Speech articulation problem question

[lisamarie]

If you had a 9 year old child with speech articulation problems who has had speech therapy before when he was 3-5, and then again for a year around age 8, with none of it making much difference, what would you do now to help them?

 

My DS is difficult to understand even for DH and me. He rushes, he slurs his words, mispronounces sounds, the whole deal. I'm not sure what to do for him at this point. I would take him to ST again if I thought it would do any good, but up to this point he will say the sounds correctly for the therapist, but then doesn't beyond that.

 

Today I told him he had a choice--we can go the ST route again or we can work on it every day at home without him getting mad at me when I correct him. He said the home route. (Of course)

 

My plan at this point is to stop him every time he speaks unclearly to me and have him slow down and repeat himself. To point out 3-4 words a day to focus on him saying correctly. And to have him start reading a paragraph a day out loud to me as clearly as he can (slowly rather than fast), focusing on sounding out every syllable.

 

I don't know what else to do for him. My insurance only covers ST through one practice and I haven't been happy with them. The school won't work with him because his speech isn't impacting his ability to learn (he is very gifted, so of course he isn't failing anything despite his speech problems--the only area it is causing problems is in spelling. Hard to spell words you pronounce incorrectly).

 

Any suggestions? Anyone had a child who struggled through this and finally found victory?

[Oakblossoms]

We are going through the exact same thing. They never could figure out what is wrong with him. I am thinking of getting him checked out more thoroughly because it is impacted his reading. We are in a different area and I am having much more success with our practice. Our school will work with us, though

 

Have you seen Mommyspeechtherapy.com?

[Dandelion]

We're in a somewhat similar situation with DS9. He also had ST from age 3-4.5. ST helped him correct all but his "S" and "R" sounds - and he had articulation issues with about 12 letter sounds when we started.

 

he will say the sounds correctly for the therapist, but then doesn't beyond that.

 

So that tells you that your DS is physically capable of producing the right sounds. That's great.

 

DS is now able to say his "R"s correctly due to lots of practice at home. He still struggles with his "S" (he has a lisp) but he can produce the right sound when I ask him to. It's just become a bad habit unfortunately. Since your DS is capable of saying the sounds correctly, it's really a matter of practice at this point. I think your plan sounds like a good approach. I know it can be difficult and stressful for everyone involved, but that's really the only way to correct this issue. Even if you went back to ST, the majority of the progress would come from practice at home. There are several websites that provide tips and resources for doing ST at home, so definitely check out those for pointers too.

[Jan in SC]

Have you been to an orthodontist? My ds' (10) articulation has gotten worse, and the ortho said that his back cross bite is causing him trouble. He did speech in K and 1st and was cleared and was fine for several years. Now, he is slurry.

[momto3innc]

Just listening in.

 

Both my boys are the same. Speech when they were young. Do not qualify for help through the schools because they can pronounce all sounds correctly. When we went the private route a year or two ago, they said all sounds perfectly for them for every session and I felt like it just wasn't worth the time/money when it didn't transfer to home. Currently, we attempt to stop them and make them repeat it slowly and clearly. Which they do...and then immediately speak super fast/unclear again. Maddening.

[Beth S]

:lurk5:

[gingersmom]

Do his friends understand him? When he is out and talking to the clerk at McDonalds or ordering in a restaurant do they understand him? Does it bother your son that you can't understand what he is saying?

 

I would still check in with a speech therapist (my son had 8 years of speech). Unfortunately it is not a problem that is going to magically correct itself.

[SailorMom]

My DS was misdiagnosed with an artic delay for about 5 years.... grrrrr.... he actually had oral motor dyspraxia. Very different treatment. As soon as he started getting the right therapy, his gains were huge!

[Ottakee]

Does he snore? Mouth breathe? I just ask as our son's articulation improved greatly once he had his tonsils and adenoids removed.

[OrganicAnn]

I once knew a lady that taught actors how to articulate and speak. I always wondered if that type of training would help kids. My mom also got a tip from an acting teacher that helped my sister's speech. My sister would stutter (because according to the teacher her thoughts were going faster than her mouth). The speech teacher told my mom that my sister should swallow before she spoke.

[wapiti]

You might ask your question on the Learning Challenges board, and/or search there for discussion of PROMPT speech therapy.

[PeterPan]

As a couple others mentioned, when the dc is not responding to traditional speech therapy, the problem could be the wrong diagnosis. If there is a praxis issue (praxis = motor control), the treatment needs to be totally different. The therapy you want to look for is PROMPT. You go to the PROMPT Institute website to look for a provider. They will teach you to carry it over at home, so you do less sessions and more at home. Like we're talking once a week, once every other week, and you doing the rest at home. It's fabulous for a homeschooling parent, because they want to teach you and you want to learn.

 

It may get called apraxia, verbal apraxia, oral apraxia, dyspraxis, etc., but the key is that there's praxis (issues with motor control) involved. The dc may have underlying issues with his motor control. One outcome is indeed that they'll rush through the sounds to cover over their inability to maintain control. The PROMPT therapist is a specialist who can actually work through all the aspects of the motor control and show you exactly what's going on and why. And it's NOT too late. You should see changes pretty quickly that let you know you're on the right track.

 

Btw, our therapist was certified and is now an instructor. The locator map will show training level. Go for the best you can get obviously. Yes it costs money, but it's the same cost as any other SLP in our area. So for the same money, I get somebody who specializes in my dc's issue. We use our HSA, but I would imagine you the therapist could help you with fighting for coverage. Speech isn't something to mess around with. It affects their whole life. No matter what you have to do, if praxis is what's going on, you WANT the therapy. My ds goes in one way and comes out talking better. It's literally THAT dramatic. We drive 2.5 hours each way and do a double session every other week. We used to drive it weekly when he was small. Each time we go he comes out sounding better and continues to make gains at home. PROMPT is AMAZING. If you've got the wrong diagnosis, get the right one. And if it's praxis, go for PROMPT.

 

Btw, there are things like flax and fish oil that can help, sometimes dramatically. They're not a replacement for therapy, but they help the connects, well, connect better.

[inmyopinion]

I could have written this post about my oldest son. Our insurance will not cover speech until after the $1,000.00 deductable is met. He gets speech from local school but getting no where. I woud gladly pay the $1,000.00 but I think a lot of it has to do with him making more of an effort. He can say the sounds in isolation but not while speaking. He is mostly coherant and he does not hear a problem and he is the type that has to want to change something to make it happen. He has mild SPD/ and motor planing issues so I am going to check out the info in the prior post.

[lisamarie]

Thanks for the suggestions. I am going to look into this further.

 

I don't know about praxia. I have never heard of it but will look into it. He drops word endings, skips over words when reading out loud, has a hard time pronouncing several sounds, etc. No one can understand him very well--his siblings seem to understand him the best, with Hubby and me being second best, but even then I understand about 60% of what he says when he gets talking.

 

Have you been to an orthodontist? My ds' (10) articulation has gotten worse, and the ortho said that his back cross bite is causing him trouble. He did speech in K and 1st and was cleared and was fine for several years. Now, he is slurry.

 

He's only been to the regular dentist who has never said anything. If you had a cross bite, would it make you jut your chin out? DS does that a lot when he's talking. When I push on his chin when he's talking, it seems to help a bit.

 

Does he snore? Mouth breathe? I just ask as our son's articulation improved greatly once he had his tonsils and adenoids removed.

 

He has year round allergies so it's hard to say if he is a mouth breather because of that or because of his tonsils/adenoids. He has never had strep, he doesn't snore, he's been seen by an ENT many times for ear infections when he was little (had ear tubes put in), so I would imagine the ENT would have said something if they were abnormally large.

[PeterPan]

He should not be having these intelligibility issues at this age. Definitely talk with a PROMPT therapist, even if it's a long drive. Ours talked with us for an hour on the phone on her dime before we decided to go. Don't be afraid to email or call and talk with them. The PROMPT therapist is a full SLP with the extra training in PROMPT. So if it's not apraxia, they're going to be able to sort out what it is.

[Ottakee]

It might be worth another check with the ENT. They are VERY hesitant now to remove tonsils/adenoids, esp. with younger kids.

[kroe1]

I do not know if this has any scientific merit at all, but I have seen several miraculous improvements in kiddos who take acting and voice lessons. One teenager in particular comes to mind. I could not understand her at all when she first showed up at the theater. It was painful to have to listen so hard to figure out what she was saying. After about 2 or 3 years, her speech problems diminished to the point no one could tell she had them. The last time I saw her, she was playing the stepmother in Cinderella. I cried all the way through it.

[J-rap]

This is a completely different situation I know, but my husband had several language deficits following his stroke. He went to 1. 5 years of speech therapy with various therapists, but until we finally found a therapist who dealt with the apraxia, he didn't make much progress. The new ST worked on very specific apraxia exercises for 9 months, 4 days/week, and that's what finally enabled him to be able to tackle the other language deficits. Apraxia is a motor planning issue, and the therapy involves a multitude of rather boring repetitions in order to teach the brain the proper motor planning for the different sounds. But boy, what a difference it has made! Just something to look into for your son, although your son's speech problems are certainly much milder.

[Crimson Wife]

He drops word endings, skips over words when reading out loud, has a hard time pronouncing several sounds, etc.

 

Have you ever gotten him evaluated for Central Auditory Processing Disorder? Sometimes articulation problems can be related to CAPD. Here is a good checklist of CAPD symptoms.

[Nart]

Has he had a hearing test lately? Not the screening one in the pediatrician's office, but one with an audiologist? My son dropped word endings and had massive articulation problems. One speech therapist even mentioned apraxia to us. Turns out he had mild to moderate conductive hearing loss, which luckily has now improved after three sets if ear tubes and getting his adnoids and tonsils out. But the intermittent hearing loss from 2 to 5 really affected his speech.

[PeterPan]

Has he had a hearing test lately? Not the screening one in the pediatrician's office, but one with an audiologist? My son dropped word endings and had massive articulation problems. One speech therapist even mentioned apraxia to us. Turns out he had mild to moderate conductive hearing loss, which luckily has now improved after three sets if ear tubes and getting his adnoids and tonsils out. But the intermittent hearing loss from 2 to 5 really affected his speech.

 

Ds was born at home and didn't get the hospital hearing testing. Hmm, maybe that's something I could get done just to get it done. Can a ped do a basic check? All I remember is the test they did in high school on everybody with a machine. It was one of the things we talked through with the SLP when we started. He definitely has apraxia but I'm always for covering bases.

 

This is a completely different situation I know, but my husband had several language deficits following his stroke. He went to 1. 5 years of speech therapy with various therapists, but until we finally found a therapist who dealt with the apraxia, he didn't make much progress. The new ST worked on very specific apraxia exercises for 9 months, 4 days/week, and that's what finally enabled him to be able to tackle the other language deficits. Apraxia is a motor planning issue, and the therapy involves a multitude of rather boring repetitions in order to teach the brain the proper motor planning for the different sounds. But boy, what a difference it has made! Just something to look into for your son, although your son's speech problems are certainly much milder.

 

Actually it's the same label, apraxia, and both my ds' apraxia and apraxia after a stroke are motor control. There are different *causes* though of apraxia in children. It has a strong connection to autism and our SLP has had cases where vaccine reactions have worsened it. Sometimes there's a genetic correlation. (They've done some family studies in Britain showing this.) And sometimes there's oxygen deprivation during birth, which is of course like the Broca damage you get with a stroke. (I was just reading about that.) We really don't know what caused my ds's. He didn't have oxygen deprivation during birth, though I've known other children where this did happen and there was apraxia. He's not on the spectrum, blah blah, and there's not actual a direct genetic line of late talkers or apraxia.

 

So whatever. Yes, what your dh went through is like what we're going through. When he was 2 we literally picked his jaw up and down. Every single step of the motor control has been taught. Sounds continue to acquire through age 5, so therapy typically goes much longer. The SLP is *hoping* (fingers crossed!) he'll be done sometime when he's 5. Right now he's at the 75th%-ile for motor control, which is up from 50th a year ago. Even when you get the motor control age-appropriate, you still have to get all the articulation that builds on the motor control. It's just a long process. He's testing 98th%ile for preschool skills but 75th%ile for motor control. Basically we're not seeing all that's inside of him, even though he has made so much progress. He's just now learning to sing. It's really odd because when dd was this age, I sang with her every day. A month ago he started vocalizing with sound, like he was trying to learn. Just yesterday he made up a little ditty. I can't even remember if it had words or not, but it actually sounded like a melody. Kermit the Frog was wrong--not everybody can sing. But it's coming. :)

 

Oh, that's moderate verbal apraxia. There's mild, moderate, severe, like you say.

[Nart]

Ds was born at home and didn't get the hospital hearing testing. Hmm, maybe that's something I could get done just to get it done. Can a ped do a basic check? All I remember is the test they did in high school on everybody with a machine. It was one of the things we talked through with the SLP when we started. He definitely has apraxia but I'm always for covering bases.

 

 

I think any kid that is in speech therapy should have a hearing test done by an audiologist, not an audiometrist. An audiologist has a masters degree, an audiometrist is a nurse/ assistant who was trained in using the machine to test hearing (lift you hand when you hear the beep). The audiologist can test for different types of hearing loss. When my son is tested they put him in a sound proof booth that is geared toward children. There are stuffed animal bears that go off and lights. My son was first tested when he was two years old. The hearing tests at a doctor's office or school are not the best. My youngest son who has no history of hearing problems was just tested at his pediatrician's office by the nurse. I could tell that the nurse was inadvertently cueing my 4 year old when she was pressing the button by wiggling her other hand. I had to tell her that he was looking at her hand not paying attention to the beep. The cut-off that many pediatrician's use is 25 decibels which should not be acceptable for children, 15 decibels should be the cut-off according to my son's audiologist. My 6 year old son had his probably 6th or 7th hearing exam with his audiologist on Wed. and he finally passed with flying colors after four long years! I would really insist on getting a referral for an audiologist for any child who has apraxia. My son did have some symptoms of apraxia (weak motor skills in his mouth, difficulty sucking/not gaining weight as a newborn/ couldn't blow bubbles) but what really helped him was getting him to hear well. If my insurance didn't cover it would be something I would pay out of pocket for, sometimes there is a discount if you pay cash since they don't have to spend time billing your insurance.

[PeterPan]

I think any kid that is in speech therapy should have a hearing test done by an audiologist, not an audiometrist. An audiologist has a masters degree, an audiometrist is a nurse/ assistant who was trained in using the machine to test hearing (lift you hand when you hear the beep). The audiologist can test for different types of hearing loss. When my son is tested they put him in a sound proof booth that is geared toward children. There are stuffed animal bears that go off and lights. My son was first tested when he was two years old. The hearing tests at a doctor's office or school are not the best. My youngest son who has no history of hearing problems was just tested at his pediatrician's office by the nurse. I could tell that the nurse was inadvertently cueing my 4 year old when she was pressing the button by wiggling her other hand. I had to tell her that he was looking at her hand not paying attention to the beep. The cut-off that many pediatrician's use is 25 decibels which should not be acceptable for children, 15 decibels should be the cut-off according to my son's audiologist. My 6 year old son had his probably 6th or 7th hearing exam with his audiologist on Wed. and he finally passed with flying colors after four long years! I would really insist on getting a referral for an audiologist for any child who has apraxia. My son did have some symptoms of apraxia (weak motor skills in his mouth, difficulty sucking/not gaining weight as a newborn/ couldn't blow bubbles) but what really helped him was getting him to hear well. If my insurance didn't cover it would be something I would pay out of pocket for, sometimes there is a discount if you pay cash since they don't have to spend time billing your insurance.

 

 

Nart, I'm doing a little reading on this to see what the options are. I'm curious, what you do you mean by getting him to hear better. You mean you did listening therapy or something for APD?

 

I found a list of symptoms of mild and fluctuating hearing loss in youngsters, and it mentioned dropping end sounds, grammar issues, etc. My ds has none of those symptoms. His grammar is off the charts for his age, unusually good. We've had no indications of any form of APD either. It's something we discussed, but in our case the SLP doesn't think there is. When we talked about it earlier on the SN board, it seemed like some of the hearing evals were very, very expensive. I'm all for checks on things, but $1K gets a little steep if all you're wanting is a basic check. I called a place in our area and left a message. We'll see what they say.

[Crimson Wife]

There is a big price difference between a regular audiologist eval and the specialized CAPD one. All 3 of my kids have had the regular one and those take about 45 minutes or so and the cost was a few hundred dollars. My oldest did the first part of the CAPD eval and that was about 3 hours and $1800.

[lisamarie]

Has he had a hearing test lately? Not the screening one in the pediatrician's office, but one with an audiologist? My son dropped word endings and had massive articulation problems. One speech therapist even mentioned apraxia to us. Turns out he had mild to moderate conductive hearing loss, which luckily has now improved after three sets if ear tubes and getting his adnoids and tonsils out. But the intermittent hearing loss from 2 to 5 really affected his speech.

 

 

His last hearing test was when he was 6 with an audiologist in the special room. The full workup. He was in kindergarten when he had that after he had his ear tubes removed. He was premature, was on oxygen, and had multiple ear infections that led to the tubes. Delayed talker which took off after the tubes were put in at 2.5yrs and then articulation issues. He had to have OT as a baby because he threw up when he ate anything with texture. He's been evaluated by 2 different psychs for giftedness, ADHD and spectrum issues and came away with a highly gifted dx and nothing else.

 

But I haven't pursued anything speech related for him in about 2 years and it seems to have gotten worse after he lost his front teeth and got his new ones. I get so frustrated seeing specialists, paying a lot of money, only to see no progress. Yet I know I can't keep ignoring the problem because he's not getting better and it's hard for him to communicate and that's not fair to him.

[Nart]

Nart, I'm doing a little reading on this to see what the options are. I'm curious, what you do you mean by getting him to hear better. You mean you did listening therapy or something for APD?

 

I found a list of symptoms of mild and fluctuating hearing loss in youngsters, and it mentioned dropping end sounds, grammar issues, etc. My ds has none of those symptoms. His grammar is off the charts for his age, unusually good. We've had no indications of any form of APD either. It's something we discussed, but in our case the SLP doesn't think there is. When we talked about it earlier on the SN board, it seemed like some of the hearing evals were very, very expensive. I'm all for checks on things, but $1K gets a little steep if all you're wanting is a basic check. I called a place in our area and left a message. We'll see what they say.

 

 

I should have been more specific. His hearing got better after getting ear tubes and getting his adenoids and tonsils removed. He had thick, sticky fluid that never drained, so it was a medical problem. I really believe that he ended up with an auditory processing problem even when he was hearing well (right after tube insertion). I think the weak muscle tone in his mouth added to his speech problems (which surprised me because his overall gross motor is great). He was in speech therapy from 2 to 4. I thought he heard fine and almost didn't get his hearing tested when I was told he needed speech therapy at 2 years, 10 months. He never had an ear infection that I knew of. I had to try so hard not to cry when we were in the sound booth and this little bear behind him with a microphone called his name and told him to turn around to play and he didn't respond. The audiologist had to keep repeating it louder until he looked. I was shocked.

 

I am a school psychologist so I have access to a lot of different tests. When I tested his auditory processing at 3 and 4 it was really poor (along with his expressive and expressive language). Of course it is not completely accurate to test your own child but I think it was roughly accurate. I was really proactive teaching him how to read and doing phonemic awareness activities (when he turned four we started reading lessons and in the next 365 days we did a reading lesson 360 days - only missing five days). By the end of that year his auditory processing score on the WJIII cognitive went from the 10th percentile to the 99th percentile rank because he could blend so well since he had learned to read. I can still see where his intermittent hearing affects him when he is reading (dropping endings of words) and spelling (ex. spelling "kiss" as "giss") and now (he is 6) having him go through Dancing Bears Fast Track and C just to make sure his phonics are solid (after having done all of 100 Easy Lessons/ Funnix for 6 months/ Reviewing all of phonics pathways).

 

I would try to get a referral through the pediatrician. Has your child had his hearing screened at the pediatrician? If they tell you he is too young or not cooperative insist on a referral to a pediatric audiologist to test his hearing tested.

[PeterPan]

Nart, the place I called about a hearing test called me back today. The price is pretty reasonable (under $300 max), and they do the booth testing. The lady said that in fact you're correct, their standard policy is to recommend a hearing eval for all kids under 5 getting speech therapy.

 

Just wanted to let you know I was following up on it. It's still a lot of $$ if he doesn't need it, but I'm at least finding out what's involved to think through it. :)