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Speech/Understanding Delay and Gentle Discipline

5K views 13 replies 5 participants last post by  RiverTam 
#1 ·
DS1 has a speech and understanding delay. We're in the process of getting him evaluated and an official diagnosis, but at the moment it appears that he has Mixed Expressive Receptive Language Disorder (MERLD). He is 3 with an extremely small vocabularly (easily less than 50 words), and he also understands very little. For example, you can say "Hand me the train" and point at a table with a train and a couple of other objects. Even though he plays with trains every day, he doesn't understand the word or connect it to the object. He will understand from the context that you want something on the table, and will bring you each object in turn.

This makes discipline extremely difficult. DS1 has a very hot temper and is very sensitive and emotional. We want to help him understand and work with all of this. At the same time, he needs effective discipline. It seems impossible to accomplish any of this with the normal AP/gentle discipline techniques. Whereas with a developmentally normal child, if they got angry and threw a bowl of water, we would say something like "You're angry. It's okay to be angry, but you may not throw water. Let me show you how to punch a pillow to let your anger out" for a first offense and explain that he may not play with water for the rest of the day for a second offense. With DS1 his lack of understanding makes any sort of naming emotions or offering alternatives or consequences impossible. We currently do warnings first, then time outs, but that feels sort of arbitrary.

We would feel much better if there was some way of addressing his emotional needs and helping him understand the consequences of his actions instead of just punitive discipline.

Does anyone have advice or suggestions? They would be greatly appreciated!
 
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#2 ·
My DS2 had a DX of Speech Apraxia, and is currently DX with Articulation Disorder.

I will say that I think a common thing among children with speech delay is how they handle their emotions. They have no way of verbally expressing what they are feeling and as such I think start acting out violently or aggressively when they are angry.

I would suggest that you just gently hold him for a minute looking at him (holding as in snuggling type of hold) and gently explain to him that you understand he is upset or angry (this way he starts to learn and be able to put a name to what he is feeling even though he may not fully understand it yet) but it is not OK to do XYZ. I would maybe give him a bit more warning before taking something away (like 3 instead of 2, because of the receptive delay).
 
#3 ·
With DS1 his lack of understanding makes any sort of naming emotions or offering alternatives or consequences impossible.

My 8 year old has MERLD with additional semantic/pragmatic deficits. It was very difficult to do this with him, but we feel that is absolutely necessary. He does not learn intra-personal skills or social skills through observation. The only way he's going to get them is if we teach them explicitly. I think of it as a software update. Most kids update their social skill "software" automatically. With DS, we have to do a manual update every single time.

We use ABA and treat speech as a behavior. We work on shaping his speech behavior to appropriate behaviors.

That means we have to do a lot of work with naming emotions and offering alternatives and modeling the appropriate speech. Ie. "D. you threw the water because you were angry and frustrated. That is not acceptable. If you are feeling angry or frustrated, you can ask for help. You should say "Mom, I can't do this. Can you help me?" When he does the correct speech behavior, we immediately respond to it by giving him what he requested. We try not treat it as a discipline issue, but an issue of lacking the appropriate skills. Once he demonstrates the appropriate skills, we move on.

If he can't calm down, we move to time-outs. After the time out, we sit with him and talk about what the appropriate behavior would be. If he demonstrates the appropriate behavior, we let him go straight back to what he was doing.

It's a lot of work. I find it demanding to do, and he finds it demanding on him. It's working, though. He is improving. The other thing is that weekly speech therapy really has helped his language ability. It's improving. As he has improved, some of our discipline issues have gone by the wayside.

I also borrow materials from autism therapy to work with him. Social skills picture books which teach social skills are helpful. Social skills videos are helpful. I found the Transporters video really useful for teaching this child to identify emotions.
 
#4 ·
Thank you both for your replies, they are very helpful. I think we need to be more consistent with naming emotions for him. He will be starting speech therapy soon, so hopefully, even if he doesn't understand much now, he will start to. At the very least I hope he will see that we are trying to help in some way instead of just coming down on him for "bad" behavior (the majority of which is likely to be venting frustrating from feeling misunderstood).

We will definitely look into the autism therapy/social skills stuff. That sounds like it would help a lot, especially after speech therapy gets him started understand a little more. I sympathize with him feeling misunderstood, but it's very important to learn to channel feelings appropriately.

We have recently begun signing with him, too, which I think he is sort of starting to get. It's just so hard, he can't even ask for help. Very frustrating for everyone involved. I know with therapy and with us working with him things will start to click soon, but right now it's a little overwhelming. We worry about even taking him places because he doesn't understand basic safety rules (e.g. stay on the sidewalk because a car can hit you and kill you.)

Thanks again!
 
#5 ·
This is an interesting thread, thanks for posting the question. My DS is 3 and ASD and has a smaller vocab than your DS but I think he's a little better with receptive language. Thankfully, he's mostly mellow with periods of tantrums when he's tired or when I push him. If he threw a bowl of water, I know it'd be futile to explain and give warnings, etc...what I do is get on my hands and knees and grab two hand towels and as him to help Mumma clean it up. Sometimes (ok, most times) I'll say that it's not fair for me to have to clean it all up when he did it, but if I remain calm and respectful, he always helps clean it up, and then we share a hug. He's a marshmallow so it doesn't happen often, but we both feel better in the end.
 
#6 ·
No advice, just sympathy. My DD, age 3.5, has an acquired language disorder which is basically the same thing as MERLD - she has difficulty with expressive and receptive language. She is fairly withdrawn and mild-mannered so we aren't struggling with the same behavioral issues, but I understand the worries about taking your child places due to not understanding basic safety rules. We have to supervise her as we would a 15 month old toddler. She is a climber and will quietly go seek out whatever she is interested in with no notice to us, so if we're not watching her, we're liable to find her on top of a dresser or walking around the block (yeah, she opened and shut the front door while DP was washing dishes at the sink with his back to the door - he didn't hear it open. We've since installed a bell that rings every time the door opens!). I find that we accommodate her a LOT. Because we can't communicate very much with her, we still parent her as if she is 15 months old - we try to anticipate and intuit her needs and wants and we have adjusted our expectations of her behavior - we don't expect her to function like other 3.5 year olds because she hasn't understood our instructions about how to behave. We still do a lot of physical intervention (meaning we physically go and remove her from situations, physically help her do stuff, rather than verbally instruct her.)

DD is in developmental preschool and her daycare provider is a retired special ed teacher, plus she goes to private language therapy with a speech therapist twice a month, so she is getting good support for language development. We are using a total communication approach - using signs (as we learn them) in addition to speech. She is making progress, slowly but surely. I would say she now communicates at the level of an 18 month old.

We also just got her an iPod Touch for Christmas and installed the iCommunicate app on it - we are using it as a picture communication system and this seems to really be helping her make the connection that things and actions have names. The app allows me to take pictures on the fly and record audio to go with each picture. For example, she was really interested in some clown dolls the other day and I took a picture of her looking at them, recorded myself saying "clown doll" and played it back for her right then and there. She instantly made the connection that the thing she was looking at was called a clown doll. She is mimicking words a LOT more since we started using the iPod Touch, and it's small enough that she can hold and wield it easily. It took her about a day to figure out how to scroll through the pictures, and she has fun tapping on the ones she likes.

So I guess that is one piece of advice: look into a picture communication system. If an iPod Touch isn't an immediate possibility, you can always take & print pictures of things from your child's life (family members, home, playground, picture of him sleeping, favorite toy, picture of him doing a favorite activity, etc.) and put those in a small photo album and then use it to tell him what's coming up next (e.g., time to brush teeth, time to get in the car, time to play puzzles, going to see grandma, etc.)
 
#7 ·
we are using it as a picture communication system and this seems to really be helping her make the connection that things and actions have names.

DS1 was an early reader, and wrote a lot of stuff down for him. We still write important stuff down. House rules are all written down and placed on the refrigerator. If we have a new schedule or a schedule for an important day (Christmas!), we write it down for him. It gives him time to absorb and understand the information in a way that he can't do with spoken verbal input.

When he was really little, I think vocabulary picture books helped him a lot. I really liked the DK "My First..." series because it had photographs and the right amount of stuff on one page. (Richard Scary books are beautiful, but they were really busy.)

Flash cards with vocabulary words on them helped, too. The Baby Einstein ones were beautiful.

Lots of these kids have some strong visual-spatial abilities, along with the speech delay, so we also encouraged those abilities and interests. DS loved blocks and drawing and puzzles when he was smaller, and loves Legos and art and chess now. He's good at those things, and feels good when he does them. We did a lot of them with him and talked to him while we did it, the way you talk to a small baby when you're doing something. The more language he heard tied to an action that he could see, the better he learned. We also played lots of "Simon Says" games for learning 1 step, 2 step and 3 step directions.

Hang in there, OP. It does get better.
 
#8 ·
Quote:
Originally Posted by isisreturning View Post

So I guess that is one piece of advice: look into a picture communication system. If an iPod Touch isn't an immediate possibility, you can always take & print pictures of things from your child's life (family members, home, playground, picture of him sleeping, favorite toy, picture of him doing a favorite activity, etc.) and put those in a small photo album and then use it to tell him what's coming up next (e.g., time to brush teeth, time to get in the car, time to play puzzles, going to see grandma, etc.)
How you described your DD sounds exactly like DS. We also have a 4 month old and honestly, DS1 is twice as much work as DS2 (DS2 is extremely mellow, though) just because he can't understand instructions, or being asked to wait for a moment, or having something that seems like a big deal to him explained to him (Such as "The toy isn't broken, if you turn it the other way it will fit"). At the end of the day DP and I will look at each other and realize that we haven't just sat all day because, like you we need to physically intervene/help DS all day.

We are lucky, though that DS has come up with a way to ask permission to do things he thinks we may not want him to do. Of course if we say no then he gets very upset, but I'm glad he asks. How scary to have DD walking around the block alone! Great idea about the bell, we may invest in one of those just to be on the safe side.

Thank you for the recommendation on the iCommunicate app. DS loves our iPod Touch and plays with it a lot, I think that would be great. We started using a felt board that has pictures of every day things he might want or need (favorite foods and toys, the park, each of us) that we printed and attached with velcro, but it is time consuming to make, print, mount on cardboard, and velcro all of the minutia of every day life!
 
#9 ·
Quote:
Originally Posted by AnalogWife View Post

This is an interesting thread, thanks for posting the question. My DS is 3 and ASD and has a smaller vocab than your DS but I think he's a little better with receptive language. Thankfully, he's mostly mellow with periods of tantrums when he's tired or when I push him. If he threw a bowl of water, I know it'd be futile to explain and give warnings, etc...what I do is get on my hands and knees and grab two hand towels and as him to help Mumma clean it up. Sometimes (ok, most times) I'll say that it's not fair for me to have to clean it all up when he did it, but if I remain calm and respectful, he always helps clean it up, and then we share a hug. He's a marshmallow so it doesn't happen often, but we both feel better in the end.
Thanks for contributing!

We've tried a similar approach before, but once DS gets to the tantrum level, which is usually when such things happen, it's pretty futile. I think this will probably work better when he understands more.

It's interesting, my DS has two modes: mellow and near hysterical. As a baby and young toddler he was extremely mellow, and he started being more highly strung around the time most children get their first language explosion. His nature is very sweet, funny, and affectionate, but he'll go into hysterical tantrums a almost the drop of a hat. It must be so frustrating to feel misunderstood all the time.

What do you find is the best way to calm a tantrum?
 
#10 ·
Quote:
Originally Posted by RiverTam View Post

When he was really little, I think vocabulary picture books helped him a lot. I really liked the DK "My First..." series because it had photographs and the right amount of stuff on one page. (Richard Scary books are beautiful, but they were really busy.)

Flash cards with vocabulary words on them helped, too. The Baby Einstein ones were beautiful.

Lots of these kids have some strong visual-spatial abilities, along with the speech delay, so we also encouraged those abilities and interests. DS loved blocks and drawing and puzzles when he was smaller, and loves Legos and art and chess now. He's good at those things, and feels good when he does them. We did a lot of them with him and talked to him while we did it, the way you talk to a small baby when you're doing something. The more language he heard tied to an action that he could see, the better he learned. We also played lots of "Simon Says" games for learning 1 step, 2 step and 3 step directions.

Hang in there, OP. It does get better.
Thank you for the reccommendations and the encouragement! I really appreciate it. DS is very visual-spatial. We try to encourage art and building projects, but he won't pay attention for long. Typically less than 5 or 10 minutes, and him doing anything independently is just a fantasy of mine at the moment
smile.gif
Like everything else, when he can understand more he will be less easily frustrated and it will most likely improve. I hope it will be a source of self-esteem for him when he's older, like it is for your DS.
 
#11 ·
Quote:
Originally Posted by ReginaPhalange View Post

Quote:
Originally Posted by AnalogWife View Post

This is an interesting thread, thanks for posting the question. My DS is 3 and ASD and has a smaller vocab than your DS but I think he's a little better with receptive language. Thankfully, he's mostly mellow with periods of tantrums when he's tired or when I push him. If he threw a bowl of water, I know it'd be futile to explain and give warnings, etc...what I do is get on my hands and knees and grab two hand towels and as him to help Mumma clean it up. Sometimes (ok, most times) I'll say that it's not fair for me to have to clean it all up when he did it, but if I remain calm and respectful, he always helps clean it up, and then we share a hug. He's a marshmallow so it doesn't happen often, but we both feel better in the end.
Thanks for contributing!

We've tried a similar approach before, but once DS gets to the tantrum level, which is usually when such things happen, it's pretty futile. I think this will probably work better when he understands more.

It's interesting, my DS has two modes: mellow and near hysterical. As a baby and young toddler he was extremely mellow, and he started being more highly strung around the time most children get their first language explosion. His nature is very sweet, funny, and affectionate, but he'll go into hysterical tantrums a almost the drop of a hat. It must be so frustrating to feel misunderstood all the time.

What do you find is the best way to calm a tantrum?
My DS's tantrums are short, thank tha lawd. I sincerely believe that my high blood pressure pills save us all, my heart can't get past a certain rate which keeps me calm (you can imagine how I might be without these meds, I'm on them for a reason), but my DS responds well to heart-to-heart hugs and sympathy and eye-to-eye level (me on the floor or him in my arms) and most of all---redirection. He might object if I all-out ask him to wipe up water, but if I respectfully ask him to wipe up a certain spot, he'll do it. And then I'll ask him to do another spot (as I'm also wiping other spots), and once it's done we hug and we're on to other things. So, mainly my secret weapon is: Propanalol. ;) But if there's none of that available, redirection works best for us.
 
#12 ·
The usual recommendation is to remove the child from the situation and place him in isolation. Ignore the child and let the tantrum run it's course. They are concerned that paying attention to the child during the tantrum will create an incentive to tantrum for attention.

I didn't do that. If you placed my 3 year old in his room during a tantrum, he'd try to kick a hole in the bedroom door. We held him instead. I'd sit on the floor with him between my legs and have him face out. I'd hold his legs and arms. If he tried to hit or kick or headbutt me, I'd restrain that body part so he couldn't. I talked calmly to him or sang softly. I sang a lot because it kept me calm. I'd ask him periodically if he was done. When he said "Yes," I'd let him go. I always explained that I would hold him because he couldn't control himself and he was going to hurt himself or someone else or break something. After doing this for some months, his tantrums gradually got shorter and he learned to control himself.

Many kids in my family were tantrum throwers including me and one of my brothers. I think this method helped DS get over it faster than others have, but all of the kids in my family outgrow it eventually. (Although we all remained spirited well into the teenage years.)
 
#13 ·
Thank you! This sounds like it would be a great thing to try with DS. It seems like he just sprials out of control the longer he goes on (We're talking hours, sometimes), I think if we did this with him right as he got started he would have an easier time calming down. Definitely worth a try. Thanks again (To you and all who replied)!

Quote:
Originally Posted by RiverTam View Post

The usual recommendation is to remove the child from the situation and place him in isolation. Ignore the child and let the tantrum run it's course. They are concerned that paying attention to the child during the tantrum will create an incentive to tantrum for attention.

I didn't do that. If you placed my 3 year old in his room during a tantrum, he'd try to kick a hole in the bedroom door. We held him instead. I'd sit on the floor with him between my legs and have him face out. I'd hold his legs and arms. If he tried to hit or kick or headbutt me, I'd restrain that body part so he couldn't. I talked calmly to him or sang softly. I sang a lot because it kept me calm. I'd ask him periodically if he was done. When he said "Yes," I'd let him go. I always explained that I would hold him because he couldn't control himself and he was going to hurt himself or someone else or break something. After doing this for some months, his tantrums gradually got shorter and he learned to control himself.

Many kids in my family were tantrum throwers including me and one of my brothers. I think this method helped DS get over it faster than others have, but all of the kids in my family outgrow it eventually. (Although we all remained spirited well into the teenage years.)
 
#14 ·
Good luck.

We also worked hard on heading off tantrums as much as possible. If we knew something was a tantrum started, we tried to redirect around it before it got started.

If the tantrum was because he was frustrated over something and he just needed to ask for help or find a better way to handle it, we would model the correct behavior after it was all over and get him to perform it and then reward the behavior.

If the tantrum was because I said "No," to something, we never gave in to that. "No" means "No."
 
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