As a pediatric speech language pathologist in Manhattan, I have worked with many children over the past 20 years. I have grown so much in that time—personally and professionally as well as emotionally– and reflecting on this growth has caused me to consider how my therapeutic interactions have shaped my beliefs.
Every therapist gets an amazing training in school, but the education that I have learned through experience is what generally guides my instinct. I noticed that I started seeing patterns as I was in the field longer and the children I was treating began to get “older”. We are generally taught that the brain is most elastic from birth – 3years and the 3-5yr period is important as well. But somewhere along the line…there is this implicit feeling that if certain things are not learned—then they won’t be learned, ever. Although no one ever really talked about it—there was definitely this feeling that a glass ceiling hovered over our client’s heads and encroached relatively quickly as they got older.
As I entered my 2nd decade in this field and was fortunate enough to still be in contact with some of my first clients, I began to realize these misconceptions around development and learning are JUST NOT TRUE. I saw my clients mature and develop and put to bed those stereotypes that we all have subscribed to at some point (consciously or sub-consciously).
Here are the top 3 things I have learned:
1. PRESUME INTELLIGENCE
The non-verbal and minimally verbal students who struggle to communicate, are in many instances, difficult to fully assess. There are typically co-morbid conditions present (Attention Deficit Disorder/Childhood Apraxia of Speech/Autism Spectrum Disorder) and as a diagnostician, getting the full scope of their receptive understanding can be a challenge. This does not mean the student who is quiet or does not verbalize that frequently, does not understand. In fact, this may be the student who is taking it ALL in and has such a grasp on his environment that even the most seasoned clinician would find remarkable. In fact, just the other day at the Atlas Foundation for Autism, where I work as the Clinical Coordinator, I was in utter shock (like hair on my arms raised kind of shock) when a non-verbal student who uses an AAC device to communicate with prompting, uttered “Good Morning” to his teacher in response to her initial greeting. Every teacher and staff member present just stopped and marveled at the AWESOME sound of this student’s voice and the appropriateness of the response.
In my daily practice, what does it mean to presume intelligence? I do not speak about the student in front of them. Ever. I take the parent and go elsewhere to have a discussion or do it via phone/email later. Also, I do not assume; I take the extra time to get a thorough clinical impression.
2. ALL BEHAVIOR IS COMMUNICATIVE
I have been lucky enough to work with some of the best behavioral therapists in the city as well as many talented allied health professionals and everyone has a viewpoint on behavior. “Challenging” behaviors in a therapy session can be frustrating. In the moment, it can be hard to consider what the preceding event or “antecedent” was—possibly because the “behavior” was a toy thrust in your face and you are IN PAIN. Taking a behavior at face value can be hard because we all have that human trait known as an EGO, and many times when a student presents with a “behavior”, our ego is immediately bruised and is the first to respond “WHO DO YOU THINK YOU ARE?!? YOU DON’T THROW TOYS AT ME!!!” An hour later, you may be able to sit down and think it through and remember that you were rolling around with your dog moments before you worked with your student (who is ALLERGIC to dogs!) and you were working on a new task that your student doesn’t fully understand yet—the perfect combination to generate a behavioral response. You consider this particular student and realize he does not have the capacity to say, “Excuse me, I am not feeling so well right now, it feels like I am having an allergic reaction and this activity is making my head spin—can I have a break?!?” SOOOOO—how does the student get this much-needed break? By throwing a toy in your face. In most instances, if we can remove ourselves from the situation and look at it objectively, we begin to realize that most of the difficult “behaviors” our students engage in are really a way to communicate a need, want, desire, etc. It does not make the behavior OK—but when you approach a therapeutic session, or even life, with this reframe, it really can be a game changer.
3. LEARNING IS LIFELONG
I will never forget the day a mom of a student I work with exclaimed, “Luke is reading!” WHAATTTT??????? Luke was just shy of his 15th birthday and he was reading fluently—not to mention writing! It was AMAZING!! Over the years, I have witnessed many such events. I have seen students (of all profiles) learn to read and write after 15 yrs. of age. I have seen students who primarily use a device (IPad) to communicate—use expressive speech when it was least expected. I have even witnessed an 18-year-old male, with a fairly robust receptive vocabulary, use expressive speech to communicate for the first time and a non-verbal student (whose receptive understanding I was not fully sure of), communicate with me, via typing, that he longed to have a girlfriend! I could go on—but I think you get the point. Don’t give up! Don’t assume your child is not learning anymore. Don’t let anyone tell you otherwise. Anything and everything are possible.