Nick was frustrated. Nick’s mom was frustrated too. Nick is non-verbal, and relies on his mom to figure out what he wants. This adorable, super-active and very self-directed almost-three-year-old was having multiple, drawn-out tantrums every day.
It’s common for children to experience feelings of frustration during all stages of development, especially as they become more involved with the world around them and want to do more things independently. Picture a two-year-old who is trying to put a shoe on his foot, persistently shoving his toes in the general area of the shoe’s opening. He may cry in frustration when the shoe is still very much separate from his foot, but still fiercely refuse to accept any assistance. These experiences are normal and are the child’s way of expressing his need for independence.
When a child is non-verbal, these feelings of frustration are compounded, as their basic wants and needs (I want a drink! I don’t like this color cup! I don’t want juice, I want milk!) are often difficult to communicate.
When I met Nick and his mom, she described the tantrums that occur multiple times every day. Nick cries on the floor of the kitchen, kicking and thrashing for thirty minutes while she uses the process of elimination to figure out what he wants (ooooh…..you wanted the yogurt, but in an individual cup instead of from the large container!) I explained to Mom that while Nick’s speech is very delayed, that shouldn’t stop him from communicating. One of the goals we set was for him to use his pointer finger to communicate.
I showed Mom an easy way to practice this skill. When Nick had been building a tower with wooden cubes, I handed them to him one at a time and he placed them carefully on top of the tower. After a couple of times of this back-and-forth, I offered Nick a choice: another cube or a triangle-shaped block. I put them on the floor in front of him and asked, “Nick, which one do you want?” Nick immediately made a grab for the cube, but I took his hand in mine and helped him use his index finger to point to the cube, while I said out loud, “I want cube!” When he was done with the blocks, I showed him another toy and asked, “More tower? Or play with pegs?”
Although it was obvious that he wanted the pegs, I made sure his pointer finger touched the pegs before he started to play. Mom tried, too, and although Nick resented the disruption to his usually-uninterrupted play, she was able to get Nick to point (communicate!) with each choice presented to him.
We practiced together and discussed ways to implement this strategy throughout Nick’s day:
- Always offer options, even when you know what he wants.
- Encourage him to point, even if it’s hand over hand.
- Use praise and exaggerated facial expressions to reward him for “choosing”.
- Verbalize the choice he is making (“I want truck”).
- Empower him to make decisions that affect him — blue shirt, or green? Sandals or shoes?
I was impressed with Nick’s mom. She was attentive, asked questions, and played an active role in the session. She tried everything herself and asked for feedback. She intuitively knew the thing every therapist hopes the parent understands: therapy, especially in early intervention, is only as effective as the parent makes it. A kid with a great therapist is lucky. A kid with a great parent is really blessed.
Two days after this session with Nick, I got a text from his mom. “I know it’s after hours, but I just had to tell you! I found Nick in the pantry and when I came in he pointed to a box of ice cream cones! You’re a miracle worker, and I just wanted to thank you!”
I smiled as I texted her back. “I am SO happy to hear! If you want to know who the real miracle worker is, it’s you!”