I took on A in Jan or Feb this year for the TALK program. He is about 5 years old.
A is almost non-verbal.He is a quiet boy who is generally withdrawn and not responsive. He only speaks a few single words when he is aroused sufficiently (excited).
The initial target of 3-5 repetition of sounds never materialised. At best days, he could only repeat certain sounds/words 2-3 times after much prompting & stimulation.
After 2 months or 6 sessions, i realised he could have dyspraxia. He was unable to retain motor patterns. I estimate his IQ is around 70-80 as he could recognise and sequence the alphabet quite easily. He also can rote count to 30 easily. He could recognise certain pictures too. He could form specific letter patterns such as FOX and PIXAR. So i knew his inability to trace/write the alphabet (a skill which his parents said he learnt last year in school) was not entirely due to cognitive factors.
Kids with this type of dyspraxia and sensory issues often require hand-over-hand prompts. Even then it would take a long time to learn imitation skills such as making a Y shape with his arms. They have a weak grasp of pencils but suddenly turn muscular if his parents try to remove the iPhone or iPad. They are easy to manage in the sense that they are not active. They “forget” easily as the brain does not register the motor movements well.
I advised the parents to do oral-motor stimulation but they were unable to follow through due to family and work commitments. It was also difficult for them to do daily exercise for sensory regulation. His basic needs were taken care of by a helper and grandparents. He did not even have to lift a spoon to feed himself in the morning.
By May, he was “babbling” more in terms of variety of sounds but was unable to repeat upon request. The school reported that he would say specific words during music & movement. e.g. bus & go. These are more predictable, compared to other random vocalisation.
He knows his teeth and will smile with tactile prompt. He sticks out his tongue at times. I made several videos of oral motor exercises & his responses & vocalisations.
In June, they requested a checklist of how often they should do the oral-motor exercises. These have been communicated from March to May – 5, 8 repetitions depending on time contraints. Ideally, they should at least do it once in the morning, afternoon and evening. (My part-time cleaner said they should do it whenever they are free. )
Suggested activities : sand paper letters, water play (squeezing water from sponge, water gun), painting, cutting, crawling, ball play, brushing cheek, etc
in the past, some sped teachers will describe such children as having poor body sense/image. We now know that the precise diagnostic terms are dyspraxia and sensory processing disorder.
Having considered his age and my medical issues, i had to advise them to seek occupational therapy and speech therapy. I referred the parents to seek help from an integrated centre which offers both OT and ST.
So we stopped therapy in June as A is likely to have dyspraxia, SPD and speech apraxia which required intensive therapy.
The usual OT protocol for dyspraxia & SPD is brushing and joint compression to sensitise or desensitise the skin and muscles. After the brain is primed, the therapist will follow up with certain exercises to help the child gain awareness of his body – range of motion, spatial judgement etc. When these exercises are repeated when the child is in an optimal state of arousal, he begins to process incoming stimuli and become aware of what his body can or cannot do. Adaptability depends on the child’s IQ. e.g. cutting skill – some kids can cut most shapes while some kids have to be taught how to cut different shapes and lines. With ASD kids, there is an additional challenge cos their minds are not engaged. They could be stimming on some topic.
Children with higher IQ tend to progress very fast within 6 months due to “low base”. There is usually a plateau after a certain period with the SAME therapist. This is because most therapists have different strengths and specialisations. They may be good with 3-6 year-olds, but are unable to help older kids effectively. It may be good to take a short 3-month break or change therapists if the child does not make much progress.
There is a certain speech therapist who is a little rough with kids but good at making non-verbal kids vocalise. However if their receptive language (vocabulary) remain limited, it does not follow that they will speak much.