Week 3 Update

Tuesday was another lab day with Dr. Ingram. I was excited because I got to start working on a project using data from a survey my mom filled out about Quince's language. This survey is called the Macarthur-Bates communicative Development Inventory (CDI). It lists ten pages of phrases and words, with an option to indicate that the child understands, says, or signs each one. The part of the survey I am interested in is the vocabulary checklist. In this section, there are 396 different words in 19 different categories (sound effects and animal sounds, animal names, vehicles, toys, food and drink, clothing, body parts, furniture and rooms, small household items, outside things and places to go, people, games and routines, action words, words about time, descriptive words, pronouns, question words, prepositions and locations, and quantifiers). Specifically, I am going to be looking at the difference between comprehending and producing certain words, and trying to establish whether the complexity of a word determines if it is both understood and spoken or just understood. 

The first step in doing this was to type out each of the words into an excel spreadsheet, which was extremely tedious but a good exercise for improving typing speed (at least that's what I told myself). I then made columns for "Comprehends" and "Produces" and filled them out, with a 1 in each column if the survey indicated that Quince could comprehends/produce each word, and a 0 if he could not. I did not include the signing option as he doesn't sign anything beyond "all done" and "more". I'm planning on further categorizing each word by whether it is monosyllabic or polysyllabic and whether or not it contains a cluster (two or more consecutive vowels). Hopefully, these categories will allow me to determine the complexity of each word, so that when I analyze this spreadsheet, I will be able to see if there is a correlation between complexity and lack of production. 

On Wednesday, I once again took Quince swimming for the last hour of ABA. Admittedly, I'm not really sure why we bring his therapist along instead of simply ending his session early, since I am the only one who gets in the water with him. We did some more speech work, similar to last week, but at the pool near his therapy location, Quince is limited to a small, shallow rectangle of the pool, which is very distracting since he always tries to escape into the lap lanes. Afterwards, we went to speech, where he was unfortunately pretty unfocused. Still, it was interesting to see how his therapists manage to keep his attention on how they are forming words.

I spent most of Thursday working on the spreadsheet of Quince's CDI and practicing phonetics at ASU. Also, Dr. Ingram sent me an article that he cowrote with his graduate student. It analyzes the daily speech diary of a child with language delay (kept by the mother). This is pretty relevant because I've been considering doing this for Quince to keep track of exactly what words he says, but it seems like a lot of work and I'm not with him all the time.

Sorry, I'm pretty sure that's the third time I've forgotten to get a video of Quince at speech. I'll try to remember for next week, but to be honest, at this point it's probably a lost cause.

Week 2 Update (Part II)

Sorry, I didn't manage to get the video of Quince's speech programs since he has been sick and thus not attending his therapy sessions these past few days. I'll work on that for next week.

Thursday was another lab day for me, so I went in to ASU with my dad that morning. Since I had already worked with Dr. Ingram for two days before, I had a better idea of what was going on and what exactly I was doing. Specifically, I entered the analysis I performed on Tuesday from the tests on children with cleft palates into a spreadsheet, and started looking at transcribing their language in IPA. Also, Dr. Ingram showed me an intriguing case of a child with abnormal language development. This child could produce some more difficult sounds such as r and l, but not sounds that children generally acquire first such as s and sh. Dr. Ingram hypothesized that this might be due to an auditory deficit, since r and l are both generally louder sounds than s or sh.

As I mentioned before, Quince has been pretty sick, so he didn't go to any therapy sessions on Friday. Instead, my mom and I took him to the zoo. One of the things we've been working on with him is the names of different animals and the sounds they make. I tried to keep track of what he said while we were there, and to practice my phonetics, I have listed both the words and a transcription of how Quince pronounced it in IPA below. For words with prompting, I counted responses to questions that my mom or I asked him, such as "what animal is that?", as well as echoing. For example, if Quince repeated the word "monkey" after my mom said "this is a monkey," I would count that as an echoed response. Spontaneous words occur when he says something without anyone encouraging him to do so. An example of this is when he got tired of walking, Quince grabbed my hand and said "up."

Words with prompting:

• Zoo (zu)
• Lion (leɪə)
• Roar (wʌ)
• Monkey (mʌnkʌ)
• Giraffe (gʌræf)
• Pig (pʌ)
• Otter (ɒtʌ)
• Lizard (lɪzə)

Spontaneous words:

• Up (ʌp)
• Casey (kʌkʌ)
• Hi (hʌ)
• Pop (pɑp)
• Bye (bʌbʌ)

While I was transcribing these words, I noticed something interesting. In many cases, Quince seems to be saying the first consonant sound followed by ʌ (pronounced like the u in cup) instead of the actual word. This is probably ʌ is a relatively easy sound to shape, and his apraxia makes motor control of his mouth difficult. 

Here is a video that provides an example of how I interact with Quince. In this scenario, he is eating cake and an apple core, and I am trying to get him to talk to me. Usually, I ask him some question and/or make some commentary on what he's doing, leaving long pauses in between to catch anything he might say. If he does say something, I respond so that any attempts to talk are recognized. In the video, I persist in trying to make him say bye-bye, because I know that's something he can say easily. 

Week 2 Update (Part I)

I'm going to see if I can get a video of someone doing some sort of speech exercise with Quince for you guys, since it's pretty hard to understand what his speech is like unless you can hear it. In the meantime, here is the first part of my weekly update.

On Tuesday, I went with my dad to ASU to meet Dr. Ingram for my first lab day of actually doing things other than introductions. I sorted through and organized a bunch of files that were part of a study on the language development of children with cleft palates. At first, I didn't really understand what this had to do with my project, but I soon realized that even though the language delays were different, the tools used to track the children's progress was the same. Specifically, each child was tested using a Profile of Early Expressive Phonological Skills (PEEPS) twice, once around the age of two and once six to ten months later. On these tests, the administrators had recorded the child's phonetic pronunciations of each word, which was interesting for me to see as I have been trying to learn a bit of the IPA (International Phonetic Alphabet) so that I can record my brother's speech. The IPA looks something like this: 

http://ipa-paradise.weebly.com/ipa.html

We also tried to work out a way for me to do the CITI HIPAA training, but we couldn't get around the request for an ASU email address, which I do not have. I think they're going to look into seeing if their department can get me a temporary one or something.

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Five hours of work in a small office would be hard on anyone, but for a hyperactive five year old, it's especially tough. On Wednesday, my mom and I decided to let Quince have a break for the last hour of his ABA, so I took him swimming, dragging his therapist along too. Quince is very stimulated by water and loves anything to do with it: surfing, swimming, even bath time.

Quince and someone (probably me, but possibly one of my other sisters) surfing.

We actually managed to fit in some speech work during this time. Here are some examples of how we can get him to practice talking at the pool:

Prompt: "Quince, where are we going?" 

Expected response: "Pool" (puh) or "Swimming" (fuh-fuh)

Prompt: Standing on the edge of the pool, about to jump it. "Ready, set, ..."

Expected response: "Go" (go or guh, it varies)

Prompt: "Are you all done swimming or do you want more?"

Expected response: "All done" (ah dun) or "More" (muh or muh-muh, this also varies). Whatever he says here, we always follow through, unless he seems to want the opposite, in which case we usually ask him again.

After swimming, we headed straight to speech. My mom and I were hoping Quince would be more focused and less hyper after using up all his energy in the pool, but this did not seem to be the case. In speech, one of the main things they have been working on is showing Quince a set of pictures and getting him to say the sounds the objects pictured make. This picture set is very focused on specific sounds that we want Quince to say, such as the long o sound. 

The aforementioned picture set

This time, when the therapist got out the picture set, she pointed to the cow and asked him what it said. Instead, he pointed to the horse and said "neigh neigh" very clearly, which was definitely good because it was spontaneous and well-pronounced. However, it was pretty clear that he was avoiding the long o sound of "moo moo" that we are trying to help him develop.

One thing I'm learning from the speech therapists is to adapt my programs to Quince's attention span, not my own. At speech, they move between exercises and breaks quickly, nearly too fast for me to follow, but it helps to prevent Quince from getting bored or frustrated.

In the next post, I will explain what I did the rest of the week, and hopefully I will be able to show you a sample of Quince's speech as well.

Week 1 Update

First of all, here's Quince (and I) hanging out at the beach:

Since this week is the first week of my project, I have been adjusting to my new schedule. I am realizing that my project can really be broken into three separate segments. In this post, I will describe these three segments. Then, I will explain what I did this week.

The first part consists of shadowing Quince's ABA therapists, both at the CARD office and in our home. I am paying particularly close attention to the exercises that focus on verbal communication, since my project focuses on this aspect of therapy. These exercises are usually what CARD calls echoics. In Quince's version of echoics, his therapist holds up a picture (out of a pile of pictures that we have taken of items and people he encounters regularly) and names what is in the picture. Then they pause and wait for Quince to repeat what they named. If he doesn't say anything or says something wrong, they will prompt him again with the name. If he repeats it correctly, they reward him with praise, a token on his token board*, or sometimes even a treat like a piece of candy. An example echoic program might go something like this:

Therapist: Quince, look. (Holds up picture)

Therapist: This is Dada. Can you say 'Dada'?

Quince: Dada

Therapist: That's right, Dada. Good job Quince. High five!

Since Quince struggles with the clarity of his speech (which we believe is due to his apraxia), sometimes what he says doesn't sound anything like the prompt. For example, he can't pronounce the letter 's', so for him, Casey is 'cuh-cuh.' Because of this, it's very difficult to decipher what he is saying, particularly if you aren't familiar with him. Quince just switched CARD locations, which means he has an entirely new team of therapists. Thus, it is particularly useful for me to shadow them for the next couple months, as I can identify what he's saying for them until they become more accustomed to his vocabulary. Quince's ABA sessions are extremely long, usually four hours in the morning and sometimes two or three hours in the afternoon as well. In these sessions, his therapists are trying to reinforce all kinds of functional behaviors, including but not limited to this type of verbal communication. 

The second part of my project is centered more specifically on speech. It consists of accompanying my mom to Quince's speech therapy sessions at Pediatric Speech and Language Associates. These sessions are half an hour, four times a week, usually right after his morning ABA. Since they are only with Quince for a short amount of time, the speech therapists have to be focused and fast-paced. They do a lot of flash cards, and books interspersed with breaks for toys, tickles, and jumping. Quince's attention span is extremely short (sometimes a span of seconds) so these breaks have to happen often. Although to me this initially seemed similar to what CARD does, I soon realized that they do emphasize how Quince should be producing the speech. For example, they will model a word, and then prompt him both verbally and physically with a touch on the throat or the chin, depending on the sound they want him to produce. This seems like a really good idea, since forming speech is one of the hardest things for Quince, and is something I'm looking forward to learning more about. 

The third part of my project involves the work I am doing at ASU with Dr. Ingram. There, I am studying phonetics and will be learning to analyze speech samples. I will then apply what I learn to specifically analyze Quince's language. 

This week, on Monday, I shadowed at CARD for Quince's morning ABA session. It was very rewarding to see how excited he was that I was coming with him. I soon saw how I could help to provide consistency among therapists and also between CARD and our family by interpreting his speech. For example, one of Quince's echoics is a picture of a lollipop, and in our family, that's what we call it. However, his therapist was asking him to say sucker, which was confusing him. By letting the therapist know that we say lollipop instead, I was able to prevent this confusion. After the morning session, I accompanied Quince to speech, where he produced the long e sound on command three times. This was an enormous accomplishment for him, since this is a particularly difficult thing for him to say. 

Unfortunately, on Tuesday, I came down with strep throat, and was unable to work with Quince at all for the next couple of days. Quince tends to get sick easily as his immune system doesn't always work properly, so I had to avoid him. By the time I was recovered, on Thursday, I went with my dad to ASU, where I had my first lab day with Dr. Ingram. In preparation, I had studied some basic phonetics and taken a brief inventory of Quince's language to show him. Once I was there, we talked a lot about my project and Dr. Ingram's expectations and training that I'll have to complete in order to work with human data. Then, he introduced me to Dr. Beate Peter, an expert in apraxia, which was very exciting. 

On Friday, Quince had clinic at CARD. Clinic is where my mom meets with Quince's head therapist to review his goals and progress on them. I accompanied my mom to clinic, and played with Quince during the meeting. After clinic, Quince had two more hours of CARD, and then it was time for an hour of music therapy. His music therapy isn't very focused on language development, so I probably won't talk about it a lot here after this, but I'll provide a rough overview. His music therapist, Mary, plays the guitar and sings to Quince while he drums. Sometimes she plays the piano and he jumps on a trampoline. It's less demanding and thus more enjoyable for Quince, so he looks forward to these sessions. 

Sorry for the lengthy post. I'll try to break it up next week.

*Quince's token board is a piece of laminated paper with ten velcro circles on it. His tokens are laminated pictures of surfboards (because Quince loves to surf) with the opposite velcro circle. When Quince is working on a program, if the token board is being used, every time he gets a trial right, they give him a token to put on the token board. Once the board is full, Quince knows he is 'all done', meaning he gets to take a break and run around. They use this board so that he can visualize the reward and exactly how much more he has to do to get it.