Hi there, I wonder if anyone can help me......

I have been teaching a little boy the piano for a few months now who has some complicated health issues, mainly that as a result of him being born very prematurely, his lungs had not developed enough to enable him to breath naturally and he has need much medical intervention to ensure he stays physically well. He is about six now, and has only quite recently had his tracheostomy removed which he had relied upon to breathe since birth. Where all this becomes an issue with regard to me teaching him piano, is that he has a very low 'gruffly' little voice and is unable to pitch notes. I have observed that his aural skills are underdeveloped which is no doubt a direct consequence of him not even being able to speak at all for the first few years of his life. This little boy also has extremely small hands making it very difficult to establish a good handshape. Another problem is that he had been diagnosed with ADHD.

I would very much like to continue to work with this child as he has great enthusiasm and loves making music, particularly enjoying playing my percussion instruments. However, I am struggle with his lessons at times as he doesn't seem to be learning in the 'conventional' way. So far I have been using 'Dogs and Birds' (including the suggested activities outlined in the lesson plans) and lots of other ideas such as 'follow the leader' games and improvisation. This student's progress is very very slow and I'd like to be able to teach him more effectively - any ideas welcome, please!

He might be able to whistle at the correct pitch? That is allowed.

Good point - I haven't asked him to whistle yet but I'll see if he can. I really feel what this little boy needs is more general musicianship stuff rather than getting too concerned with learning the piano - or should I plod on and try to teach him to play? I know sometimes these things take time and then everything can click into place. I suppose I need more ideas to keep him interested while we wait for that time to happen.

Hi pianosb.

I'm not a teacher, but I used to work in nursing and have looked after quite a lot of people with tracheostomies or who have had tracheostomies removed. You say that his tracheostomy was only removed 'recently' - how recent is this? It can take quite a long time for the tracheostomy hole to heal completely, and it is likely to have left scar (damaged) tissue in his trachea (windpipe). The 'gruffly' or 'husky' voice is normal after tracheostomy removal. In adults who had previously been able to talk etc normally before they were given the tracheostomy this does normally resolve eventually - but it may be harder for a child who has never had 'normal' use of his voice before. Have his parents sought advice from the medical staff or a speach therapist at all about his voice/singing? - if not, it might be worth asking them to do so to make sure that there isn't any danger of you causing damage to his voice and to get advice on how to help develop his vocal skills.

Humming might work better than singing? This reputedly has a similar 'feel' to talking through a tracheostomy speaking valve (or so some patients have said...).

Do you actually need to do aural work with him at this stage, or are there other things you can work on instead while his voice settles down? From what you say in your original post it sounds like he's not going to be ready to start taking exams for a while anyway.

I think 6 is quite young for any child to learn 'official' piano (many do, of course, and lots successfully but still, it's young). For children with extra problems it's even harder. I agree that general music would be better if that were possible - one of my little boys went off and did dance for a year which did him wonders but not all boys want to and maybe with his health issues that's be a problem. Percussion based things sounds great. You probably want to avoid all singing based aural work for the time being - you can still do pitch work though.

Do you feel equipped to teach general musicianship ? If so, it might be best to officially change his lessons to that - that way you can drop piano for the immediate future and not worry about his pure piano progress.

Purely on the singing side, I had one little boy who was very late to talk and had a speech impediment when he did (could read at age 3 though) who tried piano when he was 6. He 'understood' it all fine but he couldn't hold a note, hear a beat, sing any sort of tune etc. We stopped after 3 months, it just wasn't working. He came back at age 7 3/4, still had a bit of trouble talking clearly and couldn't really pitch a note but at least could now sing a tune that was just about recognisable and clap a beat. He took off flying and never looked back.

Thanks for the replies so far - just to clarify, I am not doing specific aural tests exam-style, just have noticed my student is usually unable to recognise even simple nursery rhymes. I agree this particular child is probably too young developmentally to be concerned with learning to play the piano, I suppose that is why I chose to use the 'Dogs and Birds' (Kodaly) method which is so so simple to follow, really, and is heavily focussed on rhythm. Incidentally, I have known his dad for a long time as he is my piano tuner, who knows lots about pianos but doesn't play himself.

I'm going to see this as a challenge and a chance to add to the contents of my percussion box - anything for a bit of retail therapy! I will start with the percussion instruments first for a few weeks, while I work with him on pulse, rhythm and timbre - perhaps picking out simple tunes on a glockenspiel or teaching some easy nursery rhymes from scratch if I need to. We could compose music for stories and the like. I will try to do a bit of piano with him at the end of each lesson so we keep it going. Just work on finding notes on the piano and improvising I think.

Sound like a plan? Any other ideas welcome - thank you!



Thanks - I'll try the humming - perhaps too hard to sing the words aswell. The tracheostomy was removed last year and hole is still open but quite tiny. I'll ask parents about speech therapy!

I agree with humming as a good start. I've always had trouble getting my voice to pitch the note that I'm trying to produce, but I can always hum it fine. It might be that he's in a simular situation and that he can hear what he's trying to achieve but his voice won't do it...in which case it's probably rather fustrating.

As for the lessons, having worked with children with health problems before, anything to build musical knowledge is always good. You're best just to stick with simple things which keep him interested and enjoying his lessons

I find more and more that students are more comfortable humming than singing and I even suggest to some that they hum the responses in aural tests, as they really don't want to sing. It's quite sad that so many young students don't seem to do any singing nowadays. I do encourage them to try, though. I have a few who sing really confidently and they're they ones who sing in their school choir, so all is not lost!

There are a lot of us out there trying to rectify this situation, jenny - but there are obviously not enough of us..

Yes, we need more Cyrillas in the world - what about a spot of cloning?

I don't think the world could stand it - what a spooky thought !

Not spooky at all...You're never alone with a clone!

As for the issue of them having ADHD, I know how the guy feels, it's difficult living with ADHD, it makes you a different person.

Try to stimulate him as much as possible, when going through pieces, don't stick with repeating small sections over and over again, we hate it! Instead, go through the little sections, but no more than 3 times at the most, and then the next section, and once you're at the end of the piece, just go through another doing the same. And don't stop there! Do lots of aural work, theory, etc. The key is, don't let him get bored, because that's when we get vicious! Similarly, don't get us too excited! We can also get vicious then! It's a fine balance, and it's not always easy but you'll get better as you progress. And if you get another student with ADHD, don't be surprised if your techniques with this student, don't work for the other student. We're all different!

Can't think of anything else to add, but if you have questions, ask them! I've got a lot of experience with ADHD, being someone who has it, however, what makes me different is that I've learnt a lot about my problem to try and overcome it.