Five-year-old Georgie and his mother, Susan (not their real names), came to see me at the speech clinic because he was not talking enough. “Other kids say much more than him,” she complained on the phone. When I greeted him in my office, Susan whispered in his ear, “Say hi to Teacher!” Without looking at me, Georgie echoed, “Say hi to Teacher!” Georgie probably had autism, something his mother seemed unaware of.
Working with Georgie started with a bang. He spent the first session naming every animal on the posters of my office. “Tiger!” “Leopard!” “Orangatan!” “Cow!” “Sheep!” “Pig!” He was a “namer”. So I pulled out the animal book. “Let’s look at these animals.” First up were animals on the farm. I began, “These are all animals on the ….”
He smiled and shouted “Horse!” (He was still naming.)
“Yes, that’s a horse, Georgie. These are all animals on the…”
“Cow!” Georgie shouted.
“Yes, That’s a cow! These are all animals on the…”
“Horse!” he shouted.
Time to give up on catagories. I answered my own question “These are all animals on the… farm.” I said it slowly so Georgie would hear the words.
Then I heard him repeat, “on the farm.” Georgie started his sentence before I was finished with mine.
Echolalia, the immediate repetition of words spoken by another person, is a common experience for toddlers, just learning language. But it should disappear by the age of three. Georgie, at five, was well past the age of using echolalia.
We continued to work on simple back-and-forth conversation. In therapy Georgie has lots to say, rather he has lots to name. He did call out the things he saw, and to the untrained listener he seemed bright. He seemed to know a lot. Where he broke down was in the give-and-take of language and social interchanges. I say hello, and he might say hello. I comment on the weather or the activity, and he misses it completely. I ask a question and he calls out something completely unrelated that caught his eye, or perhaps he was thinking about. Communicating with Georgie needed to be purposeful on my part. He probably wouldn’t participate with me at all if I did not push my way into his world.
Once we played with blocks, long and short, with different shapes naming them as we played. He found all the cylinder blocks and stacked them up one on top of the other on the table, “Rocket!” he cried. He was so proud of his creation! I was proud of him. Then I tried to get him to put the blocks away, to do the next activity. “No” came the protest, and he melted down. No more playing, no more communicating, only crying and refusing. His inflexibility was getting in the way of his learning. I began to imagine the kinds of problems this little boy was experiencing in school.
One of his goals is increasing his “novel” vocabulary – that is increasing the amount of words he came up with on his own. Remember, the long sentences he says, when he is repeating another person’s words, don’t count. He needed to come up with, and combine words, on his own. This is true language learning. When he first came to see me he was at the one-word level. He was coming up with single words (mostly names). We’d worked on ‘describing words’ like mama/baby, big/little, and hard/soft, and now he was understanding, and using these words to describe toys and objects. His favorites were the farm animals, and we played with, and talked about the “mama cow”, and “baby cow” and other animals. He was beginning to use novel 2-word phrases.
He came into my office. The farm animals had been moved out because it was time to learn new describing words. We talked about big/little, soft/hard and now I wanted to add colors. I knew he knew his colors from his intake testing. I held up a colored block. “What color is this?”
“Triangle!” he chirped!
“Yes, it’s a triangle. We’re describing the color….”
“Square!” he shouted about another block he saw on the table.
I brought his attention back to the triangle. “The color is….”
“Wait!” he shouted. I discovered he used this word with adults when he could not follow the task, or was confused. It’s a very effective word. When he says “wait!” the adult, being polite, will wait. It’s an ideal word for him to manage the activities (and adults) in his life. (And who says kids with autism aren’t smart?)
I paused a moment, then asked again, “The color is…?”
“It’s raining!” he chirped, as he sprung up from his chair to look out the window. It was a perfectly sunny day, without a cloud in the sky. “It’s raining!” was another phase he used to get out of activities.
I tried to bring him back to the blocks. “Today we are describing color. This block is red.”
“Cow!” Georgie shouted. “Cow..cow…cow..” he got up agitated, and paced around the room.
“Do you want to get the farm animals? I asked.
Georgie looked relieved and chirped again, “Cow!”
I took his hand and led him down the hall to another office, where we stopped at the door. I made him knock on the open door and wait. The therapist there greeted Georgie.
“Hello” she said.
“Hi!” chirped Georgie.
“Cow!” He said, and walked across the room to get the bag that held the animals. Then he walked out past the other therapist.
“Bye.” she said.
“Thank you!” said Georgie not looking back. And then he added “Merry Christmas!” (It was January 15th).
I’ve been teaching Georgie catagories. When we first started out, this 5-year-old did not know how to name basic catagories like food, and animals. So we played a game where I put a toy in a box and he had to take it out and “put it where it belongs”. We played this game with toys and objects several times, putting the plastic food in the play kitchen, and the toy animals in the toy farmhouse. But every time I introduce a photograph of a toy, food or a vehicle, he protested.
“No!” he screeched….
His reluctance tells me that his brain has not yet developed to a stage where he can understand and manipulate pictures. This usually develops in children around 2 -3 years of age. At age 5 Georgie was far behind. So back we went to the real objects, or objects that closely resemble them. It’s a good game and we keep it up for a while. Georgie is not really ready to move ahead. I’m concerned that Kindergarten is going to be a real shock for him and his teachers.
Watching his mother is like watching a train wreck in slow motion. Although no one will die in this drama, there will be the death of hope, expectations and the dreams of the child she expected to have. Instead she got a tuned-out, repeating child who cannot answer questions, follow directions, make eye contact or tolerate hugs! “He’s tired today.” “He didn’t eat breakfast.” “He’s not feeling well.” The mother’s excuses keep coming. When will she see, there is no excuse for this unusual behavior? When will she see her child as truly different, and not just slow? What will it take for her to see her son clearly? She came to me for help. She knows her son is not developing. I am waiting for her to show some understanding of who he really is. I am waiting ….
Good developments are happening. Mother is beginning to realize the kindergarten she is thinking of may not be a good fit for Georgie. She’s going to try her neighborhood public school. This is good because his private preschool was not prepared to offer him any support. I asked them what they do when Georgie didn’t want to participate in classroom activities. They said they just let him sit in a corner and look at books. I could see him really get left behind in that school. I’m so glad the mom is being proactive about his education. He’s going to need a special touch. Kids with autism always do!