A session in the right direction

We made an appointment for Ethan to see Ms KE Chia, a speech and language therapist/pathologist at the i-Sports Center in Island Hospital last Friday.  Ethan, now 2 years and 3 months’ old, cannot yet express himself in words, and although some friends have advised that “It takes much longer for boys” and “Soon he will be talking non-stop” and “Just you wait.  One fine day he will start speaking, and you’ll want him to shut up“, we decided to err on the side of caution and bring him in for an assessment all the same.

We chose this speech therapist because when we enrolled Ethan for the parent-toddler class in his current playschool, I noticed that the center was started by Ms Chia’s husband.  Her name sounded familiar, and upon checking the MASH (Malaysian Association of Speech-Language and Hearing) website, I was glad that she is a MASH certified therapist.

We waited for about 20 minutes before the therapist arrived, after which we were ushered into her room.  The major part of the room was filled with toys and books and puzzles, and Ethan immediately went for the ball.  While Ms Chia jotted down some historical details and information from us about Ethan, Ethan busied himself with all the *goodies* that were there.

Ms Chia told us that the first session that day was basically to perform an assessment to ascertain if Ethan was a habitually late talker (which is rather common in boys), or if the speech delay could be due to other factors, of which further therapy would perhaps be neccesary.  She assured us that we had made the right decision in coming over to see her, if anything, to allay our fears and confusion about Ethan’s delay in speech.

Speech delay in kids could be caused by:

• Natural speech delay (more inherent in boys) – no therapy needed, just patience.
• Behavioural issues, of which ADHD was one of the causes – some therapy needed
• Autism – therapy and treatment needed.

She performed a few *tests* on Ethan while playing.  Simple evaluations like calling out to him, and asking him to bring certain toys and also some imitation play.  After the roughly 1.5 hour session, Ms Chia almost certainly ruled out autism, which she said is not likely because:

• Ethan’s other development milestones, such as his motor skills were very good and above average.  She did ask us when he started walking and if he is eating well, all of which was in the “very good” category 😛
• Ethan had fantastic eye contact.  When his name was called, he turned around and looked at her.

However, we will need to test if Ethan is doing things based on situational scenarios or if he really understands it.  For example, if we open the door and say “Ethan, let’s go kai-kai!”, he will run and get his shoes, but whether or not he understands the concept of shoes is a different matter altogether.  What we need to find out is for instance, if Ethan can pick out his shoe amongst a group of other things, if he was asked to do so.

After the assessment, Ms Chia is still inconclusive about her findings on Ethan.  When she asked him to get her the ball while placing the ball and the car together, he doesn’t go and get it.  But he did look at the ball.  Which means he does understand what a ball is.  Why he did not get the ball for her is a mystery.  It could be because he was shy or because of behavioural reasons, i.e. “Why would I want to get the ball for you?  Go get it yourself la!” he might be thinking.

So before we left, Ms Chia gave us a Home Program to try out with Ethan.  It was essential now not to drill the words into him and force him to say it, but to make him understand what the objects really are.  We learnt that speech is something that cannot be forced, but will come naturally when the child is ready.  However, for kids with speech delay, we can do something to intervene and prod them in the right direction by helping them to understand.  For example, if I have a set of pictures of farm animals, and if I ask Ethan to pick out the duck or the chicken, he should be able to give it to me.  He didn’t do it at the session of course, but as I said, we are still not sure if this is a behavioural problem that needs to be addressed.

Anyway, some of the suggestions given for the Home Program are:

To improve listening and attending skills
This includes:

• Bubble play (I bought 6 bottles of bubble solution from Toys R Us last Sunday) – Bubble play will get the kid’s attention and it offers us parents the opportunity to prod him to say words, like “More?” or “Give the bottle to Mommy/Daddy”
• Rolling a ball – “Roll/throw the ball to Daddy/Mommy”.  By the way, Ethan is now beginning to enunciate the word “ball” even more clearly.  He started with “Ba”, then it was “Bor”, and now lately it’s “Ball” (with added emphasis on the L) 😛
• Awareness of environmental sounds – We will need to help him by being his “eyes and ears”. Now whenever I go out and I see/hear birds, I’ll say “Ethan, look at the birds! Tweet tweet!  Can you hear the birds?”  I also sign “bird” when I say it, and I am very happy with the progress, because now whenever Ethan hears the birds singing, he will sign “bird” without my prompting.  And this only after 2 days of teaching him!  Sometimes I don’t even realize there are birdie sounds until I notice Ethan signing “bird”.  This is a positive thing, and it shows that he understands what a bird is, because he is signing it.  Ms Chia was also very happy when I told her that Ethan can sign many words, although he doesn’t say it.  According to her, this shows that he understands and is willing to communicate.
• Finger play – Nursery rhymes with actions, etc.  His current favorite is Itsy Bitsy Spider and One-Two-Buckle-My-Shoe.

To improve imitative skills
Trying to get Ethan to copy what we do.  This is one of the most important steps towards learning.

To improve turn-taking skills
While playing with Ethan, we can take turns doing the same thing.  For instance, taking turns to play the xylophone, and saying, “Okay, Ethan’s/Mommy’s/Daddy’s turn!”  He will have to learn to wait his turn before doing it.  I foresee some difficulty in this one because our boy is quite an impatient chap.  Well, it’s time for him to learn patience then.

To improve understanding of common objects, animals, family members, etc

• Ms Chia suggested making my own flash cards by taking pictures of the objects Ethan often sees. So I will be doing that soon.  Then the options of playing and learning with these cards are endless.  Placing them around the house for a hide-n-go-seek game, matching the cards to the actual objects and so on.
• Wooden puzzles with pictures – The wooden puzzles that Ethan owns now has pictures of animals of which I don’t even know the sounds of (like zebra, hippo, alligator) :P.  So Ms Chia suggested using farm animals instead.  Last Sunday, I bought a wooden Melissa & Doug puzzle with farm animals, and I am currently in the process of training/teaching Ethan to get to know the animals and the sounds they make.  I will say, “Ethan, where is the duck? Quack Quack!” or “Ethan, show Mommy the pig? Oink Oink!” And if he doesn’t respond, I will pick up the correct piece and show/tell him.  So far, after 2 days of education, he is getting the “duck” quite well.  Last night, when I said, “Ethan, give Mommy the duck.  Quack Quack!”  He replied with “da-duck!”

Oh by the way, the understanding and comprehension of objects around the child is more important than say, understanding colors or shapes, which Ms Chia says will come when the child is about 3 years old or maybe 4 (US standards).  Nothing to worry about.

So yeah, I think he is getting there.  Hopefully there will be a vast improvement within the next three months or so.  Pete and I are both very excited about the information we had gained from the therapy session.  Ethan was also tired out after the session, I believe, because he fell asleep in the car on the way back.

Let’s just pray for the best 🙂