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achel: I’m learning that I don’t have to blindly follow. I also have a voice in the therapy process.

 Mr. Friedman: It’s interesting. I see that the work we’re doing with Yossi is valuable, but I also see that our new united and focused effort makes us calmer, and that spills over to our family.

 Teacher: This approach to syntax issues is unique. I was skeptical, but it worked where our other methods hadn’t. I’m excited to keep using it!

After the first eight-week cycle, we review Yossi’s progress.

We’d worked on four goals for two weeks each. The results of the reevaluation showed:

Yossi is using the -ing suffix 90 percent of the time.

Yossi is using the pronoun “I” correctly 95 percent of the time.

Yossi is using the plural S 50 percent of the time.

Yossi is using the possessive S 75 percent of the time.

For the first two goals, Yossi has achieved accuracy of 90 percent, so we remove them from the list of goals. The next two goals are under 90 percent, so we keep them. We choose two more goals:

Using the word “is”

Adding “-ed” at the end of verbs

With the two old goals and two new goals, we now have four goals for our next eight-week cycle. The new cycle will follow the same structure: Each goal gets four sessions over two weeks. The first session is just bombardment, the remaining three sessions are comprised of ten minutes of bombardment followed by practice. As always, family and school participate in the treatment.

Rachel seems more in control. “It feels better to have a plan,” she confesses. “Even if progress is slower than I want.” She hesitates. “I still sometimes feel I should be doing more… take him to that specialist in Brazil… spend more time on homework… hire more therapists…”

“You’re riding a tandem bike,” I remind Rachel. “Sounds like it’s time for a team meeting.”

Rachel looks uncertain. “Who should attend?”

“Everyone on Team Yossi. Both his parents, all his teachers, his OT and SLP at SunnyTrails, myself.”

“What will we talk about?”

“First, we should review Yossi’s progress. Each person should share input on his current level of functioning and gains he’s made. Then we can all evaluate whether we need to change our goals for him or change any other element of his treatment. For example, his OT and PT will have insight on whether you need to go to the specialist in Brazil. What might you stand to gain? How badly does he need it? How likely is it to help? Would the necessary resources be better used in a different area?”

Rachel nods. “I just hired a neighbor to help with Yossi’s ‘homework.’ ” She smiles self-consciously. “Like you said, just trying to get all the help I can. She’s considering a degree in special ed and wanted hands-on experience to see if she likes it.”

“That’s great. She should definitely attend the meeting. The others can give her ideas on how to help him, and it will be great for them all to meet so they know who they’re talking to. Also, we can develop a system of communication between the team members, so we can update each other.”

“Parents with an ‘extra-needs’ child have ‘extra needs’ too,” Rachel acknowledges. “I’m finding the balance, and everyone is happier.”

Perfection is not the goal. Additionally, it takes time for a new skill to “sink in.”

Rachel started off desperate, frantically pursuing every intervention. A better way to proceed is via careful evaluation of costs and benefits of each intervention.

Like everyone on Yossi’s team, she should also use the bombardment and practice approach.

Take It Home

 Yossi’s story is complex. He has delays in several areas, and his family inevitably struggles to balance his needs, his therapeutic goals, and the needs of the rest of the family. Below are some ideas for managing that balance.

Remember that your child needs your love most of all. Don’t let the demands of therapy and the pace of life override your child’s need for a loving and nurturing relationship with his parents.

Incorporate therapy into daily routines. If your child struggles with grammar and syntax, here are some easy ways to incorporate practice into daily interactions:

1. Read books with refrains that contain the grammatical structure you are focusing on correcting. Read the books over and over, until the child can say them by heart. If you can’t find such a book, modify the text of any book to fit the grammar structure you are trying to correct.
2. Sing fun songs (you can make them up!) that contain the target goal.
3. Create a special motion or signal for the target goal. Perform that signal each time the goal occurs. Gestures are less annoying than verbal prompts.
4. In everyday conversation, raise your voice and emphasize each occurrence of the target goal.
5. Pause occasionally to let the child to fill in the word containing the target goal. Use the hand signal as a prompt. Stop what you’re doing, make eye contact, and give the child a full 15 seconds to speak. That’s a long time, but children with speech and language delays need that time.

If your child is in a supportive school program or private therapy or both, you will only get maximum benefit if everyone works together. Here are some ways to maximize your efforts:

1. Build a collaborative relationship with your child’s therapists by communicating respectfully.
2. Express appreciation for their work.
3. Real progress is made in the carryover of therapy work to the home environment. Build follow-up into existing daily routines to make it doable.

Raising a child with extra needs can be draining. Here are some ways to stay sane:

1. Do not attempt to focus on all your child’s goals at once. Divide the work between everyone on the team. Pick one or two goals for yourself to focus on at home.
2. Mobilize the reserves. You have a child with extra needs, so you need extra help. Is there a grandparent who can help with homework? A young neighbor who can entertain the baby? A therapist-in-training who can volunteer? Teamwork is the only way. Develop the team.
3. Create bite-size self-care routines. These can be as small as sitting while you drink your coffee, resting in the car for five minutes before returning home from work, eating your meal at a table without getting up, or reading for ten minutes before going to sleep.

(Originally featured in Family First, Issue 589)