Nathan’s receptive communication skills are excellent. His facial expressions and gestures are very animated, so it’s pretty clear most of the time what he’s trying to tell us. The problem is that he doesn’t choose to SAY anything.
“Do you want some milk?” is met with a beaming smile and a turn to look at the fridge – not a nod of the head or a spoken “yes.” Many children with Down syndrome benefit from incorporating sign language into their communication repertoire, but in our experience signs go over about as well as words. Signing “milk” is also met with a smile and a turn toward the fridge. He gets what he wants, but he doesn’t say (or sign) “milk.”
I read about using Picture Exchange Communication Systems (PECS), so I mentioned it to Nathan’s speech therapist. She and I were in agreement that a true PECS probably isn’t what he needs – they are typically used with autistic children as a way to get them to engage (he has no problem with engagement). Instead, the pictures would be more like an alternative to sign language.
One thing we’ve noticed about Nathan is that he seems to love it when you know what he’s trying to tell you. “Dog” was one of the first and most easily recognizable words he said, so we reinforced it a LOT. As a result, he says “dog” over and over every day, pointing to the dog and waiting for us to say it back. I figured we could try a pseudo-PECS, thinking maybe he’d enjoy another option for getting us to understand him. I started by taking photos of some food items and a few of his favorite toys. I printed them on my crappy HP photo printer and went the poor-man’s laminating route (i.e., clear contact paper).
L, his speech therapist, came to the house yesterday and we decided to try them out. We put Nathan in his highchair to keep him corraled, and I cut up some grapes and put them on a plate on the table out of his reach. Liz handed him the card with the photo of the grapes.
She held out her hand for him to give it to her, which he did. So far so good, and not all that surprising, as he’s had a lot of practice handing things over: “Nathan, can you give me the remote?” and “Nathan, can you give me my phone?” and “Nathan, can you give me back that butcher knife?”
Kidding! Sort of…
Once he handed it over, she exclaimed, “Grapes! Yes, grapes!” (because when you’re working on speech, everything has to be spoken like you are a cheerleader high on a double espresso) and handed him a grape. She’d then place the card back on the highchair tray, somewhat nonchalantly, so as to give him an opportunity to “notice” it and hand it to her, rather than being instructed what to do.
It worked really well…for about five minutes. After that it turned into a rousing game of Fling the Card on the Floor. Rousing in that L and I were forced to rouse ourselves from our comfortable chairs to retrieve the card that he had thrown like a frisbee across the kitchen.
But today is another day.
Yay for PECs. We recently started using them in our household. They have to be pictures of things Ellie really wants (i.e. iPad, puzzles) otherwise she just mouths or throws the PECs. Good luck and keep us posted!
Aw, makes me a little sentimental about those early days, high chairs, sign language, speech therapy. Such a little village we had back then, with everybody in and out of the house, and everyone so wonderful to work with. Now that Cooper is in fourth grade, all of the services happen at school, and that’s nice, too, but those were sweet days. We used cards a little, signing a little and speech emerged slowly but surely. I love that his receptive language is so good and also that he grew tired of the card/grape game! I would tire of it, too!
I had to laugh as I read this post because Nathan and Lacey are the same age and tend to be doing things at the same time.. We also have started the PECS and today was her first day with them. She also enjoyed tossing them and watching us retrieve them. I also got a kick out of the butch knife because I have been there. At this point, Lacey is saying a few words and signing some items but we do alot of the pointing game or I ask her to show Mommy (even though she calls me Daddy) what she wants. What I have learned with Lacey is that she tends to do sign language in her terms and sometimes it takes us a few times before we figure out what she is trying to say to us. The funny part is she assumes when she signs “Please or Eat” that it will happen right then and there. Anyway thanks for the post.I love reading your blog and it’s nice to know I am not the only one out there going through the same stuff.
Andi, I don’t know how you feel about using screens to facilitate communication, but many of my friends in the autism world speak highly of ProLoQuo2Go, an app for the ipod/ipad. Here is the website: http://www.proloquo2go.com/
I don’t know if that lines up with his ST goals or not, but perhaps the technology aspect of it might do more for him than just the cards.
By “do more for him” I mean “get his interest” – not that the app would help his communication more! Hope you know what I mean… my brain cells are tired! 🙂
Thanks for the tip! I am somewhat familiar with ProLoQuo2Go, but I don’t think he’s quite “there” yet with that app. I may look into it further, though. It’s hard to estimate exactly what his abilities are in terms of speech – he communicates really well, and I get the distinct feeling that he could do more than he is willing to do.