It Starts with a K
The Family-Based Treatment Approach to speech-language therapy is a focus at UMaine's Conley Center

About the Photo: "We wanted to learn the tools to help him. We're with him all the time and the therapists are only with him once a week." — Heidi and Mark Gifford

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Kaleb slumps in an overstuffed chair, quietly nibbling away at a Devil Dog. As soon as the wrapper on the snack cake is empty, the room fills with the 5-year-old's chatter.

"'obster is my favorite food," says Kaleb, smiling at the memory.

"Remember your l's," Mark Gifford tells his son from across the room, and Kaleb repeats the word, lobster.

"I like butter, but not on my lobster," the youngster adds emphatically.

When asked what he wants to be, Kaleb rolls his big brown eyes, dramatically waves his hand and thinks, not only about his wishes but his words. "I want to be a grown-up and an adult, and a fireman and a police officer, and I know one thing: dad and I had a piece of red gum and it was hot."

The pronouncement is met with a split second of stunned silence.

"He's never said a sentence that long before," exclaims Kaleb's 7-year-old sister Kelsey, as parents Mark and Heidi Gifford exchange knowing smiles.

These days, Kaleb is full of just such surprises.

It's hard to imagine that this active, bright youngster starting school this fall was ever shy or, for that matter, ever at a loss for words. But as a toddler, Kaleb had chronic earaches — middle ear inflammation known as otitis media, one of the most common childhood illnesses. By age 1, most children have at least one ear infection; up to 20 percent of preschoolers get otitis media three or more times, according to Ear Infections and Language Development, published by the American Speech-Hearing-Language Association and the National Center for Early Development and Education, U.S. Department of Education.

The result is that youngsters like Kaleb can experience temporary hearing loss just at the age when they're learning to speak. When the inflammation is accompanied by fluid buildup in the middle ear, sounds are muffled or inaudible.

Kaleb started talking later than most of his peers. When he did speak, he was hard to understand, yet his hearing tested normal at age 2. That's when the Giffords, who live in Bradley, Maine, were referred to speech therapy at the Family-Based Treatment Clinic at the University of Maine's Conley Speech and Hearing Center.

"At first it was frustrating because you always want your children to be perfect and you never want to admit something's wrong," Heidi says. "We were hesitant to bring him to speech therapy because we thought he would get better.

"Being his parents, we understood what he said a lot more than anyone else," says Heidi. "But from the first evaluation (at Conley), I knew that we needed to be there."

The Family-Based Treatment Approach to speech-language therapy can be used with people of any age. Currently at Conley, children 18 months to school-age with their parents, siblings, and sometimes even grandparents, are the primary focus of this approach.

UMaine students in the Department of Communication Sciences and Disorders are exposed to the practice through their clinical work directed by speech-language pathologist Susan Riley at the Conley Speech and Hearing Center.

"We're teaching students to use a systemic approach, based on the theory that you can't work on parts in isolation from the whole. Something that is occurring with one member of the family — such as a communication disorder — is going to have an impact on the rest of the family.

Each family member may have a different reaction and make different efforts to help. The key to this approach is to establish a partnership with the family. It's an approach that's existed in the field of social work and family therapy for a long time, but was adapted for speech-language pathology by Mary and James Andrews," says Riley, who studied under the developers of the Family-Based Treatment model for addressing communication disorders.

For the speech-language pathologist, the 60-minute weekly therapy sessions offer a glimpse into the context in which the client's communication disorders occur and the ways in which family members may be trying to help. For family members and caregivers, such sessions are opportunities for input and involvement that are valued and respected. As part of the intervention, those who interact regularly with the child or adult with a communication disorder come away with more confidence, insight into techniques that will be beneficial and a better understanding of how speech-language change can occur.

It's important to find the intervention techniques that work best for youngsters and their families. Relationships and roles in families vary. Issues beyond those related to a child's communication delay or disorder may mean some parents are not ready to be involved in the therapy. But for others, the Family-Based Treatment Approach is empowering and effective. Therapists identify the skills of the family members to be involved, establish goals with the family and help parents learn to recognize changes in a child's speech and language between visits.

For the Giffords, the Family-Based Approach was a natural choice. It was an opportunity to be fully involved in helping Kaleb, and it was a chance once a week to come together as a family for quality time.

In the opening sessions, Riley and her team review with parents the status of the child's communication skills and the long-term goal — successful communication. They also talk about the short-term, age-appropriate goals of speech-language development that may be realized in incremental steps.

For Heidi and Mark, it was the first time they recognized the difference between what they heard and what then 2 1/2-year-old Kaleb was saying.

"It was an eye-opener when they pointed out numerous letters Kaleb wasn't pronouncing correctly at the beginning of words," says Heidi. "The most obvious one was the letter k, so he'd pronounce his sister's name, telsey. The same with the g's and s's; he was skipping over or replacing them with other letters."

Helping parents learn to observe how, what and when their child communicates is an important first step. In speech-language therapy for Kaleb, the Giffords learned to listen for the sounds he struggled to say, then used techniques to help him. They repeated mispronounced words, offered examples of other words that sound the same, or slowed down their speech when his words tumbled out too fast and made him stutter. It wasn't long before the family was coming to therapy with methods of their own that worked best for them.

Part of the approach is being solution- rather than problem-focused, says Riley.

"When are the times the youngster isn't stuttering? When is the child making himself clear? We build on success by recreating the situations when the desired communication did occur," she notes. "Parents need to be able to focus on what's changing in the child's speech and language, not what isn't changing."

At home, the Giffords worked on one problem sound after another with Kaleb through their everyday conversation. It wasn't long before their ability to "tune in" to the nuances of speech and language went beyond their household.

"When you go through the therapy, you learn a lot," says Mark. "I found myself starting to listen to other kids and realizing how they were saying some things wrong.

"Going through this has taught all of us how to better help one person in the family by doing it together," he says.

Six months ago, after two years of speech-language therapy, the weekly sessions at the Conley Center ended for Kaleb. He had made remarkable progress and his family had the skills to continue to help him maintain the momentum.

"He still has a hard time with l's," says Heidi, "but he continues to try and doesn't get frustrated with it anymore. The more times we work with him on certain letters, the more it will sink in and eventually will click, as it has with the other letters."

"He's more confident in what he's saying," says Mark.

"He tells more stories now," Heidi adds.

"Some of his words and the way he phrases things are more grown up. It surprises you," Mark says.

Just ask Kaleb how to spell his name and he's got an instant reply: "It starts with a k."

by Margaret Nagle
September-October, 2003

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