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Apraxia of speech(??)/Speech Therapy *cross posted*


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Cross posted from the general board (because I didn't even think to post it here rather than there in the first place).

 

I did a brief search, but didn't really find the specific answers I was looking for - though I did get a few GREAT links to previous threads from someone on the general board.

 

DS was evaluated by EI today and was found to be at 9-12 months on their communication test - he's almost 20 months. His receptive language is quite high. He definitely understands the majority of what you tell him and clearly follows what you're saying/talking about (if he sees you put on your coat, he gets his shoes, if you're talking about the bag, he goes and gets it, etc). He did struggle with a few of the cognitive abilities (matching pictures, pointing out familiar objects, etc) but generally scored at age level on the cognitive portions of the 2nd test given to him, but only scored at 13 months on the communciation portion of that test. He does point, but it is often more of a general pointing than at something specific. He can nod "yes" and "no" but does not use them to communicate what he wants or doesn't want. He signs "please" when he wants something and that is our only clue that he wants it, besides the "eh, uh" sounds he makes. Then the game of trying to figure out WHAT he wants begins. He does not refer to anyone in the household by "name" (not even Mama, though he CAN say "mama") or point to anyone when asked where ______ is - he only turns his head and looks at them.

 

He does say a few words:

 

Cheese (when you pull out a camera)

Truck - "guck" (only when asked to say it, not in response to seeing a truck or being asked what a truck is)

Uh oh (used at the appropriate time)

Mama - "mom-mom" (only when asked)

Bye-bye - "duh-duh"

 

etc....

 

The only words he uses spontaneously at the appropriate time are hi, bye bye, uh oh, and cheese. When asked/encouraged to say a new word he will almost ALWAYS say "eh" or "uh" in response.

 

I *think* that's most of the background. So, here's my questions:

 

1. (this is probably my biggest question at this point) Apraxia seems to fit his "symptoms", no? (They didn't really give me any information beyond where he scored and that he qualifies for services today)

 

2. What should I be expecting as far as therapy goes? Frequency? Length? (We will be having a planning meeting in a few weeks to discuss our goals and plan of action - I'm just impatient and want to know)

 

3. How quickly should I expect progress if it is apraxia? If it isn't?

 

4. Will this likely affect him for the rest of his life?

 

5. Anything else I should know or that you find pertinent?

 

I really appreciate the wealth of knowledge here and am looking forward to learning from all that have BTDT!

 

Thank you!

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Hugs to you. I have identical twins who have had severe speech issues. They were actually a little bit worse than what you describe in your post. They really only said about 3 words at age two, and when they did "start using words on there own" I was literally the only one that could understand them (the other twin could understand also...) Like you son, their ability to understand was there, just not the ability to speak clearly.

 

They are almost 8 now. Everyone can understand them. They have been in speech thereapy since they were 2. We have a few tweaks with certain sounds to work on, but certainly the end of the tunnel is near. This has not affected them in school at all. They have lots of friends, and are sharp as tacks.

 

Having a child with severe speech issues is hard. Actually for us, the hardest was when they were young, and sometimes is was next to impossible for them to communicate what they wanted to say.

 

It is not recommended for Speech therapists to diagnose a child with apraxia before the age of 3 because many children are mis-diagnosed.

 

But, any way you slice it, apraxia or not, it will be a long slow road to articulation. We met with our speech therapist once a week for an hour. Many people will meet twice a week with their speech therapist.

 

But, more importantly, I believe, it is important to practice at home. Games and fun ways of doing things at home are really important to practice whatever particular thing you are working on. We generally always practiced before reading books at night. Sometimes when I was really tired and/or frustrated, I paid my oldest to work with them. She was very very good getting them to practice.

 

And, NO!!! This will not affect him his whole life! It may seem slow, but he'll get his articulation down! Keep your spirits up.

 

Okra

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Kristin, I don't know if you've read any posts about my adventure with my ds or not. He's a bit older than your ds (27 months). A little before he turned two we began the process of having him evaluated. Took us a while to get in, because we went private. I took him to an SLP who specializes in apraxia and feeding disorders after getting the "worried mother" routine from a more general SLP. The more general SLP had said they would "work on communication", and the apraxia specialist said she could help him talk. He is diagnosed as moderately apraxic. At 2 years he had 2 sounds and one word. I do not think it's the quantities specifically that are the keys distinguishing apraxia, which is a motor control problem, from a more general delay (developmental, cognitive, whatever). The big red flag people saw in our son was dropping words. He would say a word once or twice and never again. You just couldn't get it out of him, no matter how you tried. And he had no ability to imitate sounds. So if you played animal sounds or train sounds or whatever while changing diapers, you got nothing, ever.

 

Now I think it can also be that the dc talks but the motor control is very off, making the speech unintelligible. There are variations, and an SLP who does lots of apraxia can sort it out for you. Animal sounds count as words btw. The general thing they say is 50 words at age 2. I forget before that, maybe 20 words at... ?

 

So I have no clue whether your ds is apraxic or not. There can be verbal apraxia and oral apraxia. You can google them and read about symptoms of each. Treatment is definitely in terms of years, not months. I went private because I wanted to be able to select the best speech therapist I could find. I drive 2 1/2 hours each way to get to the only SLP doing PROMPT in the tri-state area. PROMPT is amazing for apraxia, and can be radically more effective than traditional approaches. http://www.promptinstitute.org

 

The SLP can help you evaluate how many areas the apraxia affects. It can be oral, verbal, and there is apraxia (dyspraxia) that extends to the rest of the body as well. Tone issues can occur with this. There can be dyslexia. There can be cognitive deficits and delays or none at all. My SLP says it's more common to have more than one thing going on, rather than it being a pure apraxia. There are lots of areas and things they will look for. They'll screen for autism. They'll look at muscle tone in the mouth and rest of the body. They'll look at his social interaction, how he functions cognitively, etc. In fact, one of the facets of PROMPT is that they specifically look at what the weakest areas are in the child and work on them through the speech using his best modality. So if he's very physical, they use a physical method to work on say social development using the target words and sounds. The work on the child as a whole.

 

But I'm rambling. First do your reading and see what you think you have. Dropping words and inability to imitate were big clues for us that distinguished it from other forms of speech problems. I don't know other symptoms.

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It is not recommended for Speech therapists to diagnose a child with apraxia before the age of 3 because many children are mis-diagnosed.

 

Our SLP, who specializes in apraxia, had absolutely no problems seeing the apraxia at this age. The first one we visited, well let's just say I get angry about this. She gave me the worried mother routine, said it couldn't be diagnosed till they started talking (but he can't talk), blah blah. Bunch of (insert strong word). My blood is boiling here.

 

The apraxia was totally obvious to anyone who treats it all the time. It's a motor control problem, and all you have to do is do things that get him trying to do the things. She started doing the prompts with him, and you could SEE his jaw locking down, common with apraxia. Most either will have the jaw lock down or lock up. He could get it down, but he couldn't get it up. That's motor planning. He had EXTREMELY good fine motor skills, I mean mind-blowing. At 9 months he would sit on the patio and pull tiny weeds from between the pavers. His brain was putting all its energy into fine motor development because he wasn't speaking. This too is common with apraxia. (In other words, he's a future engineer, lol.) The tone problems are obvious.

 

There's no reason to wait till age 3 to get diagnosed. My ds was extremely frustrated at not being able to communicate. He WANTED to and couldn't, which is another clue the therapist looks at, communicative intent. With a developmental delay, that might not be there yet I suppose. With my ds, it was all there, wanting and needing to come out. He spent his days hitting, biting, and screaming. Two weeks of PROMPT speech therapy and it stopped. We were immediately able to help him verbalize and have positive ways to communicate. The hitting went down to the normal range of boyishness.

 

You also need to do sign language. This isn't a perk but a necessity. We got the entire set of Signing Time videos from the amazon marketplace super cheap. You want them. Sign works the same language part of the brain as speech, and the SLP will use it interchangeably to help bridge him into words. So my ds learned the signs for colors and then slowly became more and more able to say the words.

 

It's a process. One step at a time. But no, please don't wait till three. There's no need. They can be diagnosed and treated quite well by an experienced PROMPT therapist. I'm not saying there isn't an early/jumping the gun trend. But definitely by two or almost two I would be concerned. I don't think a PROMPT therapist is going to take your money without giving results. One of the very tenents is to look for communicative intent, since no progress in speech can be made without it. My ds talked THE VERY FIRST session with PROMPT. There was no need to wait till he was three.

 

BTW, google and pull up the PROMPT workshop video of Deborah Hayden that is on youtube. It's 45 minutes and totally worth your time.

Edited by OhElizabeth
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Thank you so much for your responses!!

 

He has dropped "thank you" ("duh duh" - just like "bye bye" - they sounded identical) over the last few months and I can't get him to say it at all anymore (just figured that out last night). He does NOT repeat or imitate at all either. Well, I guess that's not 100% true. He will imitate/repeat a "ooo" sound (no "mm") for a cow or something similar for an elephant. No other animal sounds though, and he doesn't even try to imitate words if you ask him. All he'll say when asked to say a new word is "eh" or "uh" - repeatedly.

 

They did a lot of testing/watching today. I didn't notice, and they didn't mention any defecits in the way of muscle tone (but maybe I don't know what I'm looking for??). I also don't think he has oral apraxia just based on the little bit of research I've done today.

 

The big thing that sticks out to me is the fact that everything on apraxia talks about the gap between their receptive communication and their expressive communication. THAT is my DS.

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.......

 

The apraxia was totally obvious to anyone who treats it all the time. It's a motor control problem, and all you have to do is do things that get him trying to do the things. She started doing the prompts with him, and you could SEE his jaw locking down, common with apraxia. Most either will have the jaw lock down or lock up. He could get it down, but he couldn't get it up. That's motor planning. He had EXTREMELY good fine motor skills, I mean mind-blowing. At 9 months he would sit on the patio and pull tiny weeds from between the pavers. His brain was putting all its energy into fine motor development because he wasn't speaking. This too is common with apraxia. (In other words, he's a future engineer, lol.) The tone problems are obvious.

 

There's no reason to wait till age 3 to get diagnosed. My ds was extremely frustrated at not being able to communicate. He WANTED to and couldn't, which is another clue the therapist looks at, communicative intent. With a developmental delay, that might not be there yet I suppose. With my ds, it was all there, wanting and needing to come out. He spent his days hitting, biting, and screaming. Two weeks of PROMPT speech therapy and it stopped. We were immediately able to help him verbalize and have positive ways to communicate. The hitting went down to the normal range of boyishness.

 

You also need to do sign language. This isn't a perk but a necessity. We got the entire set of Signing Time videos from the amazon marketplace super cheap. You want them. Sign works the same language part of the brain as speech, and the SLP will use it interchangeably to help bridge him into words. So my ds learned the signs for colors and then slowly became more and more able to say the words.

 

It's a process. One step at a time. But no, please don't wait till three. There's no need. They can be diagnosed and treated quite well by an experienced PROMPT therapist. I'm not saying there isn't an early/jumping the gun trend. But definitely by two or almost two I would be concerned. I don't think a PROMPT therapist is going to take your money without giving results. One of the very tenents is to look for communicative intent, since no progress in speech can be made without it. My ds talked THE VERY FIRST session with PROMPT. There was no need to wait till he was three.

 

BTW, google and pull up the PROMPT workshop video of Deborah Hayden that is on youtube. It's 45 minutes and totally worth your time.

 

Thank you!!!!! The bolded is 110% my son! He gets SO frustrated.

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Oh poor thing! (him, not you, lol) Yes, we had that huge gap too. As you say, I think the receptive and expressive are supposed to be pretty close. Yes, we had a lot of the eh thing, oh my. When I came across some youtube clips with apraxic dc talking that way, that's when I knew for certain. Our video camera is old and a tape, not digital thing, or I'd send you the video of our evaluation.

 

It sounds like you're on the right track. Look into PROMPT. It's worth driving for. It's worth selling your house for.

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My son could basically say about 4 words at the age of three. Poor kiddo. High vocabulary, perfect understanding. Dr's ignored me - took forever to get anything done, and then he was misdiagnosed with an artic delay until he was 6. Finally- I diagnosed his apraxia, we switched therapists and two years later he had graduated. He is still slushy at times, especially when he speaks quickly.

Anyway - if it is apraxia - get him started on therapy.... last month :)

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BTW, make sure you update the thread and tell us what you do! :)

 

Oh absolutely! I'm anxious to hear what they say at the planning meeting in a few weeks. Do they typically give a diagnosis or probable diagnosis at those goal setting meetings? Or do they typically wait until they've had more time to work with your child?

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Well was it the SLP who administered the tests? Around here EI screens in-home to see if your dc will be eligible, then the schedule you for meetings with the actual therapists. If it was an SLP, seems to me you should have gotten the diagnosis that day and gotten started on therapy. I don't know enough about EI procedures to know more.

 

You need to be very aware that typical speech therapy can be almost ineffective for apraxia. Unless the SLP has experience with apraxia and can verbalize a plan that sounds reasonable based on your research, I'd do some serious thinking. I read too many stories of kids doing traditional and getting NO progress. I wasn't willing to waste time with it. I know it's expensive, believe my I know. The irony is traditional speech therapy is usually many times a week (3-4), where PROMPT is *1*. So if the PROMPT therapy session is $100 an hour, you're looking at $400 a month. Traditional speech therapy, also $100 an hour, would be $1200-1600. So PROMPT is a more powerful tool and less expensive to boot. I did the parent workshop for PROMPT and learned even more, so that now it's very comfortable for me to carry it over in the home. It fits the homeschooling lifestyle very well. One day a week of therapy, and the rest of the time it's you talking with them and carrying over the techniques. Just some information to think about.

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My ds (almost 5) has been in speech since he was around 18 months old. It wasn't until we went to a private speech therapist (yes PROMPT cert.) that he was diagnosed with dyspraxia and a lateral lisp. He knows he can't say what wants to say and gets very frustrated. His receptive language is incredible and actually his expressive language is incredible except you can't understand him.

 

EI through the schools did a great job with my 8 year old daughter as she graduated from speech just before 3 years old but for my son it was nowhere near adequiate. In 5 months of private speech he has gotten a lot more understandable than the 3 years of EI speech. I do have to say that I don't have problems with the EI speech and I did like the therapists but their ability to deal with the motor planning issues was completely inadequate.

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He was given 2 tests. The first one was a more global developmental test given by the "service coordinator". The other was a speech/language test given by the SLP. The service coordinator's test put him pretty much right at age level for everything except communication where he scored at 13 months. The SLP's test put him at 9-12 months. They both agreed he was behind and qualified for services (he only needed to score at 14.5 months to qualify). That was the only information I was given. They did not give me any insight into WHY they thought he was behind.

 

The service coordinator did make a comment that she wondered if he scored lower in some of the cognitive skills not because he didn't know the answer, but more because he didn't know how to COMMUNICATE the answer. She wanted a teacher to come in and evaluate him also because of this?!? We're waiting on a call to schedule that sometime in the next week.

 

I was told that after that last evaluation is done we will all (the service coordinator, the SLP, and the teacher) sit down and discuss our plan of action or our "Individualized Family Service Plan". I'm assuming that is when we'll get our "diagnosis"?!? I don't know. I'm definitely not opposed to looking at other options if he does, in fact, have apraxia. I've read enough to know that it will probably be necessary, but before doing that I want to be sure that I'm accurate in that diagnosis and that traditional therapy will not work for him. I'm just not sure how to do that.

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Like we told you, traditional SLP's often do not diagnose apraxia. They don't have the skills to help it, so they just plain don't diagnose it. The SLP I visited (and decided not to use) said she wouldn't diagnose apraxia till at least 3, till he started talking (which an apraxic might not even do mind you), that he would be labeled as having a developmental delay, blah blah, and that they would work on "communication." That's the run-around you're being given. If you want to know if he has apraxia, take him to someone who specializes in apraxia. 2 hours, $200, and you'll have your answer.

 

My memory is getting fuzzy now, but I know our SLP did several paper evaluations, things where she asked me questions and marked things. One of them was for autism, and there were some developmental ones. In any case, she had no trouble taking the info from those and then sitting down and working with him (using the PROMPTS) and confirming the diagnosis. It's totally obvious when the person has experience with it. They will encourage you to bring a video camera and tape the interaction, so you can show it to your spouse, etc. Interestingly, there are kids given other (sometimes scary) diagnoses that in fact turn out to be INCORRECT once you start improving the apraxia. They've had kids shed labels spectrum disorders, developmental delays, etc. I really wouldn't conclude anything till you sort out the apraxia side. See the dc with apraxia is living in his own world, unable to come out. It can come out as negative behavior, an independent streak, withdrawal, etc. The brain is putting all its energy into fine motor and things he can do independently, since it isn't going to improving speech. You break down the communication wall with speech and sign language and a lot of that outer stuff they're looking at will change. He won't even look like the same child. I know mine doesn't. One month of PROMPT and he was a different child. I didn't even think we had a PROBLEM, but the differences were night and day.

 

Our SLP brings in another SLP to do more work on expressive language problems, but she said our ds likely wouldn't need it.

 

Just as a word to the wise, I would start looking around for your private SLP of choice now. They usually have waiting lists. You could schedule the appointment with a good PROMPT SLP and continue with the EI track too.

 

Have you found the childrensapraxianet yahoo group? It's sort of a hodgepodge, but it's worth joining. Puts you in the strain of things to see how common this is, and lets you read about some of the things people are trying. These things are NOT a substitute for therapy. You still have to do PROMPT and help them map out the motor planning for all the sounds and words. But there are some things like fish oil (or even flax oil), Nutriveyda, etc. that people are doing to help. Paired with good therapy they can give you surges in speech.

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