A year ago, as a kindergartner, Agatha Dean mostly kept to herself at school.
Though happy and good-natured, she felt uneasy participating in group activities. Home was her comfort zone.
“She just was very shy,” her mother, Max, said. “The kindergarten teacher said she hardly ever joined in.”
Part of Agatha’s reticence may have stemmed from being the new kid in town. Born in Chicago, she moved with her family to London at age 4 before relocating to Saugatuck, Michigan, two years later.
But a bigger factor was the challenge she faced with speech and language. Agatha struggled to process her thoughts and express herself. She also had trouble with stuttering.
School days passed more easily if she kept to herself.
Having known about her language difficulties since she was a preschooler, her parents lined up a speech therapist for Agatha as soon as they got settled in West Michigan. They wanted a more consistent therapy schedule for her than she experienced in England.
Work that’s fun
Since January 2018, Agatha, now 7, has met weekly with Meghan Vandewater, CCC-SLP, a speech and language pathologist at the Spectrum Health Zeeland Community Hospital outpatient rehabilitation center.
She’s making swift progress.
“A couple of years ago, it would have been hard to hear her speak a sentence, and now when she knows what she wants to say, she can construct it,” Max said. “Lots of people are commenting actually on how well they think she’s speaking compared to her last school year.”
“Sometimes she has trouble getting out what she wants to say, whether it’s a word-finding issue or she has a lot that she’s thinking of and she wants to say it all at the same time,” Vandewater said. “So we work on attention, organization of thoughts, reasoning skills.”
Most of this work looks like play. Vandewater uses toys to create scenarios that require Agatha to process and produce language.
Using play food, she might say, “Here’s a peach and a carrot. I want you to give the dog the peach after you give him the carrot. What goes first?”
Agatha thinks about the concepts of before and after, then feeds the toys to a cardboard dog while saying, “The carrot goes first.”
Then Vandewater might ask her to compare the peach and the carrot.
“She’s got to be able to express it, but she’s also got to think, like reason through, ‘How are they similar and how are they different?’” Vandewater said. “Even though it’s an expressive language goal, it’s targeting those cognitive skills.”
Along the way, if Agatha’s words get stuck and she begins to stutter, Vandewater signals her to use the strategies she’s learned to help herself break free.
“If she’s really struggling, we’ll go like this,” Vandewater said, using her arm to mimic the up-and-down motion of an ocean wave. “And then she’ll stop and she’ll go”—she took a deep breath—“and then continue with her thought using easy onset voicing strategies.”
The cues to take a deep breath and use smooth, easy speech work well for Agatha at home too, Max said. So well, in fact, that she finds herself using them less and less often.
“We just occasionally remind her if she looks like she’s getting into difficulty,” she said. “We just use that cue and she’s fine.”
Though it’s great to see Agatha’s fluency improving, the most encouraging sign is her increased confidence, Max said.
Now she can talk comfortably with an adult, answering a question without looking to her mom for help. And she’s more aware of the people and events in her life.
“(She’s) asking more questions—‘When is my parent-teacher conference?’ Last year she wouldn’t have even known what a parent-teacher conference was,” Max said.
“And actually, that’s the thing that warms my heart more than the disfluency, because that means that she’s starting to understand her surroundings and what’s going on.”
It shows that her cognitive skills are improving in parallel with her language skills.
In the months ahead, Vandewater will set higher goals for Agatha as they continue to work together on critical thinking and verbal expression.
Agatha looks forward to seeing Vandewater each week, and having a fixed schedule is a huge help, Max said.
“It’s encouraging that we have this slot every week and we know we have this support.”