Sam is 9!

Sam is now 9! I just reread my last proper blog about Sam’s birthday, when he turned 7, and much of it I would like to repeat: I can’t believe he’s 9! He’s so tall! Well done us for 9 years of parenting!

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A lot has happened in the last two years, though in many ways things for Sam and us can seem similar – the appointments, the physio, the school, his interests. When you are there every day you don’t notice your kids growing up, until you catch sight of them across a playground and cannot believe that massive child once lived in your (my) womb.

Two years ago I said Sam had:

“made huge progress on using his eyegaze computer: using it almost every day, knowing exactly what he wants to do, reliably choosing stories and then navigating through them like a pro, using communication software to create messages that were totally appropriate to the moment.”

That was true then. It is also true now: what I want to tell you on Sam’s 9th birthday is that he’s got so much better at using his eyegaze computer (and lowtech communication book). That he often knows exactly what he wants to do, will choose the story he wants and navigate through it, that he goes into and then exit activities when he wants. That he uses his communication software to say things that are entirely appropriate.

Some of what I want to say sounds so similar to 2016 that it begs the question of what  what exactly has changed since he was 7. The complexity of the way Sam learns and communicates means progress, or development, is hard won. It can be inconsistent and hard to capture precisely. I look back on Sam two years ago and I know that he wasn’t as good at navigating around his communication device as he is now. That isn’t to say he wasn’t doing those things before, but perhaps I did see small improvements and leapt on them. I know more now, I expect more of him now. In some ways Sam is doing much the same stuff he was doing two years ago, and in other ways he’s made wonderful progress.

The timescale of helping Sam learn new skills is difficult – it can take a long time. It can be hard to know whether he is improving or learning, and therefore whether you are doing the right thing. It can feel pointless to continue working on something that appears to be having little impact. We knew that communication was a long term project, probably lifelong, but you still can’t help hoping that there will be some kind of miraculous progress at some point.

Which of course there isn’t. But there is slow incremental improvement, a bit more nuance, a little more unprompted communication. It is all subtle and understated. We are talking about complex skills, involving deft eye control, motor planning, memory and language knowledge. It’s difficult to articulate, but I’ll do my best.

Two years ago Sam was using a high-tech eyegaze device that we had bought ourselves – it was a laptop with an eye tracker connected via USB. He could only use it when sat at a table. For the last 18 months he has had an NHS-funded eyegaze device which mounts to his wheel-, school- and home-chairs. He is still quite light, so his weight isn’t sufficient counterweight when the device attached which means it can’t be mounted all the time (e.g. on uneven ground), but he has it mounted on his chair at home and school for some portion of every day. For the last year he has also had additional educational funding so he has two hours of 1:1 time each day when an adult supports his communication specifically – modelling how to say something on his device, helping him find specific vocabulary, helping him use his device to do school work.

These developments have given him more time to practise and more opportunities to find pathways within his communication software. Sometimes progress doesn’t look how you imagined: over the summer he used all of this input to navigate out of his communication software every time I tried to talk to him using it. Every single time. This was disheartening – isn’t supporting his communication meant to mean he communicates with us more?

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To do this he was adeptly selecting three different cells in different positions on three different pages in order to exit his PODD communication software and then go to one of the stories on his device – clearly communicating that he didn’t want to talk to me, he wanted to read (and be read) a book. So I had to admire his determination and skill, and respect his wishes – to force him to talk would be as inappropriate as trying to make a verbal child speak to you.

Since the summer he has chilled out in this particular regard, and will now talk with his device. It is mostly in the context of a specific conversation rather than unprompted speech. It’s getting increasingly relevant and timely, with some ‘scaffolding’ provided by  his communication partner.

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For his birthday Sam’s aunt Rosie sent him some incredible shoes with lights in the soles. Once we’d opened the package and put them on, we talked about them with his device. I went to the homepage of his communication software, where there are various categories of words, and went to Special Events. He then chose ‘happy’ and ‘birthday’, and then I selected ‘present’. I said ‘this present was from…’, and I went back to the home page and into the People folder, where Sam selected ‘Rosie.

I said, ‘yes, from Rosie. And look what she’s bought you!’. I couldn’t remember where exactly to find the word but went into the ‘Clothes’ page. I then got distracted by trying to stop Stella inspecting Sam’s shoes so closely that she risked being kicked in the face. Then I heard Sam, via his device, say ‘shoes’.

He had gone to the folder called ‘shoes’ and then had ignored the cells called boots, thongs (it’s Australian software), AFOs, sandals and trainers to select the one that said ‘shoe’.

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Sam knew what I was talking about, he knew exactly which words we needed, and he found them with his eyes by navigating between pages, selecting the correct one of 18 cells on the screen, repeatedly. It’s functional, practical, appropriate communication. It’s everyday speech, only it has taken years of practice and support for this to become close to our everyday.

It’s one step further forward for a boy who has spent nine years working so hard to make himself understood. He’s 9! I’m so proud!

 

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How we learn to talk (part two)

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Recently I complained that Eli talks too much. I caught myself saying it twice, to two different people, in one week. Granted, James was away and I was really feeling the intensity of being the primary carer of all three kids, but what was I thinking?

Eli is, in the nicest possible way, a chatterbox. Some days he will barely stop talking for hours at a time. It’s a charming mixture of questions, statements and analysis of the varying powers of superheroes.

Eli was relatively slow to talk; he just said ‘oh no’ repeatedly for months and as he turned two the health visitor was a bit concerned about his lack of speech. I wasn’t worried. I had spent hours with speech and language therapists with Sam and so knew something of the basics of learning language. I could tell Eli knew loads of words and understood what we told him. He made loads of sounds. I had a feeling he was just biding his time until he started talking.

At two-and-a-bit he started saying more words. Within a couple of weeks he was putting words together. And by the end of the month he had three-word sentences. It was like a miracle, like you could see his brain working and his body co-ordinating itself with an ease and fluidity that was beautiful to watch and hear.

Since Sam will probably never talk, I promised myself that I wouldn’t take it for granted. And I haven’t – there have been numerous occasions when we have been so very grateful for Eli’s ability to tell us what the matter is when he’s ill or what happened at nursery that day.

Meanwhile there have been many times when we have been so very sad that Sam can’t tell us what the matter is, or what he has done that day. We find ways round it by school telling us each day what he has done, and recording messages on a button that goes to and fro with him, but it’s no substitute for independent communication and it’s a clunky way to converse.

We, and his school, are trying our best to give Sam the means to ‘talk’. We continue to model his PODD book with him (a communication book with lots of symbols to represent vocab), and give him access to his eyegaze computer regularly. When he returned to school after Easter, his carer/nanny printed out photos for him to take to school of all the things he had done over the holiday. I programmed new pages on his computer so he could use his eyes to describe what he had been up to (with photos) for his friends and teachers. (SO proud of myself for managing to navigate the software to do this, with only a couple of exasperating moments when I felt like chucking the computer out the window).

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Sam loved all of it – he enjoyed showing people photos of Eli squashing him in the park, and telling them about our easter egg hunt.

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But these things are manipulated by us. We choose which photos to include and which anecdotes to tell. Sam can’t tell people what HE wants to about his holiday he can only share one of the moments we chose to include. Who knows whether we have included the bits he most enjoyed? Yesterday we were talking about when we all visited an outdoor exhibition of massive light sculptures and Eli’s best, most important memory was of the Smarties Grandpa gave him, rather than any of the sculptures. Kids experience the world differently to adults, and often remember the bits we think are incidental.

Or we (adults) don’t realise what kids want to do. When Eli is climbing a tree, Sam will make complaining noises until we ask him if he wants to climb the tree? He then looks at the ‘Yes’ symbol on the arm of his wheelchair, and so we take him out and lift him up into the branches. A year ago he wouldn’t have been able to communicate this clearly something we hadn’t thought of. Or perhaps we weren’t able to interpret what he was trying to tell us.

We continue to hope we can give Sam the means to express what HE wants to say, rather than what we think he wants to say, and he is making progress with the ways he has available.

Each week at school Sam helps create a sentence and they work on the sentence each day, putting the words in the right order. On one of the first days back at school this term, staff in Sam’s classroom navigated him to the Places page of his PODD book. He had to choose the place to complete the sentence ‘I went to the …’ and through careful yes/no answers as he worked his way through the various symbols with an assistant he chose Library: I went to the library.*

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School wondered if he really meant library. We hadn’t mentioned going to the library in our various messages to school. Maybe he was confused, or hadn’t really meant library. After all, his communication can be hard to interpret.

But HE HAD GONE TO THE LIBRARY. The day before! So he had told his class something we hadn’t!

Before Eli started talking it was all in his head, he just had to work out how to say it all so we would understand. Sam clearly has so much to say, but no reliable way to say it. In some ways this makes me sad. In many ways it makes me anxious – it is our job (with various professionals) to help him find ways to talk to us and I feel the weight of the responsibility.

But mainly I feel hopeful. Sam has started to use the communication systems we are providing and has begun to talk independently. It will take time, but he’s making progress. He went to the library!

 

How we learn to talk – part one is here

* Note how many symbols there are on this page, which is one of many in the PODD book. Imagine the skill needed to identify which symbol you want on that page and then communicate it to the person you are talking to using only your eyes. Imagine if you got distracted or confused midway through and needed to start again.

How we learn to talk

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I have just done a two day course on a system that I hope will help Sam communicate with us and everyone else.

Communicating is one of Sam’s biggest challenges. He has a lot to say, but his severe disability hampers all of his efforts to tell us what he thinks or wants: he can’t speak, he can’t point, yet he understands a lot.

He has found highly effective ways to get round this day-to-day. He can smile or frown, laugh, shout or show us his bottom lip (the degree of protrusion of the lip is directly proportional to his sadness, on a spectrum that ends in full-blown sobbing). Whingeing indicates dissatisfaction. Looking expectant means ‘I’m interested’.

Sam has the intellect to express far more sophisticated ideas and desires than this – but he needs the tools. So we are working with Sam’s school and a number of speech and language therapists to maximise his opportunities, using Assistive and Alternative Communication, or AAC, the term used to capture a whole range of communication systems that don’t rely solely on speech.

Everyone involved in this effort comes together at a termly review meeting. Last week that involved eight professionals sitting around a table for several hours discussing progress. The combined level of expertise is immense.

And partly because of all of this input, Sam is doing brilliantly. In last week’s meeting someone pointed out that (PROUD MUM ALERT) Sam’s spelling is on a level with his non-disabled peers, so it’s important to not push him too hard. He already has to work much harder than a typical kid to spell consonant-vowel-consonant words but he’s doing it – on an eye-gaze computer or by looking at magnetic letters with Granny.

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The major new communication concept we are introducing to Sam is a PODD book, developed by an Australian woman called Gayle Porter, a minor celebrity on the aided language scene.

PODD books are full of symbols that you point at to express yourself. The ambition is that Sam will eventually be able to show us which symbols he wants to ‘say’ (video of a child using PODD here).

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The success of using aids like PODD books is totally dependent on the expertise of the people surrounding Sam. The course I was on last week was an attempt to increase my confidence and knowledge.

I came away enthused. This has huge potential for Sam. But at the same time I’m nervous, intimidated even. I took away three main insights from the course that really highlighted how big an endeavour this will be:

1. Do we have the stamina to do this justice?

A typical child hears spoken language for at least 18 months before they start talking (over two years if you’re Sam’s brother Eli). It therefore follows that we should be modelling use (otherwise called ‘receptive input’) of the PODD book to Sam for at least a year before we expect him to be using it with us. If we were really to mimic normal acquisition of speech, James and I would use it to talk to each other in front of Sam.

At the course we were shown totally inspirational videos of young children communicating, in ways that just would not happen if they hadn’t been taught to use PODD. But … in some of the videos, their mothers (and they were almost exclusively mothers) had modelled use of the PODD books with their children for over a year before their children started interacting with the book.

The level of skill of these women is impressively high – they can navigate expertly from page to page and find symbols really quickly. But even more important is their level of determination. They have dedicated years of their lives to teaching their kids to use PODD books, even when the kids weren’t apparently engaging with them. It is hugely inspiring, but also massively daunting. What if we’re not committed enough? What if we get bored and demoralised, and that means we fail Sam?

2. You can’t learn a language if you’re placed on mute

If you think of the PODD book as Sam’s way of talking, then you have to have it available to him all the time. Otherwise you are effectively silencing his voice. It is close to the equivalent of gagging a verbal child to stop them talking.

We are already guilty of doing this: we introduced Yes and No symbols on Sam’s chair so he can look at these to answer questions. A few weeks ago, the No got puked on, the sellotape got wet and the symbol fell off. Despite daily good intentions, I still haven’t got round to sticking it back on. And I haven’t got round to putting the Yes and No symbols on his wheelchair.

I introduced an opportunity for him to tell me things and them I took it away. Shit.

3. This needs to be a whole family enterprise

On the course I also saw videos of young children using PODD books really competently with their disabled siblings. Eli is really trying to work out the rules around him at the moment and where Sam fits into it: for example, ‘big boys’ walk and babies don’t, but Sam is a big boy and doesn’t walk (cue confused/amazed face). We’ve had discussions about whether Sam can hear Eli talking, because normally people talk back when they hear you, but Sam doesn’t talk.

Eli already talks to Sam on his terms – he says ‘night night’ to Sam every night and waits for Sam to look at him because he knows that’s Sam way of saying goodnight back. When Eli asks Sam a question he says, ‘Sam, can I play with your Peppa toy, YES OR NO’!

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Eli could easily pick up the way a communication book works (the photo above shows him at 18 months getting interested in one), but only if he sees us using it. We have to normalise it within our family, even if the wider world insists on only speaking to each other.

I should reiterate that I really am filled with enthusiasm – the PODD system has been thoughtfully developed and children exactly like Sam have learnt to use it proficiently. But, oh my goodness, what a weight of expectation. Remind me of this blog in a year, when my enthusiasm for pointing at symbols might be wavering and I need to remember that we knew we were in it for the long haul.