"So, Max is three and a half years old, and he hasn't produced any sounds from his vocal tract. This will be his third screening examination, after three months from his last test. Correct?"
"Yes," Mia replies. She is sitting upright in the spiny chair, seeming so unnaturally stiff. It bothers her that this is the fourth Speech and Language Therapist she is working with.
"And where is Max?"
"He's in the waiting room with my boyfriend," Mia answers, tucking a strand of her hair behind her ear. "I was told that you wanted to see me privately."
"Yes, I would like to ask you some questions before the screening begins," the therapist responds, as she studies the information on her monitor screen. "Firstly, have you or anyone else witnessed Max responding with a social smile during interactions?"
Mia shakes her head, while fiddling with her fingernails nervously. "No. He's kept the same poker-faced expression from the moment he was born into this world. It's very hard to read his emotions."
"I see," the therapist murmurs. There is a moment of silence with only the sound of her typing on the keyboard, adding onto Mia's growing anxiety. "Does he use different vocalizations and sounds to indicate that he's happy, sad, hungry, cross, tired, and so on?"
"No. Not one bit," Mia sighs, peeling off her nail polish unintentionally. "I've tried to communicate with him, but he doesn't respond to my sounds or movements. He doesn't try to copy me at all - that boy does his own thing, frankly." Mia bows her head down, seeming defeated. "He doesn't even look at me. His attention is always focused somewhere else."
"He doesn't look at you?" The therapist repeats with a frown. She looks at the mother with her serious, brown eyes. "Has he sustained eye contact with you at any point in the past three and a half years?"
Mia shakes her head timidly. Her caramel-brown hair is shielding her burning cheeks, as she fights back her stinging tears. She promised herself that she wouldn't cry again.
"Well, it's important that he maintains eye contact with you, as it will help him gain information about language from your mouth and face. Did you engage in any activities to develop eye contact?" The therapist queries, as she returns her attention to the monitor screen.
"I've tried a bunch of things," Mia admits. "Like, I tried playing peek-a-boo with him several times. I brought toys and objects next to my face - trying to encourage him to look at me. I even wore silly hats, glasses and scarves to grab his attention! But he never seems interested. He appears to notice everything else, but me. I've noticed how his eyes wander around the room, and there's nothing there in particular, but his attention is fixed to that space. It's really frustrating."
"There's nothing in that space, you say?"
"Not really. Sometimes I see him staring at the corner of the room, and there's literally nothing there. It's just empty but, for some reason, he finds that more interesting than me," Mia swipes away the scrapings of her nail polish onto the floor. The therapist was too preoccupied to have noticed. "Moments like this, I think he zones out from this world, and he lives inside his head."
"Hmm, here it is mentioned that in his previous screening, he had gotten his ears checked," the therapist points out, as she taps at her monitor screen.
"Yes, I... uh... requested that," Mia mumbles, as she bites her fingernail. Then she rests her fussy fingers onto her lap. "I suspected that there must be something wrong with his hearing, since he never responded to me or anyone else when we called his name. However, when the results came, it was apparent that his ears were perfectly fine. That leaves me with the conclusion that... that..." Mia gulps down the lump in her throat, as she squirms uncomfortably in her seat. "He must be ignoring me and everyone else."
The therapist taps the mouse with her fingers, as her mind races frantically with endless possibilities. Then she concentrates on her monitor screen. "Hmm... has Max attempted to show you things or draw your attention to something of interest to him?"
"I wish!" Mia scoffs. She shakes her head, as tears are finally streaming down her cheeks like raindrops. Her words sound pained as she speaks, "I'm telling you, he ignores my presence in every way possible. I've tried changing my expressions and tone of voice. So, sometimes I'll be happy, other times sad - and even angry! Still, he doesn't respond to anything I do or feel. It's like I'm invisible to him."
The therapist pauses her typing, and she turns her attention to the sobbing mother. She places a gentle hand on Mia's knee and says softly, "It's okay. We can get through this. I'll do my best to help you and Max. You just need to be strong and optimistic for me, okay?"
Mia covers her mouth with her hand, trying to stifle her cry. Her body is still shaking as heavy, gasping breaths escape from her. With her other hand, she wipes away her tears submissively.
It is three hours after the screening examination. Mia's telephone rings in her kitchen. She answers it.
"Hello, Miss Jones. This is Roberta, the Speech Therapist. I tried to contact you on your mobile phone earlier, but I was unable to reach you. I hope you don't mind me calling you now."
"No... no... it's fine... um, is everything alright?"
"Yes, no reason to be alarmed. I'm calling to inform you about our current plan of action. My colleagues will be involved - they specialize in Occupational Therapy. There'll be multiple tests that we will run on Max, and there are a series of tasks that we may ask you to do with him. We'll need your full cooperation for this to work. Please trust us when we recommend to try some activities, and report to us in detail about the consequences."
"Oh, okay..." Mia says distractedly. She twirls her fingers around the telephone cord nervously, while her eyes are fixed straight ahead.
"For some days, we will arrange to meet up with you and carry out some home observations on Max - if that is alright with you."
"That's... f-fine..." Mia squeaks. She is backed against the wall, as she sucks her breath. Her eyes are growing wider and her hands are trembling.
"Moreover, my colleagues and I wish to write a paper about this. It's such a rare occurrence to meet a child like Max! We'd like to publish our findings regarding his cognitive development, particularly focusing on his communication skills. This will hopefully support any other parents and children struggling through this too. Does this sound like something that interests you, Miss Jones?"
"Miss Jones? Are you there?"
A deep male voice replies.
Then the line cuts off ominously.