Following Schuyler

Watching this video and this one too is encouraging to me. The latter is one a few years later. You can tell her verbal speech is better as well. This is why I keep at it and think AAC is so remarkable, it definitely could be better, there's so much more that needs to be done.

I talk different

It's been a long long time since I updated this blog. And come to think of it, I can think of a turning event in October 2008 (my last post)...I just through an IEP meeting for that particular case and can say, whew, and wow, what a (good one!) difference in so many ways.

So far, in my first year as a licensed SLP, I can say that I've got the skills and now it's learning how to communicate clearly to other professionals and parents. I guess it's the business/work part of the job, and goodbye the student days. I realize the extent of forethought on my supervisor's part and the little things that needed to be done in advance to facilitate a process so that steps down the road will go smoothly. I realize how much I need to pick up on that end.

This month: It's funny how I can experience the two very extremes of emotions all at once for the same case. It would appear that the depth of which a case can get tough is very deep and I have not yet touched, or even grazed, bottom. Besides the never ending quest to find the best way to treat, I've also been faced with a) a whole new world of non-verbal communication where conversations take place in subtle (and I mean subtle) little movements of muscles of various parts of the body (the body language so to say), and b) decisions...and c) presentations! I am most nervous about talking to a group of people, esp. when that group of people involved really smart people who are at the top of their field and/or people who are really looking to you for answers cause they don't have many (yet, I hope).

Epiphany

I think I had an epiphany yesterday. After the most challenging schedule to date (the first I really think I said that I couldn't do it) and trying and trying. I finally realized that what I was doing was just trying to please everyone, even at the expense of what I really believe to be right and the best, as truth can be. And I let myself be cornered. That's not what I got myself into this field to do...I came here to stand for my clients. And I don't know everything and never will. Simply saying that I will do my best is not enough for myself to carry on. Rest, take a step back. Rest in Him who gives me wisdom and strength for each day. All I am to do is keep a clear and bright mind. Ready to listen. A mind ready to learn. Eyes that see things as they are, observant, and not the way I am told things might be. Steady heartbeat, easy breathing. And rejoice in today, in the day that the Lord has made. Hands to serve, feet to walk where He leads. A heart to obey.

The day I stop enjoying my work is the day I know I need to stop and reevaluate.

Squinting into the light

I think the best possible session yet happened last week, in a different way. I recently started to see a toddler that presents like an infant. He usually has pretty low affect, very hesitant with unfamiliar people, high anxiety. Had dad play with him, and then I joined in. That worked...he allowed me to touch him, he reached out to touch me, didn't let me guide his movements, but good enough progress for that day! I had him in a bucket swing, with dad pushing him...he started laughing and making the most sounds I've ever seen him produce. And his laughter, giggling was the cutest thing that I've ever heard, and I've heard quite a bit of unique laughter come from many different kids. I felt a connection, a soft spot, a miracle in the making in this child. It was hilarious, it was heart-breaking. Clinically speaking, this session was one of the best, and the best yet in a while, because I got to talk to the parent a lot, gave the what, how and why to help his child's communication skills along. I just hope he's buying into it, so to say...we had a practice session, that made me realize more practice sessions were in order. He is a great dad, very willing and knows his kid too. Personally speaking, this was the best session since I got here, because I saw myself breaking away from I never want to have kids to, yeah, kids are pretty awesome miracles. The laughter, and the way the dad and the child looked at each other was priceless. I think that was the first time since I got to CA that I came up with that thought, and it was authentic, not an attempt to try to convince myself that I would like to have kids one day.

Tears

There has been quite a bit of tears going on these past few weeks. Man, this field is such an emotionally charged area. I've become quite calm and collected when these moments happen, but tears always do make my heart ache. I believe these tears came from frustration and misunderstanding. Frustration because of the limited ability to communicate a message and therefore understood and also limited shaping of a desired outcome (be it speech sound, social skill, etc.). Misunderstanding due to limited ability to receptively grasp verbal cues. As you can probably guess, it's kids that are doing the tearing up. But sometimes I do push the kiddos and I feel sad that they have to be thrown in an adult-like world at such a young age. We make it as child-like as possible, but who are we kidding? No kid should be going from one appointment to the next day after day.

Autism's answer

I was watching a whole range of laughing babies on YouTube with a friend yesterday, and then I thought hey, why not speech therapy? I came across various videos of speechies doing all sorts of sessions, and then came across these ABA autism videos...I think it's from a group of people in Australia. One video (one of many made by this YouTube user) was viewed quite a bit more than others. The parents of the child featured on this video appear to be advocates of ABA therapy, or to say it in other words, their child appeared to benefit from ABA therapy. And yes, I think it's great, but not for everyone and you have to really know what you're doing. My struggle to understand ABA and its place comes up when I see how it is based on behavioral theories, strictly observational...but then see how communication, one of the largest difficulties with autism, is so much more than simple cause-effect...so much to communication is subtle...I see so many kiddos that do benefit from ABA, but then hit a wall...they can say a whole bunch of words and will stop and listen when told, but then don't initiate...that's the huge wall that needs to be climbed. Can ABA teach a child to initiate? Another issue to want to know more about is, how does ABA address language function and use? They can teach language form and content just fine, but to use language in a social context...that is lost. What then is knowing language if you don't use it? It's so hard to untrain rote phrases and the idea that if I say something, I'd get something...communication is so much more than that...it starts with intentionality--attention, just knowing that there a communication partner around, and then goes all the way up to complex conversations still with that other human being. The child may be able to say his/her name and age and I love you with perfect enunciation when asked, but can he/she say it within context, in play with a peer or when given a hug by mum. I learned early on that the phrase 'I love you' is one that parents hope for, and ask a speechie to train in once the child shows signs of verbal communication...and yet, ironically, it's one of the hardest phrases to teach...it has all those higher level phonemes in it, it's a whole 3 words, and it's an abstract concept.

Out of the womb into gloved hands

I had an eval with a little one who was very very delayed...and it was hard cause you actually knew what the cause of the delays were (but then again, it's also frustrating when you don't know what the causes are). But he was a real cutie...and his parents thought he liked me :) That's always helpful in an eval...but he still didn't show me everything he could do, and was quite upset most of the time...all this poking and proding :C Poor baby. Anyhow, this just reminded me of how many kiddos I've come to know that are whisked off into the world of therapy and appointments and doctors since Day 1 of Life. Truth be told, early intervention is great, and the sooner the treatment, most likely the better the chance of 'catching up.' But then I think of the parents who hardly knew a normal childhood for their kids because of all this intervention and the children who never knew a normal day as a child because of all this intervention. You can tell a therapy child a part...at least a therapist can...therapized. I wonder how many parents still remember the one more treatment solution called the miracle. A miracle that will solve everything overnight. After attending meeting after meeting and one search for answers after another, how many still carry that glimpse of hope, that one day, everything will just click, that that unexplainable miracle will occur, just as it does sometimes for people with more concrete medical problems like cancer, etc. I think it's harder to remember because we're usually talking about long-term therapy care, years, probably ending at 9-12 years of age, if it's just an artic issue (or less depending on the delay), and going well into the teens years if it's language/learning disabilities, and probably a life-long process if it's cognitively based (e.g. autism, MR, etc.). I know I forget sometimes, after thinking and working on goals for the next 6 months, 1 year, 2 years, long-term, projected outcome, etc. But then I remember that, s***, we, as a profession, don't know squat about the ins and outs of how things work...we only know what we can see and what science can prove, and what our human experiences tell us. Sure it's a lot, but then again, who knows what the entire picture is like? Who knows if we're missing a critical piece except for time and trial-and-error? I wonder if the future therapist will read back into today's journals and say, oh, yeah, that's just like when they knew there was mass, and mass was made of something, and one day, discovered atoms weren't really the smaller unit of matter. The knowledge that we don't know everything drives me to believe that I need God in my therapy sessions. I need Him to work in the lives of these kids, patients, whether it be healing them, making progress, performing that miracle, or using their lives to teach the people around them...God knows exact what's wrong and how it can be resolved. And with the little we know and can do, He will work His magic and use our gloved hands to do His work.