The Checkout Line

One of the remarkable talents of life is being able to reliably choose the checkout line that will get you through the fastest and with the least amount of frustration.  I do not have this gift.  Despite pausing to make a considered choice each time I approach the checkout, I invariably choose the one with the trainee, the person who needs a price check or to purchase cigarettes or a gift card or a giraffe.  You get my drift.

Anyway, this particular day I had 3 year old Noah with me and I picked what seemed to be a reasonably quick line.  The lady in front of us had an alarming quantity of small items…and the sourest expression I have seen in a long time.  It was clear she was irritated and the vibe she radiated was not designed to make anyone near her break into “Kumbaya” strains.  The poor checkout girl was meekly subdued by this woman’s uninviting demeanour.  She snatched things out of bags already packed by the checkout girl and repacked them.  When asked,”Do you want these in bags?” as the girl held up a large pack of paper towel she snapped,”Yes, EVERYTHING in bags.”  She even reached over impatiently and tried to loosen the next set of plastic bags ready to receive shopping items, only upsetting the rack and causing things to take even longer.  I was definitely wishing we’d picked another line as I tried to entertain Noah and prevent him climbing onto the register or opening boxes or helping himself to the sugary treats in easy reach and wondered how long before we would be in the line of fire.

Meanwhile, another lady had come up behind us in the line and was putting her shopping onto the counter.  She noticed we had a roll of dog meat and struck up a conversation about dogs.  In the few minutes we were waiting we covered what type of dogs we had, how they interacted with children and what we fed them, raising children, the busyness of life and balancing work with time spent with family.  Her friendliness and enjoyment of people and life was evident and she had a gift for encouraging communicativeness.  And she made my heart smile.  What was turning into a downer of a shopping trip was revived and I left smiling over her ability to cover so many topics with a complete stranger.

Simple lessons can be learnt in a checkout line.  Your attitude really does affect those around you.  In a few minutes you can make or break someone’s day.  The checkout line brings out the best and worst in people.  I will try to make it an opportunity for the best in future.

The Donkey Fart

Every now and then, something happens in my interaction with Noah that takes me by surprise and reveals some of the gold hidden away inside of a little boy who cannot yet fully express himself verbally.  On my days off, I usually spend some time with Noah going over speech exercises or incorporating speech practice into games.  This particular day I had pulled out all the Little People sets that we owned so we could have some practice making a verbal choice.

Anyway, the game was proceeding in the usual bland way.  “Who do you want to put on the bus?  The sailor or the farmer?  Which animal do you want next for your farm – the cow or the sheep?  What does the cow want to do next – eat or sleep?”

This eventually led to an interaction between a clumsy donkey and Doctor Pig.  “Oh no!  The donkey has fallen off the roof.  Has he got a sore ear or a sore foot?  Okay, Dr. Pig will fix his foot.  Oh no!  The donkey has fallen off the roof again.  Has he got a sore nose or a sore tail?”

Anyhow, “Tail!” was Noah’s choice on this fateful occasion.  Starting to get a bit bored of the game myself, I decided to let Dr. Pig grow a gruff personality and harangue the clumsy donkey before examining his tail,”Okay donkey.  I’m going to look at your tail now.  Whatever you do, don’t blow off in my face.”  Dr. Pig closed in and clumsy donkey let rip blowing the startled Dr. Pig across the room protesting vehemently.

I looked at Noah to find him curled up on the floor, laughing hysterically, with barely any sound coming out and hardly able to breathe.  Of course, the scenario had to be repeated another few times,”You stinky donkey!  You’ve been eating too many beans.  Now don’t you dare blow off this time.”  And off went Noah into another convulsion of laughter.

Well, I discovered that fart jokes are still incredibly funny to a three year old boy with speech apraxia.  Certainly Noah’s sense of humour is intact.  And a certain principle of my family of origin is passed onto the next generation: Farts Are Funny.

Finding Noah’s Voice – Part 3: the faith aspect

One thing I miss with Noah is the awesome conversation that can take place about faith at this age.  My older son, Sam is now 6 and a confirmed chatterbox.  At ages 2-3, he was already asking many questions about God, creation and why Jesus died for us.  He would even say things that would catch me and challenge my own heart.  He was praying with us when he was 3 years old and we got to hear his heart.  With Noah, I just can’t gauge at this stage what he knows of God or his relationship with Him.  What I do know is that God cares deeply for Noah and has a plan for him.  I know that Jesus died for Noah just as much as he died for anyone else.  I know that Noah can understand what we say, so we talk to him about Jesus, we pray for him, we share Bible stories with him and now I try to recall what it was like speaking to Sam at the same age and put things in a way he can understand.  He can’t ask questions back, but seeds can be planted.

Chef Noah - loves to cook!

Chef Noah – loves to cook!

One day when I was mulling over Noah’s apraxia and how he would ever be able to speak clearly, I read this passage during my daily Bible reading:

Matthew 15:29-31 Jesus left there and went along the Sea of Galilee.  Then he went up on a mountainside and sat down.  Great crowds came to him, bringing the lame, the blind, the crippled, the mute and many others and laid them at his feet; and he healed them.  The people were amazed when they saw the mute speaking, the crippled made well, the lame walking and the blind seeing.  And they praised the God of Israel.

When the mute were brought to Jesus, they spoke!  We pray every day for God to heal Noah, to help him be able to speak.  And so far, we are seeing answers to prayer.  Bit by bit we are seeing Noah’s speech develop further.  We have not seen a miraculous instantaneous healing for Noah, but we have seen progress.  We are encouraged to press on and do what is needed to help him.  And you know, I think we  and Noah will learn more and grow more this way, than if we got the quick fix!

We are currently working on getting Noah to connect two words together.  This year we have seen him growing in confidence and making many more attempts to say words and adding to his vocabulary.  We have seen his separation anxiety dissipate as he gets to know children in his pre-kindy group.  I have been surprised to see him playing with other children recently, joining in games despite his speech limitations.  I know that the day he says his very first sentence will be a cause for enormous joy and celebration.

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Happy 3rd Birthday, Noah!
Firetruck cake for our littlest firefighter

We know he will face a number of challenges yet such as interacting with his peers when he reaches school, having to speak in front of a class, learning to read and write which is generally a struggle for children with speech apraxia.  Yet we have hope for Noah – we know he has God given gifts and abilities that even now are flourishing, we know that sound by sound, syllable by syllable, word by word, he will learn to talk.  We know that as Noah learns to speak, we are being refined too – learning lessons in patience, grace, kindness, perseverance and hope.   Yes, I often wonder why it has to be so hard for him and I worry about school and the future.  But then I look back at how far he has come in 12 months and I remember the promises of God.   Jesus enabled the mute to speak and so Noah will too.  And one day we will hear him praise God himself.

Finding Noah’s Voice – Part 2: challenges and rewards

Childhood Apraxia of Speech comes along with a number of challenges, especially with not seeing your child meet important communication milestones.  It is very hard to see your toddler reduced to crying inconsolably on the floor because he cannot articulate that he would like jam on his sandwich or would like the bread cut in triangles instead of squares.  It is hard not knowing how much of an understanding he has of the world around him or to be able to hear him express his thoughts.  It is hard knowing that he will pass through that delightful age of curiosity where the “Why?” questions are so frequent and never be able to ask “Why?”  It is hard hearing children of the same age or younger chattering away and knowing that my little boy struggles to say two syllable words or to put two words together.  Or knowing he can’t even say his big brother’s name.  Sometimes I have dreamt that Noah spoke his first sentence to me and then woken initially ecstatic, only to feel empty disappointment when I realised it was simply not true.

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Noah at his tool bench (before disassembly!)

One of the joys of speech apraxia is that as parents you celebrate every new word that comes out.  We clap and cheer every time we hear a new word or Noah makes a successful communication attempt.  Initially I felt silly putting into practice all the suggestions on speech therapy websites – say target words often, simplify your speech and narrate all your activities, sing songs over and over again, prompt speech attempts at every opportunity, encourage clearer articulation with each attempt.  Bit by bit, these have become part of my everyday interaction with Noah.  Sometimes it has taken months for a particular word to come out, but what joy and excitement when it does!  See, it was worth singing,”I dig, dig, dig with my spade” every time we sat in the sandpit to finally hear “Dig! Dig!” one day.

We also appreciate more the other ways Noah communicates with us.  He has a great sense of humour and giggles and laughs and jokes as much as any other little boy.  Facial expressions and gestures are often used to get his point across.  He is very imaginative and it is quite entertaining to watch him construct a whole fire rescue scene and act it out with imaginary fire hoses, alarms, ladders and a whole host of sound effects.  While Noah’s speech is limited, his ability to produce any range of sound effects is quite amazing.  He is also quite musical and can sing or hum tunes fairly accurately.  When we sing a song, he may get about two words out, but he fills in the rest with ‘de,dee, da, dum’.  He even gives us concerts and stands up on the TV cabinet with toy microphone in hand singing his little heart out.  His big brother Sam loves Noah immensely and the boys play games together just like any other siblings.

We appreciate that Noah is intelligent.  He has focus and concentration not apparent in our hyperactive ball of energy, Sam at the same age.  Noah is able to understand instructions.  He often surprises us by running to get an item related to a conversation we are having.  When I ask questions of him to test his understanding of preschool material, he is able to answer with “Yeah”, “No” or point to pictures.  We have seen him pull off some amazing problem solving feats as well.  Our boys used to use our flat topped bin to get a leg up into the pantry to raid biscuits.  I replaced this with a dome topped bin to prevent this problem.  One day I found Noah having removed the domed top of the bin, removed the garbage bag from the bin and turned the receptacle upside down to provide a nice flat surface to stand on while he helped himself to biscuits.   Today he locked our bedroom door and the bathroom door in order to stop daddy interrupting his fun with a shampoo bottle in the bathtub!

Noah also has fantastic fine motor skills and loves tools, art and cooking.  Construction (or de-construction) is his absolute favourite activity.  He managed to use one of my husband’s screwdrivers to remove several planks of wood from the fort in our backyard and to disassemble his toy tool bench.  Just today this progressed to removing the ladder from the fort.  Noah’s fine motor skills are actually a blessing because many children with speech apraxia also have some form of motor apraxia.

One thing I have learnt is that Noah is not defined by his speech disability.  He still has plenty of personality and potential, humour and abilities.  Our job is to help him unlock and develop his giftings and abilities while we support him in developing his speech.

Finding Noah’s Voice – Part 1: speech apraxia – what’s that?

Noah age 2 1/2 enjoying the beach in Fiji

Noah age 2 1/2 enjoying the beach in Fiji

My little boy is called Noah.  He is very much like other 3 ½ year olds, except that he can barely speak.  You see, Noah has Childhood Apraxia of Speech.  This was a diagnosis I initially feared, because I knew there was no easy fix, except for many years of hard work to help him develop his speech.

Speech apraxia is a condition mostly of unknown cause.  It affects the area of the brain that sends signals to the muscles used for speech.   There is a problem with coordinating the complex movements that are needed to produce and sequence speech sounds.  These children can understand what is said to them.  They even know what they want to say.  But there is a breakdown in communication between the speech planning area of the brain and the muscles used to produce speech.

Imagine you know what you want to say in your head.  You can even imagine what it should sound like.  But when you go to move your mouth, either nothing comes out, or you produce sounds that do not sound like the words in your head.  And nobody understands you.

I had been concerned about Noah’s speech from the age of two.  He had some words, but he wasn’t picking up new words at the rate of other children.  There were words that we thought he had mastered that just seemed to disappear from his vocabulary.  By age 2 ½ he was becoming very frustrated with not being able to communicate with us.  In exasperation, we would sometimes half-jokingly say,”Use your words!” knowing that he just didn’t have the words.  We were frustrated too.  There were a lot of tantrums and crying (Noah, not us!).

Cheeky smile!

Cheeky smile!

I started reading speech therapy websites to try and find some solutions to help my son and get some clues as to what could be affecting his speech development.  About this time we met a couple who run a school for deaf children in Uganda and they had given us a DVD showing some of the children signing their names.  I was watching it with Noah one morning and then turned to find him looking intently at the screen and trying to copy the hand movements the children were making.  That day, I started looking for information on baby sign and found some websites to get me started.  I taught Noah the signs for ‘drink’, ‘eat’, ‘more’ and ‘please’.  Within a couple of days he was able to make the signs himself.  What a breakthrough!  The frustration of trying to work out what Noah wanted started to be relieved.  I introduced some more signs gradually and was thrilled to finally be able to see Noah communicating his needs and wants.  We eventually saw him start to attempt to say the words that went with the signs.

About this time I had made an appointment with a speech therapist to have Noah’s speech evaluated.  We were given some activities to do at home to help with ‘m’, ‘p’ and ‘b’ sounds.  I must say, to start off with, even these simple exercises were beyond his capability and 2 ¾ year old attention span and I wondered if we would make any progress.  Our speech therapist suspected an articulation issue due to some slackness of Noah’s lower jaw and tongue, however over several months it became clearer that Noah had speech apraxia.  I had read about it and it was new to me.  As a medical student I had never learned about speech apraxia in children.  I had never even read about it as a doctor…until I was trying to find out what was affecting my own son.  I feared it and initially dismissed it, mainly because it seemed like the hardest speech problem to address.   However, once we had the diagnosis it was a relief because I now knew what we were dealing with, could review specific information and focus on what would help little Noah to speak.