Speech Therapy unsuccessful so far - what now?

[Black-eyed Suzan]

I hope you wise ladies can help point me in the right direction.

 

DS9 was in weekly private speech therapy for articulation for 1 1/2 years with a therapist that screened at the preschool my youngest attended. The therapist "graduated" him because she said he could make the sounds when doing the specific exercises, but the therapy never did translate to his everyday speech. He graduated in July and his speech has only gotten worse. Now I can't even get him to articulate the sounds he could do. The R sound was never mastered to my ear, although she claimed that it was. She said that she felt like when my son wanted to change his everyday speech, he would. I agree that he is not motivated to improve, but I think she overestimated his ability to make the correct sounds and tongue placements.

 

What should I do now? He was never happy doing the therapy and complained bitterly about the homework, although he was generally compliant in the sessions. Should I try to find a different (better?) speech therapist? How? Any other type of therapy that might help a tongue thrust and poor articulation of S, L, and R?

 

Or should I just wait and see if he becomes more motivated in the future? He does not often care what anyone else thinks, so the idea that his speech affects how other people see him doesn't matter to him at all. We have not figured out how to motivate him to work on speech beyond the minimum. But his continued poor articulation is having a negative affect on his younger brother, who copies his speech patterns. And I feel like the longer we wait, the harder it will be to break bad habits.

 

Thank you in advance!

[PeterPan]

You'd need a motor planning expert (apraxia) to tell you if the issue is motor planning and not volitional at all.  Given how you're explaining her comments, I think you don't buy it.  Motor planning problems would be an explanation.  You'd look for a PROMPT therapist.  The PROMPT Institute site has a provider locator map.  

 

No, I wouldn't wait.  He's 9, and by all the charts I'm looking at those sounds should be there.  At least the therapist dumped you and admitted she couldn't help, even if she did it so crappily, saying it was his fault, not hers.  And you know, who am I to say?  Maybe there are swaths of children who take glee in refusing to speak correctly and sound like their peers, but I doubt it.  If they could do it, they would.  Isolated sounds but not carrying over to in context and actual speech, that could definitely be motor planning.  The tongue protrusion and tongue thrusting, my ds does.  My ds has verbal apraxia.  A PROMPT expert will go in and look at oral tone, run a VMPAC (a very detailed test of motor planning), etc. and figure out what's going on.  

 

Were they using these sounds in context in therapy sessions?  Were they drilling the sounds in isolation or were they getting them into words and into sentences?  And has he had his hearing screened by an audiologist that can screen for CAPD as well?  That would be the other thing to get done.  The SCAN3 is what you're looking for, and you will need an audiologist who can do the full booth eval for it.  I took my dc to a university, but look around to see who specializes in CAPD in your area to get it done.  It's more like cover your butt, just eliminating potential explanations for the symptoms, if that makes sense.  And has he had a screening for dyslexia?

[J-rap]

My situation is so completely different than yours, that I don't know if what I have to say is helpful or not.  But, my husband had a brain injury and is learning to speak again.  Not only does he have to learn words and grammar again, but he has to learn how to articulate sounds again.  (He is making good progress!)  He has seen probably 20 speech therapists in 5 years.  I can't tell you what a difference it makes to be with the right one.  I still remember the day when he finally met with a speech therapist (after about two years) who took one look at all of the traditional, textbook stuff he was doing and said something like, "Why are wasting all your time with this?"  and she just threw it away.  And she is the one who basically taught him how to move his mouth correctly and articulate sounds correctly again.  Why couldn't anyone else do that?  I don't know.  She was just very perceptive and had a real gift for knowing what to do.

 

I would suggest you keep looking, if you can.  I bet you can find a good one out there, and one who your son will enjoy too.

[PeterPan]

I'm gonna delete my whole rant and just say buyer beware.  SLPs tend to be very jack of all trades, and that's not always going to work out well.  They get the same money, whether they actually got the extra training to work with your problem or not.  They have no refunds for results, so we have to discriminate carefully and establish whether we have the correct diagnosis, whether we're getting optimal treatment, etc.  It seems so obvious, but sometimes even getting the CORRECT DIAGNOSIS is really hard with a non-expert.  Seriously.  Once you have the correct diagnosis, then you can google it and decide for yourself what care you want.  

[gingersmom]

Please keep looking for another therapist and don't give up. With the right therapist he will be successful.

[Black-eyed Suzan]

You'd need a motor planning expert (apraxia) to tell you if the issue is motor planning and not volitional at all.  Given how you're explaining her comments, I think you don't buy it.  Motor planning problems would be an explanation.  You'd look for a PROMPT therapist.  The PROMPT Institute site has a provider locator map.  

 

No, I wouldn't wait.  He's 9, and by all the charts I'm looking at those sounds should be there.  At least the therapist dumped you and admitted she couldn't help, even if she did it so crappily, saying it was his fault, not hers.  And you know, who am I to say?  Maybe there are swaths of children who take glee in refusing to speak correctly and sound like their peers, but I doubt it.  If they could do it, they would.  Isolated sounds but not carrying over to in context and actual speech, that could definitely be motor planning.  The tongue protrusion and tongue thrusting, my ds does.  My ds has verbal apraxia.  A PROMPT expert will go in and look at oral tone, run a VMPAC (a very detailed test of motor planning), etc. and figure out what's going on.  

 

Were they using these sounds in context in therapy sessions?  Were they drilling the sounds in isolation or were they getting them into words and into sentences?  And has he had his hearing screened by an audiologist that can screen for CAPD as well?  That would be the other thing to get done.  The SCAN3 is what you're looking for, and you will need an audiologist who can do the full booth eval for it.  I took my dc to a university, but look around to see who specializes in CAPD in your area to get it done.  It's more like cover your butt, just eliminating potential explanations for the symptoms, if that makes sense.  And has he had a screening for dyslexia?

 

Thank you, OhE!

 

I found the PROMPT website, and I can travel an hour+ for someone who have completed the Bridging training, or see someone closer who has completed the Introduction training. I'll be visiting family for Christmas near an Instructor - should I wait and go there to get evaluated? If I get it done here, is Bridging enough of a difference to justify a drive?

 

The exercises did use the sounds in context, first in individual words and eventually in sentences. He made progress initially, but seemed to regress even before the therapy was over.

 

I tried to get his hearing checked about a year ago, but the audiologist I called was very unhelpful and wanted a doctor referral, and I never followed up to get one. I'll put it back on my list. There is a university nearby that mentions apraxia and CAPD - would it be better to go there or to a private office that lists local SLPs who work with CAPD? DS is an auditory learner and is quick to answer school questions orally, loves listening to audio books, etc., so I doubt that is the root of the problem, but I think it's worth checking.

 

No screening for dyslexia yet. Why? Is there a connection with speech? 

A few years ago, I read one of the large books about dyslexia (maybe the Eides' book? I can't remember - I got it from the library.) and the symptoms didn't quite fit what I was seeing. That's when I discovered convergence insufficiency, which he did turn out to have.  It improved with some home-based vision therapy. We don't have a COVD optometrist in the area.

 

We have just started Dianne Craft's Writing 8 exercise for b/d reversals and generally bad handwriting. Do they have any connection to speech motor planning?

[Black-eyed Suzan]

My situation is so completely different than yours, that I don't know if what I have to say is helpful or not.  But, my husband had a brain injury and is learning to speak again.  Not only does he have to learn words and grammar again, but he has to learn how to articulate sounds again.  (He is making good progress!)  He has seen probably 20 speech therapists in 5 years.  I can't tell you what a difference it makes to be with the right one.  I still remember the day when he finally met with a speech therapist (after about two years) who took one look at all of the traditional, textbook stuff he was doing and said something like, "Why are wasting all your time with this?"  and she just threw it away.  And she is the one who basically taught him how to move his mouth correctly and articulate sounds correctly again.  Why couldn't anyone else do that?  I don't know.  She was just very perceptive and had a real gift for knowing what to do.

 

I would suggest you keep looking, if you can.  I bet you can find a good one out there, and one who your son will enjoy too.

 

:hurray: that your husband is making good progress! Thank you for giving me hope that we will find someone who will work.

[Lecka]

Keep looking.  This therapist has not helped him to generalize.  My older son took a while to start to self-monitor and self-correct.  

 

If someone else is monitoring for him ----- he does not have the *skill* to monitor himself.  

 

It is really, really not motivation.  It is a taught skill.

[ashamama]

Is it just articulation he has trouble with? I am reaching far back in my memory, but I have a relative who as a child was a huge mumblr and talked too quickly. I could understand them, but most people couldn't. His speech was cleared up by a public speaking class/group where he learned to plan his speech, move slowly through his words so they could be understood and present them in a manner that is understandable. The same kid who spoke as though his tongue was too big for his mouth, is a great speaker now. My child qualified for speech, but I didn't want to overload him on therapies. The OT was more important for him. We have addressed his speech through phonics and recitation. It is getting better. If he still has issues as he grows, we will look more into public speaking.

[Dmmetler]

My guess is the same as OE's. I was in speech therapy from age 5-20 (no, that's not a typo-my college continued my IEP and provided speech through my BS), and those are the three sounds that never really solidified. I can do them if I focus and concentrate on it, but in casual speech, or if I get tired, forget about it. My Dx was articulation disorder and fluency disorder, secondary to Cerebral palsy. Speech helped more with the fluency and cluttering than with the articulation, and the final decade pretty much was all fluency and practicing situational speech and ways to make myself more understood, with the expectation that those sounds simply weren't going to remediate.

 

When I was 24, I had a full eval done for rehabilitative services, and came out with a new DX of dyspraxia, including dyspraxia of speech. In 20/20 hindsight, I'd had 15 years of the wrong kind of therapy. I haven't bothered to try to find a therapist since because it would be out of pocket, and after all those years of work, I mostly sound like I have a strange accent. But when I hear a kid exited with those specific sounds still not remediated, my mind goes immediately to the thought that the therapy wasn't actually treating the problem.

[PeterPan]

Is it just articulation he has trouble with? I am reaching far back in my memory, but I have a relative who as a child was a huge mumblr and talked too quickly. I could understand them, but most people couldn't. His speech was cleared up by a public speaking class/group where he learned to plan his speech, move slowly through his words so they could be understood and present them in a manner that is understandable. The same kid who spoke as though his tongue was too big for his mouth, is a great speaker now. My child qualified for speech, but I didn't want to overload him on therapies. The OT was more important for him. We have addressed his speech through phonics and recitation. It is getting better. If he still has issues as he grows, we will look more into public speaking.

It sounds like your relative had praxis of speech, not an articulation delay. and we have better therapies now.  PROMPT has been around maybe 15 years.  When we first started 5 years ago, I had to drive 2 1/2 hours to get someone who was certified.  In the last year or two the choices of therapists pursuing certification within an hour of me have expanded to TEN.  PROMPT is THE therapy for praxis of speech, because it addresses directly the motor planning issues.  The therapist applies physical prompts, telling the brain how to move the tongue, how to move the lips, etc.  My ds went from no speech to speaking literally the first session.  

 

With motor planning, you go through a process (can do it with supports, can do it with effort, does it automatically).  Many individuals with praxis have difficulty imitating, feeling where their articulators are, etc. etc.  Even if someone made great effort and made progress, we just have much better therapies now.  

 

One scenario I had people tell me about online (here on the boards) was where their twin got ST and they didn't.  The twin who got the ST was dramatically more comfortable with speaking, indicating more automaticity for the motor planning.  The twin who did *not* get the ST felt her speech was very effortful, slowing her down and making her more reserved.  So I think *if you get effective methodology* you're better off with ST than without.  Cost is an issue, obviously, when you need multiple therapies.  My ds gets ST, OT and MT.  Some kids just have high therapy needs.  If I were in the position of choosing, I would make a compromise and alternate weeks of OT and ST, asking both for lots of homework.  But I'm dealing with severe apraxia, not articulation delays, skewing my perspective.  Anyways, I think it's important to move beyond merely do they have the articulation and get to is it automatic.

[PeterPan]

My guess is the same as OE's. I was in speech therapy from age 5-20 (no, that's not a typo-my college continued my IEP and provided speech through my BS), and those are the three sounds that never really solidified. I can do them if I focus and concentrate on it, but in casual speech, or if I get tired, forget about it. My Dx was articulation disorder and fluency disorder, secondary to Cerebral palsy. Speech helped more with the fluency and cluttering than with the articulation, and the final decade pretty much was all fluency and practicing situational speech and ways to make myself more understood, with the expectation that those sounds simply weren't going to remediate.

 

When I was 24, I had a full eval done for rehabilitative services, and came out with a new DX of dyspraxia, including dyspraxia of speech. In 20/20 hindsight, I'd had 15 years of the wrong kind of therapy. I haven't bothered to try to find a therapist since because it would be out of pocket, and after all those years of work, I mostly sound like I have a strange accent. But when I hear a kid exited with those specific sounds still not remediated, my mind goes immediately to the thought that the therapy wasn't actually treating the problem.

The sad thing is, the /s/ is INCREDIBLY EASY to prompt.  ANYONE who has had level one training can do it.  I could do it for you.  Like you could walk into a high level PROMPT therapist and get that sound pretty quickly.  The /l/ and /r/ are harder, because they involve more with the tongue.  Those would take more work and you'd need a more skillful therapist.  

[Dmmetler]

It sounds like your relative had praxis of speech, not an articulation delay. and we have better therapies now. PROMPT has been around maybe 15 years. When we first started 5 years ago, I had to drive 2 1/2 hours to get someone who was certified. In the last year or two the choices of therapists pursuing certification within an hour of me have expanded to TEN. PROMPT is THE therapy for praxis of speech, because it addresses directly the motor planning issues. The therapist applies physical prompts, telling the brain how to move the tongue, how to move the lips, etc. My ds went from no speech to speaking literally the first session.

 

With motor planning, you go through a process (can do it with supports, can do it with effort, does it automatically). Many individuals with praxis have difficulty imitating, feeling where their articulators are, etc. etc. Even if someone made great effort and made progress, we just have much better therapies now.

 

One scenario I had people tell me about online (here on the boards) was where their twin got ST and they didn't. The twin who got the ST was dramatically more comfortable with speaking, indicating more automaticity for the motor planning. The twin who did *not* get the ST felt her speech was very effortful, slowing her down and making her more reserved. So I think *if you get effective methodology* you're better off with ST than without. Cost is an issue, obviously, when you need multiple therapies. My ds gets ST, OT and MT. Some kids just have high therapy needs. If I were in the position of choosing, I would make a compromise and alternate weeks of OT and ST, asking both for lots of homework. But I'm dealing with severe apraxia, not articulation delays, skewing my perspective. Anyways, I think it's important to move beyond merely do they have the articulation and get to is it automatic.

For me, the thing that helped most on the fluency parts of motor planning was that my Sophomore English teacher put me on the forensics team, and my speech therapist worked with me on those prepared pieces. Learning how to read/deliver those prose, poetry and dramatic interpretation pieces with expression generalized much better than anything else we'd done, and that was continue into working on spontaneous speech. I will say that e-mail and texting are about the best inventions ever for me-they've largely made talking on the phone obsolete, because I learned to really, really closely watch the person I'm talking to for cues that I need to monitor more closely. I can't do that on the phone, so for me, making a phone call is something that I avoid.

 

I really do think that getting the right therapy could make so much of a difference. In my case, I think I was just plain too old-I got the dyspraxia DX in 1995, and was a grad student at the time. If I'd gotten it in 1985, or even better in 1975, it would have been different.

[PeterPan]

Thank you, OhE!

 

I found the PROMPT website, and I can travel an hour+ for someone who have completed the Bridging training, or see someone closer who has completed the Introduction training. I'll be visiting family for Christmas near an Instructor - should I wait and go there to get evaluated? If I get it done here, is Bridging enough of a difference to justify a drive?

 

The exercises did use the sounds in context, first in individual words and eventually in sentences. He made progress initially, but seemed to regress even before the therapy was over.

 

I tried to get his hearing checked about a year ago, but the audiologist I called was very unhelpful and wanted a doctor referral, and I never followed up to get one. I'll put it back on my list. There is a university nearby that mentions apraxia and CAPD - would it be better to go there or to a private office that lists local SLPs who work with CAPD? DS is an auditory learner and is quick to answer school questions orally, loves listening to audio books, etc., so I doubt that is the root of the problem, but I think it's worth checking.

 

No screening for dyslexia yet. Why? Is there a connection with speech? 

A few years ago, I read one of the large books about dyslexia (maybe the Eides' book? I can't remember - I got it from the library.) and the symptoms didn't quite fit what I was seeing. That's when I discovered convergence insufficiency, which he did turn out to have.  It improved with some home-based vision therapy. We don't have a COVD optometrist in the area.

 

We have just started Dianne Craft's Writing 8 exercise for b/d reversals and generally bad handwriting. Do they have any connection to speech motor planning?

Yes, that's why I asked about the dyslexia and CAPD, because anything that affects his ability to correctly perceive sounds will affect his speech.  They are other possible explanations for his symptoms, and you can have *multiple* things going on.  You could ask your ps to do evals, asking for not only IQ and achievement but also the CTOPP to look at phonological processing.  Or get a private psych eval with someone who specializes in dyslexia (SLD reading).  

 

The most common symptom of CAPD is going to be issues with background noise.   It's an audiologist you're looking for.  If your university can do the SCAN3 screening for a good price, that works.  Just don't get blown off.  Make sure they have the booth set-up.  An SLP or even a psych might run the SCAN3, at least the screening portion.  Our SLP had a different test (TAPS), but really the SCAN3 is what you need to diagnose.  They do part of it for a screening, and then if it flags they run the full thing.  It's just more cover your butt and eliminating possible explanations.  I'm not saying that's going on.  

 

It sounds like you need an OT eval as well.  So again, we've mentioned 3-4 evals here, and it's a matter of deciding how you'll get them.  They don't really preclude each other.  You probably need ALL of them to sort through the issues completely. 

 

Yes, Bridging is worth driving for.  It means they have done 3 levels of workshops and are now working on getting certified.  That's a serious commitment to the methodology.  Many people will do Intro for the CEUs and never bother to continue to learn.  I've read the Intro book and know roughly the equivalent after 5 years with this.  Want me doing therapy on your kid?  ;)   The Instructor will probably be amazing, but the issue is continuing care.  When will you be there?  What you could do is get the eval with the Instructor, make sure they do a full written report, and make sure you *video* the entire eval.  That will take some effort, because it will probably be several hours.  Don't bother with language testing, but all the portions for motor planning like the VMPAC.  That way the closer therapist, the Bridging level, can go through it if she wants.  Or, you know, just talk with Bridging and with the Instructor and feel them out.  The Instructor may have done some of the instruction for Bridging, meaning they know each other.  See who you click with and what you think.  

 

Fwiw, I drove 2 1/2 hours each way for years.  Then our therapist moved closer, so that now we're at just 2 hours.

[Crimson Wife]

I had a SLP graduate my daughter back when she was 3 because her single word vocabulary was ok. I took her to a different SLP for an evaluation and the lady found that DD still had all sorts of language delay in other areas (duh!)

 

I'm a student in Communicative Disorders and am in the process of applying to grad school in SLP. There is a WIDE range of programs and while the accrediting body makes sure that the curriculum is fairly standard, not all of them are going to produce equally competent SLP's. There's one school in particular that seems to be a bit of a "diploma mill".

[PeterPan]

Bingo.  And it's really not a slam on SLPs or anything personal about Crimson.  It's more if you have a less common, niched problem, you really need someone who specialized in that and got lots of extra training in it.  You wouldn't ask your OB to be your heart surgeon, but they expect SLPs to be general practice for EVERYTHING.

[Lecka]

There is another thing... if he does not self-monitor, then that means he does not even *know* that he is difficult for other people to understand.  Or maybe he is vaguely aware, but it is more like "why are people so difficult?" 

 

It is different from having that click of "I need to monitor my speech" and seeing how that fits in with other people.

 

He might think he sounds like everybody else to a pretty great extent. 

 

For my son -- he had to spend a long time self-monitoring, and then self-correcting, before anything could start to be automatic for him.  He made a lot of mistakes in the process, and sometimes he over-generalized and had to kind-of re-learn things he had seemed to already know. 

 

He did not have apraxia, and in other ways he does not sound like your son.

 

But that sense of "doesn't he know?"  Later I realized -- he was just not picking up on that.  I saw that change when he was working more on self-monitoring, than on responding to another person (me or the speech therapist) pointing out when he made an error.   

 

He did not really know. 

 

Plus if you say "talk better" and he does not know exactly what he is supposed to be changing, then he could have a great attitude, and not know, as he talks, what he is supposed to be doing differently, b/c he is not at that level, even if he is at a level of doing it during speech therapy.

 

I just think, that is something to keep in mind. 

 

 

[PeterPan]

Just to run with Lecka's thought a bit...  Lecka, this dc who was having trouble discriminating that his speech didn't sound like the other kids' speech also had troubles learning to read, needed Barton for a while, etc., yes?  I'm just noticing you've got a situation there with issues with phonemic awareness, not just random bad attitude and laziness, if that makes sense.

[Lecka]

He turned out to have major weakness in phonological processing.  That is foundational to phonemic awareness.

 

Yes, major reading intervention, too, for him.

 

It really was not addressed with the speech therapy he was getting through the pre-school speech program or in Kindergarten.  It took going to the university speech clinic. 

 

He never seemed lazy to me, though he did seem like he didn't care or didn't see what the big deal was, kind-of -- like he thought we were just picking on him, but that he was the same as other kids.  It was not clear how much he was not able to hear his mistakes.  He could not hear them, so of course he couldn't self-correct.  You have to be able to self-monitor before you can self-correct.  (I think.) 

 

I did not realize the steps in the process, until he was going through them. 

 

Edit: And I agree on things going together. My son was diagnosed with dysgraphia last year (poor handwriitng) and his private OT saw him in 3rd grade and asked me about him, and she thought with what she was seeing in OT, he probably had reading issues, too.

 

[Crimson Wife]

Bingo.  And it's really not a slam on SLPs or anything personal about Crimson.  It's more if you have a less common, niched problem, you really need someone who specialized in that and got lots of extra training in it.  You wouldn't ask your OB to be your heart surgeon, but they expect SLPs to be general practice for EVERYTHING.

 

Exactly. There are some SLP programs that have specialty tracks but the applicant really has to seek them out and they typically require an extra semester or two (often on the student's dime rather than scholarship-funded). There are opportunities for continuing education like PROMPT training but again the SLP has to seek it out and foot the bill for it.

 

[Dmmetler]

On self-monitoring, for me a big problem was that my brain corrected my speech, so I truly didn't hear myself as sounding different. That is, I heard what I tried to say, not what my muscles actually produced. That's why a big part of learning to self monitor, for me, was to learn to watch other people's body language and facial expressions for signs that they weren't understanding and adjust accordingly, because I simply didn't hear enough to correct based on that. The best SLP I had was one who worked extensively with individuals with hearing loss, because she relied a lot more on teaching me to recognize physical cues in both speech production and non-verbal communications.

 

I think that speech is a lot more complicated than it sometimes is given credit for being.

[PeterPan]

He turned out to have major weakness in phonological processing.  That is foundational to phonemic awareness.

 

Yes, major reading intervention, too, for him.

 

It really was not addressed with the speech therapy he was getting through the pre-school speech program or in Kindergarten.  It took going to the university speech clinic. 

 

He never seemed lazy to me, though he did seem like he didn't care or didn't see what the big deal was, kind-of -- like he thought we were just picking on him, but that he was the same as other kids.  It was not clear how much he was not able to hear his mistakes.  He could not hear them, so of course he couldn't self-correct.  You have to be able to self-monitor before you can self-correct.  (I think.) 

 

I did not realize the steps in the process, until he was going through them. 

 

Edit: And I agree on things going together. My son was diagnosed with dysgraphia last year (poor handwriitng) and his private OT saw him in 3rd grade and asked me about him, and she thought with what she was seeing in OT, he probably had reading issues, too.

I don't know much about self-monitoring.  I've tried to learn a little about the meta ideas (meta linguistics, meta cognition, etc.) which are all issues with executive function.  I think when you have the phonological processing problems, I think the skills are *effortful* even when you begin to get them.  So then saying kick on your meta and notice things would be doubly hard, way harder than for everyone else.  Or to flip it, a more typical person might notice those things much more easily simply because they aren't such hurdles.  I'm not the most aware, but my ear picks out grammar and speech errors like nobody's business.  I listen in ds' 2 hour speech therapy sessions and tick them off.  I don't even have to try.  His normal therapist doesn't have them, but this other chick we're seeing now (which I'm not happy about, but that's another discussion) does.  Like she'll just be doing therapy and bam grammar errors.  And this is not a STUPID person.  This is an intelligent human being with a masters in SLP and additional training in PROMPT and years and years of experience working with ASD.  It's just not a strong point of hers to process that kind of grammar AND deal with the hands-on of the therapy AND play a game AND...  It's just a lot all at once.

 

So that's why I asked how much they were practicing the targets in context.  They need to be getting them into whole language (sentences, conversations, repeated phrases as part of a therapy session game), so that he can practice them intensively over and over in context.  That gets the motor planning settled in so he's not needing to *think* about how the sounds are formed.  If he's needing to *think* about it, the motor planning is not automatic.  Now whether that's praxis or not hearing sounds right or inadequate therapy (for the OP), can't say.  But to me, you set up those therapy scenarios where he uses it in context and you get it automatic.  With ds we go through a process where he can get it only with assistance in therapy, then only with support by me at home (simplified hands-on PROMPT), then with a verbal reminder (round lips, pick up your jaw, keep your tongue in, whatever), and eventually on his own.  

 

 

On self-monitoring, for me a big problem was that my brain corrected my speech, so I truly didn't hear myself as sounding different. That is, I heard what I tried to say, not what my muscles actually produced. That's why a big part of learning to self monitor, for me, was to learn to watch other people's body language and facial expressions for signs that they weren't understanding and adjust accordingly, because I simply didn't hear enough to correct based on that. The best SLP I had was one who worked extensively with individuals with hearing loss, because she relied a lot more on teaching me to recognize physical cues in both speech production and non-verbal communications.

 

I think that speech is a lot more complicated than it sometimes is given credit for being.

 

This I TOTALLY agree with.  That's why it frustrates me that speech is treated so generally, as if someone can do a grad program and bam be an expert in everything.  These people are making 4 times what even a well-trained average worker is making.  Sure they have overhead, but so do people working construction (where they buy their own tools!), etc. etc.  

 

I get really irritable and have my ideas and stuff, but I only have to be an expert in one thing: my child.  I don't have to be an expert on tons of types of disorders.  And even then, is there more we can learn?  I find myself questioning more, asking whether we should be bringing in this or that.  Even people who've TRIED to focus on one thing and learn a ton are not the whole sum of knowledge on this stuff.  Like prosody.  I asked our SLP about prosody and it's a total blank.  I'm like WHAT IN THE WORLD?!?!  A huge portion of kids with apraxia have ASD, and ASD kids have issues with prosody.  You don't have ANY answers for me on prosody???  

 

This stuff is just SO complicated.  It really is.  And you're talking about the interplay between hearing and speech.  That's really tight.  Ds distinguishes better things as his ability to say those things comes in.  It's a really tight interrelationship there.  Working just on the sound discrimination (with LIPS, which is fabulous) was rocket fuel for his speech.  It didn't improve his motor planning, but it improved his ability to hear what in the world it was the SLP was trying to put into his brain for motor planning.  That's why I stopped/paused ST for a number of months, because I felt like we were doing the same things over and over because he had no discrimination.  We got that, went back to speech, and she could do SO much more with him.  So it's real tight.  He still stumbles, but now his stumbling is more connected to working memory and words with lots of syllables.  

[Black-eyed Suzan]

My guess is the same as OE's. I was in speech therapy from age 5-20 (no, that's not a typo-my college continued my IEP and provided speech through my BS), and those are the three sounds that never really solidified. I can do them if I focus and concentrate on it, but in casual speech, or if I get tired, forget about it. My Dx was articulation disorder and fluency disorder, secondary to Cerebral palsy. Speech helped more with the fluency and cluttering than with the articulation, and the final decade pretty much was all fluency and practicing situational speech and ways to make myself more understood, with the expectation that those sounds simply weren't going to remediate.

 

When I was 24, I had a full eval done for rehabilitative services, and came out with a new DX of dyspraxia, including dyspraxia of speech. In 20/20 hindsight, I'd had 15 years of the wrong kind of therapy. I haven't bothered to try to find a therapist since because it would be out of pocket, and after all those years of work, I mostly sound like I have a strange accent. But when I hear a kid exited with those specific sounds still not remediated, my mind goes immediately to the thought that the therapy wasn't actually treating the problem.

 

 

 

For me, the thing that helped most on the fluency parts of motor planning was that my Sophomore English teacher put me on the forensics team, and my speech therapist worked with me on those prepared pieces. Learning how to read/deliver those prose, poetry and dramatic interpretation pieces with expression generalized much better than anything else we'd done, and that was continue into working on spontaneous speech. I will say that e-mail and texting are about the best inventions ever for me-they've largely made talking on the phone obsolete, because I learned to really, really closely watch the person I'm talking to for cues that I need to monitor more closely. I can't do that on the phone, so for me, making a phone call is something that I avoid.

 

I really do think that getting the right therapy could make so much of a difference. In my case, I think I was just plain too old-I got the dyspraxia DX in 1995, and was a grad student at the time. If I'd gotten it in 1985, or even better in 1975, it would have been different.

 

Thank you for sharing your story, dmmetler, and it is so unfortunate that the wrong therapy continued for 15 years. :( I'm sorry. Dyspraxia (or what I see after googling) seems like it might connect a variety of symptoms my son experiences. Anyway, your posts have motivated me to seek out complete evaluations. Hopefully we can find the right diagnosis earlier rather than later.

[Black-eyed Suzan]

Yes, that's why I asked about the dyslexia and CAPD, because anything that affects his ability to correctly perceive sounds will affect his speech.  They are other possible explanations for his symptoms, and you can have *multiple* things going on.  You could ask your ps to do evals, asking for not only IQ and achievement but also the CTOPP to look at phonological processing.  Or get a private psych eval with someone who specializes in dyslexia (SLD reading).  

 

The most common symptom of CAPD is going to be issues with background noise.   It's an audiologist you're looking for.  If your university can do the SCAN3 screening for a good price, that works.  Just don't get blown off.  Make sure they have the booth set-up.  An SLP or even a psych might run the SCAN3, at least the screening portion.  Our SLP had a different test (TAPS), but really the SCAN3 is what you need to diagnose.  They do part of it for a screening, and then if it flags they run the full thing.  It's just more cover your butt and eliminating possible explanations.  I'm not saying that's going on.  

 

It sounds like you need an OT eval as well.  So again, we've mentioned 3-4 evals here, and it's a matter of deciding how you'll get them.  They don't really preclude each other.  You probably need ALL of them to sort through the issues completely. 

 

Yes, Bridging is worth driving for.  It means they have done 3 levels of workshops and are now working on getting certified.  That's a serious commitment to the methodology.  Many people will do Intro for the CEUs and never bother to continue to learn.  I've read the Intro book and know roughly the equivalent after 5 years with this.  Want me doing therapy on your kid?   ;)   The Instructor will probably be amazing, but the issue is continuing care.  When will you be there?  What you could do is get the eval with the Instructor, make sure they do a full written report, and make sure you *video* the entire eval.  That will take some effort, because it will probably be several hours.  Don't bother with language testing, but all the portions for motor planning like the VMPAC.  That way the closer therapist, the Bridging level, can go through it if she wants.  Or, you know, just talk with Bridging and with the Instructor and feel them out.  The Instructor may have done some of the instruction for Bridging, meaning they know each other.  See who you click with and what you think.  

 

Fwiw, I drove 2 1/2 hours each way for years.  Then our therapist moved closer, so that now we're at just 2 hours.

 

Thank you, OhE! :)

 

After thinking about it, I'll start with the university near us for a speech-language evaluation (and possibly an auditory - we'll see if they have the set-up you mentioned and how our experience goes). With those results in hand (and depending on when I get them), I'll see if it will work to meet with the Instructor. We'll be there over Christmas, but we aren't sure for how long.

[Black-eyed Suzan]

There is another thing... if he does not self-monitor, then that means he does not even *know* that he is difficult for other people to understand.  Or maybe he is vaguely aware, but it is more like "why are people so difficult?" 

 

It is different from having that click of "I need to monitor my speech" and seeing how that fits in with other people.

 

He might think he sounds like everybody else to a pretty great extent. 

 

For my son -- he had to spend a long time self-monitoring, and then self-correcting, before anything could start to be automatic for him.  He made a lot of mistakes in the process, and sometimes he over-generalized and had to kind-of re-learn things he had seemed to already know. 

 

He did not have apraxia, and in other ways he does not sound like your son.

 

But that sense of "doesn't he know?"  Later I realized -- he was just not picking up on that.  I saw that change when he was working more on self-monitoring, than on responding to another person (me or the speech therapist) pointing out when he made an error.   

 

He did not really know. 

 

Plus if you say "talk better" and he does not know exactly what he is supposed to be changing, then he could have a great attitude, and not know, as he talks, what he is supposed to be doing differently, b/c he is not at that level, even if he is at a level of doing it during speech therapy.

 

I just think, that is something to keep in mind. 

 

I had never thought of that, Lecka - I assumed he knew that he sounded different from others. But after observing him over the past few days, asking him a few questions and thinking about his past behavior, I think that he truly doesn't realize it. No wonder he considered speech a waste of time!

[Lecka]

On the bright side, he may be in a lot better place with his self-confidence, because he is not as aware of how he sounds.  

 

It is something you might need to keep an eye on, b/c as he does become more aware of it, he might start to feel self-conscious in a way he doesn't now.  

 

The university speech clinic we were at had great advice about this kind of thing.  

 

[PeterPan]

Thank you, OhE! :)

 

After thinking about it, I'll start with the university near us for a speech-language evaluation (and possibly an auditory - we'll see if they have the set-up you mentioned and how our experience goes). With those results in hand (and depending on when I get them), I'll see if it will work to meet with the Instructor. We'll be there over Christmas, but we aren't sure for how long.

 There is a really long test for motor planning (the VMPAC) and a person who doesn't specialize in praxis is unlikely to do it.  So what happens if you go and the non-expert professor tells you no praxis?  Then you go yup, no praxis?  Or you go you said that, but you're not an expert, I still go see the praxis expert?  

 

What if you compromised and did the eval with the Bridging person?  Did you say you had access to someone who has done Bridging?  They should be fine.