Thursday, June 28, 2007

Speaking More of Speaking More

Sorry for the wait. I would have come up with this second post sooner, but I trusted Blogger to hold on to my draft version and, of course, Blogger ate it. I hope it was tasty, Blogger! (If you don't know what I am talking about, then you might not have read Part One, where I went over MK's checkered linguistic past.)

The Intervention

So, what is different now? First of all, we got a new Speech and Language Pathologist (SLP). The SLPs that MK has seen over the past five years have generally appeared to be at a loss as to what to do with MK. We sought out the ones who were specialized in communications, and not speech production, and we even worked with one who was the well-published head of a university department, but none of them really seemed to have any more idea of how to help MK than we did. They flipped between play therapy and grammar drills with no noticeable effect. We found them useful as sounding boards for our own specific questions about things like how to respond to echolalia, and as book recommenders, but that was about it.

The new SLP is different. Some of her core training comes from Reuven Feuerstein, who she studied under in Israel. Her day job (MK has been seeing her privately on Sundays) is as an SLP in a school for developmentally disabled kids that is entirely based on the Feuerstein approach. Feuerstein's big idea is Structural Cognitive Modifiability, which basically states that you can not only teach thinking, but you can actually permanently change the way the mind processes information as a result. Another set of techniques she uses come from Naci Bell, who came up with Visualizing Verbalizing. This is a teaching technique aimed at ASD kids, in which they are taught to visualize events as scenes, with an emphasis on gestalt, or seeing the main idea in context. As they get better at visualizing in a coherent way, they are encouraged to draw on their visualization when verbalizing.

(I can't help but notice the similarities between these techniques and what I gather is going on with Brain Engineering, which is what MothersVox from Autism's Edges describes in her post, Trying Something New. Sweet M is likewise showing great progress, which warms the cockles of my stony heart, in part because, ever since I started reading Autism's Edges I've felt there were similarities between Sweet M and MK.)

With the new SLP the sessions are only one hour long, once a week, but she packs a lot in.

First they do Feuerstein "instruments," which are all about manipulating purely visual information. MK has just finished working on an instrument that involved five rows of pictures. Based on the pattern of pictures in each row, you he has to deduce, by inference, which picture from a separate pool of pictures belonged to each row. In addition, at the end, he has to say whether any of pictures in the pool did not, in fact, belong to any of the rows. So this involves holding five inferred answers in memory and comparing them to the pool to make a secondary inference. They do this many times, and go faster and faster each time. They do this for about ten of fifteen minutes.

Then they move to listening to short stories and identifying the main idea. They started off with identifying a main idea that was actually stated in the text, but as soon as MK had mastered the inference instrument described above, she switched him to a different set of stories in which he had to identify a main idea that was not actually included in the story but could be deduced by – you guessed it – inference. This is another ten of fifteen minutes for ten short stories.

Next they've been running though the who, what, when, where, why, how questions, with MK listening to statements and deciding which kind of WH question the statements correspond to. That's short, probably less than five minutes.

Then it's time for Visualizing Verbalizing. MK gets a picture that the SLP can't see. MK then has to describe it to the SLP. In the end, the SLP is going to describe the picture back to MK, and then they will look at it together, so MK understands that he has to make the SLP understand the picture fully. It's interesting to see how MK has progressed with this. For example, at first, when the SLP asked MK to tell her about the colors, he used to say, "I see back and yellow and green and red and brown…" Now, when she asks him that question, he says, "The boy's jacket is brown and his mittens are yellow…" What is even more interesting is the way that, after a couple of months of doing the short stories described above, when MK had gotten really good at naming the main idea, the SLP gave him his Visualizing Verbalizing picture card and said – you guessed it again – tell me the main idea.

I'm sure you are getting tired just reading this, but there is more. Now it's idiom time. They do these in sets of 50, building up 10 at a time, using cards. She starts off by getting him to guess the meaning from three possible choices. Usually that's not hard for MK as two of the choices are always close to the literal meaning, so the third answer is obviously right according to – need I say it – inference. For example, "When you tell someone to get off their high horse you want them to: a) get down from a high place; b) stop acting like a snob; c) put their horse in the stable." If you've got your inference working, you can spot the right answered without even knowing the words "snob" or "stable."

Last they usually play a board game like "Semantically Speaking," in which every turn requires answers about more idioms or homophones.

This all sounds kind of grueling written out like this, by MK loves it. He bounces out of that room just glowing with success. That is probably mostly because the SLP makes sure that the level and speed of advancement is adjusted so that MK gets 80 to 90% right answers. What is more, she responds to his answers in such a way that he perceives himself as getting 90 to 99% right answers.

The Changes

I was just talking to MK's pediatrician (who I must say is a real rock -- he sets up appointments every couple of months, just to talk to me, to listen to what is going on, to encourage me to be a pain in the butt at school and offer to write any letters that might be helpful) and I told him that Sasha was making incredible progress with language recently and also we are really impressed by his SLP, but we can't be sure that the two are connected.

That just the way it is with these things. Someone, and I am pretty sure it was someone on Autism Hub (would it ever be nice if all the archives of all of the blogs on Austim Hub were searchable from some magic Google page) wrote this really good piece on evaluating interventions. They said that everyone -- ND, DT, whatever – develops in fits and starts. There are periods where they rush forward, and periods where they appear to go backwards. This is the way the human organism works. And if you happen to start a new intervention at the same time as your kid is surging forward, the intervention will appear to be working. If you start the same intervention when they are slowing down or "regressing," it may appear to be useless or worse. What is more, we can often have two or three different interventions going on at one time, and some things are going to be more effective in combination. So I would be very reluctant to say MK's new SLP is causing MK's linguistic progress, but if she's not at least contributing, I'd be surprised.

So here's what going on. A couple of months back MK started this massive surge in vocabulary. He just started using new words and expressions in every other sentence. The big change was that he was doing it deliberately and enjoying it. He suddenly found that he could retrieve all these words and choose to use them, on the fly, just for fun. Then, all of a sudden, we got humor. MK used to say silly things for a giggle, but they were generally non-sequiturs. These new jokes made sense, had timing and were actually funny. Just as I was getting used to that, he started in with the puns. That's where we are now. Puns right left and center. A year ago, just hearing puns confused him and, if they were explained to him, they actually made him cry (MK does not like cognitive dissonance). Now he is playing with every word that comes along. The other day we were walking past Home Depot and there were all these bags of potting soil sitting out on the road. "Let's steal some," I joked. "No," shot back MK, "they're dirt cheap anyway." – Pun and idiom in one fell swoop!

Where we live, there is a mountain with lights on it that look like a letter M. I joke that it stands for my first name. MK says, "Yeah, it's your signal because you're Superman. No, you should be Super-Mar," those being the first three letters of my name. Then he goes on, "But it would be more fun if you were Super-Mars!" – a slight pause – "You know Mars has another meaning? That's the name of a month in French. It means March." You can just hear the neurons crackling!

And that is not all. MK has never been able to narrate an event that happened in real life. For some reason, he can recount entire novels, giving the chapter numbers as he goes along and reproducing the dialog, but the question, "What did you do in school today?" has always been answered by "I don't know." Now, all of a sudden, it's, "Two periods of Language Arts, one period of math, PE and an assembly. We were doing parameters and areas in math. In Language Arts I had to compare Iceland and Greenland (with prompting, details of the comparison emerge). The assembly was boring because they were playing loud music and I didn't like it." This is completely uncharted territory for us. In fact, I just got through demanding a home-school communication book at MK IEP meeting, because there was no other way for us to know what happens at school. Things have changed.

And then there is sudden capacity to understand and talk about systems in the real world. About a year ago, we saw a bunch of log rafts on the river, and I asked MK where he thought they were going. "I don't know," he answered, "to a factory." Wow! I was impressed. MK didn't usually show that kind of insight. "And what do you think they are going to make the logs into, at the factory?" I asked. "I don't know," MK replied. "Trees?"

It's harder to give short examples of general comprehension, but compare that to the conversation we had recently when I mentioned that it was possible for babies to be born at home. "So what happens," he asked, "Does the doctor come to the house?" And when I told him about midwives, he wanted to know, "What about the machines? Does the midwife bring the machines from the hospital?" There is a whole lot of inferring going on!


Niksmom said...

WOW! WOW! WOW! That was **totally** worth waiting to read about. Sounds like MK must be finding his groove with lanaguage.

Thanks, too, for the summary of the developmental bit from the Hub. I needed that right now as we are going through some of those fits and starts with Nik. So glad I found your blog!

mothersvox said...

Wow again! That is so interesting . . . Sounds similar in terms of starting with the visuals . . . I will post in more detail soon about the brain engineering work . . . It seems to really work, though I have been traveling so much for work that we have lost about two weeks . . .

Daisy said...

Wow! The success is so exciting. I kept thinking, as you described the testing, what would the SPLs do to assess a child who is also blind?

Steve D said...

Hi VAB -
Ummm, I tagged you.
Check here:

seanjsweeney said...

Hi there I am an SLP and was interested in your comments about V/V. I really like that program. Your SLP might consider using some of the products from MindWing, such as the Story Grammar Marker, that really help with narrative skills. You can see them at

(I don't work for them!)