For years, I’ve been searching for a way to reconcile my passion for speech therapy and my addiction to earning new, vibrant stamps in my passport. I was reading a news article when I came across a non-governmental organization in Cambodia helping to make speech therapy available to those with communication difficulties. In Cambodia, speech therapy is virtually non-existent but the need is overwhelming– estimates show that roughly 600,000 Cambodians have a communication or swallowing disorder.
After reaching out to the organization, I learned that their clinic in Phnom Penh was encountering a high incidence of children with autism spectrum disorder (ASD). In Los Angeles, I specialize in working with ASD populations; specifically using technology such as pictures or an iPad to help children with limited verbal language. We decided that my time in Cambodia would be best spent sharing my expertise with the speech therapists and assistants to help implement visual language supports.
Visual language supports—it’s a fancy way of saying: using pictures. My practice has taught me that children with autism are visual learners. If they can SEE it, they can UNDERSTAND it. But when we speak words, they float around and children often can’t grasp their meaning. If you connect words to a concrete image, children with autism can start understanding AND using those words. This is why iPads can be such a useful tool for communication; it makes language visual.
When I arrived in Phnom Penh, I quickly got to work seeing kids who were struggling with a traditional approach to speech therapy and began introducing technology such as an iPad. One of the most meaningful experiences I had was with a 17-year-old boy named Keo. Keo was mostly using single words in both English and Khmer (Cambodia’s official language) but his parents we’re convinced Keo was capable of so much more. They hoped an iPad might help Keo start formulating his thoughts into more complex phrases and sentences.
As I began our session, I noticed that Keo was shy and quiet. Unsure of his responses in both Khmer and English, he was hesitant to communicate. After I asked him to describe several pictures in a book, I realized that he had very few verbs in his repertoire. Verbs are the glue required to string words into sentences, so it was no wonder that he had trouble formulating his thoughts. Keo also had trouble understanding the basic structure of a sentence in English. I pulled out a blank piece of paper and wrote out the formula [WHO = person + ACTION = doing + THING]. Using this formula, we looked at picture scenes together and began describing what we saw by filling in the blanks. A simple strategy, yet so incredibly effective.
During the remainder of my time in Phnom Penh, I worked closely alongside speech therapists and occupational therapists to demonstrate the power of visual supports. Some kids benefitted from a basic communication board and others excelled with the use of an iPad. Immediately, I saw dramatic improvements in every single child that we introduced to pictures.
In my practice, I can always get a wow factor when I pull out a communication board or introduce a visual schedule for the first time because children respond incredibly well to language made visual. But the key to long-term success is integrating these types of supports into a child’s daily environment. Easier said than done, right? Here are three things I tell parents to keep in mind…
1. Basic is sometimes better
Sometimes we don’t need all the bells and whistles of a high-tech gadget to get kids talking. With Keo, I simply ripped a blank piece of paper out of a notebook. When trying to teach a child a new word, I am constantly thinking about how can I represent a word visually. I’m notorious for whipping out my iPhone and using google images or watching a short clip on YouTube, but it doesn’t necessarily have to be this sophisticated. It could be as simple as using a whiteboard and writing down the word or drawing a picture.
2. Pick one routine to start
After one of my coaching sessions, parents leave feeling empowered and motivated to get started implementing. Parents often set lofty goals for themselves, only to be disappointed in themselves when they can’t follow through. Establishing new routines is tough, so I like to focus on one routine at a time. Start with something easy, like reading a book every night and using the iPad to request the page being turned or using a simple visual schedule to get ready for bed. I find selecting nighttime routines is a lot less stressful than starting with a morning routine when you’re rushing out the door. Commit to one routine for two weeks and track your progress on the calendar or using this.
3. Give lots of praise
Sometimes we get so focused on the long-term outcomes that we want, we forget to celebrate all of the small wins along the way! Children with autism often find communication challenging, so we need to make sure we’re reinforcing all of their efforts. Reminder: all children with autism are very different, so we need to be mindful that this might look very different from one child to the next. For some children, this could mean clapping and saying “yay” and for others, it might be giving a squeeze for sensory input. When we reinforce communication positively, children maintain motivation to keep communicating with us.
In Cambodia, I realized the importance of praise while working alongside Keo. After 20 minutes of helping him formulate sentences, I pulled up another picture and said, “OK, now you’re going to make a sentence on your own using this board.” Within moments he slowly began creating a sentence, carefully stringing together four magical words: “Duck jump at water.”
He looked up at me excitedly, as if to say “Did you just hear that sentence?!” As we sat across the table from one another, our eyes locked and huge smiles spread across our faces. In that fleeting moment, words weren’t necessary for us to communicate with one another. My heart, overwhelmed by emotions, was consumed with pure joy. I could feel the excitement and pride radiating from his smile.
I looked at Keo, and exclaimed, “I AM SO PROUD OF YOU. When someone does something REALLY great where I’m from, I give them a high-five” and put my hand up, hoping he wouldn’t leave me hanging.
I’ll never forget that high-five—it was a brief moment of connection but incredibly profound. Though I help children in meaningful ways every day, this experience gave me a deep and renewed sense of gratitude and purpose perfect reminder to encapsulate why I love working with children with autism. If you can make language visual, children with autism can typically start conceptualizing it.
As a speech therapist, I work relentlessly to teach my clients the power of communication and how it can be used to connect to others. In Cambodia, I was reminded that a smile can transcend any language barrier and sometimes the most meaningful moments are left in the pockets of silence.
Rachel Madel is a Los Angeles-based speech-language pathologist, parent coach and autism expert who is dedicated to helping autism parents learn how to connect and communicate with their children. For exclusive access to free resources, visit Rachel’s website and Facebook page.
This article was featured in Issue 71 – Navigating A New Year