The Patient Boy

“It alright miss. I be fine”, almost 8 year old Kenny reassured me. Wasn’t this the wrong way around? I should be reassuring him. But this was typical of this remarkable boy. It was 1978, and it was my second year working as a speech therapist in a city in the north of England. I had been given a wonderful opportunity that year. The health authority I was working for was opening a language class in a local school. This was a self-contained, special class for children diagnosed with, “developmental dysphasia”, as we called specific language-based learning disabilities then. I was to be the full-time speech therapist working with two special education class teachers. I was so excited. I could treat the students every day. I could be involved in their classroom. Surely I could make a real difference?

The first day of school I met Kenny. I was struck by the quiet patience with which he moved around the classroom and found his seat amid the noise, some tears, and cheerful chaos that marks the beginning of the school year. Silently he nodded during attendance, put up his hand to point at the date on the calendar during circle time, and quietly lined up at the door when the teacher announced recess.

As the students ran into the playground, Barbara, Kenny’s teacher , announced, “He was supposed to go to residential school for dysphasic children this year you know. His parents don’t want to send him away from home, so they wanted to try this class first, but if he does not talk this year, then he has to go.” I had not yet seen the students’ school records so I was surprised that a non-verbal child was admitted to the language class. I blurted out, “”You mean he does not speak at all?” Barbara explained that she had been told that Kenny struggled to start his words, only tried a few words and even those words were really difficult to understand for anyone who did not know him well. So he tended not to try to talk much. However, she went on to explain that in many other ways he showed that he understood what was going on, was beginning to read and the psychologist had determined Kenny’s intellectual skills were “at least within the average range.” I couldn’t wait to get started. 

Kenny cheerfully came into the treatment room with me. I turned on the tape recorder, ready to figure out Kenny’s speech problem, and asked Kenny his name. He looked at me sweetly and shook his head. I asked him how many brothers and sisters he had. Kenny held up three fingers. I asked him where he lived. Making sure I was watching, he walked over to the window, pointed down the street and waved his arm to tell me it was many streets away then he made a car noise, the first sound I had heard from him, mimed driving and so told me he came on the bus. He then sat down, waiting for me to continue, satisfied with our conversation thus far. I turned off the tape recorder. 

This started a journey for both Kenny and me. I was pretty sure Kenny had what was then known as “developmental verbal apraxia”, where he just did not know how to organize and sequence speech movements. But I had never seen a child with apraxia. What I knew about apraxia was what I had learned about apraxia acquired by adults after a brain injury. I searched for resources I might use, but I was still faced with what could I do to help Kenny now? He couldn’t wait for me to feel prepared. Kenny and I explored what sounds he could make. He was amazingly tolerant as I asked him to repeat, move his jaw this way, stuck tongue depressors in his mouth to show him where to put his tongue, grabbed his face to try to support his movements. We sat side by side in front of a mirror practising; Kenny copying my movements as we said words over and over again. Kenny always tried, never whined or complained, repeated as many times as he was asked and patiently waited while I hesitated, changed ideas and tried to modify activities as we went along. We all chose words together: Kenny, his family, his teachers and me. There were lists at home, in the classroom and in the “speech” room. Kenny and I made up a set of hand gestures to help him remember certain challenging sounds. We were making up therapy as we went along. I was often unsure, and worried, as I frantically tried to find information, and speak to other therapists to guide me. I felt unprepared to treat a child who had such a severe speech problem. But there was no one else and Kenny’s faith in what we were doing together never wavered and I was humbled by his endless patience. We were all delighted as Kenny slowly found his voice and used his words.

In the spring of that school year, the application for admittance to the residential school arrived for Kenny again. It was decided that I would travel down with Kenny’s family to visit the school and report on his progress. It was a beautiful setting: Cozy dormitories, lovely classrooms, devoted and skilled teachers and therapists. But the children seemed so young to be away from home. Kenny held on tightly to his mother’s hand. Kenny attended a class that day and saw the team of therapists and educators. I was so proud of him as he answered questions and tried everything. The headmistress of the school told us they were all very impressed with Kenny’s progress that year. I held my breath. They went on to say they really felt they could help Kenny and he could start in September. Kenny must have seen my face. He patted my arm and smiled, “it alright miss. I be fine.” And he was. He had found his voice.