? for SLPs (or anyone else) about learning speech in apraxic children
Hi!
DS is 28 months old and was recently diagnosed with oral / motor dyspraxia. He is receiving speech therapy twice a week, but with the new diagnosis he is having a new IFSP written to increase speech and add OT. I have an SLP that I have been having some 'issues' with and am deciding now whether to switch providers. That being said, in the last two weeks or so, my son has gone from 2 words to almost 30, and has even said 2 or 3 two word sentences. His pronunciation isn't perfect, but she and I can definitely figure out what he is saying. I've asked her some questions about how he is learning speech, and she acts like everything he does is really atypical (abnormal even?) He's been evaluated twice for ASD, and both times it has been unequivocally ruled out. Instead he's been diagnosed with a motor planning disorder. All other providers, past and present, OT, PT, Special Ed have agreed that there are no red flags. (SLP's only flag was that sometimes he would avoid eye contact with her when she was doing PROMPT or oromotor work such as z-vibe - this doesn't seem terribly alarming to me. Eye contact is good in all other cases.)
Anyway.....he does the following when speaking (which he's only been doing for about two weeks). Tell me, are these really that odd?
1. Two syllable words - sometimes there's a pause in between first and second syllable. Example 'apple" becomes ah---pull. "Airplane" becomes ahh --pane. He did this with baby and bye-bye too, but has already been starting to pull them together into one quick sound.
2. Loves to label everything he sees. Since he only has about 25 words, some of those words he sees more than others. For example, he says the word "light" about 30+ times a day. Doesn't stare at the lights, doesn't turn them on and off, on and off, but likes to point them out to me and other people. It's the easiest word for him to say, and seing that out house has a lot of them, including holiday lights, candles, etc he gets a lot of practice. He doesn't always do this - doesn't seem compelled to do this, just like to show us that he knows the word - very proud of himself. SLP says it's very odd for a kid to repeat or practice a word. I had heard that apraxic kids learn through repitition, repitition, repitition, so my husband and I have really been encouraging him to repeat the same words, and now he does. He will also repeat moon, baby, blue, leaves, etc - but he obviously doesn't see the moon, or that many babies during his day. He's not as good at using speech to tell me what he wants or needs....were getting there....still uses gestures more for that. Very good at showing and telling me about everything in his environment.
3. Is great at waving hello and goodbye and matching that with words (bye is a little better since I think the ba sound is easier for him than the hi sound.) Also loves to say bye bye mamma, bye bye baby (to his doll) etc. Even puts her in the closet and shuts the door on her so he can say good bye...Anway - great waving, pointing, gesturing, but has a hard time nodding his head yes up an down. I read this can be an ASD red flag, but my neuropsych advised it can be due to motor planning. He certainly tries to do the gesture correctly, but he sort of moves his whole body. Also, when he does the gesture for "shhhhh" (he pretends to put his stuffed animals to bed) he puts his finger more to his nose, than his mouth. Possible trouble motor planning? Or something to be really concerned about?
4. Usually when he wakes up starts saying "light, light" or "mamma, light". I assume this is his way of telling me to come in and put the light on and get him (we have blackout shades) so his room is really dark. SLP acts like this is odd. Does a lot of babbling in his crib. Shouldn't it be normal for him to practice?
Any of this seem really weird, or is my SLP a little off?
Re: ? for SLPs (or anyone else) about learning speech in apraxic children
I'm inclined to respectfully disagree with your SLP here.
1. Any twoish year old is going to have trouble with two syllable words. With any kid with a recent apraxia diagnosis, anything that sounds like it might have two syllables should be celebrated so the fact that he puts a small gap between the syllables in those words wouldn't bother me. Try to encourage him to put the syllables together, of course, but if it's really hard for him then back off for the time being.
2. Of course he loves to label things...he's learned that he can actually SAY the words for all these things in his environment now and so he's going to say them whenever he gets a chance. I wouldn't consider it odd at all-a lot of my kids, both apraxic and not apraxic or on the spectrum, try to practice a word a lot after they realize they can say it...especially the under 3 crowd.
3. Considering your son tries to make the yes/no head movements and put his finger to his mouth for "shhh", his history of apraxia and other motor planning issues, and his good use of other nonverbal communicative functions (waving hi/bye, gesturing/pointing, eye contact) my first thought is that his difficulty in doing so is more likely to be a motor planning issue than an ASD.
4. The fact that he's requesting that the light be turned on the way he is is GREAT, and given his history I wouldn't be too worried about the babbling in his crib either. He's learning how to make the muscles in his mouth do things to make sounds and given his recent language explosion some practice time sounds pretty normal to me.
Another SLP may disagree with me, but I honestly wouldn't see the behaviors you've described as concerning. It sounds like he's doing great!
Before I weigh in on what you are asking...
If your DS is making (sounds like) GREAT progress with the (maybe a little off) current SLP, I would likely not change anything. Sounds like he is in a good rhythm with her - why change what is working?
And I go back to what I said to you a little while ago - the answer that you are seeking here isn't really going to change his current therapy needs or plan of care, right? Even if some of those behaviors are odd (not sure they really are), what are you going to do differently with that info?
There could be a number of things going on here - SLP may be misunderstanding what you are seeking from her, you may be misunderstanding SLP. SLP may not be certain about what she is observing, thus doesn't want to commit to an answer (no, nothing seems odd about DS or Yes, some things seem different ) - she may not know!
In addition, her job is speech and language. It isn't in her scope of practice to diagnose ASD, as we all know. So, if I were you, I would use her for what she is good at providing for you - which is speech therapy for a motor planning/coordination issue...sounds like she is doing a solid job of that.
And document in your DS journal what she is saying. In time, you will have enough pieces to solve the puzzle. Right now, take all you can from everyone you come in contact with and save it until you can make some sense of it all.
FWIW, none of what you listed seems terribly weird to me. BUT, without meeting your son and witnessing it myself, it is impossible to be certain I am answering accurately, kwim?
Glad you are adding OT into the mix. Sounds like he is doing great!
I don't know if my comments will be helpful or not. DS1 was on the very late side of the normal range for expressive speech. He did have a severe tongue tie which contributed to his difficulties (he couldn't extend his tongue past his teeth or reach the tip of his tongue to the roof of his mouth). He started talking at 20-22 months and I watched him like a hawk (still have notes from that time). I remember observing him at daycare before picking him up, wondering if he was developing normally, especially considering his speech delay.
His first handful of words would get used a lot, and we would encourage him to use those words that he knew through books and day to day living. His first few words (truck, cracker, hot tea, nana, mama) were pronounced 'ttrr--uck', 'crack--er', 'hot-tea'. Noticeable breaks between the sounds.
For a while, everything was truck. As his vocabulary grew, he dropped calling everything 'truck' and more appropriate (though poorly enunciated) words came out.
He also put his finger to his nose to make the 'shhh' sign. I did not see that as an issue at all.
All of these things straightened out. He is now 3.5 years and right on track with speech. Normal corrections for pronounciation and grammar only. Well ahead in other areas including gross motor (fine motor is not wonderful, but I am not concerned). Has friends at preschool and is socially saavy.
I know you worry very much about your DS, I have read your posts on this board. My younger son, now 22 months is right where his brother was at this time, maybe even a touch behind. I am now watching him like a hawk and scrutinizing every move the kids makes. It is worrisome and exhausting. I try to remind myself to work with the issue at hand, get professional help as is needed and let him be a toddler.
I am not a professional, and don't have significant experience with kids outside my own. So, for sure watch and listen for the more educated ladies on this board. But, if I may, try not to dwell so much on what *might* be wrong and focus more on what is right and what you can work on.
And I think your DS is extremely cute!
Sometime I think my SLP and I are having totally different conversations. She'll ask me questions like, "What did you think of his psych eval?", which makes me think she's questioning the results, and then will say later on "that of course he would never get an ASD diagnosis, why would I think that? I surely don't think he should" And then while doing oromotor work she might tell me his eye contact with her was poor and concerning to her.Then ten minutes later she'll tell me how he has the most amazing eye contact and joint attention. In a panic I'll ask her if any of this could be from a severe expressive language delay, she'll say "Of course!!!" Makes me want to say, "Then why don't you say that from the start." She has me on this roller coaster that I feel like I can't get off. She has a habit of these bizarre side comments, which I am probably incredibly sensitive too, which then send me to the internet to scare the hell out of myself. For crying out loud, he's been evaluated twice, both with a r/o ASD. And I had to beg for the second opinion. Sigh. Don't get me wrong, it's good news, I just want to move on. I also am starting to think that she's not as familiar with dyspraxia as I originally thought. She's basically abandoned PROMPT, which I have read is crucial for apraxia.
All of that being said, he's making progress so I kind of hate to try another therapist, but I sometimes think the lack of PROMPT and her 'comments' are enough to switch.
Thank you for letting me vent. Some days I've just had it.
I'm starting to think she's a little off. I agree, it's surprisingly quick. The neuropsych said not to expect any words until at least 3. I should say though that some of the 'words' are really approximations. Tree, leaves, and green all sound very much like "reee". I know for the most part by what he's showing me. Banana sounds more like mama, so I don't really even count that. Meow is more like mowwww, but he chases our cat around the hosue saying that, so the SLP agrees it's meow. And today, he seems to have lost 'red' (it nows sounds more like right) and dadda (for dad). Dadda is particularly frustrating because da should be an easier sound to say. I have been told to expect a plateau; she thinks we've hit the limit for now. I asked her if it could be phonological instead of apraxia, but she thinks due to his lack of consonants, immature munching patterns, groping /searching patterns with his mouth, his difficulty to be understood, his late start at babbling, his motor coordination problems, low muscle tone, etc it's very likely apraxia.
As for imitation, I will say that he does a much better job at imitating a word if he tries immediately after I say it. He does have some spontaneous labeling - light, baby, blue, leaves (tree whatever), bye bye, but all his 'words' sound more accurate if he says them after watching me / listening to me say them.
And any two syllable words that he has (and there are only a few) really sound like two separate words, with the second syllable being only a whisper. Apple really sounds like AHHH--------pull. And who knows, by next week it could be totally gone.
It's frustrating, it's scary, and I'm so afraid to get my hopes up. But I've been in a crappy place for a while (trouble with my EI team, a concern about ASD, some tough times in my marriage) that I'm trying to enjoy this. It's hard though, and I still cry a lot at night, because I know even 20 or some approximations (which I am very thankful for) is just the tip of the iceberg, and it could be gone tomorrow.
Thanks for responding. I have meant to email you a dozen times....I was thinking of you and wondering how you were. You have really helped me out with all this. Just wanted you to know.
I wish I could just give you a big hug. I can't imagine how frustrating this all must be. I agree with OSULori in that I respectfully disagree with your SLP. I would be THRILLED if the kiddos with apraxia I see were doing what your son is doing! I think she addressed the specific points nicely, so I won't elaborate on those.
As for your relationship with the SLP, I think that's a highly personal decision. I know that there are some parents/families whose styles just don't fit with mine, and that's OK. Our facility is very family centered, so we believe that if a family hasn't "bought in" to our approach, the child will likely not be as successful as with a therapist they feel more comfortable with. That said, if you do switch therapists, there is invariably some adjustment time to the new style and new person, so you may not feel like you want to risk it at this time of huge growth. Personally, I would rather a family be honest with me if I am not the right fit for them, although I know not every person feels this way :-)
I've just been a lurker here but I've been following your story a bit as we think our kiddo likely has apraxia of speech.
I think I'm a bit confused about your concern with your SLP. It sounds like he's made amazing progress with her - I'd be beyond thrilled if we were at that point in a few months - but if you don't feel your personalities are jiving, then there's nothing wrong with switching.
I'm wondering though if you are reading things into her comments that aren't there? Is she actually suggesting ASD as a possibility or are you reading her comments about eye contact as being a suggestion that he might have ASD? - there's a big difference. Our SLP makes comments about kiddo's eye contact - but not as in a "this is odd" or "this is a cause for concern" but rather as in a "sometimes it's hard to do these techniques with young kids with short attention spans who don't always make good eye contact" and then sometimes as in "he's doing really well following me right now" sort of way. Hope that makes sense!
I know all of this is extremely frustrating and it's hard not to worry about every little thing. I was crushed to be told that my bright, happy little kid had the expressive language skills of a 6-9 month old when he was 18 months old. But at the same time, I decided that allowing myself to overthink and stress every little thing wasn't going to help me handle it at all nor was it going to help kiddo. And he is still the same bright, happy little kid he was before that news so that's what I focus on.
I guess what I'm trying to say is, that were I in your shoes, I'd focus on the fabulous progress your LO is making right now and not over analyze everything the SLP says. It's really easy to hear things that aren't being said when you are coming from a place of stress and concern. It sounds like this SLP has done something that's working for your son - I'd focus on that.
I hope none of this comes off the wrong way. I just know it's very easy to let stress and worry take over your thinking and color everything you hear. Don't forget to take some time for yourself once in a while too to decompress ;-)
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I think this is really excellent advice. I know it is easy to read into what others say, especially if we are "looking" for something to be wrong. If your child gets along well with the SLP, and is making great progress, I am not sure if I would make any changes.
Also, you shared in another post about how you spend part of your son's session talking to the SLP about your concerns and fears for his future. In essence, you have used your SLP as a a bit of a personal counselor. You are blurring the lines and that is not going to help your perception of her and what she says. I would stop talking to her about you and your fears and rather allow the entire session to be focused on working with your son and obtaining strategies to continue between sessions. Save the counseling and talking about your fears and concerns for the counselor.
I hope your relationship with her improves. In the meantime, enjoy and celebrate your son's success!
ETA:
After reading this post of yours, it feels like you are reading into your SLP's comments because you state that prior to her, you were already looking for ASD. She is telling you the same thing that your OT and PT did. Yes, these are concerning, but "it could be a million other things." Is she saying it is ASD or are you reading into her comments? Is she pushing for the evaluation or are you? From what I read, it doesn't sound like she is the one looking for ASD, but rather, doing what we hope she would and pointing out things that are of concern.
"service with a PT and Special Ed teacher multiple times a week for 6 weeks. I brought up anything and everything that I thought could possibly be a red-flag and was given a reasonable non-ASD explanation ( a lot of them didn't even end up having anything to do with ASD - but I'm a compulsively worried parent, so...) They told me no eval was needed. Then I got an SLP who would drop hints of things that were concerning to her, but then say it could be a million other things. Had an neuropsych eval, was told that ASD was r/o. SLP said she completely agreed, but then would drop hints again every now and then. Begged EI for a second opinion (first was private) got ASD r/o again."
Ditto JustinLove.
You need to stop coloring your interactions with your child as an opportunity to diagnose him. This will not help him and it is NOT serving you well either. At some point, you have to start telling yourself "JUST STOP" when your inner doctor dialog starts rambling on. It is taking up valuable brain space that probably needs to rest, relax and recharge.
Having a child with multiple issues, I know this is diffucult. Sometimes you just have to be "The Mommy" and let the professionals tell you what they see.
In Early Intervention, the provider (SLP in this case) often plays the role of "counselor." Just my experience as an EI SLP. I do think mom needs to be ecstatic with progress, but wanted to say that it's okay to vent/talk/ask questions/etc. with the provider.