I've written about how much I love occupational therapy. But I love speech therapy just as much. Speech therapists are great. They do a lot of different things, but in Anna's case they've taught her to communicate. To this day I'm still in awe of this process. It's really a mind-blowing thing to see that a person can have words and construct sentences but still not be able to use language to communicate effectively, and then a speech therapist intervenes and said person learns how to communicate. If I didn't know better, I'd think it was a bunch of voodoo magic they employ. But I recognize that speech therapists are scientists in their own way. There is a method to their magic (okay, therapy).
So, I've already told you that Anna's speech therapist is fabulous. She knows stuff that I don't. She can do stuff that I can't. She gets what I'm trying to say when I blunder my way through trying to describe something to her. She listens to my concerns like they are important.
The other week, Anna's speech therapist suggested that it'd be good for Anna to get into a group situation to help facilitate free-form social interaction, such as what to do and say when playing a game such as kickball. She told me there are only so many tests she can have Anna take. Anna is doing well on the tests and I gather that it may get harder soon to justify (to the insurance company, not to the speech therapist or to me) the need for continued speech therapy. The tests don't measure pragmatic language skills, where almost all of Anna's difficulties now lie.
I felt a little panicky when she said this. I agree that Anna needs help with the free-form stuff, but I also think she still needs individual therapy. She still needs help with language in a way that I can't seem help her. (Admitting this doesn't do much for my complex, but at the end of the day it's all about helping Anna.) I wanted to throw myself at the therapist's feet and say "Not now! I'm not ready for speech therapy to end! Anna isn't ready for speech therapy to end! She still needs help in ways that my brain is too fried at the moment to describe for you, but trust me, she still needs help!". What I did manage to spit out was something along these lines - Anna thinks differently, talks differently, laughs about different things, uses language awkwardly, and has a hard time interacting with her typical peers. She doesn't actually interact with kids her age, she stands back and watches them intently (which I'm sure freaks them out a bit) and then copies what they do - down to their exact movements and laughter (only delayed by a few seconds). It's a little weird. And she doesn't talk or act like them even when she's mimicking them - she talks and acts a lot younger, which they also find off-putting. So the way she uses language is weird and young for her age, and she has a difficult time interfacing with her typical peers.
But there's more to it than that and I've been trying to put my finger on it. Sometimes it takes awhile to observe things and have a deep-seated concern bubble to the surface enough to express that concern lucidly. It has to do with Anna talking younger than she is. Her typical peers can run circles around her language-wise, and it seems to me that Anna is a little lost. It's not that she doesn't have language - she does. But she's not getting things in context. She doesn't get the gist of things, the give and take of communication. She not only does not seem to understand all the subtle undercurrents of communication, she also does not seem to be picking up the meaning of words and phrases in context. She's not connecting stuff and assimilating it, instead she seems to be stuck at a 3 year old level (in language and emotional expression, which I will write more about later).
So the other week I mentioned this concern to Anna's speech therapist, who lit up like a light bulb and told me it's because Anna seems to be stuck at a "tier one" level of language. Huh. I didn't know there were tiers. Apparently there are three language tiers. The first tier is where the simplest language is...the words that live there are ones like "good" and "big" and "scary". The second tier is where the bigger words live that mean the same thing as the simple words, but with extra padding. Words like "excellent" and "gigantic" and "horrifying". Words that can be picked up within the context of a sentence. This is where Anna runs into trouble. I've forgotten what the third tier is but I think it has something to do with manipulating language to have more than one meaning (like irony or double-entendre) - I can't seem to find much about language tiers online so I will have to ask around. But I can already see that this third tier will be even harder for Anna to grasp. The ways that most of us use and understand language are so deeply ingrained and second-nature that we never have to think about it. Couple that with the unspoken and powerful communication made with body language and facial cues and communication really becomes thorny for someone like Anna, who has a hard time interpreting and using all language - spoken and unspoken - to communicate. Everyone else runs circles around her and then leaves her in the dust. She must feel like an alien in a world she does not understand. Again - Anna is not ready to leave speech therapy. Like occupational therapy, I think Anna will need some form of speech/social skills therapy for the foreseeable future.
So my homework this summer, to my slight chagrin, is to read a lot of books to Anna and give her explanations of the tier two words she does not understand. Not that I mind reading to Anna...it's just that she already asks me all day long what different words mean. All day long. It's almost enough to drive me mad. But I'll read the books. I'll smile and answer Anna's questions. And I will look forward to the day where Anna can read the dictionary all by herself.