Encouraging Dialogue in a Child with Turner Syndrome

Question

I am currently treating a child with Turner syndrome. She is preschool age, no uvula present (hypernasal), tubes placed, no hearing impairment diagnosed and hearing is functional for her environment. It is very difficult to gain therapy participation or i

Answer

First, with a client who has this low of communication skills, you have to consider what she can do within the dialogue. Your description of her tells me that she initiates but does not respond well within the back-and-forth of dialogue. A child who can initiate vocal or verbal communication, but who cannot respond, needs to be worked with in a different capacity. Instead of leading by modeling, you have to do more following by responding to her. This will develop her dialogue skills and imitative ability. Ideas about how to do this are available on SpeechPathology.com as a 2-hour recorded CEU seminar called Becoming Verbal with Childhood Apraxia. It also is described in my book of the same name.

Second, you did not mention this client's cognitive level. This factor is critical in determining treatment expectations.

• If she is functioning below one year of age (i.e., she understands language like a baby), she should not be speaking any words at all at this time. The best you can expect from her is pre-speech vocalizations such as cooing, laughing, crying, vocalizing, making raspberries, squealing, growling, and babbling. I would be encouraging these types of sounds now. I would expect her to use these vocalizations in communication now and expect words later.
  
  
• If she understands language at least like a toddler (1-2 years of age), then you should expect words to emerge. But you still may need to spend some time encouraging pre-speech vocalizations to prepare her for words. Also I would be using several types of augmentative systems along with stimulating verbal speech. Start with simple pictures, gestures, and actions.

Third, I would communicate with the team occupation or physical therapist regarding the client's neuromuscular status (muscle tone, vestibular responses, reflexes, and so forth). Put your heads together in order to understand the client's speech movement capabilities. Teamwork like this will help you begin to understand the types of activities and techniques that may facilitate improved control of the four speech subsystems- respiration, phonation, resonation, and articulation (jaw, lip, and tongue movements).

Pam Marshalla, M.A., CCC-SLP, is a speech-language pathologist with over thirty years of experience working with children of all ages and ability levels. She is the author of eight highly practical books related to speech-language therapy with children. She has spoken at hundreds of continuing education programs in the U.S. and Canada on articulation and motor speech disorders.