4. Using toys to build early language skills

"I spend my life blowing bubbles and balloons and driving cars with little 3 year old kids, but it’s work because there’s a point to all these things that we’re doing." - Dr. Bob Buckendorf

Image from "Our Favorite Toys with Bob Buckendorf" on Youtube.

As mentioned in blog post #1, the core issues of autism that speech therapies seek to treat are related to social relatedness and communication. Social relatedness refers to a wide range of skills mentioned in earlier posts, like reciprocity, joint attention, eye gaze, interpretting facial expressions, and proximity. Communication refers to all forms, verbal and non-verbal.

In sessions with all children, including autistic children, toys and games can be great to incorporate. Most importantly, toys and games help engage the child's interest, which makes them more likely to participate in treatment activities and more likely to succeed in general. In addition, as Bob's sessions make clear, toys and games can be used to target just about every skill area children for which they may need treatment.

As we can see in the picture above, Bob has lots of toys and games at hand in his clinic, and will frequently cycle through several over the course of a session. I imagine for a lot of Bob's clients, especially his younger ones, they may barely realize how much great work they do with Bob because of how much fun they have.

A session I observed with Bob and a 4 year-old boy named M who moved to the US from China at the age of 2 provides a great illustration of a session with toys used well. For the most part, the focus of this blog has been on speech therapy for autistic children. M does not have a diagnosis of ASD, but I found the use of toys in his session too effective not to highlight.

M has a repaired unilateral cleft lip and palate. As a toddler, his lip and palate were reportedly repaired in China, however at the age of 3 in the US he presented with hypernasality and insufficient oral air pressure, reflecting significant velopharyngeal dysfunction. As a result, he had two palate surgeries to improve his speech, so he's now receiving speech services focused on interventions specific to cleft palate. Oral air pressure has improved following the surgeries, so it's a critical time for him to work with a speech therapist while he's so stimulable due to his young age and before he's developed many compensations like glottal stops.

According to the literature, individuals with cleft palate often have difficulties producing "oral pressure consonants", or consonants that require a high amount of oral air pressure including stops, fricatives, and affricates. Over time, insufficiant oral air pressure can cause these individuals to develop compensations, also known as compensatory articulations, resulting from an atypical place of production (Nikhila, 2017).

As a result, treatment goals for these first years of speech therapy were focused on producing oral pressure consonants.

The session observed takes place about one year into these services. The goals for this session were to work on stop sounds - /p/ /b/ /t/ /d/ /k/ /g/ - in initial, medial and final position in primarily with one-syllable words. By practicing these sounds in different words and in different placements within words, Bob will also focus on carryover in this session, meaning moving from one sound to another and not just targeting these sounds in isolation.

I'll tell you what Bob did not do. He didn't start the session by saying, okay today we're going to work on /p/ sounds, or something to that effect.

As M walked in, a colorful "pounding toy" caught his attention on Bob's bookshelf, perhaps because he's played with it in previous sessions, or perhaps because Bob deliberately placed it there as a communicative temptation, as he's been known to do.

Bob's goal for this lesson is to practice stop sounds, so how does he respond?

• Bob: "Oh sure. We can hit that with my hammer."

• (M's response is unintelligible but he asks some kind of question about the hammer.)

• Bob: "I have a hammer, I will show you. You sit in your chair and let me get my hammer out of course. It'll be really noisy! Do you think it'll be a noisy toy?"

At this point, M is hyped. This Bob guy is about to give him a hammer and let him hit a noisy toy with it?

Bob takes out a pounding toy and the mallet.

• Bob: "I found it. There's two things you have to hit." (Pointing to the front of his mouth, presumably because that's how they've practiced producing /t/ sounds in previous classes.)

• M: "Hit"

• Bob: "Oh nice. And again, can I hear, hit?"

• M: "-it"

• Bob: "Ah! Wonderful. One more time - hit."

• M: "Hit"

• Bob: "Boy you are so good at that."

M, whose hand was outstretched waiting for the hammer during this last exchange, now receives the hammer. M might not be totally sure why Bob had him say hit three times but he's about to hit a toy with a hammer and that's what matters.

• (Bob slides the toy over in front of M.)

• Bob: "Right here. Hit."

• M: "Hit"

M has now produced 4 out of 4 /t/ sounds at the final position of a one syllable word.

M reaches for another colorful toy that he wants to hit with a hammer as well.

• Bob: "Oh you want both of them??? So it goes - two." (Pointing to the front of his mouth.)

• M: "Two."

• Bob: "Oh nicely done. Can I hear that again? It goes - two."

• M: "Two."

• (M proceeds to hit the second pounding toy with the mallet.)

We're now 2 minutes into the session and M is engaged, and Bob is well on his way to creating hundreds of opportunities to practice stop sounds in initial, medial, and final word positions as well as carryover.

Over the next 40 minutes, Bob transitions to a dinosaur puzzle, and then to blocks, and then to a coloring activity, allowing for lots of opportunities to for practice on the target goals of the lesson, with words like "both", "purple", "red", "top", "tail", "hook", "tape", and many more. Given an open ended goal like practicing stop sounds, I get the sense Bob could've created a great lesson like this with any toy or game in that room.

M deserves a ton of credit for being such a hard working kid, though the fact that a 4 year old was able to put in over 40 minutes of good work also speaks to the effectiveness of a well-planned session with games and toys.

Link to the next blog post:

Blog Post 5: The importance of parents in child language development