On Language Facilitation

I was with two friends the other day, both speech-language pathologists, both with young families. I was catching up on news and photos of the little ones. It gives me enormous pleasure to hear of their antics, especially what they say. My friend was relating a story about another of our friends, also a speech-language pathologist. On a recent visit, her son had become a little fractious, so she had produced a toy from her private practice equipment for him to explore. Without missing a beat, his mother started to narrate what he was doing with short, repetitive, intonated phrases. She was irresistible to the toddler; he imitated, commented, and shared her excitement. At one point she looked up and said, “Sorry. I can’t help myself!”

I smiled. We speech-language pathologists, when we become mothers, become instant zealous converts to the wonders of language facilitation techniques. We learn these things in our classes and practice in our clinical placements. Many of us work with young children when we graduate, and these techniques, this knowledge, becomes the focus of our treatment. We believe it. It is best-practice, and the evidence is overwhelming. But I don’t think anything prepares you for the power of these techniques like using them yourself, daily, with your own children. It is also humbling to realize how difficult it can be to remember to give your child time to respond, to talk about what you and they are doing, to repeat, to get down to your child’s level, and to revel in communication as it develops. We are busy. Life is fast. We do not even realize we have negotiated most of the day in silence, except for instructions and reprimands. Language facilitation though has lasting benefits, embarrassing and useful.

When my eldest daughter was three, we were stuck in a huge line at the fruit and vegetable store. The baby was fussing and I was jiggling the stroller to calm her and trying not to drop the items I had balanced on top of the stroller canopy. My three year old wandered just out of reach to the huge barrels of nuts near the cash. I looked over to see her up to her elbows in the nuts. She was enjoying the clicking, crashing noises as she picked up armloads of nuts and let them slide through her fingers. The busy cashier was throwing me filthy looks. Everyone was staring. I tried a hissing whisper. The little imp heard me very well, but ignored me completely. The baby was fixing to howl. I jiggled the stroller harder. With a contortionist’s reach, I grabbed the three year olds’ hood and yanked her away from the nuts, anchoring her to the counter in front of me with my knee. I was furious. She, however, was unperturbed and unrepentant. As I was paying, she hauled her chin up over the counter by standing on her tiptoes. She announced, loudly, and with perfect clarity, “Mummy, how does it make you feel when I don’t listen? I like the nuts!” As some people grinned, the cashier still scowled, and the baby howled, we made our escape. I regretted even encouraging her to talk at that moment.

Yet I observed this same daughter, years later, working at summer language camp, effortlessly imitating, recasting, redirecting and supporting the communication of the language delayed four year olds in her charge. She said to me, partly accusingly, “You did all these things to us for years and years!” I admit it freely, but consider it one of the gifts I was able to give my children. I know it is not always easy, not always immediately rewarding, but worth it? Without a doubt.

Hearing vs. Listening

She sat quietly, hands folded in her lap, watching. The conversation was lively and fast. The occasion: a visit to a cherished grand-daughter's new apartment, following a celebration restaurant dinner with two of her daughters and grand-daughter. Everything had been seen and admired, house warming gifts received, flowers carefully put in water and prominently placed on the piano. Dinner had been lovely; the restaurant not too loud early in the evening. Now there was some catching up to be done; what the various cousins were doing, summer plans, family gossip.

It was nice to be there, but at 80-and-a-bit it had already been a long outing. She said, "I'm not hearing all you're saying!" The daughters heard, and for a few minutes directed the conversation to their mother. They had heard this many times before. It often meant, they knew, "I don't understand." Talk of emails, Facebook postings, computers, travel plans swirled around her, confusing in their unfamiliarity. But some of this talk was expected, the daughters reasoned. Not often did they see each other and surely topics could include things not everyone was interested in? The daughters and the grand-daughter were so careful to help: guiding her on stairs, bringing groceries, calling, visiting, making sure she knew she was loved.

She couldn't hear all that was being said. And she wanted to, even if she didn't understand. She was interested, She was as sharp as ever. She was not content to let the tide of conversation wash over her with no discernible form. Her eyes started to water. She felt alone, isolated. The conversation faltered as the tears, hastily brushed away, were noticed. "I couldn't hear you." she said. "I was trying so hard to be a part of it all, but I couldn't hear you enough. I think I am just tired" Everyone was immediately contrite, apologies were made, goodbyes, hugs and congratulations passed around and the evening was over.

The daughters were kind, solicitous, careful as they tucked her into the car for the ride home. Next time, they suggested, please say, "I can't hear you well, I need to see your faces." She nodded, embarrassed. The elderly woman had picked a comfortable chair arranged around the coffee table with the others. But she was not seated where she could see everyone's faces as they talked. The light cast shadows on the faces she viewed from an angle. Had she been sitting facing the sofa, the light behind her on the other side, she could have heard more words, felt more involved. That small modification and perhaps slightly louder voices, more careful speech, could have made the difference.

These environmental modifications and communication oriented strategies are part of our treatment plans. In some cases, these are the only things we can change for our patients. Small things can have powerful impacts on communication and also social-emotional well-being. But they are not always easy to put into effect, with all the best intentions, care and love a family has. We clinicians need to be patient and understanding. We need to provide patients and families with as much explanation, repetition, modeling and support, for all strategies or techniques we provide, as they need. There is no room for judgment. No timetable for mastery.

I, of all people, should have known better. I didn't. I'm sorry Mom.