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Friday, June 12, 2015

Henry Wellness Update: Looking, Listening, and Pre-Language Skills

I feel sure that without Henry I would never have had the chance to appreciate the very subtle elements of emergent communication. Here are some of the ways that Henry, though still nonverbal, is showing us how much he understands and helping us to understand him.

Good looking, Henry!

At speech group, Henry is sitting in his special chair (with a buckle so he doesn't fall out) at a small table with other kids and their parents. His speech therapist, Monica, calls his name. Henry looks up, looks at her and makes eye contact. Monica cheers, "Good looking, Henry!" and holds up two toys. "Do you want the blue one or the red one?" she asks. Henry looks from her to each of the two toys and then grabs one with both his hand and his mouth. 

He didn't say blue or red, or even point to indicate a choice. But he looked at Monica when she spoke to him, and he looked at each toy before grabbing one. It's a tiny thing, but directing his gaze with intention shows that he understands what is going on. And when Monica says "Good looking!" she's not calling him handsome ;) She's letting him, and me, know that he did a good job of making eye contact at an appropriate time and focusing on her while she was talking to him. The therapists call it "shared attention."

Sometimes Henry is too distracted to pay attention when someone is talking to him. Sometimes his other sensory needs get in the way. Another day at speech group, he just couldn't seem to stop biting the table long enough to look at Monica and listen to her when it was his turn. When that happens, it's frustrating. For us the parents and therapists, and possibly for him. But more and more we see him becoming able to do things more intentionally and less impulsively. More and more we see that he is able to pay attention to someone speaking to him and create that shared attention.

There are other ways in which Henry's gaze shows us what he understands. One of his speech goals is to respond to "distal pointing," or looking at something far away when someone else points it out to him. So if I say "Look, Henry, it's Daddy!" and James is across the room, the goal is for him to follow my gaze or my gesture and focus his attention on his daddy. He does this best with people. I think it's because the names for people are more familiar to him than the names for objects. If I say, "Look at the airplane!" and point up into the sky, he generally won't look up. Because maybe "airplane" doesn't mean much to him yet. But this speech goal isn't really about words he does or doesn't understand, it's about knowing that if someone says "Look over there!" and points, then you're supposed to look where they're pointing. And occasionally he does it... but mostly we're still working on it.

Sing Me a Song

Henry sits in his high chair at home with his other speech therapist, Holly. Holly is doing songs and rhymes with him. "Open... shut them. Open... shut them." Holly sings slowly. When she says "open," she holds Henry's hands apart. When she says "shut," she brings his hands together as though he is clapping. "Give a little clap, clap, clap!" she sings and she helps him clap his hands three times. "Open... " she repeats, pulling his hands apart - but then she pauses. She waits and watches him. He waits and watches her, eyes wide, anticipating the next part. A moment passes and then Henry pulls slightly on Holly's hands. It's a tiny movement, the slightest pressure, but that, combined with the expectant look on his face, shows that he knows what comes next. Holly responds with the next part of the rhyme, and a nod to let him know he got it right. "Shut them!" and helps Henry bring his hands together. 

Henry has really been interested in songs and rhymes lately, and I think it's because he is just starting to understand them. He is starting to be able to follow along to the words, the rhythm, and the gestures. In the past, he wouldn't really attend to songs and hand motions like he does now. Now, he is really watching and listening. He's starting to get it. I feel like it won't be long before he can do some of the hand motions himself!

His favorites are "If You're Happy and you Know it" and "Open, Shut Them."

Let go! 

At breakfast, Henry has snatched his spoon out of my hand and is chewing on the handle. I need it back to feed him another bite. "Henry, give me!" I say, and I hold out my hand. He takes the spoon out of his mouth and looks at me out of the corner of his eye with a sly smile. He continues to clutch the spoon and waves it around. "Give me!" I say, still holding my hand out. Henry looks at my hand, then back at my face. He smiles broadly. Finally he holds out the spoon over my outstretched hand, but his chubby little fingers are still holding tight. "Thank you, Henry! Now let go!" I say. But he doesn't, and I pry his fingers open as I say again, "Let go. Thank you."

Henry is learning to follow some simple directions. "Give me," "let go," "come here," "put in" and "look," to list the ones that come up most often. He definitely understands "give me," but he's so funny about it! He almost always does this thing where it's like he's trying to be sneaky and not hand it over even though he knows he's supposed to! And then when he does hand it over, it's like his hand doesn't get the message and he can't figure out how to loosen his death-grip on the object. The same thing happens with "put in" when we're putting toys in a bin. He'll finally hold the toy over the bin, but he still has to figure out the part where he's supposed to open his hand and let it drop in!

It's been recommended to me to keep the commands short and simple: just one or two words. So I don't say, "Give me the spoon please." I'll usually just say "Give me" or something like "Give me spoon" with a one-word name for the desired object.

More More More!

Henry sits in his high chair during lunch. I tear off a small bite of PB&J and put it on his tray. He scoops it up with one hand and pushes it into his mouth. Since he's had a few bites already and I know he's not famished, I pause before offering him another bite. "More?" I ask. "Do you want mmmooore?" I exaggerate the word for emphasis. Henry says nothing, but bounces in his chair and claws the tray like he is picking up invisible bites. I take his hands and help him make the ASL sign for "more" and I say it again, "Mmmooore!" Then I give him another bite. 

Calvin is asking for something. I turn away from Henry to help Calvin with his lunch. After a few moments I hear Henry softly saying, "Mmmoh! Moh! Moh!" I turn back to him with raised eyebrows. "More? Oh! You want more! Good talking, Henry!" I cheer as I place another bite of sandwich on his tray. 

This is the closest thing Henry has to a first word! Not "Mama" or "Dada." Nope. For this guy, food is apparently the biggest motivator. He only says it for food, though we use the word and sign "more" for many other things. He won't say it on command, and he doesn't say it every time. It usually comes out in scenarios like this one where I've turned my attention away from him and he's ready for another bite.

He does a lot of babbling, and sometimes his babbling sounds very much like words but it's hard to be sure. He is even starting to imitate sounds. Here's a video of Holly playing with Henry and using bouncing to encourage him to vocalize.

Henry's pre-verbal skills give us a glimpse at how his cognition is developing. It looks like he's becoming more able to focus on specific things. He seems to be recognizing patterns, like patterns in rhymes and songs. He's starting to show that he remembers things. He's starting to show that he understands things we say. He shows us his sense of humor :)

There's some overlap between his speech therapy and his occupational therapy. Hand motions in songs and rhymes, using gestures and pointing to communicate, and that business about letting go of the spoon!

It has been eye-opening to realize that there are so many elements that play a role in communication, and it is so amazing to see them unfold little by little for Henry. It does seem a little strange that it's possible for him to have made so much progress in speech therapy without any real words or signs, but these pre-verbal skills that he's developing have already made a big change in his ability to communicate with us.

Holly and Monica, if you are reading this, first of all THANK YOU so much for all the support for Henry and for me. It is wonderful to get to work with you! Also, if there's anything here that I haven't got quite right, please feel free to correct me! I'm learning as we go.

More updates on Henry's development are in the works. One about his motor skill development, and probably one more about his eating/feeding.

Thanks for reading!!


  1. Diana, It is always wonderful to read your updates about your kids and family life. I am so glad that you are able to see the progress Henry is making. I think that as parents we generally miss so much of what is going on with our kids because we don't know what to be watching for and also because we are pulled in so many different directions at any one time just by life itself. Kudos for you girl!!! btw, your video comes up as "private" and won't play for me even when I'm signed in. I just thought you might want to know. ~lynn

    1. Thank you, Lynn! And thanks for letting me know about the video. I changed the settings on it, so hopefully it will work now!