Sometimes when a child can be difficult to engage in an assessment or therapy session, I start to ponder… ‘Why? Why is this child so difficult to engage? Are my activities motivating enough, or is something else going on that I do not know about?’’
I do everything in my power in that session to engage the child. I change the activity once I have determined the child’s communication level, I change my own communication level depending on the child’s communication level (at times a 4 year old may have a communication level similar to that of a 2 year old), I try to use activities that are on trend and popular (my ‘Frozen’ bingo game is often a hit). I even try to incorporate Mum or Dad into the activity to show that I am not a scary person to play and interact with at home.
Sometimes none of those changes work. So I wonder again, “Why? What else is going on?” It is at this point I ask parents questions that may give me more insight into a child’s behaviour and interaction at home, at day care/Kindergarten/Prep and in social environments.
On occasions, parents will say “He just won’t play with other children, he’d rather play on his own” or “It’s not really playing, he lines up his blocks in colour coding” or “He just LOVES spinning Thomas the Tank Engine’s wheels”.
In my head, I’m thinking, “Is this typical of this child’s behaviour or is this a sign of something else?” This is when I recommend a Paediatrician consultation, as it may be a sign of a life-long condition. We Speechies can only diagnose what we are qualified to diagnose – communication and swallowing disorders. We do not diagnose a life-long condition that impacts on an individual and his/her family.
If a diagnosis is determined for the child, then it will be important to involve other health professionals as necessary (e.g. occupational therapist, physiotherapist, dietician, social worker, psychologist, podiatrist). A diagnosis also allows the speech pathologist more information in determining whether a change in therapy approach is necessary to ensure the child can engage within his/her capabilities.
If you are noticing unusual and/or atypical behaviours in your child, certainly consider Paediatrician involvement. Whilst you are definitely the most experienced when it comes to your child, a Paediatrician’s input can be extremely valuable in determining whether your child may need different therapy approaches.
CB