Karen was a cute and bright eight-year-old girl. She needed a quiet predictable environment. Frustration manifested in emotional tantrums–throwing herself on the floor, screaming, and crying. Her distress was most often related to her lack of spontaneous language. Karen was dependent on visual prompts to access her words.
Karen loved to draw. One day she drew a picture of a girl with tears streaming from her eyes. A zipper was drawn from the top of her head through the middle of her body. It was unzipped through her torso. With her limited communication ability, it was difficult to discus her feelings about the picture; however, I could not help but wonder if that haunting picture depicted her own internal world.
Karen learned sight words easily. Since she loved to draw, I wrote sentences about what she was drawing; then I had her read them back to me. Using the pictures as visual cues, I often prompted her to assist me in generating the sentences. For example, she drew a picture of a girl with a clock on her head. As I pointed to the picture of the girl’s head, I prompted, “the girl has a clock on her__________.” Karen responded “head.” As I pointed to the picture of the clock, and subsequently head, I said, “The girl has a ________ on her_________.” Karen filled in the words “clock” and “head.” Next I said: “Who has a clock on her head?” Now I would point to the pictures of the girl, clock, clock and head respectively. I said, “The________ has a ________on her _________.”
Overall, Karen made great strides emotionally and academically. By spring, tantrums seldom occurred. Toward the end of the year, the diagnostic teacher administered a standardized test and informed me that Karen’s academic progress had gone from a kindergarten to a third grade level. However, the test did not measure her deepest deficit, spontaneous speech. Third grade reading level or not, she was still significantly impaired. She still could not request what she wanted, answer questions, comment or share her feelings without visual prompts available.
The school year had passed and Karen was now in my class for summer school. I had a community-based program. Each day, one of the children chose where they wanted to go that day. The nonverbal children or those like Karen, who had difficulty accessing their words, chose from a menu of options. I would encourage them to use their verbal language, written words, and/or pictures to assist me in generating a short story on the chalkboard. The simple stories stated who was going, where we were going, when we were going, how we were going to get there, what we were going to do and why. The activity was followed with relevant related language activities at each child’s level.
In this little child generated story, The kids were referring to a Pizza Parlor with a candy machine that dispersed tiny candy in the shape of apples, oranges, and bananas.
I want to walk to the Pizza Restaurant.
I want to buy food candy.
I want a quarter, please.
A few weeks after we had written the above story, and carried out the activity, with a blank chalkboard in front of her, Karen spontaneously spoke in sentences for the first time with no visible visual cuing. She did this by recreating the sentences in her mind’s eye from the above story she had seen on the board several weeks earlier. I marveled as she created her own self-determined imaginary visual prompts. Moving her eyes from left to right and pointing to each word, she slowly read each invisible word. At the end of each sentence, she turned her head back to the left again to read the next remembered imaginary sentence.
There were only a few weeks left of summer school and our time together when she stumbled on this strategy. Karen used it a few more times before we separated. Once was at the zoo. She visualized a sentence she memorized from the board that morning about riding the merry-go-round. Using the same technique, as she did with the pizza restaurant, she pointed to each imaginary word in the sky and read, “I want to ride on the merry-go-round.” She knew she needed money to ride the merry-go round and again, pointing to in the air, she added her memorized sentence from the pizza story: “I want a quarter, please,” as she put out her hand. Needless to say, we all happily rode the merry-go-round.
It was the last day of summer school and it was Karen’s birthday. When she got off the bus I wished her a happy birthday. To my surprise, she spontaneously said, “No happy. No more Mary Ann,” as she dramatically threw her arms around my waist. For the first and only time, she accessed her words without any outward show of any visual or imaginary visual stimuli. I could not have asked for a more wonderful good-bye!
Lessons I learned from Karen:
• Use the child’s strength and interest to compensate for weak areas. Reading and drawing was her interest. It got her to verbalize with the use of the written word.
• Insure that activities are motivating enough to stimulate formation of cues that work for them. (Karen really liked the food candy.)
• If a child can read, but not initiate speech, it might be helpful to write out a series of useful generic sentences that they can select and use in a variety of situations.
I have served as a teacher of individuals with autism for 18 years. What they have taught me was to be sure of nothing, and open myself to the extraordinary. Along with severe deficits, each child demonstrates amazing gifts.
Mary Ann Harrington
http://web.mac.com/maharrington
