Maggie’s Story: A Gift to Remember
With all the hard work involved in therapy, the success stories that motivate me to keep trying are priceless.
I first encountered Maggie when she was only two years old. At that time, she had very limited skills: she didn’t talk and didn’t play appropriately with toys. During our first meeting, I observed that she was a quiet but active child, running around her home.
I had hope for her. As any therapist will tell you, it’s hard to know how a child will respond to therapy, or how quickly they will improve. What is crucial is that we have a positive outlook for our little learners.
During that first summer after I met Maggie, I worked with her two days a week, for a total of six hours. It was a slow start. Though I saw progress with her play and visual skills in the first couple of months—she was doing puzzles and playing with shape sorters—there was no improvement in her language skills.
Unfortunately, I was limited to the number of hours that I could work with her, so that impacted the range of skills that we could work on. But I continued to have hope as I saw continuous improvement in other areas.
In November of that year, her mother confided in me that what she most wanted for Christmas was for her daughter to be speaking. It was a positive and well intentioned request but I remember thinking: “How can I get her talking in just over a month when there hasn’t been any progress in her language skills for the last four!”
The prospect of failing Maggie’s mother, and Maggie herself, was a little daunting. I never make promises in therapy because I just don’t know how long it’s going to take for a child to acquire new skills. I did have one ace up my sleeve though: I had read some new research that included a process for pairing sounds with reinforcers or rewards. The research indicated that the pairing had proven effective in building language skills. I decided to give this modality a try and see if I could get the breakthrough that Maggie’s mom so desperately wanted.
I asked her mother to give me something that Maggie would find rewarding, something that Maggie wouldn’t have access to when I wasn’t around but rather only on our session days. Associating the reinforcer with our sessions was part of the process.
Her mother came up with the idea of using Timbits. Little Maggie loved Timbits, so I would break them up into tiny pieces and say the sound ‘ba’. If Maggie didn’t produce the sound, she got a tiny piece of the doughnut. The goal was that after repeated trials of ‘ba’ followed by a piece of doughnut, this pairing process would be effective and she would eventually say ‘ba’.
I used other items to reinforce the sound, such as bubbles, puzzles and other toys I knew that she liked, but since Maggie had access to those all the time, when I wasn’t around and outside of sessions, I couldn’t say for sure that they would be as effective as the doughnut pieces.
We went on with this pairing process for 6 hours a week: all I said was ‘ba’ and she got pieces of doughnut. Then I evolved the process a little: I would say ‘ba’ and then I would spin her around. I would say ‘ba’ and then I’d blow bubbles. I said ‘ba’ three times before she got a piece of Timbit reward. This amount to about 18 presentations of ‘ba’ per minute, and about 100 ‘ba’ an hour, with just over 300 in a three hour session. It’s not a stretch to imagine that after that many times saying ‘ba’, I was beginning to sound like a sheep. But it was worth it! After 18 days she finally said ‘ba’!
I can perfectly recall the elation I felt with this breakthrough: it was one of the happiest days in my career to that point. I remember her mom picked up the phone and called her husband right away to tell him. She also video taped the session and Maggie went from saying ‘ba’ to ‘baba’, as we were blowing bubbles. It was so incredible to finally hear her little voice!
This was just the beginning, though. I knew I had more work to do but there was great relief and rejoicing in seeing that we were finally getting somewhere with her language.
In December of that year, we started introducing other sounds and she started producing them all: oo, ah, la, da, ma. She was babbling away and happy to use her voice, like a newly discovered toy.
Christmas was fast approaching and, just before the holidays and in time to make her mother’s wish come true, Maggie started saying her first words! She loved Dora the Explorer, so it was no coincidence that her first words were ‘backpack’ and ‘boots’. She picked up other words, such as Timbit and cookie, too. What a perfect gift for her parents, for her… and for me, as well.