1. For each of the following five case studies, give the following information:
a. Recommend a piece of AAC (Augmentative and Alternative Communication) technology that specifically aligns with the needs of the individual in that case study to improve their communicative
effectiveness. You will then explain why your choice of technology would assist that person in communicating.
b. Give an example of a communication method a teacher might use with this person that takes into account their disability’s characteristics. Then, indicate which of the three categories –
language proficiency, cultural differences, or linguistic differences – your communication method relates. Finally, explain why you chose that method.
Lilly
Reasons for referral
Lilly was referred for speech therapy by her parents and school due to concerns over her difficulties pronouncing certain speech sounds. These difficulties were making it hard for others,
especially those outside her family, to understand Lilly. Lilly had suffered from hearing loss and had grommets inserted at age 3.
As children develop their speech sounds they progress through a certain number of ‘speech processes’ which are essentially ‘normal error’. These resolve naturally by certain ages. However, for many
reasons, including hearing loss, some children have delayed speech development and benefit from speech therapy to resolve this.
Assessment
Lilly was seen for an initial assessment to look at her current speech profile and to provide information as to whether intervention was needed and what kind. Assessment results revealed that
Lilly had difficulties with the ‘t’ and ‘d’ sounds and was replacing these with ‘k’ and ‘g’ so ‘letter’ was ‘lekker’ and ‘bed’ was ‘beg’. This process is called ‘backing’ whereby sounds that
should be produced at the front of the mouth are produced at the back instead. This is not a process found in typically developing speech and therefore was targeted in therapy.
Lilly also showed difficulties with other early developing sounds ‘s’ and ‘v’. These sounds that are produced with a long flow of air were being cut short so ‘f’ was ‘p’ -therefore ‘fish’ was
‘pish.’ This process is called stopping which is expected to have resolved by the age of 3 years and so was also targeted in therapy.
Therapy
Lilly was seen for individual therapy sessions. The sessions focused on developing Lilly’s awareness and production of the above speech sounds and processes. For each sound visual materials were
used to help Lilly learn them including a picture card with the grapheme and cued articulation (similar to a gesture/sign). Before asking Lilly to produce any of the sounds she had difficulties
with, Lilly was provided with many opportunities to hear these sounds being produced correctly (this is known as auditory bombardment). Lilly then completed tasks in which she had to discriminate
between a target sound e.g. ‘t’ and the sound that she replaced it with e.g. ‘k’ to ensure she could tell the two apart.
Therapy then moved on to production. How each of the sounds is produced in the mouth was explained to Lilly using words accompanied by diagrams. The first step was to get Lilly to have a go at
producing her new sounds in isolation (e.g. ‘t’) and then combined with a vowel (e.g. ‘tee’). The next steps were to practice new sounds at the start of words (e.g. ‘tiger’), followed by the end of
words (e.g.’boat’) and then in the middle of words (e.g. ‘bottle’) and finally onto sentences. These were incorporated into fun games. Parents and school staff were given activities to practice in
between weekly sessions and advise on how to support Lilly’s new speech sounds in natural conversations was also given, for example if Lilly made an error with one of her new speech sounds, others
were to provide her with options e.g. is it a ‘kiger’ or a ‘tiger,’ emphasizing the correct sound.
Sophie
Sophie was referred by her preschool teacher at age five years. Outside-the-family listeners were understanding about 50 per cent of what she said, well below the norm of 100 per cent
understandable speech by age four years. Sophie was making mistakes on the early developing speech sounds “k, g, f, as well as others. Her mistakes were errors of substitution, so that she used a
“p” for “f,” a “t” for “k,” and a “d” for “g.” Sophie was making these mistakes in all parts of words, so that “fun” was “pun,” ‘office” was ‘opice,” and “leaf” was “leap.” Early developing means
these consonants are mastered in conversation by most children before the age of 4 years; speech intelligibility is adversely affected f they are in error past that age. Sophie also made mistakes
on consonants “r” and “th”. These, however, are later -developing sounds and we decided not to focus on them immediately because research indicates some children at age five will learn these on
their own.
Albert
When I met him he was seven years old, in second grade, and getting some speech therapy at his public school. Albert was a late talker; his mother said he was not really putting words together
until he was age three. When he did begin talking, his sentences were immature-sounding and even in kindergarten and first and second grade he was making below-age-level grammar mistakes (referring
to females and males both with the pronoun “he;” dropping the “is” verb occasionally; and mis-producing past tenses of verbs, especially the irregular verbs like “go-went.” He was also having
difficulty with syntax (word order), especially question syntax so that when he asked me “how that get in there,” he meant” how did that get in there” Albert also had difficulty with precisely
expressing his thoughts in specific words and phrases. This seemed to reflect problems with word retrieval, choosing just exactly the word needed to express his intent, and it also included
difficulty organizing his thoughts into sentences that exactly expressed his intent. For example, one day he was describing a birthday party he had attended and he spoke of the birthday boy’s
mother putting “firesticks” on the “birthday food thing.” When he came to a word or phrase that was hard to retrieve, he substituted a vague word or series of words that negatively affected
listener understanding. Albert was also experiencing difficulty in school with reading comprehension and expression as well as writing, and spelling.
Henry
Henry had been stuttering since age five when I met him. He had tried speech therapy several times, first in elementary school and then at his university. Because of his years as a person who
stutters and because of irrefutable brain imaging evidence that there are brain structure and function differences in adults who stutter, Henry was treated as someone in whom the stuttering would
probably not go away.
Henry, like many adults who have stuttered for years, had developed compensatory methods. He was very adept at switching words to a synonym if he thought he was going to stutter. Sometimes
inserting “uh” into his sentences helped him say words and he was quite good at pretending these “uh” sounds were thought pauses. The problem with all these methods is that they reinforce avoiding
and hiding stuttering. Very often, bringing stuttering out into the open, studying it, talking about it, and even stuttering on purpose (called voluntary stuttering) helps to reduce the anxiety
associated with trying to hide the stuttering, and the stuttering itself decreases.
Jasmine
Apraxia of speech is a neurological difference resulting in difficulty planning and executing the movements necessary for speech. It is a disorder of movement. The brain usually knows what it wants
to say but the message gets twisted on its way from the brain to the muscles of the articulation structures (lips, tongue, soft palate). Typically, children with childhood apraxia of speech will be
delayed in talking because it is so difficult to put sounds and syllables together. When they do talk, these children will often use very short sentences, will omit many initial consonants,
especially “y, l, r,” and may, if asked to say the same word three times in a row, say it differently each time. Children with apraxia of speech are sometimes very creative as two year olds,
developing numerous intricate gestures to refer to specific objects, needs, and situations.
When I met Jasmine, she was using just a few single words but had many gestures which she used to communicate. She also used noises like animal and vehicle sounds. She was initially very reluctant
to attempt imitation of sounds and words which is very typical. It is my experience that these children know early on that talking is hard and will try to avoid it.
My experience with children with apraxia of speech is that they need to gain confidence that when they make the extra-ordinary effort required to produce an understandable word, they will be
rewarded by being understood. Progress for these children requires many, many repetitions of functional words. As they do so, many seem to gain an understanding and acceptance of the extra effort
required to produce understandable words.
