Anniversary

Alan and I have been married thirty-five years this week. Being married to Alan is as natural, and essential, to me as breathing. We will likely go out to dinner and vie for supremacy in the ongoing really soppy or really tasteless greeting card contest waged over many years. We do not always exchange anniversary gifts. It depends upon whether one of us has a great idea. Alan is most definitely better at finding those truly unique and thoughtful gifts.

About ten years ago though I had a wonderful plan. My husband loves music, all sorts of music. His tastes are eclectic and his knowledge vast. He particularly loves a good guitarist. He mentioned in passing that Colin James would be playing in Montreal that year. I secretly schemed to get tickets for him. I went online to buy the tickets. This was the first time I had ever purchased anything online. I went to events in Montreal, clicked on Colin James, clicked on the date, got a whole page of events, saw the title “Millencolin” and clicked “buy”. I figured, given that it was the first year of the new millennium, that was the name of Colin James’ concert tour. Remember please those who are rolling their eyes, in my defence, I thought I was still on Colin James’ website.

The tickets in hand, we headed to the Metropolis on concert night, leaving our second daughter babysitting our youngest. We know this great Montreal concert venue, so we arrived very early and went up to the balcony. Our seats were terrific. Below us on stage the drum had a skull and crossbones on it. We wondered who could be opening for Colin James? Perhaps he was trying to appeal to a younger crowd? As the place started to fill up, I realized that no one around us seemed to be much over sixteen. Lots of black shirts, spiked hair, piercings and safety pins. The kids looked a lot like one of our daughters. We thought Colin James appealed to a much broader age group. Perhaps the older fans were downstairs? Now the place was packed. Fog carpeted the stage as the dry ice was set free. A skinny kid bounced onto the stage and shouted “Are you ready Montreal!” The crowd roared, the opening band raced to their places, and started. It was the worst, loudest, heavy metal, make- your- ears- bleed , music I had ever heard. The kids were on their feet. The area in front of the stage was a seething pit of kids jumping in the air waving their fists. Muscular men in t-shirts marked “security” were circulating trying to keep kids from hanging dangerously over the balcony. My husband, lover of all music that he is, was stoically trying to wait it out. I began to think something was terribly wrong. I said, “Just stay here a minute, I am going to check something out.” I pushed my way downstairs.

Kids were still streaming through the front doors. Management had made a narrow passage between the ticket booth and a large security guard so they could ensure everyone had a ticket. I went up to the security guard and gently tapped him on the shoulder. I said, “Excuse me. I hate to bother you, but this isn’t Colin James, is it?” To my eternal gratitude, the young man did not laugh out loud. He composed his face and replied, “Uh no, this is Millencolin a Swedish heavy metal punk band.” I blushed and stammered and tried to explain that I had made a mistake. They must have felt sorry for me. The security guard offered to go upstairs to get Alan. The ticket- taker leaned over and said helpfully, “Don’t worry. We wondered when you arrived, but then we thought you must be the band’s parents!” I didn’t know whether to laugh or cry. Soon Alan came downstairs; the security guard seemed to have no trouble finding him in the crowd. We thanked the staff, and still blushing I headed for the door. But there was to be no fast escape from my humiliation that night. The Metropolis staff stopped us, and with great courtesy, gave us our money back.

On the way back to the car, I apologized profusely to my husband for the disappointment and the failed gift. My highly amused husband replied, “Are you kidding? This was the best gift ever! You NEVER screw up. I ALWAYS screw up. I am going to get mileage out of this for years!” His grin stretched ear to ear. I said testily, “Oh, well, that’s alright then. But you don’t have to be so damned pleased with yourself!” He chuckled all the way home.

Our daughter was very surprised to see us so early. She asked us what happened. Alan replied, “Ask your mother.” Throwing him a dirty look, I said defensively, “It wasn’t Colin James. How was I supposed to know Millencolin was a group? It COULD have been the name of Colin James’ concert tour!” My daughter dissolved into helpless laughter. Snorting hoots of, “Mom, you are sooooo lame!” followed me all the way upstairs as I withdrew, trying to preserve some of my much tattered dignity. My husband and daughter howled with laughter as he recounted, for the first time, the entire story.

The story is now a treasured part of family history and has been told to many an appreciative audience. I don’t mind. These stories, where everyone in turn gets to play a starring role, are part of the glue holding marriage and family together, the more embarrassing, the better. It turned out to be the perfect gift.

The next summer, Colin James came to the jazz festival. I managed to get the right tickets this time.

Happy Anniversary love.

Mam

I have been thinking about role models lately. My almost 18 year old is a camp counselor this summer. Her little 7 to 9 year old charges absolutely adore her. I hear her say things in a confident self-evident way such as, “You know if you give one a strawberry, they all need exactly the same thing, or such drama!” I lightly said, “So, do you feel sympathy for me yet?” She looked at me wryly and said, “Not yet.” But she knew what I meant. She has two older sisters, and is well acquainted with the sibling lament, “It’s not fair!”

It is so interesting to watch your own children reflect the world as they understand it, and have the heady experience of influencing others. You realize their role models are many and diverse. Like most women of my generation, I wanted my girls to be exposed to what I saw as strong women role models. In my mother’s generation, many women did not work outside of the home. They did not have much education, and rarely “careers”. My generation rejected these traditional roles so vehemently, revolution did indeed result. In our estimation, these women could not be role models for our daughters. But in our march towards change, I think we missed something important.

I spoke to my mother- in- law in Wales today. We call her Mam. She stands barely five foot tall and seems unchanged in the thirty- five plus years I have known her. She turns eighty nine soon, though you would not believe it. She comes from a generation and a time that seems so old fashioned that I imagine scenes from a Henry James novel.

When she was two, her mother died from septicemia. She had scraped her arm on a rusty nail in the outhouse at the bottom of the garden. In those days before penicillin, she became ill and died quickly. My mother- in- law remembers very little about her. She recalls the sound, starched smell and whiteness of her floor length apron, worn over her every day dresses, as she did her daily chores. The tickle of those skirts on Mam's toddler cheek as she played on the landing is a single abiding memory. She and her three older brothers were left in the care of their dock- worker father. He did his best, but was ill-prepared to take on the housekeeping and mothering role at a time when household responsibilities and provider roles were strictly assigned. After a few years of unsatisfactory housekeepers, the family decided to do without that support, and Mam started to take on the role her family situation had decided for her. At six she was standing on a chair mixing vegetables into the night's supper stew before she went to school. They all helped, but she was the girl, so she would look after the house and the boys, of course.

This destiny may have been set, and Mam did her duty, but there was nothing weak and docile about it. Mam remembers with great indignation how the schoolmaster used to dismiss her from the discussion about jobs the students might have. He would say, "Not Jean of course, as she'll be needed at home!" She would stamp her foot in defiance. And the time she totally over rode her practical and thrifty father when he went to buy her sensible laced boots. She would have those desired patent leather shoes, just this once. There was a brief respite from housework when women were recruited to the war effort, but she was soon married, her first son on his way. She cared for her father for the rest of his life, while bringing up four sons, with her husband, in her mother's small house. She lives there still.
When I first met Mam, this quiet spoken, little Welsh woman who seemed to be constantly in motion, serving the many men in her life, I was ready to be outraged. After all, I was Canadian. I had grown up with two sisters. I was part of the women’s liberation generation. I tensed every time Mam popped up from her dinner to run and get something for one of the boys. I glared if my husband watched sport with his father and brothers as Mam and I did the dishes.

But slowly I learned to understand the complex story I was witnessing. Mam was the main character. The family revolved around her. There was respect, humour and great love. It was never discussed, it was just understood. Mam loved her husband for sixty years. She brought up four good men. She did what needed to be done, with no regrets, quiet grace and great strength. The example is not in the roles filled, but how the life is lived.

Recently she was debating the merits of having knee replacement surgery; her arthritis of the knee has slowed her down. She told us, "They only last ten years, and you cannot kneel you know. " We asked her why she needed to kneel. She retorted, "Well how will I wash the kitchen floor then?" A modern woman’s role model? Absolutely.

But I Need to Hit Him!

But I need to hit him!
I swear I turned my head for just a second. Michael launched himself across the game board we were using at Nick. The board, pieces, cards went flying. I caught Michael mid leap, holding him securely. He struggled wildly saying, "But I NEED to hit him!". Nick repeated over and over, at higher and higher volume, "It's four spaces for red!". Krista wandered over to check out the window blinds while Jackie retrieved and lined up the scattered game pieces.

Michael was more "traditionally" language impaired; short sentences, poor grammar, disorganized explanations and descriptions, thus not often communicatively successful with his grade one peers. The other group members had reasonably good sentences and grammar, and excellent vocabularies. Social language skills were harder. Knowing when to talk, what to say, sharing attention and looking and generally letting others know they were engaged and participating. The group had been a good experience. The students were learning to wait, listen, look, initiate, take turns. Sometimes they needed a lot of support to set them up for success; reminders to look, adjustments of body posture, models of what to say. In this group, Nick was the "rule policeman". It was important to him that the correct number of spaces were moved, the order of turns exact, and the timing of the game, according to his internal timetable, be respected. He was constantly "helping" the others move their pieces and telling them what to do. We were working on helping Nick think about why his friends did not like this and modeling different strategies. Michael's sense of fair play was particularly affronted by Nick's interference. Today Michael, in his excitement to play, had taken Krista's turn. She did not notice. As I turned to her to guide her to notice, indicate, and tell her friends appropriately, our "rule policeman" sprang into action. He took Michael's piece off the board, and substituted Krista's red piece. But he did this silently, not looking at Michael, not saying "Hey, it's Krista's turn!" It was too much for Michael. Chaos.

In terms of social interaction and reaction, Michael was appropriate. In terms of game rules, Nick was correct. But in terms of social language comprehension and expression, what a mess.

Social language group therapy is challenging. Even in a small, highly structured therapy group, there are so many factors contributing to the smooth, natural looking social experiences we take for granted. For our social language impaired students, nothing can be taken for granted. In school and at home they are often told what to do, but these instructions may be only superficially understood. "Wait your turn"' , "It's not your job to tell the rules"', "Look at me when I am talking to you!". They struggle to comply, but often do not remember. After all, the pieces are not in the right order, he didn't move the right number of spaces, and who should I look at again? So confusing.

Is it possible to break down these subtle, fluid social skills, teach them, then build social language competence? I believe it is, but it does require constant examination of your perceptions of social success and failure, and a willingness to try and try again. Michelle Garcia Winner has it right I think, when she puts such emphasis on perspective taking. Your social success depends upon being able to appreciate and react to others' perceptions of your behavior, and your understanding of their motivations and thus behavior. This is true for all of us. Imagine if your brain just does not make those connections by itself? The speech language pathologist has a responsibility to address social language impairment as vigorously as sentence structure and grammar impairments. It is as crucial to communicative competence.

But was it wise to mix the social language impaired students and the expressive language impaired students in the same therapy group? Maybe not, in this case. It was also not wise to conduct this group without support, a therapy assistant makes for more effective treatment. Things you learn through experience.

It is encouraging to see more clinicians taking up the social language challenge. Evidence based treatment means integrating the client's perceptions and needs into the treatment plan, along with the best evidence and our best clinical judgment. This therapy is difficult, the concepts slippery, the implementation a definite work-in-progress! But the field demands our effort, and the children deserve it.
Michael didn't hit Nick. Play resumed. Everyone went home happy. I needed a cup of tea.

Flat Rock Summer

Time slips away and months go by. I did not get done what I had planned. It was a summer of children moving, traveling, and a host of other family distractions.

When I was growing up our parents were not so involved in our lives, even when we were very young. Children went out to play, and were called home for meals and homework by mothers on front porches throughout the neighborhood. The group of neighbourhood mothers always seemed to know where we were, and what we were doing, as we found out if we stepped a toe out of line, the news reaching the relevant parent with lightening speed, and certain punishment. Today parents have complex, busy lives, revolving around their children: with daycare, after school programs, piano, dance, gymnastics, hockey, soccer, scheduled play dates. Parents are involved in all aspects of their children's lives. My own mother would often shake her head, as I loaded the kids into the van, and zoomed off to another activity, or to pick up or drop off my children and their friends. She sometimes would say she didn't know how I did it. She really did admire her modern daughters, but there was an implied questioning, and in my ears, criticism, of why we did all these things? Were times really so different? Did the world demand such vigilance? I heard these silent questions, and I was always annoyed at how she did not seem to understand.

It has only been very recently that my mother has shared some parts of her past. In my mind's eye I see four small girls from long ago. In the early 1930s in Montreal, children swam in the river from "Flat Rock" in Lasalle. It was a long walk from Verdun, miles and miles. Much of it was on dirt tracks, after the paved part of Bannantyne Road ended. Most hot summer days, my mother and her friend, both just six, and her older sister and her friend, age ten, would set off to Flat Rock for the day, alone. They walked, their wax paper packet of tomato sandwiches made, packed and carefully carried by the big girls. My grandmother cleaned offices at night. She needed to sleep during the day. My grandfather had been killed in an industrial accident two years before. Limited insurance depleted, and no social assistance in existence, my grandmother worked. My mother's two year old sister played quietly by the bed, or napped in her crib. The other two girls were expected to play outside, the older sister in charge.

So on hot summer days, with the lure of a cooling swim, they walked. My mother does not remember the walk to the swimming spot well. The swimming and splashing with friends, and the taste of the warm, soggy, but delicious tomato sandwiches, are vivid for her, as is the walk home. I visualize the tired little legs going slower and slower, as they trailed through the fields, lunch a distant memory, her big sister's admonishments to hurry ringing in her ears. I feel the joy and relief they must have felt, on the few occasions when the girls were allowed to catch a lift part of the way, with the milkman or bread man. The delivery men would take the opportunity to allow their horses to gallop on the dirt trails, as a break from their steady, slow clomp through their rounds. Sometimes they would allow the girls to hop on the side steps of the delivery wagons, and take them on a splendid ride, closer to home. But this was a rare treat, and I imagine how long it would take such little girls to walk so far summer day after summer day, alone.

So I shake my head, and say I do not know how you did it Mom. I hope you are not annoyed that I don't seem to understand.

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.

Learning Disability?

Some experiences set events in motion in ways totally unexpected. I did not think babysitting as a 13 year old would shape my future so directly. The Hayes family lived across the street. They had two children,lively 18 month old Amanda, and 8 year old Jason. I particularly loved working for the Hayes. Both parents were English teachers. They had a whole room lined floor to ceiling with bookshelves. After the children were in bed, I was allowed to choose anything I wanted from the shelves and read until my eyes were itchy. Also, the family sailed and I often went out sailing the Great Lakes or Georgian Bay with them to help crew, but also prevent the children from drowning themselves in their enthusiasm to be part of all and any action. Jason was very active and full of fun. He easily learned how to sail, tie knots and eagerly listened to any story I was willing to make up. Jason could build anything and was constantly at war with little Amanda who wanted to knock down his elaborate constructions. But Jason did not have many friends and did not roam with the noisy pack of little boys who raced through the neighbourhood. This was so different from the confident sailor and eager collaborator for adventures planned within his family. Still, I thought Jason was a typical, well-adjusted second grader.

One day I arrived to look after the children just as Jason arrived home from school with a face like a thundercloud. He flung his school bag on the floor, shouted rudely at his mother, and pushed Amanda down on his way to his room. The door slammed. Mrs. Hayes was on the verge of reprimanding her son, when she saw a crumpled paper amongst the contents of Jason's school bag, which were spread over the kitchen floor where they had landed. "Oh no" she said, and bent to retrieve it. She spread the paper out on the table. It was Jason's report card. His marks were represented in the form of a graph, where the class averages were in blue, grades above the average in green, and those below, in red. An angry red line slashed across Jason's report. For a moment Mrs. Hayes looked defeated, but then she looked very angry indeed.

I suppose because I was there comforting Amanda, Mrs. Hayes decided to explain to me. She told me that Jason had a learning disability. He was having difficulty learning the same way as the other children, although he was just as smart. Reading was particularly hard for him. He had few successes at school. Mrs. Hayes had become an expert on learning disabilities. She was an advocate for Jason in a school system which, at the time, had little interest in students with special needs of any kind. She had specifically asked the school to mail Jason's report card to her. She knew that all the children would open their envelopes in the school yard and compare marks. She had wanted to spare her already fragile son that indignity. My 13 year old self had a glimpse of the frustration, pain and loss a mother could feel. This was clearly an educated, loving family who immersed their children in words, books and learning. I thought that children who did not do well in elementary school were either not stimulated at home or perhaps just "slow".

I had never heard the term "learning disability". My high school was populated by the typical groups: the jocks, acid-heads, "shop" boys, smart kids, cheerleaders, "bad" kids. We all desperately tried to fit in somewhere. The "dumb" kids were always persecuted. We never stopped too think about why any of our peers did poorly at school, except to conclude that it was "lack of application", as our parents and teachers told us, or lack of ability, to be pitied.

That year I learned a lot from Mrs. Hayes. I read my first journal article. I did essays for school on learning disabilities, the brain and intelligence. I became interested in special education. That was the year too that my friends and I started to dream about what we might become. I thought maybe a teacher, or a special education teacher. But it did not seem quite right for me. The more I learned about learning disabilities and other special needs a common theme seemed to emerge, language. I started then to think about language. What did it mean to not be able to understand or express yourself with ease? How did we learn to speak? The concepts were difficult for me to grasp. I found out there was actually a profession that was all about language, a speech pathologist! From that time on the die was cast for me. I wanted to be a speech pathologist.

I lost touch with the Hayes when I left home to go to university. I often wonder how things turned out for Jason. Well, I like to think. You never anticipate what can profoundly shape your life. Thank you Jason.