Severe Speech Delay and Reading

[Guest AHithersay]

My son who is 4 has mild CP (right hemiparesis) and a severe speech delay, but he is extraordinarily bright. We have noticed that teaching phonics is helping his speech and he had begun picking up on some sight words so I've begun phonics with him. The difficulty is that he cannot articulate the sounds well. I've encouraged him that reading is done in his head and he does not need to speak to be able to read and he is confidently working and doing doing his best, but it is difficult to gauge his full understanding and readiness to move on because of the speech delay. Does anyone have experience with this? Are there any creative ideas for checking reading readiness and comprehension? I would love to hear from other parents. 

[Rosie_0801]

I didn't worry too much about comprehension at that age because I was more concerned about pronunciation. I worked very hard at keeping in mind that I was using phonics instruction as a method for speech therapy, and any actual learning to read was a bonus. If I knew she was reading correctly, though not pronouncing it properly, we worked on it, but I let her move forward. They are two different skills, after all. 

 

We have very different reasons for speech delay here, and I'm only now starting to put much effort into comprehension. She's "over the hump" with reading now, so she can continue to learn phonics with enough brain space left over to be learning new words. 

[Daria]

Look for a reading curriculum that focus on helping kids analyze connections between the words in different sounds, rather than a more traditional "start at the beginning, say each sound, and then put the sounds together" mode.  

 

Two curriculum I find that are written for typical kids (so they don't underestimate a kid like yours who is bright with a specific disability) and use an analytic approach, and that have worked well with kids with limited verbal skills are Words their Way, and Systematic Sequential Phonics They Use, by Patricia Cunningham.  Both do a lot of words with manipulating words cards, and cards with letters and sounds, which can allow kids to respond without speech.  I have a little girl with no speech, who uses eye gaze to tell me how to manipulate the sounds and words for Words their Way in our tutoring sessions, and it works well.

 

I also like to pair both of these programs with the iPad app, Word Wizard, which makes the letter sounds as you manipulate the letters.  You can set it up really easily to do the word building activities in Systematic Sequential Phonics in particular.

 

Depending on how much motor control he has, I find it's really helpful for kids to learn to associate a physical movement with each of the 44 sounds of the English language.  I really like the movements from Jolly Phonics.  Since they do a movement per sound, rather than per letter, it really helps young kids get the difference between a letter and a sound.  They know, for example that /k/ which is represented by opening and closing their hands like they're "click castanets" can be matched with the letter C or the letter K or the letters CK together, and that the letter C can also be matched with the /s/ sound which is represented by moving their hands like a snake.  For kids who have trouble making different sounds, hand or head movements can really help them clarify whether they were trying to make a /t/ sound (moving their heads back and forth like they're watching a tennis ball go back and forth across the net) or a /k/ sound.  

 

ETA: I missed the specific diagnosis in your OP.  I don't see why a kid with hemiparesis would have any trouble with the Jolly Phonics hand motions, since most of them can be easily modified to do with just one hand.  

[Lecka]

If he has good motor control, maybe you could have story cards that he sequences, or maybe you can ask him questions that he can answer by pointing, or maybe you could ask him questions where you have some answers and he points at the answer.  My son can do a lot "receptively" that he can't do as well "expressively," and for him he does a lot of pointing, and he does a lot with picture cards.  He is not a reader so he can show comprehension with story cards instead of with written words.  They do not have to be great art, if you give an explanation of the picture, too.  Also if you read about a theme, you can re-use a lot of pictures.  And for him, since a lot of his will be about feelings, it is not hard to say "how did the girl feel?" and he points to a picture of a person with an exaggerated facial expression -- we change them sometimes, but he uses the same set of facial-expression cards for a while -- they are from google image - you can google "birthday party" and things and will find a photo that will be good for some expressions.  Also you can buy sets of cards like this from places like Super Duper.  

 

I would question if getting an AAC device would be useful.  I have a good opinion.  If he has a speech therapist, I would ask.  The speech therapist might have some suggestions in general that you can ask about, that he/she hasn't brought up yet, but could know if you asked.  

[geodob]

Hi AHithersay,

 

I've recently been discussing this topic with parents on the Apraxia Kids forum.  http://www.apraxia-kids.org/

 

While typically a child learns to speak first, and then learns to visually read.

It can equally develop the opposite way.

So that they can become fluent readers, but have a difficulty with 'reading out loud'.

 

Where 'reading out loud',  is no more than confirming a correct connection between a written word and the sound of the word.

Which could equally be confirmed ?  If they hear the word, and then point at it.

So that they don't really need to say the word themselves.

 

But a really important issue, is that learning to read, and understand visual written language?

Can provide another perspective to concieve of language.

So for example, they can then see the difference between: 'f,th,ph'.

 

Where importantly, you have already talked to him about 'reading is done in head', and 'silent reading'. Using his inner voice.

Which at 4 he would still be developing.

 

Though I am rather exploring the idea, that for children with speech apraxia?

That reading could be developed ahead of their speech?

 

[Crimson Wife]

I've seen non-verbal kids demonstrate reading ability via the iPad. So if you don't already have an iPad, that would be my suggestion to acquire. If the cost is an obstacle, research grants because there are organizations that buy iPads for SN kids.

[Lecka]

For some reason, locally everyone seems to say "AAC device" but in practice it seems like people I see are using iPads. 

 

The usual 3 things are PECS (little picture icons, using Boardmaker, is how I see it), sign language, or an app on an iPad. 

 

On iPad there are apps "Speak for Yourself" and "Proloquo2go" that some people use. 

 

There is also LAMP "language acquisition through motor planning" that I think is also an iPad app.

 

They can be recommended by a speech therapist or you can request an appointment with an AAC specialist. 

 

It has really turned out not to be an avenue for my son, but we thought it might be for a while, and he has done a little PECS and uses Boardmaker icons for some things. 

 

I really agree -- if he would do good with an app on an iPad, I would go that direction.  If he does not quite need that -- there are a lot of other visual things to do where the child points to the answer. 

 

My son really does not need an iPad, but he can answer by pointing when he cannot answer orally in a lot of situations. 

 

We also do something where we have one fist as one choice, and the other fist as another choice, and he points at the fist.  That is more just for when we are in a noisy place -- he has autism and it is more that he has trouble speaking when there is too much noise or if it is a newer place and he is feeling shy.  But he does not have any physical problems that we know of. 

 

I have seen kids who communicate extremely well with their AAC devices, who are not even delayed in language/communication, but just have a physical problem.   

 

I am more concerned with comprehension and cognitive skills, b/c those are more of a worry than his speech.  His speech is like -- he needs speech therapy, but it is not too big of a deal for him. 

[PeterPan]

The most effective therapy for praxis of speech is PROMPT.  It gets directly to the motor planning problem.  www.promptinstitute.com is has provider locator maps.

 

Don't get stuck on some tangent for AAC if you haven't even tried PROMPT yet.  Look for someone who is certified if possible.

 

As far as the reading, just put two options in front of him and have him choose the correct one.  I agree, don't elicit from him sounds he can't say correctly.  You say the sounds, he pulls down the letter tiles.  

 

 

[Daria]

The most effective therapy for praxis of speech is PROMPT.  It gets directly to the motor planning problem.  www.promptinstitute.com is has provider locator maps.

 

Don't get stuck on some tangent for AAC if you haven't even tried PROMPT yet.  Look for someone who is certified if possible.

 

As far as the reading, just put two options in front of him and have him choose the correct one.  I agree, don't elicit from him sounds he can't say correctly.  You say the sounds, he pulls down the letter tiles.  

 

If he has CP, the issue is probably not specifically praxis.  Praxis may be a component, but there are likely also tone issues in his mouth and other complications.

 

AAC is not some tangent.  It's a way to give a kid communicative ability while their speech is still developing.  Kids need to be able to communicate for their social and academic growth.  Asking a child to hold off on social and academic development while you wait for articulation, isn't appropriate. In addition, through AAC a kid can practice other pieces of language, like using vocabulary correctly, and composing sentences of gradually increasing lengths.  That way, when their speech does come together, they'll be able to use it in age appropriate ways.  

[Crimson Wife]

I've never seen a case where AAC was used in lieu of speech therapy. The way I've seen it used is as a supplement to working on verbal communication. I can't say whether or not PROMPT would help the OP's child, but there's no reason that a child who would benefit from PROMPT couldn't also use an iPad or other assistive technology.

[Jennifer132]

I'll chime in only because my dd, who will be four in August has the same diagnosis (mild, right side hemi) and severe speech delay. She has an amazing mind though, and I believe she is close to ready to learn to read. She does use an AAC ( lamp). She has a dx of dysarthria and dyspraxia and receives speech therapy. I'd be interested in how learning to read works out for you since our children are close in age. I'm thinking of using the I See Sam books by Academic Sucess for All Learners, which is mainly a whole word approach, and not worrying too much about pronunciation...in my experience, although the vast majority of people can't understand my dd, I'm so used to her speech patterns that most of the time I can, so I think I'll be able to tell if she is reading the right word, even if it is pronounced wrongly.

[PeterPan]

Our PROMPT therapist provides*both* in her practice and has a therapist she brought in who specials in AAC so clients can get both.