puts it, 'a melon strolling on two tendrils'. But what happens when language doesn't seem to be developing quite right? If your baby doesn't babble, your toddler isn't saying "me do it!", or your young child can't express herself, you're bound to be worried.Enter the Speech-Language Pathologist, a healthcare provider who will work with your child to assess and treat their language and speech communication difficulties. And then, we all rest easy, right? Not so fast. Speech therapy, as our Sunday Brunch guest Mica Vincent tells us, is more than just correcting lisps. It's like that line in The King's Speech. The movie was a completely inaccurate view of speech therapy, and also of the history of the British monarchy as relates to Nazism. But I'm sure you remember the part where the king describes his cruel early childhood nanny: "she-she wouldn't feed me". Difficult stuff. Sometimes a speech therapist needs to be all things: responsible, empathetic, knowledgeable, insightful, professional.
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| Mica Vincent with sweet pea |
Mica is one of those really outstanding people who seems to effortlessly think of the greater good and then make her decisions based on it. I would trust Mica with the care of my child; I would give her power of attorney over my estate (if I had one), and hire her as my Life Coach if I thought she would do it.
Mica recently graduated from the University of British Columbia's Msc programme in Audiology and Speech Sciences. She works with kids in a number of environments, including clinics, community and school settings. She's seen a lot of parents make a lot of mistakes; and she's seen a lot of beautiful things, too.
In this two-part Sunday Brunch interview she fills us in on the most important parts of child language and speech development -- letting us know what we should look for and when we should just chill the fuck out. It's all, she says, about helping our children to become great communicators.
Happy Sunday Brunch. Bon appetit!
- Svea Boyda-Vikander
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SV: So I thought we'd start out by finding out just what an SLP does. What do you, as a Speech-Language Pathologist, spend most of your time doing?
MV: It's pretty wide-ranging. An SLP works with children and adults with communication and swallowing difficulties and disorders. With some children it's obvious from birth, typically with a significant developmental disorder, that an SLP should get involved with their feeding and swallowing as well as communication skills as they develop. For other kids it's usually around one year or 18 months that parents start to have concerns because their children aren't learning to talk at the time that their peers are. But there are also more subtle delays or difficulties that don't show up until children are school-aged and have diffficulty in the classroom.
SV: So what are the most common speech/language difficulties you come across?
MV: I would say that language difficulties are probably more common than speech difficulties, but it's the speech that people notice. So you get a lot of parents coming in because they're concerned about the fact that their kids can't make specific sounds, but when you look further you see that there is actually an underlying language problem.
SV: What do you mean by that? What's a 'language' problem?
MV: A language problem is a more general difficulty beyond just not being able to make a 'th' sound. One of the misunderstandings about SLPs is that they're speech therapists and they only work on speech sounds like lisps and that kind of thing. But the language component is huge, and probably makes the biggest difference for the kids we work with. There are expressive and receptive language disorders; the expressive ones concern the ability to use words, put them into syntactically correct sentences, communicate in appropriate ways, that kind of thing. Children with receptive language delay or disorder have trouble understanding what is said to them -- so, for example, they wouldn't understand what to do when someone said, "Point to your toes." This can be quite subtle and not show up until after the first few grades of the school system, when the language in the classroom becomes increasingly complex, and students are expected to listen not only to understand what is being said, but to learn new information. It's more than following directions -- without comprehension children will have difficulty learning. And that can have far reaching effects.
SV: I think the 'subtle' element is the part that worries most parents. How is a parent supposed to distinguish between normal language development and disordered? Can you tell us some of the obvious early signs of disordered language development?
MV: First of all, if there's a child at increased risk for a speech-language disorder, for example, premature infants, if there were complications during pregnancy or birth or indication of genetic or neurological disorder...
SV: OK, but in an otherwise healthy child?
MV: Otherwise, you're looking for social interaction skills: imitating others, maintaining eye gaze, following a point with the eyes, and babbling (vocal play, making raspberries, those kind of noises, cooing). Reacting to sounds in the environment, understanding simple games and routines like patty-cake or tickle. If it's young infants who don't have speech yet you're looking for those skills of showing you in some way what they need and responding to you. Being 'tuned in' to their parent.
SV: That's interesting -- we always think about the parents being tuned into the kids.
MV: Right, it's a reciprocal thing. And it's important to remember that kids have different communication styles. So some kids are very sort of active and engaged, and some are more on their own agenda -- the kid sitting their playing with his toys and making noises to himself.
SV: So when should a parent contact somebody?
MV: Well here are some barebones milestones. You should contact someone if: a) there's no babbling within the first year, b) there's no social interaction skills emerging in the first year, c) isn't starting to use any words in the first year, or has a very limited vocabulary by 18 months old, and d) they aren't starting to combine words at around two years. Those are the earliest stages... With older kids, a lot of parents worry about their kids' speech sounds so there are milestones for that as well.
SV: You don't seem as concerned about that.
MV: I think being able to communicate is your first priority, developing language skills is second. My third would be the clarity of speech, and of course --
(Ed: At this point Sweet Baby James came into the kitchen with a mouthful of styrofoam. I fished around in his mouth but he swallowed most of it. Should I make him throw it up? I asked Mica. Probably not, she said.) NB: I didn't, and it came out the other end within 12 hours. Amazing.
SV: Now where were we... Yes, what kind of parenting style best helps a child's language development?
MV: In general I would say, just being engaged. Some of the suggestions that I would make for parents are... getting down to your child's level, literally. Playing on the floor with them, involving yourself with their play. So if they're banging a spoon, you're banging a spoon. Responding to how they communicate, without judgment. For a shy or reluctant child, you could try playing alongside them so rather than forcing interaction from them your'e just kind of cultivating that with less pressure.
(Sweet Baby James playing with his Aunt Emily)
SV: Interesting. What abut people who decide their child is shy -- I think that can be stigmatizing (it was for me). What do you think about that?
MV: It's important to recognise your chld has a communication style and it might not be the same as others you know. But recognise that even a quiet child is communicating so maybe tune into the more subtle ways they're doing it -- maybe it's eye connection, gesture, body-language. You could encourage your child to imitate you by imitating them.
SV: What are the most common mistakes you see parents making?
MV: Asking testing questions like "What's this?", "Where's the ball?" I think it comes from parents wanting their children to be ready for school so they get focused on things like their child learning all the names of the colours. But for me, my priority is more that they are able to communicate in order to interact with other people. And so maybe the most important word for them to know isn't all the colours of the rainbow but the sort of vocabulary that's going to be useful in their daily life. Things like potty, bathtime, hungry, thirsty. They're not the most glamorous words, but they're really important.
SV: So are those kind of testing questions ever good?
MV: Well, it's not to be confused with you know, helping your child to learn vocabulary, but to have the emphasis on the communication and the interaction rather than being focused on them giving you the right answer.
SV: Can you relate a beautiful or funny experience you had while working with a family?
I was working with one immigrant family, a mother and her daughter. She had a lot of anxiety around her child sort developing as she expected her to. We just went over some language facilitating strategies, like getting down to the kid's level. She was used to a more directive parent role so she was uncomfortable with it. We set it up so she would have her special playtime with her daughter where she wasn't being a directive parent, she was being engaged with her child. And when she came back she was so happy. Like she had found the freedom to just play and be with her kid instead of always 'parenting'...
There was this other little kindergartener. His speech was unintelligible but he would try so hard. He wanted to do more and more repetitions when we worked together -- and this is the kind of therapy that's not really that fun because you have to do drills, basically. But he just loved it. We were working on /s/ and /sh/, and also s+, like star, sw, and those kinds of sounds. One day we were playing an ocean game and he decided he was going to say 'starfish' which was pretty much the hardest word he could possibly have conceived of, given his difficulties. And he tried it like five or six times and his little face was all scrunched up and then he got it! And he started jumping around and running around the room. Everyone there was ecstatic. That he said 'starfish'.
(some poor little kid being harassed into saying starfish by his mama)
SV: That sounds so lovely. (though actually that video sounds really annoying) What from your own childhood do you bring to your work with kids?
MV: I've been told by supervisors that my style is very gentle and I think that benefits me. It's important to first establish a good rapport and build trust and understanding and have open communication. The speech therapist might be with the family or child maybe once a week, maybe once a month, depending on the context. For an hour. But the parent is with the child all the time so the most powerful thing I think for a speech therapist is to share their knowledge, their experience, their problem-solving skills in order to help support and empower the parent to help their child develop. So if I were to relate that to my own experience... it would just be about recognising that parents have their own lives and their own challenges and finding ways to work with their children in a way that works for them, in their own life. I didn't grow up with any developmental difficulties but I can recognize that it's important to get support for parents.
SV: So it's not just the child in isolation, there's a whole family dynamic.
MV: Yes, and I think that a lot of practice these days is moving more towards family-centred community service, which sort of aims to create the optimal environment for the child. Then the SLP can help assess what that might look like for each child.
SV: What are the greatest challenges you face in your work?
For me, the biggest challenge is also what keeps it so interesting: every child is so different, every family is so different. Speech and language is probably the most complex cognitive function that humans have and there can be so many interacting factors. It's like a crazy thousand-piece jigsaw puzzle with no picture [laughs] so it can be certainly very challenging. But I like puzzles.
Mica Vincent, MSC RSLP, graduated from the Speech-Language Pathology programme at the University of British Columbia in 2011. She encourages concerned parents to contact their local health authority as most speech and language disorders improve with early intervention, but there's often a year-long wait list. Most school boards also employ Speech-Language Pathologists to assess and treat children. If you have further questions or comments, Mica can be contacted at micav.slp@gmail.com.
This was part one of a two-part interview. Stay tuned for our further discussion of the impact of Attachment Parenting on speech development. We'll also give Mica the floor to answer some of your own questions.
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