Reading comprehension with ASD

[luuknam]

What do you do when your kid makes autism-related mistakes (e.g. answering questions like: "in the story, how do you think Katie felt after she did x" wrong)? This is about my 3rd grader, fwiw. He gets speech therapy, in which they sometimes work on pragmatics, but I'm wondering if/what I should do more.

[PeterPan]

Yes, social thinking will affect reading comprehension.  You can go to Socialthinking - Home  and get materials.  I just went to a 2 day workshop on it, and it's pretty fascinating stuff.  Here's her article on getting started.  

Socialthinking - Getting Started

How is he with Wh-questions?  Can he answer how and why questions?  For that, I have materials by DeGaetano like Auditory Processing of "WH" Words - Great Ideas for Teaching

[PeterPan]

Socialthinking - Think Social! A Social Thinking Curriculum for School-Age Students

 

You Are A Social Detective!

 

Superflex®… A SuperHero Social Thinking Curriculum

 

I just wanted to say that if you click that link to the Getting Started article and scroll down to elementary, she lists these three things.  I got the red book (Think Social) and it is TERRIFIC.  It really is all that the summary guidance there says about being this just super, super expansion of all the process.  It's this bird's eye view, a bit of everything.  It's basically the print version of what I paid $$$ to learn about at the workshop.  Then your more topic-specific books like Social Detective and Superflex are going to expand particular sections in there.  If you're feeling spendy, buy all three and throw in the Unthinkables poster set.

 

A lot of the things you need for reading comprehension, like perspective taking, making inferences, etc., are all going to come from the social thinking.  She throws into Think Social so many good things.  I think social behavior mapping (as a concept) is in there. If you're feeling super spendy, you could even throw in the books on using lit and movies to teach social thinking.

 

Socialthinking - I Get It! Building Social Thinking and Reading Comprehension Through Book Chats

 

Socialthinking - Movie Time Social Learning

 

But at least the red book and then either Social Detective or Superflex.  That's where you would start.  :)

Edited May 3, 2016 by OhElizabeth

[luuknam]

Thanks.

 

How is he with Wh-questions?  Can he answer how and why questions?  For that, I have materials by DeGaetano like Auditory Processing of "WH" Words - Great Ideas for Teaching

 

I'm pretty sure he's okay with Wh-questions in general, so long as they're pretty obvious (like in the sample pages of the book you linked to). I'll do the sample pages with him tomorrow to make sure. Is there a reason for the "auditory processing" part of the title? Like, does it matter if I read the questions to him with him having only the pictures, or if he can see the questions while I read them, or just give the questions and let him write the answers?

 

It's more subtle stuff... like a text about a boy who cares for orphaned koalas, and one of the koalas spontaneously left to go live with wild koalas in the neighborhood, and sometimes comes to visit the boy, and the boy is happy about that. Out of multiple choice, my son thought that the boy was happy because the boy will have more time to do other things now, whereas the correct answer was that the boy was happy because koalas belong with other koalas in the wild. It's like, most people can figure out that people who regularly care for orphaned animals don't mind about the time it takes to care for them, so that it's more likely they're happy the animal was successful in getting back to its peers. So it's two things in that question: 1) the difference between how my son might feel in that scenario, vs how the boy in the text feels, and 2) the fact that caregivers can feel happy when the beings they cared for are happy/successful. He struggles with 1, and I think 2 wouldn't even cross his mind. I think he understands 2 if explained to him, but there's a difference between getting it when told so, versus coming up with it on his own. Whereas I'm pretty sure that in a picture of someone with a lawnmower (like in the sample pages to the link above), he knows that lawnmowers are used for mowing grass, and the only reason he might use a lawnmower would be if the grass were too long, so that must be why the other person has a lawnmower, even though he's never used a lawnmower so it's a little abstract, but still a rather concrete abstract, if that makes sense.

 

I haven't clicked on the other links yet, will read them when I've got time.

[PeterPan]

Yes, some people have trouble with social thinking *and* language problems.  It sounds like you're thinking he doesn't, which is good!  For the DeGaetano sample, yes you want to read it to him.  The pictures go to the student and the questions to the teacher.  It should be a pretty easy thing.  My ds has had issues with wh-questions.  It's just one of those things to eliminate.  Your SLP probably would have mentioned working on it if it's still an issue.  It's one of those obvious things they check.

 

If the SLP is working on pragmatics, then somewhere along the way he has (presumably) had a pragmatics test.  The CASL has a pragmatics component as does the CELF.  There are also dedicated tests like Social Language Development Test Elementary By Linda ...  What you might like to do is look through your paperwork and see what has been run.  That will give you some breakdowns on where the weaknesses are.  The SLDT is quite detailed, so that would give you some really helpful information on what to target and where he's already at expected levels.  For instance, the one my ds had has sections on: inferences, interpersonal negotiations, multiple interpretations, and supporting peers.  You could also look through your paperwork to see if they've done any recent language testing (in the last year) to confirm whether there are any weaknesses there.  The CASL is particularly good for that.  It has breakdowns on antonyms, inferences, etc. etc.  

 

It sounds like a lot of it right now is the social thinking for him, and that's definitely stuff you can teach.  You could ask what the SLP is using when she works on it, but it's a broad enough topic that there's really not an overkill.  The red Think Social book is going to be what you're wanting, with the addition of Social Detective.  However if you're looking at that going can't do that, not never, then Amazon.com: teaching the basics of theory of mind  is your alternate.  It hits a lot of the same topics and is very easy to use.  I have it sitting here, and I loaned out my red book to the behaviorist.  (Yes, she'll hopefully buy her own, lol!)  So I can't compare them till I get my red book back.  In general though, the red book is 2-3", lots of lessons, very hands-on.  The yellow book (Ordtex) is more streamlined, less than 1" thick.  I already had the yellow book and then picked up red at the Social Thinking workshop.  The key is actually to TEACH it and APPLY it.  None of this has to be PERFECT.  The key is actually getting it done and applying it.  It's when it clicks in your mind *Oh, that's the gap!* and then you think of creative, obvious ways to apply it.  

 

Yeah, I'm going through the yellow book here.  It basically has 12 lessons.  They are a little simplistic to me, not really giving you all the extras the red book will have.  No lit, no list of games, no extensions.  It's just super trim.  But the 12 lessons are good stuff and hit a lot of really essential concepts!  So for instance their lesson 2 is "What makes me feel..." and they give you a worksheet.  Well the red book will take this a LOT farther, having you do People Profiles where you do that same kind of worksheet for LOTS of people.  You could do that for characters in a book!  Is that something you could have done with the yellow book?  Obviously.  It just didn't TELL you to and give you as much help making those connections.  And at $40 that's a lot of money to spend and not get the extras.  I think red book is $90, ouch.  

 

So I'm just trying to give you options here at a couple price points.  If you can make the Social Thinking materials work, they're going to take you a lot farther.  If you go to a Social Thinking workshop, they give you 10% off and bring everything they sell.  But I think that's spending more of your money, lol.  I'm just saying if you have the chance the Social Thinking workshops are AMAZING.  You get to talk with Winner, get your questions answered, see videos showing the things so you see in action what they're really talking about.  

 

Does your SLP have something you can borrow?  See, for me, the bummer about "professionals" is that they are buying this stuff and implementing the books, just like we are.  And they're like $75-100 an hour!!!  So if I'm going to pay a professional for one hour, I can just buy the book.  In our case, I'm spread pretty thin and need some help.  We have the scholarship, mercifully, so I can get some help.  But whether you're wanting to give yourself enough understanding so that you can carry over her work to your class time (which would be good!) or do it entirely yourself (which also works!), this is the stuff you're looking for.  

 

None of it is hard.  It's more about putting words to things and then practicing the skill and stretching it and applying it to new situations to increase his awareness and noticing.  When I do something like that with my ds, it's total blank response.  When I ask him how the driver of the other car felt last night because he was getting too close while they were about to move forward, total blank response.  There's just no noticing, no registering.  Even when I explain how they felt, total blank.  So that's not something that is going to improve with just one short phrase or session in therapy, kwim?  That's a PROCESS.  That's why they'll do something like the people profiles, because they're trying to get the person to realize someone else actually HAS feelings or preferences that could be different from theirs.  That's the seed that later grows into more complex skills.  So that takes time and watering.  You're really in a terrific position to do that, because you can do that carryover in his lit, during the day, while watching tv, while doing read alouds.  It will be very obvious to you.  The Social Thinking materials put words to these things so you'll see how.   :)

 

Adding: If the issue is *only* making inferences or *only* one thing, there are some targeted materials people will use just for inferences, etc.  However if you're backing up saying whoa he's scoring low on pragmatics, we actually have a bigger picture here of theory of mind and perspective taking issues, then really you want the more complete solution which is the Social Thinking materials.  Just saying if you were looking for the $15 solution, that would be the scenario, that you're needing to hit just one very precise target.  

Edited May 3, 2016 by OhElizabeth

[luuknam]

I remember him having Wh-questions in his IEP 2 (and 3) years ago or something, but I know they're not on his IEP currently - his IEP currently has something about conversational skills (and pronunciation).

 

So, he missed "where is the broom kept", which he didn't quite understand and answered "at the top?". When I told him it meant "where is the broom stored", he did get it correct (well, he said "in the basement", which seems like an okay answer to me). Then on "where is she digging a hole", he said "in the backyard?", which wasn't apparent from the picture - I assume the answer was supposed to be "in the ground", but I could be wrong - and "backyard" is a reasonable guess. And on "where do the grass clippings fall", he said "next to it?", and then I asked him if he'd looked at the picture, and he said "behind it?", and then I pointed out that in the picture there was a bin attached to the lawnmower that the grass fell in. Other than that, he got everything correct, although all his answers did sound like questions, like he was unsure. Then and again, if someone asks me stuff like this I'd probably also sound unsure, wondering if there's a trick question somewhere.

 

I'll try to talk to his speech therapist today. Quite a lot of his speech therapy time is spent on pronunciation, still working on /l/, /sh/, etc. The plan is to increase the number of hours of speech therapy next school year (it was 2 hours/week last year, with a recommendation to keep it at 2 hours/week this year, but I requested trying just 1 hour/week this year (first year homeschooling him, did not want to have to drive him to school 4 times a week for therapy), but it looks like we really should go back up to at least 1.5 hours/week next year). IEP meeting is in June.

[PeterPan]

/sh/ is a very foundational sound not to have by that age.  Are you sure about his speech diagnosis?  You might want to read about apraxia.  It might lead you down the path of finding more effective speech therapy.  

 

Look at the page number on that sample you did.  Is it sort of in the middle of the book?  Remember, the book will start off easier and get harder.  

 

Honestly, it sounds like he needs some language work and would benefit from both some focused work on language by you every day *and* work on social thinking.  Language is *not* as hard as it sounds to work on.  You can go to Super Duper or Linguisystems or Great Ideas for Teaching, buy something that looks right, and read and do it.  No brilliance required.  I agree with you that his answers sound quirky and tentative.  They also weren't complete sentences, which in our house means that it's enough effort that he's skirting how difficult it is by giving short answers.  There's room there for you to work with him, definitely.  

 

It's really hard to ask an SLP to work on articulation AND expressive language AND pragmatics.  That's three separate things.  So you have the question of whether that speech diagnosis is correct and just a delay or whether it's a motor planning problem.  Then you have three separate areas that, in some speech therapy practices would result in three different practitioners, three different sessions, some for more than one hour a week.  But you're handing him to her 1 hour and hoping it all gets solved.  They're not miracle workers, lol.  

 

I know it's not realistic to go to tons of therapy (financially, time wise, etc.).  If you have the coverage, yes you could widen your team.  I'd want the motor planning question answered/eval'd and some fresh language testing and someone to address the pragmatics/social thinking.  But if it's limited to you and her, then you have her do what you can't do and you do the rest.

Edited May 3, 2016 by OhElizabeth

[PeterPan]

Oh, this is a school SLP?  That's the problem.  He's getting 2 hours a week of speech therapy and in that time she hasn't gotten /sh/???  Please, please get an outside eval by a PROMPT practitioner.  He should have that sound by now.  That's a sound that is EASY to get with PROMPT.  Like you could walk in and they could just get it on him.  

 

My ds gets PROMPT speech therapy 2 hours a week, yes.  And I do language work at home.  And we're adding in the Social Thinking materials using a behaviorist.  So we're sort of where you are, sigh.  Our ps SLP that eval'd for our IEP is a really nice lady, but she has NO training to help my ds' speech problem.  If he were there, it would be that very thing, with hours and hours of therapy and no progress.  Instead, I spend tons of time on the road (2 hours each way!), but they get the sounds and it works.  So I would question that, because being nice does not mean you have the skill to help a particular problem, sigh.  And the ps will not necessarily bother to train the person in the best techniques.  Without the training, she isn't even qualified to diagnose.  Like seriously, she said well he can do /p-t-k/, are you sure it's apraxia?  Seriously.   :svengo:

[luuknam]

Well, she didn't diagnose him with anything. He got early intervention at 2.5yo, and then an IEP when transitioning to public school at 3yo. The IEP was for a speech delay. At 4yo they added educational autism. He was in one school at 3yo, a second one at 4yo when the first one closed their preK SpEd program, a third one at 5yo when he transititioned to regular K in the town we lived in, and then a 4th school at 5.5yo when we moved to WNY, where he finished K, 1s, and 2nd grade. Then now I'm homeschooling him for 3rd grade. At this last school he had one speech therapist for K-2nd, and this 3rd grade year, he's got a different speech therapist (due to scheduling, though I was totally okay with trying someone else after 2.5 years). And, this year he's only got 1 hour of speech therapy, so I didn't set his new therapist up for success with that. Just, the driving, new to homeschooling, and I just needed a break from having everything focus on what he's NOT good at (he also gets OT and PT), and yet, in academics, he's above average in just about everything.

 

He's made a huge amount of progress over the years, from having less than 20 words around his 3rd birthday to scoring above average now for reading and language arts (on the CAT, he's taking this week, it looks like he got about 60 out of 70 questions right on the reading and language arts section, and aside from a couple of careless mistakes (he finished it in 1/3 of the time allotted), his mistakes were on questions like I mentioned - inferencing, ToM, autism-related, basically). But, he's got pronunciations problems still, and some problems with inferencing/ToM, etc.

 

I probably should get a private assessment and a private therapist. It'd be expensive, and we're not rich.

[luuknam]

Reading up on apraxia. It says kids often have receptive speech skills that are better than their expressive speech skills. My son was behind in receptive speech as well, and I tried to get him evaluated for an auditory processing disorder when he was 2 or 3yo or so, but the place I called (in Dallas, forgot the name, maybe Callier?), said auditory processing isn't tested until 6 or 7yo. I've asked his speech therapist again at 6yo or so, but she thought it wasn't necessary (I wasn't asking her to do it, I was asking if I should take him somewhere). By then his receptive speech skills were much better (and his expressive ones as well). Learning to read (at 3yo) helped my son learn to speak. He loved letters and numbers.

 

Also just wanted to throw in that my son talks too fast, and we're still working on eye contact. And I hate the speech homework. I feel incapable. English is not my first language (nor my second language!). I can't do a /th/. We spent a long time at the beginning of the year doing /th/, and he'd be supposed to look in the mirror, while practicing, and he wouldn't (well, he'd turn his head to the mirror, but I don't think he looked at his mouth). I just don't feel that I'm the right person to work on his pronunciation. I can do /sh/, and /l/, but I can't teach speech, and sometimes I feel that the speech homework does more harm then good when I hear him doing it wrong and I just can't get him to do it right because I don't know how to get him to do it right and I can't even say some of the words right myself. It's like, I'm foreign, so it's okay I mispronounce some things, but he's not, so it would be bad for him to mispronounce the same things, because adults with speech impairments are often seen as less intelligent than they are.

 

(rant) I'm just stressed out. He's had speech therapy since he was 2.5yo. He's almost 9yo. And then I get shit like a classroom teacher saying that maybe his pronunciation is just messed up because of my accent, or because he's from Texas. Hello, he doesn't sound like *me*, nor like Texans. He has different pronunciation issues than I do. Yes, we both struggle with /th/, but my /th/ sounds different from his, and he has issues I don't have at all. Gah.

[Crimson Wife]

 

I'm pretty sure he's okay with Wh-questions in general, so long as they're pretty obvious (like in the sample pages of the book you linked to). I'll do the sample pages with him tomorrow to make sure. Is there a reason for the "auditory processing" part of the title? Like, does it matter if I read the questions to him with him having only the pictures, or if he can see the questions while I read them, or just give the questions and let him write the answers?

 

With my DD, there is definitely a BIG difference between her performance in answering wh- questions with a visual vs. without one. But she's got hearing issues (physical and most likely auditory processing as well) so a child with ASD but typical hearing & auditory processing abilities may not see that kind of discrepancy.

 

My DD's answers to "why" questions can definitely be on the quirky side. Her SLP and ABA therapists do a lot of, "maybe, but why ELSE could _____?" to prompt for the expected answer.

[luuknam]

I put in an ILL-request for "You are a social detective" (closest library that has it is 60-something miles away). I really wish she had some sample pages for things on her website - not very eager to spend big amounts of $$$ on a book without looking through it first.

[Crimson Wife]

I'll try to talk to his speech therapist today. Quite a lot of his speech therapy time is spent on pronunciation, still working on /l/, /sh/, etc. The plan is to increase the number of hours of speech therapy next school year (it was 2 hours/week last year, with a recommendation to keep it at 2 hours/week this year, but I requested trying just 1 hour/week this year (first year homeschooling him, did not want to have to drive him to school 4 times a week for therapy), but it looks like we really should go back up to at least 1.5 hours/week next year). IEP meeting is in June.

 

It's expensive if you get the 2nd edition, but I'm really liking The Late Eight by Ken Bleile. The 1st edition is available used very inexpensively. It covers English phonemes so if he's having difficulty with ones in your native language (Dutch?) that are not found in English, then it won't help with that. But it may help you keep the school-based therapy to 1 hour/week if that works better for your schedule.

 

[Crimson Wife]

I probably should get a private assessment and a private therapist. It'd be expensive, and we're not rich.

 

I don't know about NY, but here in CA clients of the Regional Center with autism automatically qualify for the Medicaid waiver that picks up the deductible and co-pays for speech therapy, OT, PT, and other healthcare from any participating provider. My DD had a speech eval in Feb from the children's hospital that cost $1750 but we didn't have to pay anything out of pocket because our health insurance picked up 90% and Medi-Cal picked up the remaining 10%.

 

The only thing we are paying out-of-pocket for these days is the speech therapy from the specialized clinic for the deaf & hard-of-hearing since they do not accept Medi-Cal. That is out-of-network for our insurance as well so we have a 30% co-pay.

 

[luuknam]

I don't know about NY, but here in CA clients of the Regional Center with autism automatically qualify for the Medicaid waiver that picks up the deductible and co-pays for speech therapy, OT, PT, and other healthcare from any participating provider. My DD had a speech eval in Feb from the children's hospital that cost $1750 but we didn't have to pay anything out of pocket because our health insurance picked up 90% and Medi-Cal picked up the remaining 10%.

 

The only thing we are paying out-of-pocket for these days is the speech therapy from the specialized clinic for the deaf & hard-of-hearing since they do not accept Medi-Cal. That is out-of-network for our insurance as well so we have a 30% co-pay.

 

If NY has something like that, I'm quite sure I'd never make it through the paperwork (still trying to make it through the paperwork to renew my passport, which expired only 9 years ago). Multi-step paperwork things like that literally cause paralyzing anxiety.

[Crimson Wife]

If NY has something like that, I'm quite sure I'd never make it through the paperwork (still trying to make it through the paperwork to renew my passport, which expired only 9 years ago). Multi-step paperwork things like that literally cause paralyzing anxiety.

 

It was surprisingly easy to get on Medi-Cal. Our Regional Center case manager handled all the paperwork for us.

 

Now I did run into a snag last year when DD turned 6 and Medi-Cal transferred her from their under-6 category to the over-6 category. They put a "hold" on her file while this happened and it was right when we needed to get her hearing aids. Normally it wouldn't take very long for Medi-Cal to do the transfer but things were very backed up because of the Obamacare Medicaid expansion. I finally did get it straightened out, but it took multiple in-person trips to the county Medi-Cal office to get it done. 

[PeterPan]

What I've read is 50% of the time speech problems in autism are due to apraxia (motor planning).  It's possible that he is speaking rapidly to cover up his poor motor planning.  The PROMPT Institute  I suggest you go to the PROMPT site and use their provider map to locate an SLP trained in PROMPT.  Look for someone who has *at least* done Bridging, preferably certified.  But either could help you.  You can give them a call and talk through your situation.  

 

It is outrageous that your ps is continuing to give you many hours of ineffective therapy.  If the PROMPT therapist evals, she can do the VMPAC, which is a very detailed test of motor planning.  That will give you the data to show that even after multiple years of extensive therapy from the ps that he STILL has the problems.  Therefore you can compel them to pay for the PROMPT therapist!  I've met people who successfully sued their school and got them to do this.  Your ps can also be compelled to get someone trained in PROMPT to be able to provide the therapy.  

 

So don't assume you have no options.  Call the PROMPT therapists within maybe 2 hours of you, talk it through, see what they think.  Ask upfront what test they do (VMPAC, something else) to diagnose.  

 

I think PROMPT is going to give you a breakthrough on your speech problems.  If it's praxis (a motor planning problem), then there's nothing he can do about it.  He can't try harder and make it happen, the way the teacher is implying, and it's NOT YOUR FAULT.  That /sh/ sound is really basic, really foundational, and my guess is that when the PROMPT therapist evals they'll find he has some higher level skills but is missing some foundational things like jaw stability, rounding, ability to lift his tongue, etc.  That's why he's talking so rapidly, because he's masking those deficiencies.  And that ps SLP, with her 2 hours a week, is NEVER going to bust through that, no matter how much you go.  If she could have, she already would have.  PROMPT is what you want for that.

 

So hopefully they can do that eval in a couple hours for not too much money.  If you can line up some insurance to pay for it, that would be good.  Does your state or county have disability funds?  He has an autism diagnosis, so you need to use it!!  Did you ever get it confirmed by a doctor or psych?  That would help you.  Our county and state both have funds.  

 

So I would get the eval by the best PROMPT therapist you can find, then use that data to go back to the school and pressure/compel them to pay for private therapy.  

[texasmama]

I have worked daily with my ASD kid in real life situations on inferring feelings in other people.  We use situations with friends, in public, TV, etc. to discuss why someone would do/think/feel something.  He has improved in his ability to identify and understand the feelings and actions of others.  He is Facebook friends with a young adult man who provides a lot of fodder for our discussions, as he is very transparent and often presents as a mystery to my son.  My ASD kid is now 15 so this has been many years in the making, but he is actually now able to do a fair job of inferring feelings of others fairly accurately.

[kbutton]

Do you have a local support group that you could contact? Maybe someone would give you the NY version of what Crimson Wife is talking about and help with the paperwork. I know it can be hard to reach out, but some of those groups understand anxiety and will go the extra mile if you at least make contact.

 

I am with texasmama on figuring out why other people think certain things--lots of talking about it helps. And Crimson Wife's added on question that therapists use with her daughter is pretty practical. The nice thing (if you can see a silver lining right now) is that the novel thinking has some really good uses in the right situation.

 

Don't worry about feeling overwhelmed by speech. I totally get certain kinds of therapy and can really watch for and help with details at home, but speech therapy totally escapes me. It's just not something that I can process concretely. I understand the concepts, but my kid who is receiving speech therapy can see tiny variations in his own jaw movement that go by for me in the blink of an eye. I just cannot see it. And to do the hands-on prompting required for PROMPT? Not happening for me. Thankfully, our therapist can work that out. If my son was two, we'd be in trouble, and my husband would have to do this and then teach me. I cannot see and feel what I am supposed to see and feel.

 

Anyway, I would consider looking at PROMPT. We were told two years ago that my son did not motor issues related to speech. The evaluation was done by an SLP who is known locally as the apraxia lady. Over that two years, his speech degraded considerably. We had a new evaluation by a PROMPT specialist (via OhElizabeth), and the tester could tell us going back to birth what some of his motor issues were!!! It was crazy. The therapist who works with my son told me how frustrated she was a conventional speech therapist because she could tell a child HOW to make sounds, but getting trained in PROMPT changed all that. And it's true about the fast talking--it could be a cover for motor problems. It's actually true of other motor problems as well. The faster a child does something that they are not skillful at, the more likely it is that fast is the only way they can make the motor skill work out. It's very difficult for them to slow it down. When they slow down, it falls apart. It kills my son to slow down, but it's the only way to get the motor sequencing on board. (He's 8 BTW, and we just started PROMPT.)

[luuknam]

So, I mentioned apraxia to his SLP yesterday, and she said he may very well have that - that she's going back and forth between thinking he's apraxia or dysarthria. I asked if I should try to get a private eval, and she said that if our insurance would cover that, that she'd definitely recommend that. She recommended a specific place too.

 

For pragmatics, she says she uses some stuff from Teachers Pay Teachers, but (I forget how she phrased things), she doesn't really have a good program. 

 

I don't know if he talks fast to cover up weaknesses or just because he likes everything fast (he talks about being a fast runner, a fast bicyclist, does math tests in less than 1/4 of the time allotted (while still getting (near) perfect scores), etc). I talk fast too. I suspect he'd talk fast without any speech problems too.

 

To be clear, he can do /sh/ and /th/ and /l/ now, but he's inconsistent - doesn't do them right all the time. He has a tendency to move his entire jaw when he's not supposed to be moving his entire jaw. The beginning of the school year he did a bunch of tongue strengthening exercises because he could not get his tongue up without moving his jaw - he now can, it's just that he needs to be consistent. He's just gotten some more tongue strengthening exercises yesterday. FWIW, he also have low upper body muscle tone according to the PT eval.

[Crimson Wife]

My little one has mild hypotonia and we saw a big improvement adding acetyl-l-carnitine (she tested deficient in carnitine) and Coenzyme Q10 (someone on this forum recommended this, maybe OhElizabeth but this was years ago so I'm not 100% sure). MCT oil is also supposed to be good but it's expensive so we just use coconut oil and coconut milk. My DD was able to graduate from PT within 6 weeks of starting the supplements and also had a breakthrough in her speech.

 

 

[luuknam]

What I've read is 50% of the time speech problems in autism are due to apraxia (motor planning).  It's possible that he is speaking rapidly to cover up his poor motor planning.  The PROMPT Institute  I suggest you go to the PROMPT site and use their provider map to locate an SLP trained in PROMPT.  Look for someone who has *at least* done Bridging, preferably certified.  But either could help you.  You can give them a call and talk through your situation. 

 

Okay, so the closest PROMPT certified person is almost 6 hours away. There's one person about 2 hours away that has done bridging. Then there may or may not be someone closer who's done the basic PROMPT training (unclear, one is clearly only working for a school district we're not in, the other two work for an organization that seems contract with early intervention and schools but not individuals, but I'd have to call to verify). I could drag my son to an eval two hours away, but obviously not for regular treatment. I'll have to go see what my insurance says about speech evals.

[luuknam]

Oh, and on the topic of pronunciation, we restarted Rosetta Stone Dutch a couple of weeks ago, and he's doing fine with that. We tried it maybe 1.5 years ago, and it was too hard (perfectionism combined with speech problems and the speech recognition software made that not work back then), but now he's doing just fine with it. Just in case anyone was thinking his pronunciation is terrible. That said, there are times we all mishear him (most recent one that comes to mind - the TV show "You, Me, and the Popcorn". Er, "Apocalypse". At least it's a comedy...).

[PeterPan]

Well I drive 2 hours each way for speech therapy.  I used to drive 2 1/2.  :(  I've done it since he was newly two, so clearly it's worth it to me.  I would strongly encourage you to at least get the eval with the Bridging person 2 hours away.  Someone who has done Bridging has shown a commitment to learning PROMPT, and she'll be able to help you, no problem.  She's probably working on getting certified.  It takes quite a while to get certified.

 

You're describing pretty classic apraxia.  Frankly, it's appalling that the ps SLP has kept him this long.  I think you'll be BLOWN AWAY at the results you can get with 6 months of therapy.  I'm not saying how long it will take.  I'm just saying you might see ASTONISHING changes that would make the drive worth it.  These things you're describing are fixable, EASILY FIXABLE with PROMPT.

[PeterPan]

There's some ok stuff on TPT, but to do that as the entire extent of his pragmatics is absurd.  He has ASD and would benefit from quite a bit more.  Odds are the school isn't giving her the funding to buy the materials and isn't sending her to the training, therefore she's limited to whatever is $4.99 on TPT.  :(

[luuknam]

There's some ok stuff on TPT, but to do that as the entire extent of his pragmatics is absurd.  He has ASD and would benefit from quite a bit more.  Odds are the school isn't giving her the funding to buy the materials and isn't sending her to the training, therefore she's limited to whatever is $4.99 on TPT.   :(

 

Right, I'm a little confused about that as well. Since this school was paying for a full-time 1-1 aide for my kid, so it's not like they're one of those districts trying to give the minimum possible.

 

I would strongly encourage you to at least get the eval with the Bridging person 2 hours away.  Someone who has done Bridging has shown a commitment to learning PROMPT, and she'll be able to help you, no problem.  She's probably working on getting certified.  It takes quite a while to get certified.

 

She completed the intro in May 2012, the bridging in Sept 2012. The PROMPT site says to be certified they need to complete a 4-month certification project, which doesn't sound that long to me. Or maybe I'm misunderstanding something.

 

I'm also considering requesting further evaluations by the school district - not sure what exactly I should ask for if I do that.

[PeterPan]

Well the Social Thinking workshop I went to was FILLED with school workers.  There were OTs, SLPs, administrators, behaviorists.  So absolutely it's reasonable for you to want them to have someone trained in the materials and to be giving complete intervention!  But it's expensive, takes time, and well have fun fighting.  

 

If your insurance will pay for it, you can do the intervention privately.  

 

It does sound like you have enough concerns you're noticing that you need to talk with the IEP team and see what they can do.  It might be that some of the things he needs now are things he wasn't ready for before.

 

I don't know that it's actually 4 months to get certified.  I get the impression people have to find a mentor and spend a LOT of time getting that experience.  I think what you can do is call and talk with them.  Ask them upfront whether they do straight PROMPT or blend it with other things.  Ask them what their plans are for getting certified and who is mentoring them.  It also sounds like you should call the farther person who *is* certified, even if it seems impossibly far.  Odds are that person knows the closer person and can give you some guidance.  

 

If there's a BIG gap in skill or the closer person is not showing a commitment to doing PROMPT, then one option you would have is to go for a week to the farther person and do intensive.  So you'd go for one week, and he'd have maybe 2 hours of therapy a day broken into chunks.  You'd do that daily for a week.  Then you'd take off maybe a month or two or three.  Then you would go back for another week of intensive and repeat.  During the intensive, they would teach *you* to do things at home with him (simplified, modified prompts, not hard!), so that you'd be able to carry it over at home.  It might have a much more potent effect that you anticipate.  Or do the intensive with the more qualified person to get him jump started and then continue with the closer person.  

 

I'm just thinking you'll come up with some options if you call and talk with people.  

Edited May 6, 2016 by OhElizabeth

[Lecka]

For the school district, just call somebody first, and see if they know who you should talk to.

 

If you can figure out who to call directly, that is great.

 

I would never be able to figure it out, and just expect to make a "who should I talk to?" phone call.

 

I also wonder if you could get creative about filling out paperwork. Could any relative help you? Could you ask at church? Could you look at a community organization that might help people?

 

I have a lot of sympathy for you on the paperwork.

 

I have had times I have been very overwhelmed, and frustrated, with paperwork.

[Mom28GreatKids]

I agree that it sounds like Apraxia and a 2 hour drive at least for an eval may be worth it. We did 8 months of traditional therapy with little improvement. I

drive a little over an hour to the same clinic OhE drives 2 hours to. She dx'd DS (3.8) in less than 30 minutes. And in 2 weeks she got him to say "me," a target word he had been working on for 6 months.

 

I do not have time for this either. I have 7 other kiddos who need me desperately, but we decided, if one of our children had cancer, we would drive him/her to the hospital where the very best treatment was available. So why would we not do the same for DS's Apraxia. We are also paying out of pocket. We are far from rich. Good gracious. We are working several angles for funding now. We want to give him the best chance, and his response to PROMPT has been amazing. If funding comes through, we will up it to 2 sessions a week.

 

OhE told me a few months ago it would be worth the drive. It is. Our PROMPT SLP (different than OhE's) is working on certification but is in practice with her instructor so she is flying! She will be certified by end of summer I think. She is also the perfect personality match for my DS, and he loves loves loves her.

 

One more story to convince. . .a friend of mine has a 17 yo son with profound Apraxia and ASD. She just started taking him to the same PROMPT clinic early this year. It has made a huge difference. She said she wishes she would have done it years ago, but she did not know, and when she did learn, she thought it was was too far. Now she is driving an hour both ways 2x a week. Why? Because it is worth it. I think it is worth a call at least.

Edited May 8, 2016 by Mom28GreatKids