Communication and Autism

It’s been fifteen years that I have been trying to solve the puzzle of Autism. Since the last fifteen years, I have been getting trained to help out kids with Autism with some great success. However, there are many kids who teach me and inspire me for more learning and blending various treatment techniques.

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Here is this girl, Suraiya who had come to me when she was five years old. Now she is fifteen. She had come only for Occupational therapy and we did work on her sensory processing issues and also saw her in group therapy sessions to help her with social skills. At that point of time, I had got certified in PECS (Picture Exchange Communication System) and because Suraiya had no speech for communication, we started PECS for her. We made the folder and she used the pictures for her communication needs very well. We reached the Phase 3 of PECS.

Suraiya’s parents enrolled her for regular schooling and therapy stopped for her since they could not manage her school and therapy timings together. Suraiya was out of sight and out of my mind. Then suddenly, I see her when she is twelve years. By then, parents had really tried their level best promoted her, repeated grades till grade 3 hoping that she will cope with regular schooling. With six years of intensive work by the parents and no breakthrough, they thought that it’s really time that Suraiya’s sensory issues should be resolved and communication should be worked on.

I saw the twelve year old Suraiya again and now I saw that she was not using the PECS folder anymore neither was she communicating. The only way to communicate was by taking the person to the object that she wanted. At that time, I had done a lot of behaviour therapy workshops with Dr. Patrick McGreevy and also Dr. Duncan Fennemore who promoted the Verbal Behavior Analysis approach. Suraiya had beautiful imitation skills and was very good at planning. I wrote to my mentors and asked about what is it that I should do with Suraiya- sign language or PECS to promote communication. Most of them said that it is always better to use hands because then it’s easy to communicate without being dependent on a PECS folder. With the parents consent, we started using sign language (modified version of makaton). Suraiya learnt more than 100 signs in less than two months. We were really happy with her progress but the signs were not really being used. We had to ask her to sign even though she knew each sign very well. We were stuck….

By now, Suraiya had started intensive therapy sessions with us and I still thought on the same principle that a sign would be easy because there is no dependency on a PECS folder or a fear of pictures falling off and getting lost while traveling. But we were still stuck and Suraiya was using very basic signs for communication.

Suraiya had a little speech where she could speak what she wants in words but in whispers which were barely audible. We started her on Therapeutic Listening and we saw that she was a little louder but not confident of talking or even audible. The worst thing was that she was not using her little speech or the large repertoire of signs. It was getting really frustrating with her. Most other kids responded well to therapeutic listening or signs or PECS but here we were stuck, really stuck!!!

Then there was this forbrain device that we ordered which enhances specific patterns of your voice, delivering your voice directly via bone structure hoping that this would help Suraiya to talk a little louder. We tried it for three months and there was some great difference in her speaking and labeling and she was audible though she still spoke in whispers. But again none of that speech was being used for communication.

Now, we added RMT (Rhythmic Movement Training) with Suraiya really hoping for some magic or miracle to happen. Three months of RMT passed by and mom was reporting some positive changes. We were doing Moro reflex balance with Suraiya and the mother reported decreased frustration and anger levels in her. She was at peace with herself and also more flexible with changes. She was showing willingness to communicate. She used to get really bothered by her brother crying but now, it did not bother her at all.Not just that, she was finding new ways to pacify him.

Suraiya was also good at sight reading and during the Occupational therapy sessions, she was getting frustrated sometimes when she wanted a break. The Occupational therapist working with her suggested we use “break” and “help” cards for communication because Suraiya does not say them even if she can speak. So we started PECS again with sight cards. Two weeks passed by and she was using the cards when she wanted but not really consistently. One new therapist had come to our centre for observation and she was observing Suraiya work with her Occupational therapist. My Occupational therapist was working on ideation and asked Suraiya to complete a task which she really found difficult. Suraiya did not like this in front of the observing therapist. She flung out of her place and frantically started searching for her cards everywhere in the room, found them and gave the “help” card to my therapist. It was a Eureka moment for all of us…..She used the card on her own at the right moment without any prompt…..Hurray!!!

Now, after four months of RMT (Rhythmic Movement training), the mother reported that Suraiya is now using a lot of speech for communication very spontaneously. This was another EUREKA moment for us…..

Now Suraiya’s speech is coming like a spring which we have been digging since the last three years……………..we are hoping much more …….I am very strongly feeling that she needed a combination of various different therapy modalities to reach to where she is now…….

Reena Singh

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