Delayed speech - 2 year old

[knittingmama]

My two year old is still not speaking very well. She can sign about 15-20 words now (we've been signing to her since birth, just like we did with my older kids), and she can say about 10-15. Those she can say don't always sound like the actual word, like "iss" for "sit" or "rrg" for "drink," but she is fairly consistent. She is finally putting two words together with "Hi mama" (or dada or bubba or mimi. That was quite an accomplishment. And she is finally starting to vocalize and just make sounds in general now, like baby talk. She has been in speech now for 8 months, and I just don't feel like we're making any progress. Her therapist has thrown around the term "speech appraxia" some, but I don't know much about it other than that it's poor motor planning, making it hard to get together everything that goes into talking. She did have some major nutrition issues in the first year or so of her life (horrible food intolerances that weren't really dealt with until after her first birthday) that I think contributed. Her receptive language is fantastic. Just wonderful. She can follow directions like nobody's business. She sings on pitch well too, and she can repeat rhythms on either a neutral syllable like "ba" or on an instrument, so it doesn't seem to be a hearing issue. Anyway... I just was wondering if someone on here could point me to a resource(s) that might help us out some, or even just commiserate. All of my other kids have either been early talkers or right on schedule, so this is so new for us.

[celticadea]

My daughter (2 1/2 now) is also apraxic and was just formally diagnosed about a month ago. We initially just did therapy through the school system early on program. Since she's close to aging out and the 'in school' program is drastically less services, I pursued private testing/therapy. We're still using the school system and kind of meshing it with the private therapy.

 

There's a lot of scary info about Apraxia but early treatment can and will make a huge difference! I would check out www.apraxia-kids.org to start. As with most things there are levels of severity with Apraxia (also called Childhood Apraxia of Speech or Developmental Apraxia).

 

Standard ST(speech therapy) is not considered to be particularly helpful for Apraxic kids. The two types I have learned about that are recommended are PROMPT (I'm sure OhElizabeth can detail this more) and Kaufman. I suggest learning about them and getting the best treatment you can afford and physically reach. At 2, most places won't officially diagnosis but you can be working with that assumption (so it would be "suspected CAS"). I don't have PROMPT available to me but have been happy with our progress using Kaufman methods (her school SLP who suspected CAS initially used Kaufman type methods and we go to the Kaufman clinic now).

 

My daughter is doing so much better now than when we started Early On speech services at 18 mo. At 2 years she only had maybe 10 approximations (close to words but not actual words like 'ba' for ball) so she qualified for Special Ed (lot more speech services). Developmental sites will say that 50 words are ok at 2 but, honestly, a typically developing kid would have around 200 so don't let them push you off.

 

On a positive note, you're daughter is verbalizing at all which is great for an apraxic kid. Some don't at all and it's very difficult to correct or assess speech when they're not making any noise! :) The signing will help keep her frustration down about communicating while you work on speech and clarity. And the movement of the hands can help to 'trigger' or cue the movement of her mouth for speech. (not that the signing directs the mouth but if you get the body moving, the speech muscles can get brought along for the ride ;) .

 

An interesting thing to notice is after you get a kid bouncing or running, you can get them to repeat "go!" or "woooo!" or whatever even though they normally can't . For us, just getting her to try to imitate anything was a struggle and she could say fairly complicated animal noises but not the words, like 'meow' but not cat. Once we got past the imitation barrier, things got much easier!

 

I think that was a bit rambly but I hope there's something helpful for you. :)

[knittingmama]

Very interesting information, thanks a lot! It really helps me to hear from someone else who has gone through this.

 

I never even thought about having her bounce to get her to repeat things. She just usually smiles when we're trying to get her to repeat instead of actually repeating, but I have noticed that sometimes several hours later she will make something close to the sounds we're trying to get her to make. Maybe coincidence, but her speech therapist has mentioned that maybe she just has a slow processing speed. We are using ECI right now, and I just really don't see how she's doing anything we don't normally do during the day, you know? And it's only 2x/month, too...

 

I have noticed that often we'll ask her something, and she'll move her mouth as if she's answering, but she doesn't make a noise. Mentioned it to the therapist, but she really didn't say anything about it. I'd love to know if that's typical with speech delays. She has recently started saying "yesh" for yes which I think is fantastic. And she has "no" down very well!

 

Our speech therapist just keeps saying that she's "right there," but although I've seen some progress since she first started, because she wasn't saying anything at all then, it's just not quite where all her friends are (saying 4-6 word sentences).

[PeterPan]

An apraxia specialist will certainly give you a firm answer on apraxia at 2. It's only regular therapists who don't. The regular therapist we went to said they wouldn't diagnose till the dc started talking. The specialist knows how to elicit the motor control problems and demonstrate them even when there is no speech.

 

Yes, look into PROMPT if at all possible. The PROMPT Institute has a provider locator. Don't ask your therapist if she does it. Just look on the PROMPT site and find the most qualified person within a sane drive. I drive 2.5 hours each way (and sometimes my dh does). PROMPT for us was a miracle.

 

Yes, your therapist is saying what ours says, that it's uncommon to have pure apraxia (apraxia in isolation). Usually there's more going on. Deal with that when it comes. Right now, your issues are motor control, feeding, speech. Psych evals and all that come later. The SLP will probably do a spectrum screening (ours did), but other than that you just ride it out and work through the process. Our SLP has done tests periodically. There's a test they can do at 3 (VMPAC) that tests motor control. At that point they can start plotting all the parameters and comparing it to age norms. She did it when he turned 3 and again when he turned 4. I think it has charts to go through 8 or so in the packet. There are other tests the SLP can administer when the dc turns 4 (preschool skills, etc.). So even with just the tests your SLP can do over the next couple years, you're going to start to get a sense of where she's at. The tests our SLP did have shown us learning style preferences, auditory recall, all sorts of things that affect how I work with him now. So just work through the process. Don't assume anything. It is what it is. Your cruise is going to Denmark, iykwim.

 

The good thing is, she has speech. Now that you suspect apraxia, I would move on to a specialist. It doesn't respond well to traditional methods, and if she plows forward WITHOUT a good motor control foundation, you can have someone who ends up speaking really rapidly or doing other things to cover their lack of motor control. You want a specialist who will get in there and make sure she has jaw stability, etc. etc.

 

And yes, 50 words, actual words, is the bare minimum for age 2. Even EI around here will kick in at that point. I don't know what normal is. That's great that you're signing with her. Read to her a lot. Put on audiobooks and get language going in the background. Play with her and interact with her. Encourage any correctly formed sounds she does have by having her say them to elicit things. If mimi or me is coming out well, then have her say ME for everything. Don't give her anything by grunting or pointing. Require her to use whatever accurate speech she does have. Don't try to elicit more complex speech. Just use the things she can say accurately. Let the new therapist help her to move forward.

 

The therapist will appreciate the signing you do with her. Ours especially liked to use colors, numbers, and letters as well as basic words.

 

Btw, I'll be extremely controversial here and suggest you consider the role of vaccines and think through that for the future. Not sure if that has been an issue for you, but it's something to think about.

[celticadea]

Being able to say yes and no are great! It took us forever to get her to say no....It felt sooooo odd to work so hard to teach my kid to say no! lol

 

One thing to remember is that if it is apraxia, it's not a speech delay, it's a speech disorder. No amount of growing will fix it. Only proper therapy. In a delay, their speech develops in the same method as other kids just at a later time table (ie able to say dada/mama first then work up to things like ball, cup, then harder words etc). With a speech disorder, besides the onset of speech being 'delayed', the order they learn to speak is 'out of order'...for example, my daughter's first word approximation was 'guck' for stuck (wanted out of her car seat on a long drive!)...but couldn't say dada til she was over 2 years old and couldn't get "daddy" until just a month ago (although she had done it for about a week when she first started saying 'dada' but then lost it). I don't think that not making noise when she's trying to make a word would be a speech delay type of thing.

 

I don't know how your particular ECI (I'm guessing that's the same as my Early On) works, but you should be able to request an updated eval if you don't have one coming up. If you don't think she's making progress, it's a good reason to re-evaluate and change goals or methods. Ours was automatically done at 6 mo into the program which happened to be at 2 years. In my case, the SLP wanted to do the special ed eval because she didn't feel that my dd was making enough progress. This eval qualified her for special ed and moved us from 2x's/mo to 1 hr/wk with the SLP and an extra 3hrs/mo with the special ed teacher who comes in to work on speech stuff, OT stuff, development stuff, etc....

 

Also, at least here, the EI ST is just done differently than private. EI is more play based and meeting the kids where they are. Private will be more intense. At very young ages, too intense may not be a good thing anyway. Little ones often don't respond well to 'work' but eliciting speech and imitation of sound effects and exclamations all work up to trying to use speech. Everything I've read agrees that Apraxic kids need frequent, one-on-one therapy sessions to see benefits. So it'd be great to get them to up their frequency.

 

Comparing to her friends is a good way for you to do a little sanity check that there really is something there, but try not to get too hung up on it. Every kid is different anyway and especially with speech delays/disorders. A friend of ours who's only a couple months older than mine could say "aurora borealis" (seriously!!) and mine still couldn't say 'mama'. It was pretty disheartening but good motivation to fight for what she needed.

[PeterPan]

One thing to remember is that if it is apraxia, it's not a speech delay, it's a speech disorder. No amount of growing will fix it. Only proper therapy.

 

 

Amen!!!!

 

Just for your trivia, PROMPT sessions are less frequent (typically only once a week, we now go every other week) but extremely potent. My ds goes through a session and then crashes. Yes, they use play for the entire session. There are no flashcards, no imitation. It's all the therapist eliciting the target and applying the PROMPT (input) that tells the brain how to move. Sound comes out, rinse and repeat. So it's very intense, because they literally spend 1-2 hours sitting there with a person touching their face and getting hard sound after hard sound after hard sound.

 

What's interesting is that the kids actually LET them do this. It's sort of a weird dynamic I never anticipated going in. My ds was good as gold for weeks and weeks and then started bucking. The therapist basically said he had gotten what he wanted, had gotten as much speech as he felt he needed, and after that he was ready to be done. Since of course WE knew he needed more, lol, we had to get over that hurdle. ;)

 

There really is a lot of psychology in how she handles him. Yes it's work and intense, but I wouldn't say he hates it. Actually the golden moment was this past fall (newly 4, after 2 years of therapy), when he CRIED when our therapy session ended! That's when we knew he was ready to go to double sessions, hallelujah! That cut our driving down, so we could go less often and still make progress. Now we do double sessions every other week. I follow through at home. His motor control at age 3 was at the 50th percentile on the VMPAC. At age 4 it was at 75th %ile. Since most of his preschool skills scores are in the high 90s, we know we need to work hard to get his speech to match what's going on in his head. VMPAC is motor control, and from there you have articulation. So in our case we're always working our butts off to keep his motor control (and then articulation) ahead of what he's wanting to say. It's nuts.

 

So yes PROMPT will be like play, yes it's intense, but no in general the dc is usually fine with it. The therapist will have experience with SN kids (since most kids with apraxia have more than just the apraxia going on) and she'll know how to connect and make it work. No fear of that should keep you from therapy. PROMPT is astonishingly powerful to unlock their speech, and it will be FUN for the child, honest. We take games and toys and they PLAY and he comes out speaking better. Last week he took his new cash register and an Usborne book of hidden objects. We've taken hunting toys and Thomas the Train and board games and all sorts of stuff. She can turn ANYTHING into therapy. He even took Hexbugs one week, hehe. She loves working with him, and he loves the things he gets to do. Playmobil is AWESOME for speech therapy sessions, because it's social and has so much language. It's amazing to watch the sessions. If you don't sit in, then at least videotape them so you can get inspired for how to carry it over at home. At least I find it inspiring. :)

[knittingmama]

Alright, so this PROMPT therapy sounds awesome. Would I just find one, call, and then see if I could get insurance to cover? And they would evaluate her, right? I've pretty much always done everything with the ped's referral, so stepping out on my own feels a little strange. ;-) I can't imagine her making that kind of progress. How awesome that has to be to watch!

[knittingmama]

Being able to say yes and no are great! It took us forever to get her to say no....It felt sooooo odd to work so hard to teach my kid to say no! lol

 

One thing to remember is that if it is apraxia, it's not a speech delay, it's a speech disorder. No amount of growing will fix it. Only proper therapy. In a delay, their speech develops in the same method as other kids just at a later time table (ie able to say dada/mama first then work up to things like ball, cup, then harder words etc). With a speech disorder, besides the onset of speech being 'delayed', the order they learn to speak is 'out of order'...for example, my daughter's first word approximation was 'guck' for stuck (wanted out of her car seat on a long drive!)...but couldn't say dada til she was over 2 years old and couldn't get "daddy" until just a month ago (although she had done it for about a week when she first started saying 'dada' but then lost it). I don't think that not making noise when she's trying to make a word would be a speech delay type of thing.

 

I don't know how your particular ECI (I'm guessing that's the same as my Early On) works, but you should be able to request an updated eval if you don't have one coming up. If you don't think she's making progress, it's a good reason to re-evaluate and change goals or methods. Ours was automatically done at 6 mo into the program which happened to be at 2 years. In my case, the SLP wanted to do the special ed eval because she didn't feel that my dd was making enough progress. This eval qualified her for special ed and moved us from 2x's/mo to 1 hr/wk with the SLP and an extra 3hrs/mo with the special ed teacher who comes in to work on speech stuff, OT stuff, development stuff, etc....

 

Also, at least here, the EI ST is just done differently than private. EI is more play based and meeting the kids where they are. Private will be more intense. At very young ages, too intense may not be a good thing anyway. Little ones often don't respond well to 'work' but eliciting speech and imitation of sound effects and exclamations all work up to trying to use speech. Everything I've read agrees that Apraxic kids need frequent, one-on-one therapy sessions to see benefits. So it'd be great to get them to up their frequency.

 

Comparing to her friends is a good way for you to do a little sanity check that there really is something there, but try not to get too hung up on it. Every kid is different anyway and especially with speech delays/disorders. A friend of ours who's only a couple months older than mine could say "aurora borealis" (seriously!!) and mine still couldn't say 'mama'. It was pretty disheartening but good motivation to fight for what she needed.

 

Oh--I forgot that they are discussing having some sort of teacher coming out twice a week. That will certainly help, I think. No mention has been re-evaluating. My service coordinator (I think that's what she is called) is supposed to be coming soon to update our service, so I could also see if they could start coming out more often. I'm in a fairly rural area, so I think that makes a difference on what they are able/willing to offer.

 

So much of this just seriously sounds like my little one. Her progression is coming all over the place from how my kids normally progress in talking. Like finally starting "baby talk" after she is able to say a couple of words. Or putting "hi" with some words, but still not saying other basic words.

[PeterPan]

You think that's awesome? You ought to hear my story about our first day... He went in with NOTHING. Moderate verbal apraxia, when she evaled she got 2 sounds (m, a) and one word (mama) that he never said. Quiet as a church mouse, never a peep, lost him in the house, newly 2. She sits him down, or more accurately STRAPS him down in the chair, puts glitter glue containers (or was it the peg towers? I forget) and gets him wanting to play. Oh yes, it was the peg builder things. So you play with those by stacking. They're in front of him out of reach, but he WANTS to play, voila communicative intent. She applies the PROMPTs so he can say the words to receive each piece. He says PUT, ME, ON, MORE, DO... OVER AND OVER AND OVER AND OVER for an hour!!!!!!!!

 

Tell me that's not a miracle. Tell me you wouldn't drive hours for that. Never thought twice after that. Nothing to unlocked speech, just by touching him. Now not all kids are that time table. Some take a LONG time (hear me sighing). I get it. But that was our story. It's why I know it works. It's why I tell people get what works and DON'T stay with a therapist who CAN'T get it to work. She touches my boy and he speaks. She teaches me how to do it, and he goes from not hitting the target to hitting it. I can do it at home. We do it all throughout the day while we play and work, just integrated into our lives. We do it in our preschool time and when he wants a snack and when we dress or kiss or play. It's so easy, so natural now. It was really stressful the first couple years. I ballooned up from, as a WTMer at the convention aptly put it FAT food (fast food), hehe... But he speaks and it's coming.

 

So that's my miracle. It's worth driving for or doing whatever you can do to get. Yeah, you have to be a bit of a Tiger Mom. (I finally got that book for a quarter at the library btw, need to read it.) Don't fret it though. They're not going to think twice. You go through the ped to get the insurance stuff worked out. Find the SLP you want, get on their waiting list, and they can tell you how to get coverage through your insurance.

 

Keep us posted on how it goes and what you find. :)

[knittingmama]

Well bummer. The closest PROMPT provider is at minimum a 6 hour drive away, each way. I don't think there is any way I can do that. But after reading your post. WOW!!! I cannot even imagine her saying all of that. Our speech therapist right now just tries to get her to say "go" when they're playing, and she flat out ignores her. I just cannot fathom that kind of result. It gives me chills. But seriously, 6 hours away--we'd nearly have to move there. And I have no idea what I would do with my older kids. sigh It looks so good.

 

My oldest at one point went to OT at a really awesome place. I'm wondering if they might be a good place to look into? We have an appointment with the ped at the end of the month, so I think I'm going to push for a referral. I am going to mention the PROMPT idea to our ped and see what she thinks, though. I have known this ped since long before I had kids, so I trust her opinion.

[knittingmama]

And I wanted to mention, too. Thank you so much, both of you, for talking me through all of this. It helps so much just to talk to someone who understands. We've had such a different road with this baby than we've had with our other kids, and everyone just says, nah, she'll talk when she's ready. Well, she does seem ready. She just doesn't talk yet. And I think she's starting to get frustrated. She'll yell at me, but I just don't know what she's saying.

[PeterPan]

A few things. One, PROMPT has only been around 10 years, so the ped may know nothing about it. Two, if the person isn't on the PROMPT Institute website, they're not doing PROMPT. (You'll meet people claiming to, and they're not, they're prompting, not the same thing.) Three, you're not without options. In that situation one option would be, well yes to move. If it's severe apraxia, you probably would move. I've met people who moved from another state to be near our therapist. There also happens to be an amazing school for the deaf that also lets in dc with apraxia, so it's a double win for them. But yes, some people move. More realistically (besides closer options that I don't know about for you) is that you go once a month and stay for a couple days. Talk with the therapist. Just call her, see what's in the pipelines. It really depends on how good she is. If she's level 1, I'd be on the line. If she's certified, that's another ball of wax.

 

Our therapist has had clients come in from out of state and do a week of intensive therapy then go home for several months. Rinse and repeat. The mom gets taught how to carry it all over at home. The first 6 months were mostly spent picking my boy's jaw up. Then we spent months on basic things like /m/, /t/, /p/, oral tone. The prompts for many of the early sounds are easy, easy, easy for a parent to learn. Later ones (like /r/ and /l/) are complex, but a lot of the beginning ones are easy. So just talk through it and see your options. They want to talk with you, so call them. :)

 

Some people have gotten the ps system to be required to get a ST trained in PROMPT, because the other therapies weren't working. Takes a lawyer and work, but that's another approach.

[knittingmama]

Yes, the therapist is certified. Well, I have found 3 who are certified, and then there's one in the same city as my sister who is level 1. The one in the city with my sister would give us a place to stay at least. The others we would have to stay in a hotel. I will be calling tomorrow and seeing what I can learn. As long as they don't care if I call without a referral, I'm all over it! ;-)

[PeterPan]

Unless the level 1 person is on path (like registered, definitely going) to get her level 2 training and then do the bridging and get certified, I'd go for the certified if you at all have the choice. It's not rocket science. The better trained person is going to be lightyears better, and they both cost the same amount.

 

I'm glad you're finding some options. Yes, they'll be happy to talk with you. Ours talked with me for an hour on her dime. You *want* to talk with them. You want to talk with them ALL and feel pretty confident before you start, so you're not having to jump a bunch. They're also likely to have a waiting list to get in.

[RootAnn]

My youngest doesn't have apraxia, but he didn't have even 10 words at just-under-3. And the only time he would say them was repeating after me.

We had him evaluated after he turned 3 by the local school district at the request of our pediatrician. (The 'evaluation' wasn't very professional. They used a form for under-3-yr-olds and used some iPad app to make notations. I completely disagreed with their interpretation of the sounds he was making. One lady would repeat what she thought he said for the other to write down.) There was no question he qualified for services, but they only offered twice per month (or 3x/month if he went into full time pre-school). They admitted we were already doing everything they recommend to do at home. If I hadn't done some homework beforehand, I would have been really upset.

 

Something to think about doing while you are calling around & finding out more is getting her on some essential fatty acid supplements like fish oil or flax seed oil. It may not be a miracle drug, but I'm convinced it has done some really awesome things with my son.

 

We started giving my son flax seed oil and within a few days, he said his first spontaneous words (his first was ice, his second was 'chocolate'). His progress has been slow & steady since then. About a month ago, he put his first two-word phrase together. (It was either "No, YOU" or "Me Show.") This morning, he knocked on the locked bathroom door and said, "Let I come in!" A FULL SENTENCE. He's just over 3 1/2 now and his spoken vocabulary is probably closer to 200 words. :hurray:

[knittingmama]

I have to be really, really careful as to what I give her supplements-wise. She has horrible, severe food intolerances that have brought her near to shock several times. We have found a fish oil she can take. She has been on it since shortly after Christmas. Around that time we also finally found a probiotic she can take, and I think that's why she can take the fish oil. She cannot actually eat fish. In fact, she only has around 8 foods she can safely eat. I do think that nutrition has played a part in all of this, as does our dietician who we see once a month. We thought that once we had her nutrition figured out that she would take off in speaking too, but she hasn't like they were hoping.

 

that's awesome though that your son is now at around 200 words! Yea for you for sticking with him and helping him get what he needs!! I love hearing stories like this as it makes me feel so encouraged that we will get there eventually. :D

[PeterPan]

On the apraxia kids list people can talk nutrition as well. Yes, the fats and nutrition can make a huge difference. My ds takes flax oil, and it's essential for him. Some people on the apraxia kids list use a supplement called Nutriveyda. I decided not to, but some people rave about it.

 

My nutritionist is amazing with food allergies and getting people to be able to eat more foods. (including a friend who was down to less foods than your dc) If you hit a wall with yours, I can give you a name. I've sent a lot of people to her.

 

For my ds, the flax oil is almost as important as therapy. Given her nutritional situation, I'd probably be working on that more than driving 6 hours each way. Apraxia in girls would be much less common in boys. In fact, that was my first question when I read your thread as to why you even had a girl with apraxia. I think it's largely boys.

[knittingmama]

Well I have emailed the therapist that I found, and she's almost done with certification. I will at least talk to her and see if she thinks she can offer us anything.

 

I really don't think I want to give flax oil right now. She has gotten horribly sick with every single grain we've tried, and I would be terrified of trying flax. We see our dietician this week, though, so that's definitely something I will mention to her. You've given me a lot to think about. The dietician we have is really awesome with seeing food's relationship to development, so I think she'll be a good one to ask. I might also mention it when I talk to the therapist over the phone.

 

That's interesting that apraxia is more with boys. And it may be that it's not what she has. It's just something that the speech therapist threw out there.

[RootAnn]

Many people think fish oil is better than flax. OhE's son tolerates flax better. I already take flax, so it was easier for me to add to my kid's supplements than fish oil.

Glad you have gotten in touch with someone. Ask lots of questions! (I read up on apraxia with books from the library. My son didn't match with the characteristics. Check your library for Up To Date books on speech & apraxia.)

[celticadea]

I'm glad you have some good resources for diet and I hope that SLP will work out for you. Good luck!