Interview Transcript

This is a fictional interview between a speech-language pathologist and the mother of her client. 

Characters:

    ~Allie: a nonverbal, three-year-old girl with autism

    ~Jessica Jones: Allie's mother

    ~Sheila Clark: the SLP who will be providing Allie's therapy. 

This piece provides information on the possible symptoms, characteristics, and treatments for autism.  The links to all my "creative genres" are in this piece, so click away.

Sheila Clark:  Hi, my name is Sheila Clark.  I'm a speech-language pathologist, and over the next few days, I'm going to be assessing how Allie communicates.  You're Allie's mother. . . Ms. Jones?

Jessica Jones:  Yes!  It's nice to meet you.

Clark (shuffles through papers):  Likewise.  I have some good news for you -- the worst of your interrogation is over.  I understand you went through a lengthy series of interview with your pediatrician before he diagnosed Allie with Autism Spectrum Disorder. After our program accepted Allie as a client, we continued to bombard you with questions on your child's medical, developmental, and behavioral history.  I've reviewed any information that could possibly be beneficial in Allie's treatment regime. 

Jones:  Of course, I'll answer any questions I can. 

Clark:   Actually, this is going to be a pretty informal interview.  I've briefly met with Allie and I was hoping we could discuss some of my first impressions.  I also wanted to answer any questions you might have as a concerned parent regarding my role in treating Allie--though you're welcome to contact me anytime.  I'm sure we'll be meeting frequently to discuss Allie's progress.

(Jones nods)

Clark:  She's an absolutely beautiful little girl.  She's so determined, strong-spirited.

Jones (laughs):  A feisty little thing, isn't she?  I love her more than life itself, but she's a handful.  Allie knows exactly what she wants, though she doesn't seem to understand the right way to go about getting it. . . (laughs again)  Of course, my entire family is a little high strung.  Speaking of which. . . I'm sorry, this is a little off-topic. . .

Clark:  No, no, continue!

Jones:  My niece, Megan Thacker, is a budding speech-language pathologist herself.  A junior at Marshall University.  It's all she talks about.  (rolls eyes).  Her program requires that she view a session of some type of speech therapy . . . and she absolutely adores Allie.  Would it be all right for her to observe a session?  She would be filling out an observation report *, describing what goes on in the therapy, and analyzing how affective she believes the therapy is.   

Clark:  Not a problem. (pauses) Allie is nonverbal, so I'll be working with her on very basic language skills, probably using strategies from Applied Behavior Analysis.  I have a pamphlet that I can give you with more specific information on autism and ABA. 

I'll start teaching Allie how to use PECs, the picture exchange communication system.  It has been effective with many of my clients because people with autism are extremely visual.  Many people with autism don't think in words.  They think in pictures.

Jones:  Will teaching her PICs or PECs or. . . whatever. . . will this keep her from speaking?

Clark:  No, no, not at all!  PECs can set the stage for verbal communication.  If we get the child to understand indirect representation -- here.  Let me  show you.  (picks up pencil).  This is a pencil.  (takes pencil and haphazardly scribbles on post-it note.  holds the post-it in one hand, the pencil in other hand).  This is a picture of a pencil.  In the PECs system, the child learns to hand me this (extends hand with the picture) in exchange for this (extends hand with the pencil before putting down both props)  This is indirect representation.  The picture is not the object at hand (eyes pencil); it is a symbol, a representation, of the object.  Indirect representation is the foundation for speech and language. 

And if Allie cannot acquire language, PECs will give her a way to convey what she wants and what she needs.  Does she attempt to communicate with you now?

Jones:  She tantrums.  She'll scream and cry when she's upset.  Oh my goodness, like when the Teletubbies come on.  When they start dancing about . . . when they start socializing with that. . . floating sun-baby thing. . . oh, she yells like there's no tomorrow.

Clark:  Is this intentional communication?  Is she crying because she's upset, or because she expects you to do something?

Jones:  I feel certain she wants me to turn off the television in response to her crying.  If the crying doesn't get my attention, she'll kick the television set.  I think she realizes that her kicking forces me to drop whatever I'm doing and run to her aid.

Clark (nods):  As a speech therapist, I've realized how important it is to understand how a child may attempt communicate.    From these behaviors, we ". . . formulate goals to make communication conventional.  For example, [we] can teach a child to shake his head 'no' instead of screaming and throwing" (Maurice, 1996, p. 299)

Jones:  I brought my journal with me.  All the entries are written before Allie was diagnosed with autism . . .  the last entry was written two days before.  I want you to tell me what you think about her diagnosis.  I thought was born with autism.

(Clark accepts journal and skims through)

Clark:  I'm not certified to diagnose autism, but I will provide you more information regarding the disorder.  

Autism is a developmental disorder, and it's not always identifiable at birth.  Symptoms should be evident within the first 36 months, and more than likely the problem will be evident before 30 months.  (Rogers, 2005) There are so many reasons some children go a long time without being diagnosed.  First of all, children with autism can lose language, motor, and social skills. (Rogers, 2005)  Other times the symptoms aren't apparent until the child reaches an age where more is expected from him or her.  They aren't meeting linguistic milestones, they're abnormally reclusive, etc.  

Jones (nods):  Allie'll take all the shoes in the house and just line them up against the wall. She'll rearrange shoes for hours and hours.  It scares me...

Clark:  This type of play behavior is a difference in children with autism.  Their play can be very restricted, and their attention can be difficult to divert.

Jones:  There are times I call "Allie!" two or three times before she looks up! 

Clark:  Just know that Allie is not being defiant.  "It takes a long time. . . for children [with autism] to process, understand, and organize information they hear..." (Janzen, 1999, p. 20)  "Sometimes this delay is as long as 30-45 seconds"  (Janzen, 1999, p.20).  "These children also have difficulty maintaining attention on verbal information.  Their attention fades in and out as it is diverted or overwhelmed by background noises" (Janzen, 1999, p.20)

Jones:  Allie's much less responsive when any kind of noise is in the background.  Even the sound of the running dishwater seems to distract her.

Clark:  It's impossible for us to understand exactly how a child with autism perceives the world, but we do know that autism is also a sensory disorder.  Someone with autism can be hypersensitive or hyposensitive to sensory stimuli--whether it be tactile, visual, or auditory information.  (Janzen, 1999) People with autism process things differently than you and I do. "They may miss what appears obvious to others and notice subtleties that others miss" (Richard, 1997, p.11) She might not be able to discern your voice from the sound of the dishwasher.

Jones:  I just wish things didn't have to be so hard for her.

Clark:  I assure you, we'll do everything we can to help.  "The available evidence from a variety of programs and studies suggests that early intervention leads to better outcomes" (Corsello, 2005, p.81)  And the sooner the problem is identified, the earlier intervention can begin.  Fortunately, "...the preschool years are still considered 'early' when it comes to intervention" (Corsello, 2005, p.82).

Jones:  I pray for her everyday.  I pray that she will be provided every possible opportunity to find happiness.

Clark:  There's not a cure for autism -- but we're learning more about the disorder everyday, and discovering new strategies for to help individuals with autism communicate with others.

Jones:  Thank you so much for taking the time to meet with me.  Now (pauses) Allie doesn't take to strangers very well --

Clark (laughs): Hopefully we won't be strangers for very long! I'm looking forward to working with Allie-- as well continually updating you on her progress. I'll call you within the next week so we can schedule another meeting.

Jones:  Next week it is. (pauses) Take good care of her.  She's my baby.

Clark (nods):  You have my word.  I'll see you next Monday!

Jones:  Bye! (exits)

*  In the interview, Ms. Jones asks if her niece can fill out an observation report on Allie. The link goes to the observation report that her niece has already filled out.  I realize this is confusing, and I'm sorry -- we're looking into a future therapy session with Allie and the SLP.

References: