Speech therapy for my 23 month old

[Changed]

I had my son evaluated through EI, per everyone's suggestions here. He doesn't say any words, doesn't wave, doesn't make animal sounds. However, he understands everything and follows most commands.

 

The process seems to take forever! It took three visits to determine he was eligible, and now two more visits to plan the therapy (next week will be the planning session with goals and finally meeting his slp). The woman today mentioned they will only meet with us weekly for an hour. What on earth are they going to do for him in that time?!

 

Is there anything I can do now to help him? And my main question: WHY isn't he talking? Is he unable physically? Just doesn't want to? Will he FOR SURE learn to talk, or do some kids have some disorder that prevents them from talking?

[gingersmom]

I would see if your health insurance will cover any therapy. An hour once a week is never enough.

[Lecka]

My twins had speech therapy for that amount of time at that age.  It was mostly parent training.  The speech woman brought some pamphlets and gave me advice on how to speak to them and interact with them.  I had a "one up" rule to use one more word than they seemed to understand well -- so I was doing a lot of very short phrases, when I had just been rambling on.  But rambling on is fine too, I just also used very short phrases.  

 

Honestly, I found it helpful.  I felt like she was giving me good advice for what to do over the next week.  

 

She would also suggest games to play or leave games with me, that she thought would be at just the right level for them.  

 

But I agree ----- it is not much for direct speech services, and I think you should see if your pediatrician will refer you for a private eval.  With my insurance -- we are required to do the public paperwork first, then when we have that paperwork, we can take it to the pediatrician, and she can use that to request the private eval.  

 

You sound pretty concerned and I think it would make sense to take that step, or at least see what the pediatrician.  If you walk in wanting a referral, then keep that in the front of your mind.  You can ask "at what point will you make a referral" or "what are you seeing that makes you not want to give a referral right now."  If he/she says something like "if I were seeing x I would give a referral" or "when the child is 24 months I would give a referral" or whatever ----- be like "okay" and then if you see those things, come back and say you want the referral.  

 

Maybe you do not need to be this pushy, but I personally feel like it is better to be up-front about asking, b/c then I am clear in my mind on what is going on, I don't have to wonder "why didn't I get a referral?"  

 

There are totally kids who have not made a sound and go on to talk, though.  There are.  

 

Nobody on the Internet can tell you what your situation is, but it is very, very early to think he will never talk ----- very, very, very early.  

 

In the meantime -- you might want to ask the speech therapist and/or pediatrician about how to build non-vocal communication skills.  This could be with sign language, PECS (little pieces of paper with picture on them), or AAC device (I don't know what this stands for -- something augmentive communication).  

 

Otherwise -- is your child able to request, or communicate wants and needs, in some way?  B/c ---- kids need to be able to do this, or they are very likely to have behavior issues (not guaranteed or anything, but it is a potential problem, when kids cannot communicate what they want or don't want, etc).  If he is able to communicate with pointing, facial expressions, showing things, etc, that you understand -- then that is how he is communicating now.  

 

See if he can follow directions when he cannot see you.  You may be giving him visual cues/prompts -- he may be understanding visually.  He may not be understanding from hearing the words.  If you suspect this -- you need to rule out a hearing problem.  If you see that he is following directions b/c you are also pointing and gazing at things to give him clues (turning your head to look can be a visual cue/prompt too ---- which is fine, you just don't know if he is hearing, even though he is following the direction) ----- mention this to people and see if you can get a hearing screening.  

 

You may have already gotten a hearing screening with the EI screening.  If not -- you need a new one, even if he had one as a baby.  He could have fluids in his ears or something, or maybe there is a change.  It is just something to be sure is ruled out.  

 

If it is at the library, that you can find some books ----- there are books about encouraging speech.  I do not know about all of them -- I am sure they are all good.  If you search on Amazon for "It Takes Two to Talk" you can see a lot of similar titles.  

 

I am subscribed to a Facebook group that encourages early use of AAC devices.  I will see if I can find the name.  

 

 

 

 

[Lecka]

Besides a hearing check, I think you should check and see if you think he could have apraxia or autism.  Off the top of my head -- I think it sounds like those are possibilities.  I am sure there are more -- I don't know what they are.  

 

You can look into them some yourself, and also ask -- "could it be autism" or "could it be apraxia."  See what people say.  If what they say makes sense with what you read, that is good.  If not -- you may need to keep asking more people or bringing it up.  

 

I think there is a chance you will get some answers at the meeting where they list his goals.  I would try to be prepared and ask some questions there.  Also ask -- what is available in your community for children who are found to have apraxia or autism -- hopefully people at this meeting will be people who can answer this question.  Also ask about AAC devices and at what point they would recommend one (keeping in mind -- you may not like their answer, but it is good to know).  

 

That is what I would think of.  

 

For my twins, one ended up having autism, the other caught up very quickly after having tubes in her ears.  They both got tubes in their ears right before they turned 2, my son was found to have active "silent" infections in both his ears at the time, my daughter had a minor "silent" infection in one ear.  The EI woman had a tymponameter (?????) that she would bring -- she is the one who helped me to advocate for them with the pediatrician and ask for my referral to the ENT -- they were not having signs of ear infections and I was confused, like, "the doctor said they don't have an ear infection."  So the speech woman was very helpful for that, but did not recognize that my son had some signs of autism -- and then when we knew his hearing was not good while he had the fluids, we thought that was the whole reason. 

 

I hit it off with her, though, I liked her, and my kids liked for her to come.  

[PeterPan]

I had my son evaluated through EI, per everyone's suggestions here. He doesn't say any words, doesn't wave, doesn't make animal sounds. However, he understands everything and follows most commands.

 

The process seems to take forever! It took three visits to determine he was eligible, and now two more visits to plan the therapy (next week will be the planning session with goals and finally meeting his slp). The woman today mentioned they will only meet with us weekly for an hour. What on earth are they going to do for him in that time?!

 

Is there anything I can do now to help him? And my main question: WHY isn't he talking? Is he unable physically? Just doesn't want to? Will he FOR SURE learn to talk, or do some kids have some disorder that prevents them from talking?

I'm sorry you're having a hard time with this.  What are your options financially or with your insurance?  To get out of that system and get other answers, you'll have to go private.

 

Yes, some kids don't begin to talk without therapy.  We can't tell you for sure why your specific dc is not talking.  There can be different reasons, as Lecka was going into.  Ear infections, plugged ears, sure.  It sounds like his receptive language is very good.  I agree that the mix of no speech *and* not waving is concerning.  Did they do complete screening on him?  (OT, spectrum, etc.)

 

My ds has verbal apraxia, otherwise known as Childhood Apraxia of Speech (CAS).  There's nothing childhood about it and it's not a developmental delay.  Praxis is motor planning issues, so verbal apraxia is issues with the motor planning of speech.  In that scenario, a dc will have communicative intent but no ability to get it out.  They'll typically become very frustrated as time goes on and one common sign is dropping words (saying them once and never again).  You can also have oral apraxia, which is difficulties with the movements of the mouth (chewing, blowing bubbles, etc.).  When a stroke victim loses their speech, that's praxis too.  In our case the psych thinks the apraxia came in on the dyslexia gene, a 2-fer deal.  There are a variety of ways to end up with apraxia.

 

There can also be developmental delays.  I'm NOT talking about bloom time, because well I'm just not going there.  I'm talking about a developmental delay, something you would go to a developmental pediatrician over.  And if you have other flags, that would certainly be something to consider or to talk over with your ped.  He's just about to turn 2, so you should be having your 2 year appt.  They'll go through developmental things and you should be prepared to discuss them.  That's when we were told to make the move on ST, and our ped was very aggressive about it.  If there's more going on developmentally, hopefully your ped can help you determine that and see if a referral should be made.

 

I really don't know causes of no speech beyond that, but I'm not an SLP.  I can tell you our SLP puts no stock in the late bloomer thing.  Anyways, PROMPT is the therapy to look for if you can find it.  If you're going to pay privately, I suggest you use the provider locator on the PROMPT website and see what your options would be.  They can help you sort out if there's praxis or not.  There can be praxis *on top* of a developmental delay, as confusing as that sounds.  The PROMPT therapist is qualified to elicit the motor planning problems and demonstrate them for you, so there will be no doubt of what's going on.  Or conversely they can clear you on motor planning concerns and tell you it's NOT apraxia.

 

Apraxia is not the end of the world.  It needs strong, effective intervention.  The irony is that PROMPT actually is done ideally just once a week in most cases.  But for a dc with apraxia to receive traditional therapy only once a week, that would be concerning.  But it just depends on what is going on.  A non-specialist may not be able to identify the motor planning problems.  The first SLP I visited totally beat around the bush, saying this crap about how they'd work on "communication" blah blah.  And she wanted sessions 3 days a week!  Went to the PROMPT therapist, who sat him down, demonstrated the motor planning problems, and when she did the first therapy session, the FIRST SESSION my son SPOKE.  Not communication, not sign, not crap, SPEECH.  Put, on, more, me, do, up...  Over and over and over he said these words.  So when people ask why we've driven so far for speech, that's what I tell them.  You find somebody who can put their hands on your dc and he begins to speak, and you'll drive that far.

 

Also we did oils.  I use flax with him and am just starting EPO.  Most people use fish.  

 

But whether it's apraxia or a developmental delay or something else, I can't help you.  I can just tell you how to find the person who can sort it out.  How to afford it I can't help you with either. I've met someone who successfully petitioned and required her ps to get an SLP trained in PROMPT.  It's the law that they have to provide within certain parameters and in this case, for that child, PROMPT was the only effective therapy.  So don't give up hope.  First figure out what you're dealing with.  One step at a time.  This is going to be a journey, not a sprint.

[geodob]

From what you wrote, it seems that he isn't attempting to make sounds or words?

But you didn't mention whether he through the Babbling stage, of practicing making sounds?

Then trying to imitate sounds.

 

Where the first thing would be to check his hearing ?

You could do this yourself, by simply making sounds, saying words while standing behind him.

Also doing it when he isn't expecting it.

To see whether he turns around, in response to the sound/ word?

 

[Changed]

Sorry to leave out important info...He did have his hearing checked. He passed that test. :-)

 

No, he never went through any babbling stage and he doesn't really try to imitate sounds or words. He HAS in the past, and has even repeated a few words, but then never says them again. Now that I think about it when we were on vacation over the summer (taking a million pictures) he said "cheese" a lot because we would always say "say cheese" when we took pictures. But he hasn't said it again since that week over the summer. The slp put in her initial report that he only made vowel sounds, and no consonants. I'm not sure if that matters. ?? She also mentioned that after she played with a car and made car noises he didn't try to imitate the noises. But he does push the cars around.

 

I'm not sure why he doesn't wave, but I'm not concerned about him being autistic. He makes eye contact, interacts with his siblings, smiles and hugs people. Just to make sure I actually asked the slp if she was worried about him being on the spectrum (not that I even know what that means!) and she said "oh no".

 

The slp mentioned that they only ALLOW a max of one visit a week. So, if he has a problem that requires more than that I guess I would need to get in touch with someone else.

[Changed]

I'm sorry you're having a hard time with this.  What are your options financially or with your insurance?  To get out of that system and get other answers, you'll have to go private.

 

Yes, some kids don't begin to talk without therapy.  We can't tell you for sure why your specific dc is not talking.  There can be different reasons, as Lecka was going into.  Ear infections, plugged ears, sure.  It sounds like his receptive language is very good.  I agree that the mix of no speech *and* not waving is concerning.  Did they do complete screening on him?  (OT, spectrum, etc.)

 

My ds has verbal apraxia, otherwise known as Childhood Apraxia of Speech (CAS).  There's nothing childhood about it and it's not a developmental delay.  Praxis is motor planning issues, so verbal apraxia is issues with the motor planning of speech.  In that scenario, a dc will have communicative intent but no ability to get it out.  They'll typically become very frustrated as time goes on and one common sign is dropping words (saying them once and never again).  You can also have oral apraxia, which is difficulties with the movements of the mouth (chewing, blowing bubbles, etc.).  When a stroke victim loses their speech, that's praxis too.  In our case the psych thinks the apraxia came in on the dyslexia gene, a 2-fer deal.  There are a variety of ways to end up with apraxia.

 

There can also be developmental delays.  I'm NOT talking about bloom time, because well I'm just not going there.  I'm talking about a developmental delay, something you would go to a developmental pediatrician over.  And if you have other flags, that would certainly be something to consider or to talk over with your ped.  He's just about to turn 2, so you should be having your 2 year appt.  They'll go through developmental things and you should be prepared to discuss them.  That's when we were told to make the move on ST, and our ped was very aggressive about it.  If there's more going on developmentally, hopefully your ped can help you determine that and see if a referral should be made.

 

I really don't know causes of no speech beyond that, but I'm not an SLP.  I can tell you our SLP puts no stock in the late bloomer thing.  Anyways, PROMPT is the therapy to look for if you can find it.  If you're going to pay privately, I suggest you use the provider locator on the PROMPT website and see what your options would be.  They can help you sort out if there's praxis or not.  There can be praxis *on top* of a developmental delay, as confusing as that sounds.  The PROMPT therapist is qualified to elicit the motor planning problems and demonstrate them for you, so there will be no doubt of what's going on.  Or conversely they can clear you on motor planning concerns and tell you it's NOT apraxia.

 

Apraxia is not the end of the world.  It needs strong, effective intervention.  The irony is that PROMPT actually is done ideally just once a week in most cases.  But for a dc with apraxia to receive traditional therapy only once a week, that would be concerning.  But it just depends on what is going on.  A non-specialist may not be able to identify the motor planning problems.  The first SLP I visited totally beat around the bush, saying this crap about how they'd work on "communication" blah blah.  And she wanted sessions 3 days a week!  Went to the PROMPT therapist, who sat him down, demonstrated the motor planning problems, and when she did the first therapy session, the FIRST SESSION my son SPOKE.  Not communication, not sign, not crap, SPEECH.  Put, on, more, me, do, up...  Over and over and over he said these words.  So when people ask why we've driven so far for speech, that's what I tell them.  You find somebody who can put their hands on your dc and he begins to speak, and you'll drive that far.

 

Also we did oils.  I use flax with him and am just starting EPO.  Most people use fish.  

 

But whether it's apraxia or a developmental delay or something else, I can't help you.  I can just tell you how to find the person who can sort it out.  How to afford it I can't help you with either. I've met someone who successfully petitioned and required her ps to get an SLP trained in PROMPT.  It's the law that they have to provide within certain parameters and in this case, for that child, PROMPT was the only effective therapy.  So don't give up hope.  First figure out what you're dealing with.  One step at a time.  This is going to be a journey, not a sprint.

 

I just read through your response again, this time while awake. ;-) After the first few sessions with the therapist I guess I'll evaluate if anything seems to be happening, and if not I'll try and find a provider on the PROMPT website. I keep reading about how early intervention is important, so I don't want to wait around forever...

 

[Lecka]

I don't think it is too early for you to look at getting on lists, or to call on the phone and ask questions.  You don't want to wait around and then have to get on a waiting list -- if you call and the list is short, then you can call back later.  If you call and the waiting list is 9 months long, get on it.  

 

When I went to my EI meeting, they had information for programs to apply for (just how it is done in our state) that might be different kinds of insurance or grants to pay for therapies or needed items.  My husband's insurance covers things pretty well, so I did not look into it.  But ---- I think you could also go ahead and contact your insurance and find out what they will cover so you can know if you need to apply for these things (they may take time for your paperwork to go through).  

 

Since my husband is in the Army and we go on post, people there know just how our insurance works.  At other times, when I have been at a speech or OT place, there has always been a person in the reception area/office who knows just how our insurance works.  But anyway -- if you find out your insurance will cover speech therapy that is good.  If you find out your insurance will not cover it, you might be able to ask the EI people at the meeting.  Maybe they are helpful, maybe not, you can ask.

 

I think you can take these steps while you are also taking a wait-and-see to the EI speech ------ but some things take a lot of time to go through or a lot of phone calls to figure out,  you might want to start asking, since the EI meeting and the 24-month visit might be convenient times to get this kind of information.  

 

I also hope you will consider looking at Early Signs for autism spectrum.  My local area is not very good, but seems to be improving, for having kids diagnosed before about age 4 (my son was diagnosed at age 3 years 11 months).  There are just starting to be kids diagnosed younger.  The EI speech woman also said "oh, no" to me about autism.  My son is a great kid, he has never been a kind of stereotype that some people seem to have.  But autism-specific therapies are what have helped him.  I do not think it is something to worry about -- but if you are just aware, I think it is something worth being aware of.  I also know a lot about encouraging communication for autism.  My son did not really have communicative intent (to some degree he had it, to some degree he didn't) and for him -- when his communicative intent increased, he started talking more and being interested.  If you do think in this direction, I know great resources to look into and try, that I think are really good.  It would also (to me) put my mind to rest if you asked -- in our community, what age are children being identified?  Does EI here look for early signs and diagnose kids at a young age?  You could ask this same thing to your pediatrician.  

 

That is nothing about anything you have posted, it is more just me feeling like I need to share, that in a lot of places, you cannot count on EI or your pediatrician to look for early signs of autism.  Then a lot of places they are more on top of it.  But I think it is worth looking into just to be aware for yourself.  My son is doing very well and talking quite a bit, too :)  

 

I think if a PROMPT therapist or someone in the office when you call, would speak to you on the phone, that is probably worth doing right now, just to see what they say, and find out if you will have hoops to jump through to schedule an appointment, or if it will be easy to schedule an appointment.  And -- just to see if they can answer any questions for you, or refer you to any resources they might know about.  It really never hurts to ask -- sometimes people are like "why are you asking me?" and other times they are happy to talk and have a ton of helpful information.

 

 

 

 

[PeterPan]

Lecka is correct that there will be a wait (most likely) to get into a good PROMPT therapist.  You would do well to go ahead and research and find the person NOW.  You are not too early.  You're at just the same age my ds was, and I'm telling you that first therapy session he went from nothing to SPEECH.  

 

Yes, the things you're describing are all the flags for apraxia.  I always say it straight, so I'll just tell you straight that if they've already seen him that many times and they haven't diagnosed it, they aren't qualified to treat it.  Every session you spend there is time spent NOT getting proper therapy.

 

When you see the difference between traditional therapy and PROMPT you will be angry at the thought that someone would keep your dc in a therapy they KNOW can't work.

 

This should be the link for Deborah Hayden's explanation of PROMPT.  It's long but very much worth your time.  And yes, losing words (saying them a few times and never again) is THE red flag for apraxia.  It was the ladies here on the board who identified it in my ds 4 years ago when I asked about it.  It's the most classic symptom.  It means the motor planning was so hard that he could get it a few times and never again.  My ds had some odd words (door, a little boy's name, cow, etc.) that he said a few times and lost.  No, he never babbled.  You're talking CLASSIC verbal apraxia symptoms.  If that therapist can't say duck when duck is in front of her, MOVE ON.  She's keeping you from getting therapy that will actually work.

 

PROMPT: Speech Production Disorders - YouTube

[geodob]

You wrote that he passed his hearing test.

But perhaps you could try that simple test, of whether he can hear you. Without seeing you?

 

As it is of concern that 'he never went through the babbling stage, and he doesn't try to imitate sounds or words'?

Where I would suggest that the reason for this needs to be understood?

Why he didn't try to imitate sounds?

[PeterPan]

If he has passed his hearing test, in the States that test is fine.  They did it on my ds when I took him in.  It's tympanymetry (sorry for the butchered spelling).  Thing goes in the ear, sends out waves, and the computer reads the ear's response.  Same test for babies and bigger kids.  

 

I'm saying this because my ds did NOT respond to things when he was little and also has had a lot of areas of non-responsiveness over the years.  That's why I took him to a major university to get a thorough, thorough ear exam, because I did NOT want to miss anything.  A kid with apraxia may have social withdrawal and be unresponsive to stimuli and it's not his hearing.  My ds also has adhd as part of his mix, so there were times he just wasn't attending, hence not responding.  And he has poor proprioception of anything *behind* him.  So if you call him from behind, he doesn't necessarily answer.  AND it's well-known that kids with language processing kids may need a physical stimulus to get their language processing going.  So for instance I will touch him on the shoulder and then speak to him.

 

You could get really freaked out as a parent if you have that kind of unresponsiveness and think something got missed with his hearing.  I'm just telling you there *are* other explanations for not responding.  If he has had his proper hearing test when he was a baby and has had no high fevers, accidents, injuries, or other things that would have caused hearing loss, it might not be.  But you know I did get the hearing test.  It was $35 at the university and would have been almost $400 privately.  They didn't laugh at me or say I didn't belong there and they saw the unresponsiveness I was worried about when he did it to them.  (It caught EVERYONE'S attention because it was very dramatic.)  But they were able to clear it as NOT a hearing problem.

 

Just go through the steps.  Or as the audiologist at the university said "Surround yourself with a good team."  Best team you can build, and just work through the issues, one by one.  

 

I want to expand on social withdrawal.  I didn't realize how much my ds was evidencing social withdrawal till we started ST.  They retreat into their own world because they can't interact in yours.  Unless there's a developmental delay or expressive language delay, all that language is there, inside, processing, just not coming out.  They give up and withdraw.  Have you tried Signing Time on him?  You definitely, definitely should.  See what happens.  Signing is a *language* and develops the language portion of the brain.  Our SLP used it interchangeably and it's definitely worth your time, even in modest amounts.  I bought the entire Signing Time dvd set for a nice price (maybe $100?) on amazon.  I think the ST site has some deals going.  As you try that, you may see the signs don't even click or that he can understand them but not imitate.  You may see issues with praxis or motor planning.  So you'll learn some things by trying it and it will give you some ways to communicate.

 

Your library may have the Signing Time dvds...

[Lecka]

For some reason I can't link -- but if you google "learn the signs" there is a link to autism speaks, and that link has a link to the M-CHAT.  It is a screening.  

 

What you will notice ----- a lot of the questions could be positive for autism OR for apraxia OR for other things.  But the point is -- if you are getting red flags on it, you do need to make sure you are following up on things and asking for referrals from the pediatrician, or bring it up with EI.  But -- if you get blown off, keep asking, ask somebody else, do what you can to follow up.  B/c it is so easy to let a year go by.  

 

I think it will be a load off your mind to feel like you are following up, and whatever you find out, you will be able to use that information to help your son and to help your family (so that you don't get frustrated or spend time wondering what is going on).  

 

My son did not have all the warning signs, it says on this link, to follow up with questions if you see one warning sign -- and it looks like you do have one warning sign, maybe two.  But that does not mean -- having one or two warning signs is a huge problem, it just means it is good to try to get real answers.  

 

 

[PeterPan]

Dropping words is a HUGE red flag, HUGE.  

[Changed]

I went through the M-chat quiz online, and it did say there are warning signs. I'm confident, though, that he doesn't have autism. You'd just have to see him to understand. He is the most social child I have! At church he loves to get people to look at him so he can smile at them. He loves to cuddle and hug and play with kids. He grabs us and points to what he wants while saying "uh uh" until we get up and get what he wants. I think the ONLY autism sign he has is not talking. But please correct me if I'm wrong. He is very responsive to us, just not with words. I say get up to the table to eat, and he comes in the kitchen and gets in his chair.

 

In fact, he doesn't throw fits or get frustrated because I almost always know what he wants. Now, he'll throw a fit if I tell him no. Lol. But him not talking doesn't really cause us any problems, other than the fact that I know he should be talking.

 

He sometimes says mama and dada, but only if I sit there and repeat fifty times. He never just says it to get our attention. But if I say "where's dada?" Then he'll point and laugh.

[PeterPan]

Even there were autism (which I totally hear you there's not), you'd still be calling it by the correct speech diagnosis (apraxia, expressive language delay, etc.).  60% of the time, speech problems in autism are apraxia, or at least that's what I've read.  

 

I'm just saying you might want to proceed like it's apraxia and get that clarified by a specialist.  My ds was the same age, and the FIRST DAY of therapy he spoke words for an hour straight.  Any time with ineffective therapy will be too long.

[geodob]

Though I would come back to: " he doesn't really try to imitate sounds or words."

 

Which is different from Apraxia, where a child repeatedly tries to make sounds or words. 

But the difficulty is with the motor planning and control, in producing sounds or words.

 

What I am rather thinking about, is his ability to capture and hold a sound in his mind?

To imitate a sound, we first need to retain the sound in our mind.

Which we can then try to imitate.

But if after hearing the 'sound', it has disappeared without a trace?

Then their is nothing left, to try and imitate?

Repeating it fifty times, wont help if it disappears instantly?

 

Though this capturing of the sounds of 'mama' and 'dada', uses our Minds Ear.

Which is equal to our Minds Eye, where we can picture mama and dada.

Where we are more familiar with people who: 'can't picture something in their mind'.

Who can look at something, but can't retain a mental visual image of what they just looked at.

As the visual image has disappeared from their Minds Eye.

 

So that an equal to this, is not being able to retain a 'mental sound image' in the Minds Ear?

Which is different from saving a sound/word in Memory.

Which is stored in our Auditory Memory cortex.  So that speech can be understood.

But words can't be recalled.

 

Though the SLP reported that he made 'vowel sounds'.

Also you noted that when he will point and say "uh uh".

Which is a vowel sound.

Where I wonder if this could be a key?

So that you could work with him on imitating the different vowel sounds?

Rather than consonants.

Which reduces mama and dada?

To a-a.

Using the different vowels a,e,i,ou , which he tries to imitate.

 

Where once he can imitate your production of these vowels?  As simple sounds.

Variations could then be explored, for him to imitate?

Taking the vowel 'a' for example?

Perhaps you could explore the different ways that you can sound out 'a'?

Firstly the 'length' of sound, from a short clipped sound. To an 'a,a,a,a,a,a'.

 

Then another variable, is the 'pitch'.

Where if you explore the pitch of 'a', you can vary it from both ends of piano keyboard.

So that 'vowel sounds', could be used for him to practice capturing and imitating sounds?

 

Where different verbal noises could also  be practiced?

 

Though I should declare a personal interest in this area of the develop of what I like to term as 'Minds Ear'?

Which I've been doing study and research into for about 8 years.  With different university depts and organizations.

Where I'm leading international research in this area.

But my study so far, with 98 Participants.  Has been with children and teenagers from the age of just over 3 to 16.

So that  I am looking at your sons difficulties, in terms of an earlier stage in this developmental process, of the 'Minds Ear'?

[Lecka]

It does sound like he has good receptive language, and it doesn't sound like he has autism.  

 

Good luck!  I hope you can find out some helpful information locally.  Do keep asking, though.  It is worth it to ask!  I would ask about sign language, PECS, or AAC, too.  Either he makes a huge burst of progress, or he is going to start not being able to participate in things requiring expressive language, and other areas of development can be impacted.  You want him to have a way to play with other kids as he starts to get old enough to want to do that, and that kind of thing.  

 

But -- hopefully he will be talking by then.  But at the same time, it takes some time to make things happen, so it is good to ask now, I think.  Then you can be ready and know what is being suggested for you.  Edit:  I mean just in case, really.  But he is not too young for any of these, and they might help him have a way to communicate.  I think it is worth asking about, at least, and thinking about it and finding out information.  And like OhE said -- all it takes to try sign language, is to check out some Signing Times videos from the library, and see if he likes them.  It is not a huge commitment or effort to try and see.  

[PeterPan]

Geodob, I think you might be a little off.  My ds has moderate verbal apraxia diagnosed by a specialist.  He VERY CLEARLY has the motor planning problems of speech.  He could get his jaw down but not pick it up.  He struggles to lift his tongue, to round his lips, etc.  

 

People with praxis typically have difficulty imitating.  A lack of imitation is a HUGE red flag for praxis.  You can have overall (global) dyspraxia, where a person will struggle to imitate motions demonstrated to them.  So for instance if you demonstrate an ASL sign to my dd, she CANNOT imitate it.  That's praxis.  In her ice skating classes she needed teachers who could put the expectation and sequence of actions into words, because she could not imitate the demonstration.  That is praxis.

 

So with the ineffective methods of therapy for verbal apraxia, you'll have a person holding up a flashcard or demonstrating the expected motion but the dc is unable to imitate.  That is why traditional therapy struggles to be effective.  Kids with verbal apraxia need a method that gives them the sensory input to tell the brain MOVE THIS, because their system cannot observe others, motor plan, and imitate.  Apraxia is a motor planning deficit.

 

It is also true you'll meet kids being labeled as having apraxia by nonspecialists who in fact have a developmental delay.  No one wants to talk about that now and people don't like that kind of label.  You'll hear situations where the dc had no speech and then BAM it comes in clear as a bell.  

 

Apraxia is not MERELY late speech.  Apraxia is not a developmental delay.  Apraxia is difficulty with the motor planning of speech.

 

My ds was utterly silent.  When he would play, there was NO sound.  If you called to him, NO sound.  If you lost him in the house, give up.  I once lost him in our house, and it was a frightful thing!  I had to call my dh home from work and my BIL came too.  We looked for 15 minutes, trying and trying to find my ds.  It is a FRIGHTFUL thing to have a totally nonverbal child, and with some kids there will be nothing.  

 

So we may be talking past each other with labels.  In some countries they use different terms for things.  In the US, it's called apraxia for speech and oral, dyspraxia for global (the rest of the body), and praxis implies, at the core, issues with motor planning.  That will result in severe difficulties with imitating.  After all, if they could imitate, they would be speaking.  ;) 

 

That's why PROMPT is such a miracle, because it makes the signals connect between the muscles and the brain, so the brain realizes what it needs to move to make the speech happen.  No ability to imitate.  It's why people sue their districts to require them to get an SLP trained in PROMPT, because PROMPT is the most effective (and sometimes only effective) therapy for praxis of speech.

[Lecka]

I think someone would have to diagnose at what level there was a problem, whether it was at one place or the other, or both.  

 

It can be so hard to tell.  

 

Or, something works, but why did it work?  Did it work b/c it addressed one problem, or another -- when I think sometimes one intervention could be effective for multiple issues.  

 

I am thinking of my younger son..... he is in OT now and it is good OT, he has finally had a good, solid OT eval, when everyone involved things it reflects his ability and not ???????? because we do not think it reflects his ability but it is hard to know exactly why.  And she says he "is not significantly impaired in motor planning."  So -- basically, his motor planning is a little more of an effort and he needs a little help, but it is not a major problem.  

 

And yet -- he has benefited from interventions that ARE targeted towards kids who definitely have impaired motor planning.  

 

And, I know those interventions have helped him!  I have seen them help him!  

 

But I don't know why.  I don't think it has ever been fundamentally because of his motor planning, though.

 

But, he used to have zero imitation skills, too.  So what was the deal with that?  I don't know, exactly.  It is an autism thing with him, though.  But he went from zero imitation skills to, now, being able to imitate peers with no intervention or special training.  He can just watch them and then do what they do.  He is not perfect -- but he is sure doing it, and it is so different from when we used to do "if you're happy and you know it clap your hands" and he would sit and look like he wanted to join in, but didn't know how.  And, if he raised his hands, it would be a big effort and I would be so proud.  Now he can understand what people are doing and copy them.  

 

So whyever it was, maybe it was more the mind's eye and not motor planning.  I don't know.

 

But it is very hard, b/c I do think, when there is one thing happening -- there could be many reasons.  

 

But for the OP -- I think it may not really matter.  

 

I do think it sounds like apraxia, to be honest, but I think you need to find that out locally by pursuing things locally, and finding someone who will know, and having them see your child personally.  I think it is worth doing!  

 

Then when you have a really good idea that way ---- I think you can totally find people on this forum or on other forums, and hear about what they have done with their kids, and things.  

 

But it is hard to know what to look at, without that, unless you look into it and it is just totally obvious your child fits one thing.  

 

I have an older son, too, who does very well, but he had secondary concerns as a result of not having intelligible speech.  He got to be 4 and 5, and I understood him (almost all the time), but he wanted to be able to play with other kids, and he was limited to either parallel play, running around the playground, or going along with other kids' suggestions.  I saw him so many times, want to give an idea for how to play or pretend, and it was passed over with kids not knowing what he was saying.  It was sad for him, and I am not sure what I could have done differently exactly, it is hard to know, and maybe it is just the way things are sometimes, but it was hard on my son.

 

And, I know, kids in my younger son's pre-school did well with AAC and PECS (just what they used ---- I have seen pros/cons for PECS, AAC, and sign language -- and I cannot say if any is better than the other, just for what is decided for individual kids as far as I know), they were able to really play with other kids, or it seemed this way to me, in watching them.  

 

I think it is one of those things -- with my younger son, he is the same at all levels to some extent -- he is not so frustrated -- he can speak at the level he can understand, he can play successfully at the level he wants to play at.  But with my older son, he had a desire to do things at his age level, but he did not have intelligible speech to allow him to do all the other things he wanted to do at his age level.  And, that was hard.  But -- he made great gains in speech therapy, and this has not been an issue since 1st grade.  But even with that -- the ages of pre-school and Kindergarten are still a lot of time to be kind-of unhappy to not be able to play with other kids like you would want.  But it is one of those things -- I do know I did the best I could, and he had a lot of good experiences in those years, too, and people in his life who took the time to figure out what he was saying, and I do not think he has any lasting negative from it.  

[PeterPan]

Lecka, just for your trivia, that's what our OT found with ds too, that his motor planning globally was a little bit slow, so he needed more instances to figure it out, but he *could* get it.  Dd, on the other hand, struggles much more, enough that she has quite ASL classes over it, which is really a shame as she wanted to do ASL.  She still didn't get a dyspraxia label.  So there are definitely those degrees of it, just as with apraxia.  

 

That instance with your ds is interesting but I think you're seeing the convergence of a bunch of things, not just one thing.  

 

Our SLP who does PROMPT brought in an SLP who specializes in AAC.  There definitely, definitely are cases where that's the route needed.  What bugs me is when kids are young and being given that MERELY because they aren't getting the most effective therapy (PROMPT).  I even talked with a person who was told apraxia and told to go AAC when it was more likely a developmental delay.  To me the point is get them the most effective intervention before you say they CAN'T learn to speak.  

[Lecka]

I think AAC/sign language/PECS should ONLY be for an assumption that the child IS getting effective therapy and IS going to learn to talk.  Things I read are all written that way.  I am also horrified that someone would get AAC in the absence of effective therapy.

 

I am not disappointed with someone using AAC when they had a developmental delay, b/c being able to use AAC in the mean time can keep a child has is already dd, from falling behind in areas that they might be able to keep up in by using AAC.  It keeps vocal speech from being a road block that holds up everything else.  B/c -- for a child with dd, maybe they need work on social skills, too, and having the AAC means they can advance in those areas.  I can imagine being horrified at exactly how it was done  -----  but in general, I would agree with that.  Also locally "developmental delay" is often used interchangably with autism since our school district cannot diagnose autism, and often it seems they are using this word as a place holder ------ even though that is not what it means!  But that is the context for me.  I think it would have been appropriate for my son who has a label "global developmental delay" if he had not been able to produce vocal speech (he was diagnosed "autistic disorder" and "global developmental delay").  So -- that is my perspective.  But anyway -- just to say, using AAC does NOT mean kids are thought to be unable to learn to speak.  It is supposed to help them in the mean time.  And, for kids where it is difficult to produce speech, it lets them have a way to use language that is not physically draining to them.  So that just b/c you can use vocal speech, it doesn't mean you should not be allowed to use AAC.  But this is all the kind of thing people think with autism -- and I think the reason it might be different, is that speech might just be one problem with autism, so other areas need to be considered as well.  Where with apraxia -- you may be seeing that there are not as many other areas having problems -- and if there are, you may expect them to be solved with speech.  Where with autism -- you could get speech, and it would not make the other problems just come together -- there could still be other problems needing attention.  And -- in our area, if you say "speech delay" as opposed to "developmental delay" then you are assuming that the only problem is speech.  But "speech delay" is just expressive language/articulation, probably.  "Language delay" is probably receptive and expressive language delay.  "Developmental delay" is probably autism or something that is more than just speech or language delay (I think people also use it to mean intellectually delayed, but with having a child with autism, and with the parents I know, I personally always hear it used for autism -- and intellectually delayed/ID can also be a dual diagnosis with autism, so there is that, too).  That is how all those words are used locally, when I hear them used.  

 

But I do see the points of early AAC use..... when I am familiar with it, it is absolutely not saying kids can't learn to speak, it is just a stop-gap measure until they can learn.  It is also supposed to allow kids to continue developing more advanced language skills and to have responses made to their more advanced language skills, so they are able to advance beyond where they might without it.  It is kind-of a thing, supposed to be very good, but I do not really know about it first-hand, either.