AJ’s Journey: From Non-Verbal to Speech Production

I met AJ in April 2014, a mere 6 months ago. His story makes me realize why I do what I do, day in and day out. When I met AJ, he was 9 years old. He had a diagnosis of Autism. His family had relocated from India to Orange County a few months prior to our meeting. His mother later told me that they had made the move specifically because she wanted AJ to receive P.R.O.M.P.T therapy. His mother also revealed how AJ had been through no less than twelve speech therapists, several ABA therapists, and a few occupational therapists. They had also tried Neuro-Feedback therapy; several detox programs, and nutritional supplements, all in the hope that they would help with speech production. After all those setbacks and disappointments, it still amazes me that this family decided to move across the world to try another program. But I guess hope is a crazy thing.

During the initial evaluation, I realized that AJ was truly non-verbal. There were no vocalizations on demand. When asked to say “ah,” he would open his mouth, but there was no sound. He could imitate some lip movements with tactile prompts and cues, but again, without any vocalizations. He did spontaneously babble labial sounds like /baba/ and /mama/, but there was no intentional speech. I realized that at age 9, with little to no progress after years of speech therapy sessions, the odds were stacked against us. When I tried to explain this to his mother, she was quick to respond, “But it can’t hurt to try, right?” I knew then, I had to at least try. P.R.O.M.P.T therapy with tactile cues, in combination with Sara Johnson’s TalkTools® was definitely the way to go.

I saw AJ once a week for 45-minute sessions. His mother would sit through each session, carefully taking notes about the activities and target sounds and words. She would then practice all the activities each day during the week. This video is proof of AJ tremendous progress and his mother’s singular dedication. It was taken after merely 25 sessions of P.R.O.M.P.T. therapy. While there is clearly a long way to go, his incredible achievement so far, makes the future look bright and positive.

Adapting the Sign to Talk Program

Using PECS (Picture Exchange Communication System) and signs form an integral part of therapy for a lot of speech language pathologists that work with children who are predominantly non-verbal and require a functional communication system.  For one little guy, who was diagnosed with Autism Spectrum Disorder,bubbles Severe Apraxia of Speech and a seizure disorder, I attempted the “Sign to Talk” program (Tamara Kasper, M.S., CCC-SLP, BCBA; Nancy Kaufman, M.A., CCC-SLP).  The program is offered as a “bridge to vocal communication for children that are not yet vocal imitators.”  The program consists of two sets of flashcards and instruction manuals.  The flashcards are pictures of the object or verb on one side and on the back they have the picture of the sign for the word.  On the back, each card also displays a series of ”successive approximations” of the target word based on least physiological effort, as proposed by Nancy Kaufman.


Each set costs approximately $150.  However, you can purchase the Sign to Talk app for the iPad for about $20.  While the flashcards are a lot easier to use during therapy, the difference in cost definitely tilted the scale in that direction for me.  Since my little guy had a hard time attending to flashcards in the first place, I began the program by selecting a group of objects/ toys that were motivating to him and used the objects instead of the flashcards.  We worked on the signs for several weeks until he could produce the sign with minimal prompts to request his favorite objects or make choices.  I then found pictures of the objects on “Google Images” and put them on index cards.  I didn’t put a picture of the sign on the back since both the parents and myself were now familiar with the target signs.  I also hand wrote Nancy Kaufman’s “successive approximations” on the back.  The advantage to making your own cards (apart from the obvious cost factor) was that I could include pictures that are not in the repertoire of the original set.  I did have to make my own “successive approximations” for those words, but it does get fairly easy once you’ve done a few.  If you are familiar with the Kaufman cards, it won’t be hard at all.  Since my little guy was by now comfortable using signs, I introduced the flashcards to see if he could produce the signs on demand.  As his consistency increased, I gradually introduced the speech portion, which is the successive approximation of the syllables.  Since we also use signs, it alleviates some of the frustration that used to follow speech imitation when it was attempted in isolation without signs.  Of course, I always use P.R.O.M.P.T (PROMPT Institute) along with the signs.  We are seeing significant progress in his speech imitation skills.  More importantly the frustration and behaviors that accompanied any speech imitation task earlier are now almost completely eliminated.

Intervention for /r/ errors

Errors in the production of /r/ sounds in children are very common. It can be a tricky sound to correct, and intervention is harder as children get older, but it can be corrected. I use a combination of the “Say it Right” program and the PROMPT approach. The Say it Right program helps organize the treatment in terms of which /r/ to intervene first. There are in fact several /r/ productions- initial /r/ (e.g., rat, road, rain), and several vocalic /r/- (e.g. -er, -ar, -or, -air) and r-blends (e.g. br, kr, tr, fr, etc). There is a systematic approach to determine which /r/ should be targeted first for the intervention to be effective. In addition, I also use the PROMPT approach which is a tactile approach. The PROMPT approach provides the necessary sensory feedback by showing the child exactly what he or she needs to do to produce the /r/ sound. These PROMPTs are gradually faded until the child can produce the sound without the PROMPT. You can read more about the PROMPT approach on my website.

Hello world!

I am so excited to finally launch my website. I want to officially thank everyone who helped make my vision a reality. I thought I’d write this blog to share ideas and techniques with parents and other speech language therapists. Thank you for reading and I can’t wait to hear your comments.