The Joseph Robert Shaw Foundation

Helping Children Recover from Brain Injury

Connecting Communication with Grammar

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A, As. Ases. Dog. dogs. Doges. Is. ises. Iseses. 

Joey grins at me as he explores the newly discovered -s button on his device. It’s fun to be able to suddenly add ‘s’ to your words, and he’s enjoyed seeing just how many ‘s’s he can add to a word. At first I felt put out by his distracted activity with the ‘s’ button, but then I remembered that if Joey is going to learn how to make words plural, he is going to have to know how to use the +s button. So explore away. Sillyeseseseses

The most difficult part of supporting Joey’s speech development for me is helping him – as a five year old – understand correct grammar. Parts of speech still feel fairly abstract to teach to young children, and I tend to be more interested in his interactive exchanges and his academic knowledge. Yet supporting him in his understanding of speech that sounds typical will help him better communicate with his world. 

For most of us, we learned to make items plural in our speech by listening to our parents and then copying their speech. If we made a mistake – “Mommy, I want ten cookie,” our mom would correct us, we’d copy her, and then we’d get our cookies (or be told no, ten cookies is too much).

If Joey wants to make a word plural, he has to hit a whole separate button after he selects the singular version of the word. It’s another teaching point – and another button to explore and test out. Right now, he’s enjoying testing it out, and I’m letting him play with it and see how it goes. He particularly likes making silly words – adding ‘s’ as many times to a word as he can to watch the word grow. 

Another grammatical aspect I have difficulty helping Joey understand is when we use ‘ing’ on some verbs, and not on others. The problem here is that the picture of the verb is only on one of the buttons – sleep. Sleeps, sleeping, and slept are all represented with a bucket in different positions. Joey does not believe me when I tell him that selecting the spilling bucket next to the picture of someone sleeping sounds better in a sentence than the picture of sleep itself. “He is sleep,” he insists, regardless of my prompting for “he is sleeping. From a picture and device perspective, it makes sense. He doesn’t want to talk about a bucket – he wants to talk about sleeping. 

I realize that to support Joey I need to take time to support his understanding of grammar and parts of speech more than I would a typically-developing kindergartener. I’m looking for books that let us explore making words plural, and when we can make sentences like “He is running.” It’s also important to remember that while Joey’s sentence structure may be off right now, it doesn’t reflect a decreased ability in communicating – just that learning to speak on a device requires additional learning steps. 

Taking Steps Toward Kindergarten Success

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I was finally able to introduce Joey to my own five year old daughter. She had been begging to meet him for awhile. Joey lit up when he saw that I’d brought him a friend, and quickly found the words “Hi. My name is Joey. I live in Virginia” on his eye gaze device. When she buried her head into my back, not immediately replying in perfect response to his introduction, I whispered that she was shy. His eyes responded with understanding. It didn’t take him long before he repeated, “Shy. Shy” for emphasis. 

Before long, my daughter realized that Joey was a silly five year old, just like her. Maybe it was when he burped, and he quickly announced that he’d done it. “Burp.” in the middle of a story. Or when they competed to see who could answer some of the questions correctly. Both of them clearly wanted to get the answers correct, or wanted the chance to choose the next book. 

My daughter has many strengths, but being a patient and understanding five year old is not one of them. Although I had so much fun during the visit playing with two of my favorite people, I was also able to see Joey through my daughter’s eyes. She asked the honest questions – without malice – that older or more understanding kids know not to ask. “Why does he keep dropping the toys I give him?” “Why do his arms move like that?” “Why does he keep saying numbers next to the right answer, but doesn’t say the right answer?”

They are honest questions, and answering them doesn’t detract from the great kid that Joey is. In fact, I hope that by answering them she can realize he isn’t dropping things on purpose, to be mean, or because he doesn’t like her. I want her – and all the kids in Joey’s kindergarten class – to understand that although his body does not work like theirs, he still has a lot to offer as a friend and classmate. 

After her long string of questions on the way home – and after watching her play “I can only talk with a computer” with her sister – I decided to start working on a book for Joey’s classmates about who he is and what his limitations and strengths are. We are hoping it will give his teachers some words to use to encourage and support positive, understanding interactions between Joey and his classmates. 

Another thing I noticed as I watched my daughter play with Joey, was how the games needed to be adapted slightly. My daughter isn’t fabulous at giving anyone wait time (she actually gave Joey more wait time than she’ll give me), so it was a good reminder of what we are asking other five year olds to do when they interact with Joey. I added this to the book as well – ways kids can interact with Joey so that they can still have fun. 

Joey may not be able to chase his friends around on the playground, but he can roll balls down a ramp or wave a giant bubble wand, making bubbles for his friends to pop. Seeing my daughter with Joey gave me the chance to see how we can put together a recess bag so that Joey can have fun at recess and participate with his peers. My daughter can be my guinea pig the rest of the summer as we test out good five year old games.

We want to set Joey up for success, while knowing we won’t be there to help him in the day to day. Getting him used to group settings, seeing how he interacts with peers, and how they interact with him, is going to help us start preparing him for the kindergarten experience. 

Using Good Dog, Carl to Support Language Development

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I’m pausing in our neuroplasticity series to share the new book that Joey and I are enjoying together.

As a child, I loved the picture book, Good Dog, Carl by Alexandra Day. The wordless book depicts a mother leaving the house alone with Carl, the rottweiler dog, as the baby sitter. Once the mother leaves the house, the baby climbs out of the crib onto Carl’s back. Carl carries the baby throughout the house – to jump on the parents’ bed, play dress up with the mom’s jewelry, check out the fish tank, dance in the living room, eat a snack and even takes a bath to hide the evidence of the messy snack. Before the mother returns home, Carl puts the baby back into the crib as though nothing has happened.

I desperately wanted to have a dog like Carl who could carry me around the house. My own children loved this book as well, and so I wasn’t surprised when Joey also seemed to love the sweet, sneakiness of the dog and baby on an adventure together.

Wordless picture books are excellent for supporting Joey’s vocabulary right now. Instead of expecting him to repeat words I’ve already read in the book, Joey can use his eye gaze to generate the story himself. He can label what Carl and the baby are doing, use his prepositions to describe where the baby is and where Carl is taking him. Joey recently had household rooms added to his device, and so now Joey can also add what room Carl is taking the baby into. Joey also recently had the word ‘carry’ added to his vocabulary, so he can now tell that the dog is carrying the baby up or down the stairs. He can label how the baby and dog make a mess, and that the dog needs a washcloth to clean the baby. 

Joey and I have read Good Dog, Carl again and again. Each time I am sure he will be bored with it and will choose another book. I brought it along with Go, Dogs, Go – which is by far more exciting because you can talk about cars, helicopters, and boats. Joey repeatedly chooses Good Dog, Carl though. I suspect it is for the same reason my own children (and why five year old me) loved it. The idea of a dog baby sitting you, in secret from your parents, is just too exciting. It is fun to imagine what you and a dog would do in the house alone, and how everything would get cleaned up before the parents get home.

Good Dog, Carl also lets us explore story elements in a way that many children books don’t. As fun as Go, Dog, Go is, it does not have a set problem, solution, characters or setting. Good Dog, Carl has a clear sequence that can be retold, with clear characters and a setting. It’s essential that as Joey is learning vocabulary and communication skills that he also continues to learn age appropriate academic standards. His motor development should not keep him from accessing learning. 

Communicating His Needs

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   Asking for help on his eye gaze AAC device is something we’ve wanted Joey to be able to do for a long time. We model the phrase “I need help” and try to encourage him to use the help icon as much as he can to tell us what he needs. And he will use it, occasionally.

Joey’s never been a fan of being given the specific words to use in any given situation. I learned this awhile ago when I tried to get him to use the word want. He used every possible word but want, and ended up working a lot harder than he needed to.

Lately, Joey’s been letting us know what is going on with him in far more detail than simply “I need help.” One day each week I see him immediately after occupational therapy. He works hard in OT, and it shows each time he sits down in his chair to work with me. On this particular occasion, as soon as he was close enough to his AAC device for it to respond to him, he said “sweat. Washcloth.” I looked around for a washcloth, and not finding one, I grabbed a tissue and patted his head. He gave me a withering look. “Washcloth. Dishes bumpy” he said, and craned his neck in the direction of the kitchen. Clearly, the tissue I got him wasn’t good enough. He wanted a dish towel that was bumpy for all that sweat.

He’s told us, in great detail, about other needs he has too. It’s exciting to see him put these words together into descriptions of what he needs. The grammar is off, and doesn’t include verbs, but he is working on making his exact needs known.

I struggle with this, as I want him to be able to ask for help so that anyone will know. But frankly, “I need help” isn’t nearly as descriptive as “Sweat. Washcloth. Dishes bumpy.” Or is it? Do I know Joey too well so that I can figure out the intention behind the words? How important is the formal “I need help with my sweat” or “I need a bumpy washcloth.”

After getting him his requested item, I modeled the full phrase, to which he replied “read”. You can say, “I want to read.” I modeled. He gave me another look.

Full sentences or not, I love his descriptions. It seems clear that he is thinking about what his communication partner needs to know to understand what he wants. We’ll keep working on the sentences, and keep celebrating his descriptive comments.

The Importance of Peers

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When I arrived at Joey’s house a few Fridays ago, I was thrilled to find his seven year old cousin there with him. She could only stay for about ten minutes of our session, but it was one of the best, most targeted ten minutes I’ve seen from Joey.

Typically, when I first begin to work with Joey each session, he fills me in on random parts of his week. Sometimes I introduce a topic and he changes the subject to a preferred topic, or if he is really bored with me, he might begin exploring his words. I live with a five year old at my house, so while these behaviors are frustrating, I’m also 100% sure they are age appropriate. I find myself giving Joey reminders to stay on topic like I would with any five year old, or reminders that we can talk more after we do our work first.

On this Friday however, in the presence of his cousin, Joey needed no reminders. He was alert, engaged, and on topic. I asked “wh” questions like “who is in the story?” “where does the bear live?” “when does this take place?” and Joey quickly gave me answers. He had a few mis-hits in trying to find the correct word, but he stuck with it to show his cousin what he knew. Changing the subject suddenly did not seem as interesting as sharing his ideas with the two of us.

Even after his cousin left, Joey remained on point. He was quick to share jokes about books we read, and to add “funny” or “silly” after he told me a joke. I think he throws those words in to make sure I know he’s joking and not just clicking on the wrong buttons.

It was wonderful to see Joey so motivated to participate and talk with his cousin. I was also happy to be able to share Joey’s insights and ideas with her. For many kids (let’s be honest – and adults), it can be hard to understand that a child who does not speak has something to say. We can be quick to make assumptions. I watched Joey answer my “wh” questions through her eyes – and hoped that she was impressed as I was with his ability to navigate his words and talk about the story in a way I’d expect any five year old to do. His answers might not have been as robust as a talkative five year old, but my questions are the same.

I need to find more opportunities to include other children in my work with Joey to encourage his motivation and give him the experience of interacting with children his own age. Talking and playing with a peer is far more interesting than having one on one conversations with a boring adult.

Saturday Serenade

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Test post for Saturday Serenades https://www.musichealsglennjan.com/saturday-serenades

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