My client, T, is a three year old boy who has been diagnosed with pervasive developmental disorder and tracheomalcia which is a weakness of tracheal support cartilages. T has delayed speech and language and has been in therapy for 1 1/2 years. He began therapy in the Birth to Three program and then started in our clinic for the Spring 2007 semester. T's past therapy has proven to help him significantly. He has become more attentive during sessions. He has also increased his eye contact and mean length utterance. T is also able to follow simple direction now. However there are still many issues that he is working on overcoming.
T has been specifically working on language in therapy. Some of T’s goals in treatment right now are to answer who and what questions and increase mean length utterance. These goals are often addressed through a variety of activities. I will often ask T questions and initiate conversation during structured play, but I also use books to initiate responses. The books that I use most were recommended by my supervisor and are from the Buddy Bear series by Beth W. Respess. I use the same books each session because I have found that T is familiar with and thoroughly enjoys the series. After researching, I now know that there are even more benefits to using the same stories consistently. Repeated reading of the same book causes the child to become so familiar with the material that he is more able to successfully discuss an understandable topic and more able to focus on detailed semantic and syntactic relationships in order to enhance his language development (Bradshaw, Hoffman, & Norris, 1998). When reading the books, my supervisor has encouraged me to ask many questions based on the material in the books and to expand on T’s answers. For example, a conversation about a page in a book would proceed as follows:
Me: Who is that?
T: Buddy Bear!
Me: Good! That is Buddy Bear.
Me: What is Buddy Bear doing?
T: Eat!
Me: Right! Buddy Bear is eating.
Me: What is Buddy Bear eating?
T: Ice-cream!
Me: Good! Buddy Bear is eating ice-cream.
By expanding on T’s answers I am helping to increase his length of utterance and his understanding of the material. According to Bradshaw et al. (1998), a study done between two preschool children showed that using expansions and cloze procedures rather than a simple question and answer condition leads to 26% more utterances and 77% more interpretations by the client.
Not only does this method seem to be effective on paper, but it is important to note that T has been very responsive to the method as well. So far in therapy, T’s length of utterance has slowly been increasing, and his percentage for correct who and what questions has also been climbing. I feel that much of this can be contributed to our repeated reading of the same stories and to me asking questions and providing expansions to T’s answers. T has seen a fair amount of improvement so far, and I hope that this continues with our future sessions!
Reference:
Bradshaw, M. L., Hoffman, P. R., & Norris, J. A. (1998, April). Efficacy of Expansions and Cloze Procedures in the Development of Interpretations by Preschool Children Exhibiting Delayed Language Development. Language, Speech, and Hearing Services in Schools, 29, 85-95.
