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.

Empathy

I was in a consult today whereby the parents were told they could expect their child to be in therapy for many years. It wasn't a quick fix, and the road ahead was long. Severe disorder, may not be completely resolved. And that was the truth as far as today could tell. And the mum started to cry. This is not the first time I've been involved in a case whereby a less than preferred prognosis was given and there were tears, but at some degree this was my first case whereby I play a significant role. I feel that responsibility as least. Today was preceded by the few years in which this battle has been fought, since birth. And I recently joined in. It's frustrating not being able to provide a cure. It's even more frustrating for the child, frustrating for a parent not being able to solve and alleviate the child's frustration. And even more frustrating knowing that the child understand what's wrong and is constantly affected by it at such an early age.

And then I got an email that a colleague's mum had passed away. A colleague not so far off in age from my own. I realized that times have indeed changed. It used to be grandparents that passed away, now it's parents. Friends don't live with their parents, they live on their own, independent decision makers.

On a separate note along the same line

I have a pretty tricky client...simple put, really tough. I guess I didn't put two and two together when I decided to work at a sensory integration clinic. Anyhow, one of my more sensory kids, the ones that don't know what input they need and you have to ease in the input without them running away, stayed with me for 15 minutes without being distracted internally or externally. Whew...AND *drum roll* imaginative play came out today!!!! That is super super exciting to see, I have not seen it in his age group but once or twice here since I started, all my clients being pretty low. And once I got the play initiated, gave a starter idea, he took it and ran with it...granted, it was just one more main idea added, but that is GENIUS! I am sooo proud of him. And I got the look on his dad's face when he did it, pure joy :) This is the child that ran the opposite way when he saw me...we'll see how this goes, hopefully continue in the right direction. And perhaps it's the hardest ones in the beginning that gives you as the professional the most satisfaction in the end. We'll see.

Bright sunshiney day

Yesterday I got news that a parent said she felt that her child had a connection with her, and that "I got her." That's one of the biggest compliments I could get from a parent, and that totally made my day, my week, my month, actually, the first positive affirmation deal since I started working. And it came the day after I thought I couldn't do this anymore, that I wasn't up to par, that I just was hitting the ceiling again and again and couldn't learn from my mistakes anymore, and just plain making mistakes. That compliment lifted me up again. And I know God knew I was at the end of my rope and needed something. I cry out to my God and He answers me. In all my sins, despite all my shortcomings.

I wonder what my role is in this field. The way things are going doesn't necessarily reflect how I thought things would be. Since the day I left Calvin, things have gone differently that I imagined it to be. I know I want to specialize. In what, I'm not sure...what I thought I would be, I don't see it coming anymore...maybe it will come back.

Vesti

I sat on the spinning wheel (or whatever it's called) today with a client, thinking, if so many like to be spun around, why not try it myself...bad baaad idea...I got so dizzy I felt sick..but managed to remain composed and did not throw up. The room continued to spin while the wheel stopped and my head is still spinning 5 hours post-event. Ugh. I have a highly sensitive vestibular system...since coming to know sensory intergration methods...I have come to find reasons why I get so sick of sugar, fast movements and other oddities I have that other people don't understand why I don't like theme parks like Six Flags and other jerky rides.

PROMPT

PROMPT is a technique used to treat motor speech disorders, mostly heard when it comes to childhood apraxia of speech, which does not always qualify for services under biling codes, therefore you simply bill it under 'apraxia.' Anyhow, I observe that many more children that I see under age 3 are showing signs of apraxia (to begin with, they aren't vocal...so it takes a while to get them to vocalize, be spontaneous in vocalizations and words, and then figure, oh, now that I see your mouth moving, something's amiss...or rather, extraneous). The other biggie I'm seeing is grading of the articulators...it's kinda wondrous actually...why is almost every child I see having some grading difficulty? What causes it? Low tone? What low tone, if everything else in typical? That is the question I can't answer now and am itching to get an answer.
But PROMPT--from an academic standpoint (meaning the 'talk' in grad school and below), PROMPT is not viewed as very happily...of course there is not prefect method, and PROMPT is always referred to as 'having it's own place, which tends to be very narrow and specific.' And they don't tell you beyond, 'it's one method used to treat apraxia.' True...in a way. But now that I'm getting to know the theory and principles of PROMPT better, things are clicking and making a lot more sense...the different way speech movements are viewed by PROMPT is refreshing and to me, creates a clearer way of observation and systematic treatment, an explanation why errors happen in certain patterns. And especially when the child is not cognitively ready for verbal cues and attending long enough for visual cues consistently. It's also a way to be able to diagnose...haha...ok, I mean, screen...diagnose is such a D-word I am finding out.
In the speech as a job world, PROMPT seems to be either loved or rejected. One reason why not all like it is because the carryover, and dependence on prompts is difficult to eliminate over time. This is something I have yet to take a closer look at simply because 1)I am not PROMPT-certified (yet), and 2)I've only started working a few months, and those children that have been PROMPTed have not shown significant dependence on tactile cues over time, I do see the 'weaning off.' But then again, I'm working with really great clinicians. And although they use PROMPT, they also use best practice...whatever works best for the child. There's a beginning point where PROMPT would be most effective, and then an ending point, which is always gradual in the majority of cases.

The deal with all these techniques is, in grad school, you hear opinion, professional opinion of why they aren't best practice, and then you get out into the 'real world' and people are using these techniques (depending on setting I guess)...and you wonder if what you learnt in grad school is any good...sigh...I like school...you get to debate all these ideas and concepts and come up with crazy new ideas and people are willing to talk about them...and at work, it's just plain crazy, why would you want to think of that when it's not helpful to any specific kid?

Another biggie in grad school that I learnt concerned oral motor exercises...they are for strengthening purposes...therefore, the problem has to be weakness...and never never never use oral motor in Tom, Dick or Harry case...in the case of dysarthria, only flaccid dysarthria would qualify. And no doubt, O-M exercises are a hot topic now and generally, viewed as overdone. And now (please don't look at me with disappointment, prof) but I am doing them to children who are not vocal and think can benefit from tactile input (oral motor) to create awareness or articulators...the touchpoints for speech. And these kiddos have a general low to no body awareness or environmental awareness...like children with autistic tendencies, and those who keep crashing into walls and don't feel pain at normal thresholds. And it seems to work, or maybe not...they get PT and OT and all this other good input from peers and whatnot around them. So...but they's better communicators!

AAARGUHHH

I feel overwhelmed...part of me is relieved that I am finally feeling overwhelmed...I think I'm suppose to feel that way as part of the process of getting inducted into the world of working professionals. So, now that I am, ARRRRRRGUH! It all came crashing down like waves breaking over my head...and thoughts swam and crammed into a space too small to contain them all...names, names, names, too many names, and along with them histories and points to remember, allergies, developmental levels, family members, family dynamics, funding sources, reports to do, hobbies, therapies, schedules, lives, lives, lives...too many and too complex, twisting and wrapping around every which way. I hope I can take a deep breath, close my eyes, fix my mind on order, and pull out a name, focus on it, finish what needs to be done that associated with that name, and move on to the next, calmly, composely. Neat little boxes and defined lines are simply delightful right now.

I had piggie tails for hair today. Halloween, staff were required to dress up as part of the festivities...my suite's theme was cowgirls...since I lacked the cowboy hat, boots, shirt, belt and accessories, I figured I could do something to the hair. I borrowed the bandanna. A parent asked me what I thought of bottle feeding and transitioning from it...I said what I thought was correct by evidence based practice standards and added my own opinion based on what I saw in practice...the scary part is he said, "It's nice to know a professional's opinion on things, it gives reassurance and...professional (implying trustworthy)." Was what I said right? Was it true? I guess my deal is no one really takes me seriously most of the time, and my opinion never really counted all that much...and now it does...yikes! I am careful in what I say all the time, it tires me out...I have to be careful what I say to different persons, how much information I share...all this red tape and whatnot. At times I feel odd...here I am, hardly much experience to hoot about and being asked questions that weigh a heck of a lot. One of the little ones in my suite started coughing during snack time...as the speechie in the room, that was my call to investigate what was going on with the swallowing. My heart stopped when she showed no sign of stopping and the cough sounded far back in the throat...not a good sign...if she hadn't stopped coughing, as the person nearest to her, I would have start the Heimlich or CPR if things got worse...THANK GOD she managed to cough out the piece of food from her mouth. I was FREAKING out for sure...I had positions in my mind and was deciding if she was little enough to be treated like an infant or a small child...how many pushes, how much force...I've only done it on dummies!!! And she's such a fragile child too...low tone. I am so so so so glad something turned out to be nothing and I hope I never will have to perform any BLS on any child! It's odd still, how calm and anxious I feel at the same time. And calm...I had a patient that had mini seizures all the time, medication couldn't treat it completely. So midway therapy, he would seize and I'd be terrified it would get worse, and would pray; try to coax him out of it, and it worked mostly. Scary thing was it was hard to tell when he was having a seizure...you saw something odd about him, but seizures comes in so many ways I've learned. Funny how I got used to the routine of him seizing and being with him to help (help...more like hope with physical intervention) him through it...but it was never safe...thank goodness the nurses where done the hallway from the room!

Results

A number of my clients are showing wonderful progress. At times I let out a long slow breath, perhaps I what I do does help the client, and then, sometimes I reserve judgment and wonder if what I do does indeed make a significant difference for the better, never mind for the worst. I can never know for sure I think, not within the next few years as far as I can speculate. And then I also think, am I playing well a role on the team, cause I know the team that moves together helps the patient the most...if there is possibilities. Most of the time, I just pray and hope God will work His magic despite everything we humans mistakenly do. Good intentions mind you.

"Wanna pway?"

That's what the little cutie I used to work with always said when he saw me anywhere within his sight. And such a huge smile he had :D While the greeting was very cute and all, it was also not so to say appropriate, after all, that's pretty much all he said, plus a few other rote phrases, once I bent down and gave me back a smile and yes, let's go play. He was discharged after many weeks, and then I saw him again, still with the walk that resulted from his injury...I actually heard him before I actually saw him, I heard "wanna pway?" It was very gratifying to see that he recogized me, usually clients that young don't remember anything or anyone once you're out of the daily picture. I hope he's continuing to progress. I do miss the little one.

Aug 6th, 2007

I am no longer a student, officially. I no longer get student discounts on flights, movies, bookstores or hostels. Darn. Oh well, maybe I'll make enough moolah to cover all that.

Day 1 at work as a person that actually getting paid to do what I have been doing for the past 2 years, I can't believe I'm actually getting paid. This deserves a poignant pause.

*pause*


:) My biggest nightmare was that I would not be competent, I'd be doing treatment and goals that were not reliable and didn't make sense with no clinical judgment. Well, I was wrong. I'm a pretty awesome clinician--I may not be born with amazing talent, but I sure have developed some mad skills. This was an occasion where I felt it was ok to compare myself to others in my position/profession, since I had no objective working standard, and I compare my self to myself for progress and personal goals anyways. I'm not the best, but I accept that that comes with experience.

That said, I do worry and think about how my clients are doing. I work for a pediatric clinic now, hence, I want to see progress, I want to see my clients blossom. And I worry everyday if what I do will hinder, or enhance, progress. I need to see progress. I evaluate myself daily, after the day's treatment has ended, what did I do, how did I do it, was it effective, when was it not? And I observe other more experienced clinicians, what are they doing, is it effective, or not? And I see myself doing what they are doing for the most part, with touches of my own style mixed with conviction of what's effective (all that schooling...). But I do need to develop this clinical intuition and foresight, that would be my key to being a really super awesome clinician, a.k.a., one that bring life back to the person and his/her family.

My supervisors must be wondering where's the girl on the resume...I came as one who's mostly quiet and looking like a high schooler...can't help the young looks, I refuse to wear make-up daily at work. And I'm still learning to brush off those student attitudes, and be a professional, with a working person's demeanor. She's coming out.