Kaitlyn then and now

This week, my daughter, Kaitlyn, will graduate from high school. As I look at this vibrant 18 year-old young woman, I find myself thinking back to her birth. She was born at just 26 weeks gestation, weighing only 1 lb., 12 oz. A few days later, her weight dropped to 1 lb., 6 oz. The neonatologists were cautious; they spoke in hushed tones and could only muster a guarded prognosis. We didn’t know if she would survive.

Just before delivery, while my wife, Maria, was in preterm labor, we had a parade of physicians and residents who visited her hospital room to check her status. The hospital was affiliated with a medical school, so we became accustomed to a regular flow of medical students who were more than a bit curious about the possibility of delivering an infant so early. Each time two of them came into the hospital room to check on my wife (they seemed to travel in pairs), they would do a quick exam and then reach into their coat pockets to get the “card.” This seemingly magical card contained a set of statistics that detailed the survival rates of infants born at various birth weights and gestational ages. Each physician would then proceed to recite these statistics, which sounded something like this:

“Mrs. Houston, you’re at 26 weeks gestation, and according to our research, infants delivered at this gestational age have a 20% chance of survival. If you deliver at 27 weeks gestation, the survival rate improves slightly to 26.8%. Of course, if you deliver later, the percentage of children who survive continues to increase.”

Like clockwork, each physician and/or medical student would reach for his or her card after every visit to the room. The story was basically the same except for a few additional potential “complications” for a child born at each gestational age – such as blindness, deafness, cerebral palsy, brain bleeds, and a variety of other medical conditions. After witnessing a few of these episodes, my wife and I could recite the statistics from memory!

At the time, repeatedly hearing what could happen to our daughter was difficult to absorb. The information could have been delivered in a more patient-friendly – and parent-friendly – manner. The statistics that were shared were grim, but knowing what could happen helped us to prepare. Those two days in the hospital trying to prevent and then waiting for Kaitlyn’s delivery allowed us to understand the worst possible scenario but, at the same time, hope and pray for the best outcome.

As I reflect on that experience, the statistics that the physicians cited were quite impressive. In fact, I’m a bit envious that we can’t say something similar for children born with hearing loss, which is the population that I work with most frequently. That is, I wish we had the ability to confidently state that: “…an infant identified at birth with a severe to profound bilateral sensorineural hearing loss and fitted with XYZ hearing aids and immediately enrolled in early intervention will have a 96% success rate in developing intelligible spoken language by the time s/he is five years old” or “an infant who fails to develop adequate listening, speech and language outcomes with hearing aids and then gets cochlear implants by one year of age will achieve age-appropriate developmental outcomes within 18 months if the parents are fully engaged in the intervention process and when services are delivered by a qualified provider.”
To accomplish something like this would require enormous resources and standard protocols for professionals across many disciplines, including but not limited to: Pediatric Medicine, Audiology, Speech-Language Pathology, Deaf Education, Special Education, and Early Childhood Education.

The myriad factors one would have to control to obtain similar outcome data for children with hearing loss truly boggles the mind. Some of those factors would include: cause of hearing loss, degree of hearing loss, age of diagnosis, type of hearing technology used, communication approach, type and frequency of early intervention, level of parent engagement in the intervention process, the skills of the service provider, the family’s socio-economic status, and additional medical conditions or disabilities beyond deafness –and that would be just to capture the most basic information.

Parents today who have a child with hearing loss deal with too many challenges to ensure their child is successful. Too often, they face obstacles securing appropriate audiological services and early intervention that supports their preferred mode of communication. Furthermore, the variability in services from community to community is alarming, and if the family lives in a rural area, there’s an even greater chance the child will be grossly underserved or not receive services at all.

Kaitlyn, my 1 lb., 12 oz. baby girl, is leaving high school and will be entering college this summer studying pediatric nursing. Aside from spinal surgery for scoliosis about six years ago, she is a rather typical teenager making the transition into adulthood. We owe her success to treatment and intervention that was well-defined, consistent, and delivered by practitioners who were highly-trained. Someday, I hope all parents who find themselves dealing with a premature infant or some other medical condition at birth – such as hearing loss – can receive the same level of support from the professionals surrounding them.

(Note: This blog was adapted from an original posting by the author on the Better Hearing Institute’s Pediatrics Blog.)

K. Todd Houston, Ph.D., CCC-SLP, LSLS Cert. AVT, is an Associate Professor in the School of Speech-Language Pathology and Audiology at The University of Akron. His primary areas of research include spoken language acquisition in children with hearing loss, strategies for enhancing parent engagement in the intervention process, Auditory-Verbal Therapy, and telepractice. He directs the Telepractice and eLearning Laboratory (TeLL), an initiative to evaluate clinical practices in the area of distance service delivery in Speech-Language Pathology.

In addition to it being Better Hearing & Speech Month (BHSM), this week is also National Stuttering Awareness Week! ASHA partnered with the Stuttering Foundation to raise awareness among parents and other caregivers about the warning signs of stuttering and the need for early intervention. The Stuttering Foundation has information and resources about National Stuttering Awareness Week which you can use throughout the year to raise awareness about stuttering.

In addition to the hundreds of tweets this past week about BHSM, here are just a few of the many blog posts featuring BHSM ideas:

• Consonantly Speaking cultivated a great list of free printables for BHSM.
• The Pediastaff blog lists more great resources for BHSM.
•  Heather Gehringer, CCC-SLP, created a calendar for BHSM planning, which is posted on her blog, Heather’s Speech Therapy.
• The Apraxia Adventures blog has a great idea for raising awareness about apraxia during BHSM–31 facts about childhood apraxia of speech that you can share throughout the month and beyond.
• Not a blog post but a terrific idea to promote BHSM on Facebook and Twitter, Beginnings of North Carolina is running a “Donate your status” campaign throughout the month. They make sharing BHSM facts as easy as retweeting/sharing their daily posts.
• The image above is by Jakhai Ellerbe from New York City, who won first place in last year’s ASHA’s annual BHSM Drawing Contest.  You can download the screen saver [link is executable file], and also have your students enter the 2012 BHSM drawing contest–details and complete contest rules are available on the ASHA website.

Maggie McGary is the online community & social media manager at ASHA, and manages ASHAsphere.

Coloring Flowers with Bingo Markers

Materials:

Bingo markers

Regular markers

Paper

Procedure:

Draw a flower. Include its pedals, stem, and leaves. Keep it simple and make the parts easy to identify. This is especially good for children who need help in identifying parts from a whole. As you are drawing the flower, narrate what you are drawing (TIP # 1). For instance, “I’m drawing a flower. Now, I’m drawing the leaves…the pedals…stems….etc.” This may seem obvious, but it’s amazing at how quiet some parents are when they are playing with their children. If you’re expecting a child to verbally communicate, it’s important to use language during these intimate experiences because it teaches them that communicating is fun and exciting! Be animated and add inflection to your voice (TIP #2) – especially when introducing new vocabulary. For instance, if you are drawing the stem, stress the new word to alert your child’s attention to it (e.g. “I’m drawing the stem”. Repetition is also important. Children need multiple repetitions (TIP #3) and various contexts (TIP #4) to fully understand the meaning of a new word. Enriching, hands-on experiences and multiple yet different interactions really help the child to fully understand. I’m not a huge fan of using flashcards for younger children, like toddlers, because they are one-dimensional and can be easily misunderstood. So, repeat new vocabulary many times during the activity (“I drew the stem.” “The stem is green”. “The stem is long.”). Then, after the activity, take the child on a stroll through your backyard or neighborhood and point out flowers and name their various parts. Lastly, avoid asking the child too many test-like questions (TIP #5) – “What’s this?” or “What’s that?” Children are usually pretty aware that you are “testing” them and it takes the joy out of learning new things.  Once you have drawn a flower (or two or three or more flowers) let the child “color” them with the bingo markers! It can look something like this:

Some Possible Target Words:

Summary of Tips:

1: Narrate your actions (Feel free to narrate your child’s actions too!)

2. Be animated and add inflection to your voice

3. Provide multiple repetitions

4. Expose the new word in various settings and contexts (see extension activities for examples)

5. Avoid asking too many “test-like questions”. Two words: NOT FUN!

Extension Activities:

Go on a nature walk

Arrange some flowers in a vase

Plant a flower in the yard or grow some seeds in a styrofoam cup

Kimberly Scanlon, M.A. CCC-SLP, is a speech language pathologist practicing in Bergen County, NJ. She provides home based speech therapy for children and adults through her private practice Scanlon Speech Therapy, LLC.  To learn more about Kimberly visit www.scanlonspeech.com.

Happy Better Hearing & Speech Month! This May marks the 85th anniversary of Better Hearing and Speech Month (BHSM), a month dedicated to raising awareness about communication disorders and to promoting treatment that can improve the quality of life for those who experience problems with speaking, understanding, or hearing. ASHA offers many resources for BHSM, and with each passing year, more and more SLPs, audiologists, and others interested in CSD are using social media to share ideas for celebrating BHSM.

Twitter is a great way to hear what others are doing to celebrate BHSM. You can follow the #BHSM hashtag on Twitter or just bookmark this link and check it throughout the month to follow the conversations about BHSM on Twitter. We’ve also started a Better Hearing & Speech Month Ideas board on Pinterest, where we’ll be pinning/re-pinning resources and ideas we see throughout the month.

Each week throughout May ASHAsphere will be highlighting some of the blog posts and other resources we’ve found using these social media sources. Here are just a few of the many posts we’ve seen this week:

• Christopher Bugaj, MA CCC-SLP, did his annual A.T. TIPSCAST podcast and accompanying blog post about language-based curriculum, dedicated to BHSM.
• Dan P McLellan, CCC-SLP, did a post about BHSM in his new blog, Speechguy.
• Stephanie Bruno Dowling, M.S. CCC-SLP, lists some BHSM resources on the Advance  Early Intervention Speech Therapy blog.
• Canadian SLP Skye Blue Angus has a great May Month (Canada’s Speech and Hearing Month) photo of the day challenge on her blog, CREE-ZY, CRAZY SPEECHIE.
• Lisa M. Geary, MS, CCC-SLP created printable information pages SLPs can share with parents, teachers and other educators, along with some other BHSM resources, on Livespeaklove.

Share your blog posts or other resources in the comments and we’ll continue sharing them each Thursday throughout May.

Maggie McGary is the online community & social media manager at ASHA, and manages ASHAsphere.

Photo by mbeo

Far fewer middle school students need our services as compared to the number of preschool and elementary aged children who do. Those who still need therapy present with the unique challenges. After all, they still need our services. Finding apps for our middle school population can be challenging.  I have found a few apps that can be used with those students who have deficits in language.

Proverbidioms: After publishing this post, I downloaded this app. Rather than publish a new post, I decided to edit the post by adding my review of this app. T.E. Breitenbach produced an illustration, Proverbidioms, in 1975, that became a popular poster. It is now produced as an app. It approaches the understanding of 264 proverbs and cliches in two ways. The student is given a list of idioms. He selects one and then searches for it in a scene where a specific illustration demonstrates its literal meaning. The scene is busy but one can increase one’s specific area of focus by moving two fingers outward on the screen. This enlarges a specific illustration. This also allows one to scan the screen and see more detail. Once one matches the idiom and picture, a screen appears that defines the idiom and its derivation. If the child correctly makes the match on the first attempt, he is awarded a gold star, two attempts a silver star and three attempts a bronze star. I think middle school students will enjoy the pictures and the challenge of matching idiom and picture. A word of caution: some illustrations may be more explicit than one may consider appropriate for this age group.

Ages: 13 to adult
Ratings: ++++
Developer: Greenstone Games
Cost: Free for one illustration, $1.99 to $2.99 for additional illustrations

Word Stack Free: This app can be used to strengthen a student’s vocabulary and reasoning skills. It does so by presenting a stack of words. Each word is arranged in random order on eight blue stacked strips on the left side of the screen. The task for the student is to find relationships between words. Words can be synonyms, antonyms, or be made into compound words. To start the game, the student reads the starter word that is on a green strip on the bottom right hand side of the screen. The student looks to find a word on a blue strip that is a synonym, antonym or can combine with it to make a compound word. The student places the word selected on top of the first green strip. If the selection is correct, the strip turns green. There is now a two word green stack. Next, the student must find a word on the left for the new word on the stack. Again, it must be a synonym, antonym or combine with it to make a compound word. The task continues in this fashion until all blue strips have been correctly stacked and are green. If the word the student selects is incorrect, it cannot be stacked and returns to original position. I played a few rounds and found that, at times, finding the right word can be challenging. (A word of caution: words can be randomly placed until one is found that turns green.) To extend the task further, the child can be why the words are the same or opposite in meaning. If a pair of words forms a compound word, one can ask the student to use the new word in a sentence.

Ages: 12 to adult
Ratings: ++++
Developer: MochiBits
Cost: Free for 40 game stacks (one stack per game). One can purchase additional stack packs for $.99 each or all four stacks for $1.99.

Confusing Words: This is not the first time I have downloaded an app and then months later cannot find it in the app store. But I was able to find what looks to be a similar app, called “Which Word?” Both of these apps try to help untangle similar sounding words that tend to confuse such as affect and effect, passed and past or there and their. I have not downloaded Which Word? so cannot review it. However, it looks similar to Confusing Words but in a more pleasing format. Each word is defined and then used in a sentence. The confusion of similar sounds words can be most evident when students write. This app may help students better understand which word to use.

Ages: 10 to adult
Developer: Triad Interactive Media
Cost: $.99

Feel Electric: I reviewed this app a few months ago for my post on descriptive apps.  Feel Electric is animated, interactive and offers a variety of options for learning a range of 50 emotions. The student starts with What’s the Word to see faces of real people expressing each emotion. From there, the student can select her emotions at the moment, create a diary of emotions, manipulate the facial features of creature to show specific emotions and play a Mad Libs type game that, when completed, will create a zany story based on the words selected. There are three fun interactive games where the child needs to pair the facial expression with the written word. Each of these 3 games is scored. The app also allows one to add ones own pictures, music and videos. This is a great app to use with middle school students. It can be used to help tweens and teens identify and discuss a range of emotions they may be prone to feel. The app’s activities can be expanded to make this a fun language learning activity.

Ages: 5+
Rating: +++++
Developer: The Electric Company by Sesame Street
Cost: Free

(This post originally appeared on Apps for Speech Therapy)

Mirla Raz, CCC-SLP, is a speech pathologist in private practice (Communication Skills Center) and the author of the Help Me Talk Book: How to Teach a Child to Say the “R” Sound in 15 Easy Lessons, How to Teach a Child to Say the “S” Sound in 15 Easy Lessons, and How to Teach a Child to Say the “L” Sound in 15 Easy Lessons (also available in Kindle). Her latest endeavor is her blog Apps for Speech Therapy.

(Google Reader and Email subscribers, please click through on the link to the post in order to see the presentation on the blog):

(This post originally appeared on SpeechTechie)

ASHA/NSSLHA Student Hill Day 2012 was a success!  On April 2^nd 2012, the NSSLHA Board, along with over 100 fellow speech-language pathology and audiology students had the opportunity to meet with our state representatives and senators on Capitol Hill to discuss legislature important for the future of our profession.  With the help of the ASHA Federal Advocacy team, over 250 visits were conducted to bring audiology and speech-language pathology issues to the offices of those who represent us.  This means that students are impacting how these offices think about our services.  We were able to talk about what we do, the individuals who makes our jobs so special, and what legislation would truly allow us to help others more efficiently and effectively.  Even as students, we can impact federal legislation, which affects the future of our profession.

ASHA provides an abundance of information regarding current legislation and how each of us can get involved at the state and federal level. Even if a visit to Capitol Hill is not an option, a letter, email, or phone call is a great opportunity to let your Members of Congress know what’s important to his/her constituents.  You can visit the ASHA Take Action Center for more information.  It is never too early to begin advocating for our chosen professions.  Even as students, we are also voting members and we can have an impact on how services are rendered.  If you are interested in participating in future Student Hill Day visits, please contact Caroline Goncalves with the Federal Advocacy Team at ASHA at cgoncalves@asha.org .

Imagine the impact we can have if the Student Hill Day gets bigger and bigger each year?  Speak out and be heard by those who represent you and take charge of our professional future!

Ellen Crowell Poland, AuD/PhD Student, East Carolina University NSSLHA Executive Board Member-at-Large and Caleb McNiece, AuD Student, University of Memphis NSSLHA Executive Board Region 3 Councilor, wrote this piece for ASHAsphere. 

This activity is one I pull out from time to time as a special treat and is a particular hit with the boys.  A year or so ago, my son and his grandfather put together a fabulous catapult.  The lid/target combos are the perfect ammo for launching.  (See my post, “Lots of Pros” from April 10, 2012 for instructions on making articulation target lids).

We run through our first set of words which I’ve inserted into the lids.  Then, I have them say the target a couple more times before we launch it from the catapult.  Sometimes we see which word goes the furthest, sometimes we set up a basket and see if we can get any in it.

Click to Play

The building instructions for my catapult came from “The Art of the Catapult” by Gurstelle.  I did a quick search online and there are several kits for catapults that would probably work, as well as instructions for a plastic spoon/popsicle stick version that goes together fairly easily (I’ve seen these put together….many times!).

Give it a try and launch something new!

(This post originally appeared on Activity Tailor)

Kim Lewis M.Ed, CCC-SLP has a private practice for pediatrics in Greensboro, NC. She is the blogger at www.activitytailor.com, providing creative ideas for speech therapy, and the author of the Artic Attack workbook series.

Photo by bluishorange

Get Organized

• Weed through all of the papers, manuals, and orientation/training materials you received and make a list of all important deadlines in progressive order. This will ensure you stay on top of them!
• Make a spreadsheet schedule of when you see clients/students, laminate it, and follow it!
• Print a list of your clients/students in order of when annual reviews and reevaluations are due.
• If you’re overloaded with initial evaluations to complete, pick a feasible number of evaluations to be completed weekly. Schedule those and pat yourself on the back when you accomplish the number you set, even if it’s just one or two weekly.
• When first getting to know your clients/students, place simple abbreviations of their goals on the data sheets you’re utilizing to quickly jog your memory about their challenge areas. Even if your main target for the therapy session is X, you can be indirectly addressing Y or Z as well.
• Be prepared for meetings. If you know certain topics, disorders, or clients/students will be discussed, if you are unfamiliar with that subject, do your homework. You don’t have to know it all, but aim to gain the trust of those around you by adding to the discussion.
• Maintain open and frequent communications with your CFY supervisor.

Get Creative

• As you build your “tool box” of therapy materials, think functional, relevant, and motivational. Invest in materials that will motivate your clients/students to invest themselves in their own progress.
• Don’t merely make plans for great therapy sessions…carry them out!

Get Involved

• Make yourself readily available to family members, parents, teachers, administrators, and coworkers. Be an approachable point of contact for questions or concerns. If you don’t know the answer, there’s always opportunity to look it up!
• Know your clients’/students’ birthdays and other important information. We all like to know that we’re more than just a name (or number on a caseload).
•  Take part in your clients’/students’ special activities or life events when possible.

Get Noticed

• Develop a simple monthly or quarterly newsletter for family members, parents, teachers, administrators and/or coworkers. Let the first one be an introduction to yourself and market yourself as a resource on speech and language issues. Because we’re all inundated with things to read and little time to read them, make each newsletter short, concise, and interesting.
• Prepare a bulletin board accentuating your services or an area of interest or benefit to your clients/students. Don’t wait until May when Better Speech and Hearing Month comes around!

 (This post originally appeared on The Speech Stop)

Ana Paula G. Mumy, MS, CCC-SLP,  is a trilingual speech-language pathologist and the author of various continuing education eCourses, leveled storybooks, and instructional therapy materials for speech/language intervention, as well as the co-author of her latest eSongbook which features songs for speech, language and hearing goals.  She has provided school-based and pediatric home health care services for nearly 12 years and thoroughly enjoys providing resources for SLPs, educators and parents on her website The Speech Stop.

Photo by Horia Varlan

In my article “A Therapist’s Mantras for Early Intervention” on Pediastaff’s Blog, I mention the importance of asking questions in early intervention. We all ask a series of questions when we are completing an evaluation, then during treatment we often ask families how things are going to check in on a child’s progress, but there are so many more questions to ask that can help build a healthy parent-therapist relationship. These questions get to the heart of what’s going on and can truly impact the success of intervention.

By asking the right questions you can get to know a family for who they really are and allow them to see your genuine interest in their opinions and their child’s success. With appropriate questioning you can also establish communication with even the most shutdown of families, repair misunderstandings, and most importantly, encourage families to own the early intervention process as their own.

The following are the categories and sequence of questions I have found to be most useful in my own practice, to first build a foundation of trust and then allow for open and honest conversations as the therapeutic relationship grows. The first few categories may seem obvious, but if you stick with me, hopefully by the end you will have found an idea that you hadn’t thought of or tried before. Here goes…

1.  Ask questions that establish roles.

When first working with a family, it’s important to find out what ideas they have about how the intervention will work, what you will do when you come for a visit, and what their part as parents will be. I like to ask questions like these:

• How would you like my help?
• What do you hope to get out of working with me?
• How would you like to take part in your child’s therapy?

The answers to these questions then provide an opportunity for you to discuss things like the importance of attendance, how your sessions will be set up to include them as the parents, and what therapy is and isn’t.

2. Ask questions that set goals.

The next category of questions gets more specific about what a family wants to see their child accomplish. You may have discussed some of this when completing the evaluation or other paperwork with the family, but due to time that has likely lapsed and changes that can happen quickly in a child’s development, it’s important at the beginning of therapy to re-establish those goals. I also like to focus parents very specifically on one thing we can start with that their child can likely accomplish right away so that parents are motivated to continue to work hard and set new goals. Questions to help set goals may sound like this:

• What time of the day is particularly difficult for your child?
• When do you get frustrated with your child’s difficulty communicating?
• What’s one thing you think your child could do with a little help that would make a huge difference in his life?

Keep in mind that answers to the last question may still be broad behaviors like, “pay attention”, “talk more”, “listen better”, or “have better behavior”. It helps to take those answers and explain how a specific behavior, like taking a turn during an interaction, attending to an activity, pointing to make a request, imitating gross motor movements, or looking at an adult to ask for help can be the first steps to helping their child get to the overall goal. Once parents know what specific behavior they are looking for, they know when their child’s accomplished it, and they can see progress happening. Establishing those successes early on goes a long way in earning a parent’s trust for the long-term.

3. Questions that build routines.

Questions that build routines help parents figure out how they are going to implement these new behaviors and strategies you have introduced. Without a plan, a set day, time of day, activity, and specific behavior, it is unlikely that a parent will follow-through on your interventions for the simple fact that change is hard. With a specific plan, established by the family itself, it makes it much more possible to integrate these new behaviors into daily life. Examples of these questions include:

• What times of the day do you think would be good to help your child practice taking turns?
• Out of the toys here in this room, what toy do you think you’d like to use this week to help your child practice pointing?
• What kind of activity would you enjoy doing with your child where he can imitate your movements?
• Can you think of several times during the day you can make sure your child hears you saying the word “up”?

4. Questions that gather feedback.

This one is easy. To gather feedback you can simply ask, “How’d it go?”

5. Questions that spark action.

The questions that spark action are where the real relationship building happens. This is where you can encourage parents in their successes and help them to solve problems and overcome obstacles. It’s easy enough to guide parents through what therapy is all about, help them set goals, plan activities and then drop the ball. And, yes, just asking, “So, how’d it go?” with no follow-up questions still counts as dropping the ball. We’ve all done it because we’re frustrated that a parent didn’t follow through and we can’t seem to politely muster another question, or we can sense the parent is shutdown and we don’t want to push too hard. BUT the question after the “How’d it go?” is where you get the 411. Those questions are tricky, take special care, and go something like this:

• So _________ pointed to what he wanted when you were working with him on the puzzle. Wow! How did that feel when he did that for the first time?
• I know you said you didn’t have a chance to work on the word “up” this past week. Do you think you’ll have a chance this week or would it be easier to work on something different?
• I know we had a difficult conversation last week after you got the diagnosis from your doctor. How are you feeling about all of that now?
• I know _______ didn’t want to imitate your movements when you sang “Old McDonald”. What do you think made it difficult for him to participate?
• Since _______ didn’t want to take a turn with stacking the blocks, would you like to practice it together today so that we can see if we can find a way to make it easier for him to participate?

Depending on the answers to these last questions, you may also need to go back to the previous questions to make sure you and the family are still on the same page as far as setting goals and building routines.

To sum it up…

And now I would love to hear what you think. What questions have you found to be helpful? How do you feel asking the tough questions? Other than asking questions, how do you keep the lines of communication open?

Kim Rowe, MA, CCC-SLP, is a speech-language pathologist working in early intervention in Savannah, GA. She is Hanen certified and passionate about family-centered services. When she’s not working, Kim enjoys writing at Little Stories, spending time with her husband, volunteering with her therapy dog Charlie, and listening to her daughter’s story unfold as she develops language.