Speech Therapy: From Oral Aversion to Meaningful Communication Through Alternative Methods

This is what Benji’s current Proloquo layout looks like as he practices communication with support.

Early Speech and Feeding Challenges: Benji’s Journey Speech therapy for Benji began at 9 months due to swallowing and feeding

issues. He had an abnormal swallow reflex, and we worked with a speech-language

pathologist (SLP) to determine feeding strategies and reduce risk of choking. Benji also

exhibited a strong oral aversion, refusing anything near his mouth and making adequate nutrition difficult. The SLP worked to reduce the aversion without success and recommended a surgically placed feeding tube directly into his stomach. We viewed this as a last resort and intensified sensitization approaches and positive oral experiences.

Over several years of careful feeding, Benji's oral aversion resolved.

Speech therapy to promote verbal language started by 18 months, as Benji had no

spoken words. He appeared to understand when spoken to, maintained eye contact,

and showed emotional connection through facial expressions, but had limited gestures and no verbal speech. Therapists implemented modeling techniques, parallel talk, word- picture pairing, visual schedules, and play-based therapy. Despite diligent and intense application, these approaches did not advance verbal language beyond one or two words.

We recognized that Benji's verbal comprehension far exceeded his verbal output,

consistent with verbal apraxia. Verbal apraxia is a motor speech disorder where the

brain has difficulty planning and coordinating the precise movements needed to produce speech sounds, even when the child knows what they want to say and their muscles are not weak. Motor apraxia, which Benji also had, precluded sign language use since he could not plan and execute complex motor movements.

Benji received traditional speech therapy using every evidence-based modality to

address verbal apraxia, including PROMPT and the Kaufman Speech to Language

Protocol. Despite hours of intense daily therapy, Benji made no progress.

In 2009, we traveled to The PROMPT Center in Santa Fe, New Mexico, for two weeks

of daily intensive PROMPT therapy with expert practitioners who founded the method.

After two weeks without progress, we hired local speech-language pathologists to train under the PROMPT Center and deliver consistent therapy in Toronto for several hours daily, five days a week, over several months. No progress was made. We even

considered relocating to New Mexico for several months but ultimately realized this

would not help.

By 2013, when Benji was 9 years old, we reluctantly abandoned hope that any type of

speech therapy would enable verbal speech. We had to acknowledge that Benji would

never communicate verbally. However, he still needed and desperately wanted to

communicate. We shifted to exploring Augmentative and Alternative Communication (AAC) using a Picture Exchange Communication System (PECS) to facilitate simple communication and reduce frustration. We had attempted these years earlier without success, though at that time we still believed verbal speech was achievable.

Before he could successfully use communication cards, Benji needed to overcome

multiple obstacles including visual apraxia (the ability to direct his gaze where he

wanted to look), depth perception and hand-eye coordination issues, and poor tolerance for learning tasks given his substantial neurological challenges. Medical issues and complex sleep problems created additional barriers to learning readiness. Using PECS at that time was another frustrating failure.

Through years of trial and error, Benji’s communication has evolved. In 2025, he

primarily uses well-stocked picture binders customized for every setting and activity,

along with an iPad though this is sometimes difficult due to eye-hand coordination

challenges. The apraxia persists, but by building trust with his team and increasing his

self-confidence through social acceptance and success in other areas such as living an integrated life in the community, Benji has become a partner in his own learning.

Benji’s Growth with PECS and iPad

Every small success is celebrated and builds the foundation for further growth. Benji now understands that his efforts are recognized, he successfully communicates his needs, and others respond accordingly.

He has learned that trying to communicate results in success rather than futility. He has realized he is capable, has an expert team that cares about him and will not give up on him, and he no longer gives up on himself. With patience and diligence, he now proudly carries his word folder or iPad and can engage in simple interactions with support, including greeting people, responding yes or no, choosing where he wants to go, and selecting what he would like to eat.

By focusing on meaningful exchanges rather than verbal speech alone, he has learned

to make choices, express needs, and participate fully in daily routines. PECS and his

iPad have become tools that allow his personality and preferences to shine, helping him feel heard and engaged at home, school, and in the community.