By Larisa Berman MS, CCC-SLP Special to ADVANCE Right Key Unlocks Silence of Non-Verbal Child The girl came toward the door, shuffling her feet rather strangely. She treaded slowly and carefully as though planning every step. The wide-opened, unblinking eyes reflected profound sorrow and nostalgia and seemed too large for her thin pale face. Poliomyelitis, I thought, and looked down at her legs. What I saw made me want to burst out laughing: her thin little feet were stuck inside huge high-heeled shoes, and she carefully shuffled over the floor, afraid she might fall and lose them. Catching my eye, her grandmother whispered, "She's scared her mother might go away. So she got the idea of wearing her shoes." I went to the little girl's room. A young woman of about 30 was perched on the edge of the sofa. She began telling me her story without waiting for me to ask questions. "NANCY IS 5," she began. "The pregnancy and delivery were normal. Her early development was age appropriate. When she was 1 year old, I met a man, fell in love with him and realized my marriage had been a big mistake. One day I rushed off to meet him when Nancy was sound asleep and my parents were due back at any moment. But she probably woke up soon afterwards and crawled into the next room. On the table in my mother's room there were some medicines, and she stuffed the whole lot into her mouth. When my parents came in, she was hardly breathing." After being hospitalized, the mother continued, Nancy developed more slowly. She stopped saying new words and hardly ever said the ones she had before. When she was 2 1/2, there was another terrible incident. "I put her to bed, and my boyfriend came over to see me. I was sure she was asleep and didn't go to see her for a long time. When I did go in, she was lying still on the floor-her face was pale gray like a mask. I called her name and shouted, but she could not hear me anymore. I had to do something quickly, but I just stood there paralyzed with fear and gazed mindlessly at my dying little girl and empty vial of sleeping pills on the floor." For a long time Nancy was in extremely poor condition. Day by day the doctors prevented her from dying. After she was discharged from the hospital, she remained rather inert and fatigued easily, wasn't interested in toys and didn't enjoy doing anything.	- 2 - "BUT WHEN I came up to her," her mother recalled, "she would cling to me with both hands, and I could never break free. I could not leave the house for a moment, and my private life became very limited. I decided to leave her to avert another tragedy." I continued taking background information and performed a speech evaluation. Nancy was practically non-verbal. The only word she could say was "Mommy," and she kept repeating it. Her mother said Nancy had been seen by neurologists, psychologists and speech-language pathologists, but "they can't get any response from her." I completed the assessment and made a recommendation for intensive speech-language therapy. "I'll be going now," the mother said. "I'm not really needed here any longer.” Nancy immediately jumped up, kicked off her huge shoes and raced toward the door. She flew along, afraid that she would be too late and her mother would go. The little girl flung herself onto the floor across the door in a rehearsed manner, attempting to bar the way out of the house with her small body. She did not cry or throw a tantrum or grab the hem of her mother's skirt, asking her to stay. She just laid on the floor-on the rubber mat we had wiped our feet on-and gazed up at her mother in a pleading way. HER MOTHER calmly took her in her arms, carried her into the next room, locked the door and left. Nobody and nothing could make her stay. When treatment began a week later, Nancy refused to communicate and ignored all my efforts. I tried to interest her in toys, games and pictures; but she rejected all my ideas. Every day I would start all over again, mustering my patience and creativity, repeating endeavors to play, singing nursery rhymes, dancing or listening to music. But it was impossible to establish contact with the girl. She looked at me without seeing me and was unwilling to participate. Nancy always brought along something belonging to her mother, like a handbag scarf or nightgown. She would show it to me, say "Mommy" proudly and sit down, hugging the precious object. Days and weeks flew by, but I still had not found the key to this child. I wracked my brain, replaying our sessions over and over in my head and wondering what else I could do. If only I could make contact with her, I thought, she would start developing.
- 3 - Several days later, at midnight, I stayed at my desk looking over reports and scanning my weekly notes. Suddenly, a simple idea struck me. I had an inspiration to make a doll, a Mommy doll. FOR A WEEK my friends, family and volunteers helped me fashion a doll. It exceeded all expectations. The doll was large and pretty, with clothes and hair just like Nancy's mother. Now the main thing was for Nancy to accept the doll for what it was. I worried about how their first encounter would go. This was my last hope. That morning Nancy arrived at the office as usual. She took off her coat, looking bored, and walked over to the play table. Suddenly, she stopped still. Her mouth dropped open in wonder and her wide-open eyes lit up. "Mommy!" exclaimed Nancy, and she flashed a big smile. It was the first time I had seen a smile on her face and heard her laugh. She hugged me gratefully and squeezed my hands to show our newfound understanding. And so our Mommy doll came into being. From that day on the doll sat beside Nancy during our sessions, sharing the work and the problems. Now when she came for a session, Nancy hurried up the stairs, pulled her coat off, tore into the room and rushed up to her "Mommy." She kissed her affectionately, pressing her cheek against the doll's and stroking her. She always popped some little present into its pocket, like a candy, toy or drawing. NANCY TRIED so hard to please "Mommy" with her progress and get her praise that she exceeded all my expectations. The Mommy doll was kind-hearted, affectionate and generous, with nothing but words of encouragement for the little girl. Nancy would get so involved in our games that she ceased to see and hear me-I simply vanished from our therapy. My voice was Mommy's, and I served as an invisible link between them. DAY AFTER DAY Nancy delighted me more and more. Her vocabulary grew larger and richer. We moved from easy structures to more complex ones, from single words to phrases and sentences, which we introduced into our conversations with the doll and then practiced and polished them in speech games. Many weeks and months passed before Nancy acquired skills to describe events, express facts, and put her thoughts into the right words and gradually demonstrated good judgment and problem-solving skills. Our games became more and more literal for Nancy, enabling her to express her feelings, demonstrate her love for her mother and show how much she missed her.	- 4 - Our treatment program was coming to end. With all my pediatric patients I end with a visit to the Magic Kingdom of the City of Beautiful Speech. One day she arrived to find on my desk a brightly-colored envelope. Hurriedly unsealing it, she pulled out an invitation card and a little gold key on a red ribbon. I read the invitation to her and told her we were going to visit the Magic Kingdom. She could open the gates with her magic key, and we would walk along the beautiful streets speaking wonderfully well. We would find Noisy Street, where everything we said had to be loud and clear; rest by pretty Lake Tranquility; and then set off to Hush Park, where we had to speak ever so quietly. WE PLANNED what to take with us on our trip. Nancy listed all of the clothes and food she would need, and then we started discussing who she would take with her on the journey. Of course, her mother came first. "Who else are you going to take with you? Let's invite your kindergarten friends. " "Oh, no, they'll eat all Mommy's chocolate and ice cream." "So, you're going to go all by yourself?" "I can't go myself," she replied. "My suitcase is too heavy. I'll take you. You can carry my suitcase, and you know the way. You're also good at playing games, so we'll have fun." When we seemed ready to set off, Nancy suddenly looked sad. "Do we have to walk a long way?" When I told her we would indeed be going a long, long way, she thought for awhile before saying, "No, don't let's go. Mommy'll get tired. She's got high heels." She quickly assessed the situation and came up with a solution. "We'll take Grandpa with us. He can drive us there, and Mommy will be happy then." So whatever she was playing at, doing or saying: all her thoughts revolved around her mother. I was touched by all the warmth, affection and devotion she showed her. And our "Mommy" loved Nancy very much, too. But she was only a pretty doll.