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Early Intervention Speech Therapy

Different Paths to Communication, Part 2

Published March 13, 2009 11:11 AM by Stephanie Bruno-Dowling
Today's post is a continuation of the one written earlier this week. In that post I highlighted the four main tools SLPs use to help a nonverbal child become a verbal child. Just to recap, the four methods are:
  1. Sign Language
  2. Picture Communication
  3. Phonemic Cueing/Articulation Therapy
  4. Augmentative Communication

Of course, the long-term goal, especially in early intervention, is to teach the child to TALK. As we know, there are exceptions to that statement and there are children who may never speak if affected by a number of disabilities, syndromes and/or profound neurological damage. However, I believe that as long as there is hope, and especially while the child is young, the goal should be to teach the child to be as verbal as possible.

I like to think of the four methods listed above as vehicles used to carry a child over a bridge. When they enter EI, they are on one side of the bridge—the nonverbal side. Our job is to help them travel over the troubled waters to a new land of complete and effective communication. This is the visual I share time and again with families and it seems to help them understand and support the process of speech therapy.

Below are some additional tips on how to determine what type of communication system to use when assessing and treating a child in EI:

  • You may want to try several modes of communication—every child will respond differently to each mode and sometimes it is difficult to predict how they will respond. For example, some children really take to sign language and then start talking more shortly afterward.
  • Introduce pictures informally at first and see how they respond (i.e. books, flash cards, music). If the child responds positively to these things, picture communication may be a good option.
  • Remember you may not need to CHOOSE any one mode of communication... simply empowering the family to foster good communication in the home may be enough.
  • Oral motor should be used when needed and when appropriate to supplement additional communication therapy.
  • Eye contact and the ability to focus and engage are vital for communication. If these key components are missing, the child may not be cognitively ready for a full communication system— therefore the focus may need to be on helping the child attend to tasks before introducing a detailed communication system.
  • If the child has been diagnosed with or shows signs of verbal apraxia, the tools needed may be different and therapy more intense. Please read my two-part interview with Sharon Gretz, MEd, the founder executive director of the Childhood Apraxia of Speech Association of North America (CASANA), where she addresses the most effective ways to address apraxia in therapy.

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About this Blog


    Stephanie Bruno Dowling, M.S. CCC-SLP
    Occupation: Speech-Language Pathologist
    Setting: Early Intervention in Delaware County, PA
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