn’t you? It would be like living in The Twilight Zone.
Because she also could perceive the fussiness coming again she began to ask more questions, “What do you want? Do you want to sit in the cart?” He gave no reply to these questions yet she tried to force him into the seat anyway. I could see the screams were right under the surface again. I wondered if this was how every day went.
Application to Therapy
Unfortunately, I have witnessed many SLPs do this type of thing, too. Asking too many questions, making too many demands for performance. Maybe it is something I also did as an inexperienced therapist until I figured it out.
The key is to stop doing what you are doing and begin to study the child instead. Watch for subtle hints that he is listening, taking in the language (processing), and able to do what you want him to do. If he shows you once or twice that he cannot or will not do it, you have to alter what YOU are saying and doing.
Working with Parents
When I work with parents I do not give them “activities” or “homework” to do with their toddlers. Instead I teach them to speak to the child in ways that foster HIS attention, HIS processing, and HIS cooperation. It is not about what WE want the child to do. It is about what THE CHILD already is doing. If we adjust our therapy to what the child is doing he can be made to do just about anything for us. We slip the speech-language stimulation into their routines.
This means watching very carefully. I ask myself very practical questions about the child and his parent:
- Does the child speak more when I speak directly to him or when I ignore him?
- Does he speak more when his mom is in the room or when she is in the waiting room?
- Does he speak more when I ask him questions, or when I simply respond to what he says spontaneously?
- Does he speak more when involved in gross motor or in fine motor activities?
- Does he speak more when reading books, playing with toys, interacting with siblings, and so forth?
- Does he speak more when I use baby talk or when I speak to him like a little adult?
- What does the parent do that fosters his output?
- What does the parent do to shut him down?
- What does the parent do to put pressure on him to talk?
- What does the parent do to ease the pressure?
- What does the parent do to get his attention?
- What does the parent do to cause him to withdraw?
For more ideas about how to encourage cooperative participation in very young children, please see my video lecture, Stubborn and Uncooperative, on DVD.