As a child, I have never ever liked tongue depressors. In fact, I recall as a child the mere presence of them and watching them come towards my mouth would result in severe gagging and occasional regurgitation. Tongue depressors were a norm for me as a child as I was always a casualty of October strep throat. Even as an adult, every September and October…I get a bit of a cold (when I fall off of my healthy eating regime). I did quickly learn, as a youth, to open wider and verbalize to the doctor that I did not require a tongue depressor.
As a speech language pathologist working primarily with children with autism, I get their perspective quite frequently. For those verbal, vocal, and nonverbal…I understand that often times you just don’t want to share, you just want to relax and not work, and you just don’t want the tongue depressor. I have been fortunate to attend awesome schools and have extraordinary mentor SLPs in my young career. These SLPs pushed me to the limits and today I am forever grateful. One in particular, in the North surburbs of Chicago (Andrea, SLP), taught me how to reduce use of tongue depressors, horns, and the like to elicit speech and use real things. Andrea was the district consultant for Assistive Technology for children with Intensive Learning Needs in this special education school district. First day, I was given assignments and told that my job was to make children better…get going. She did not hold my hand at all (very different from the training and supervision a lot of new SLPs now want…is this generational?!? hmmm)!
I was taught to reimagine how I could elicit the target sounds and integrate Anatomy, Nerve Function, Physiology with Real food/real objects. Real: items that are part of the child’s everyday world or exposure and accessible to families. I quickly learned that the Twizzler wrapped in gauze (for weight) and dipped in applesauce (or any other flavor) can give a wonderful impact for placement cues for lingual back sounds (k, g). I utilize P.R.O.M.P.T. and other tactile cues to support…but let’s face it, food is much more appealing and welcoming when we think of objects that should come towards our face and mouth.
This week I have been working with a youngster trying to achieve bilabial placement for the production to [m]. We have some real coordination and placement issues. I pulled out a trusty cracker. and we held it with both lips at the place where the lips should be meeting for the production of the sound. We did not over place this food item, but quickly transferred that placement cue to the production of the sound. And he’s got it.
Social Emotional Learning is important when it comes to supporting motor speech disorders. He likes crackers. From a behavior analysis standpoint, I paired the “like” with the goal I am trying to achieve, and now I am shaping speech. Communication connects people. The tools we use to elicit these motor patterns, oral motor placement cues, must also support the transference of the connection to the desired movement. Yes it takes thought and a great deal of time, especially if the youngster has aversions to textures, tastes, and the like.
For those that are more Finicky Eaters, it is a wonderfully messy task to play with food from the feet up. In Speech Therapy, Occupational Therapy, and ABA Therapy we are rolling our car toys over crackers and pudding, playing in foam, steping on fruit snacks and then moving up to the mouth. Motor begats motor. Sensory Motor processing supports speech therapy. Both are important. This week I have worked more than a sweat in treating children and loving every minute of it. I just wanted to thank a school SLP who was my graduate mentor for a full semester while at Northwestern because I went back to the basics.