:: Speech and Language Therapy at Kestrel Manor School |
by Elizabeth Kruger
Since 1998 I have worked at Kestrel Manor School as a private consultant helping children with
- Delayed development of Speech and Language due to general delayed milestones, brain damage, congenital disorders like in Down's Syndrome; sometimes accompanied with additional behaviour problems like Hyperactivity. This requires intensive cooperation with
the parents and where necessary instruction to helpers.
- Problems in development of Auditory comprehension and Speech and Language in children with hearing disabilities and or auditory Processing disorders (often leading to dyslexia). Especially the class teachers are involved and parents of hard of hearing
children usually attend the sessions once a week.
- Delayed development of communicative behaviour due to problems in emotional interaction like in autism. Behaviour modification will be trained individually, by means of advice to home (training of helpers) in class.
- Speech disorders due to motor disorders like in Cerebral Palsy, which can be accompanied by problems in feeding and swallowing (drooling). Training of augmentative/additional communication is often necessary. Communication between school and home is
essential.
Since our focus at school is INTEGRATION, only children with mild to moderate disorders can be admitted. But we have experience with children with profound hearing loss and severe C.P. who can be well integrated into the classroom situation if there is
provision of hearing aids and sitting/standing equipment. If necessary, REFERAL or ADVICE in these areas is given by me or in cooperation with our occupational therapist.
ADMISSION
In the above cases I am usually requested by the Headmistress to do a screening of the prospective candidate. In case of delay of milestones or learning problems there is cooperation with the Learning Support Coordinator, with whom views are shared. Usually
the Headmistress chairs the meeting with the parents where we professionals work as a team and give our conclusions and advice of the screening.
THERAPY
HEARING-SPEECH-LANGUAGE-COMMUNICATION rehabilitation may be administered by a registered (licensed) paramedic only. This implies the medical diagnosis of the child is confidential and only after consent of the parent information can be shared with others
only for the understanding of and well being of the child.
REFERAL
The therapist may, after consultation with the parents, refer to other medics eg audiologist, ENT doctor, neurologist, paediatrician, and psychiatrist.
Usually after consultation with the Headmistress and the Special Needs Teacher referrals could be made to a clinical psychologist, centre for epilepsy or to support groups for parents (Autism, Down Syndrome, Attention Deficit, Hard of Hearing, C.P.) etc.
KESTREL MANOR has set up it's own SUPPORT GROUP. Parents of children with SPECIAL NEEDS meet and share in an informal setup where respect and confidentiality is the rule. We have presented topics like: balancing your needs with the needs of your child, dreams
and reality, background of hearing disorders, challenging behaviour, etc.
Parents need to give written consent prior to the start of therapy. Frequency varies from three times to once a week, individual or sometimes in a small group. Parents are invited, in some cases requested, to attend hearing/speech/language/communication
therapy. For most children parents' participation is essential for progress!
MULTILINGUAL APPROACH
A full assessment is usually necessary to get a picture of the child's ability to understand and communicate. Assessments are carried out with the help of class teachers. However, a child needing speech therapy but understands (for example) only Gujerati,
Kikuyu or French can still be assessed if a parent or relative is there to translate. We are here to serve the child! For hard of hearing children we make use of additional say/sign method (Makaton) unless the parent prefers a purely oral method and the child
can cope with this.
CASE STUDIES - AUDITORY/SPEECH/LANGUAGE/COMMUNICATION THERAPY
I believe in child-friendly pragmatic therapy that is rooted in the reality of every day life! Adequate communication helps a child to feel adequate, self confident and able to relate to his family and to develop friendships.
Let me present some examples of training of communication and cooperation with our parents and/or teachers of Kestrel Manor School:
Communication is strongly linked to behaviour
A little boy - profound hard-of-hearing and non-speaking - who had terrible temper tantrums, snatching food from his classmates, and kicking them. His teacher had the right impression that he understood non-verbally well but was very frustrated. She invited
me over break time to observe him. I decided to go for a strategy of sharing. Individually, with his mom being present, we had 8 little potato chips to share for Teddy, his mom, himself and me. I taught him the say/signs for give, me, you and wait. After three
sessions and practice at home he was able to offer the chips without snatching them, being reassured he would get his share! The teacher allowed me to have a class discussion on sharing and to explain to the children (between 3 and 4) the implications of being
deaf. Since then the children tap him on the shoulder instead of shouting! Ever since, he offers one chip to every child in his class, saying "me" or pointing "you"! The sign "wait" works magic!
About integration
In a class where an intelligent but small and spastic girl was integrated, some of the children were scared because of her sudden jerky movements. This made the girl very sad, but luckily her class teacher had observed this and invited me to come in during
circle time. I noticed that she was seated wrongly and made her sit cross-legged, shoes off. In this posture she could better control herself. All the children (5 years old) were very interested in our practical demonstration about spasms. And they were
surprised to hear that with help the little girl could say her vowels/sounds! Next day the teacher reported that one of the formerly scared pupils had offered to be the little girl's helper and even sat next to her! His comment: "Now I know that this girl
does not want to be mean; she is only spastic - that's o.k!"
One day later I witnessed: the class sitting in a circle on the grass enjoying a ball game; his comment to the sports teacher: "You have to make her sit like this. And I can make her talk!!" The teacher let him demonstrate, well, lots of noise and
laughter, and this teacher commented: what happened, the fear has gone...!!! Clearly, open explanation works wonders!
Reinforcement of articulation and help of a classmate
A hard-of-hearing girl (R) of 13 years still could not manage to pronounce the "ck" sound and was embarrassed about it, avoiding all "c" and "ck" words. My usual technical manipulation of the tongue seemed not to work, either;
she was very uptight about it. Well, help came: a classmate asked if I could demonstrate her how to pronounce. I called R's mom who commented: "No matter whom you invite please do not give up, she has already tried for one year at her former school!"
Luckily there was some Coca-Cola. For fun the three of us gargled with Coke! All of the sudden the friend grabbed the mirror and I the torch, and - there was the "ck" sound! It was lunchtime and with me as a surprised distant onlooker the girls
ordered two big cokes...they wanted to celebrate with the whole class. I set the condition that R would ask permission herself from the class teacher to end class 5 minutes earlier. Thank you teacher M!
I was very proud to take part in the Coke-party but made sure R would offer a soda 12 times saying: " Coke for you?" The whole class cheered! Next day I found a little note on my desk, a thank you card.
Guess which letter was underlined?
About parental change in attitude
A little boy of almost three, youngest in a very close and warm family. He did not speak but could move his tongue, the soft palate and lips and screamed with a good volume!! My word comprehension test showed reasonable understanding, thus probably normal
hearing. It soon became clear that he liked to dominate all actions, grabbing my cars, throwing tantrums, unable to play or imitate. I tried to very tactfully inform his home about his behaviour. His mother said: "It's worse because my husband spoils him;
he is our only son you know...Please teach him to talk, then he will be o.k..."
To cut the story short: I arranged a meeting with both parents and the headmistress to stress the importance of having the same attitude towards their son and really cooperating. In this case a lot happened, even the father came regularly to attend
speech/communication therapy! After two months the little boy's behavioural changes became apparent, he benefited from say/signs, started to listen better, to express himself in signs and some word/actions. After six months he was speaking in two word
sentences, after one year in four word sentences! There was quite a battle but thanks to the efforts of both parents a great improvement in communication was finally achieved!
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