Speech Delay @ 2

[4Boys4Me]

Hello,

  I have 4 boys, my youngest just turned two. He is home with me all day, but has many opportunities to interact with children of all ages.  He talks constantly but only uses Ma,  Da Ba sounds.  He has maybe 5 words that he uses that anyone would be able to understand.  Until recently 90 percent of his conversations would be closed mouth.  No hearing problems (Passed)  We had him evaluated by our states early learning program.  He scored 97th percential receptive, 2nd percentile expressive.  He has qualified for services through the early learning program. Basically he has a therapist who comes an hour a week and plays with him and encourages him to make the correct sounds.  He understands 100 percent of what is being said, he repeats everything with Ma, Ba, Da.   He repeats syllables and inflections, I would love to find more research on this specific delay and new ideas as to how to help overcome it.  Can anyone recommend a resource or give more insight?

Thank you in advance

[PeterPan]

That's terrific that you have gotten these evals and gotten some interventions going!  The challenge is determining whether it's a delay or whether it's apraxia.  Apraxia is a motor planning problem, and the therapy you want to try to find is PROMPT.  Having a HUGE gap in receptive and expressive language is your big clue that it's apraxia.  So go to the PROMPT Institute website, use their provider locator, and try to find someone advanced trained or certified.  

 

My ds has been getting PROMPT since he was newly 2.  The very first session my ds went in, she touched him, did the prompts, and he spoke.  I kid you not.  Now it has been years and years of therapy and we're still going.  It's a long road!  But I'm just saying I knew on the very first session it was worth it.  If it's apraxia, you do NOT want to screw around with ineffective therapies.  All you're doing is wasting time.  It doesn't matter if they're nice.  It doesn't matter if they're trained in that other program that starts with a K.  (I'm being polite here.)  Go get PROMPT.  I've driven 2+ hours each way for years, because it's THAT WORTH IT.  

 

What you'll do when you find a good PROMPT therapist (preferably certified, but see what you can find) is get an eval to see if it is apraxia.  Then, when you have that determined, then you can decide how to do this practically.  Some people drive a long way, and some people move.  But maybe you'll be lucky and find somebody close who is committed to learning the methodology and growing as a therapist!  And really, the thing to know is that when you go to a PROMPT trained therapist their level of training is high enough that they can discriminate apraxia from just a delay.  That way you're not wasting your time with long drives and things if it's not what you need.  It's easily distinguishable with training.  

Edited April 15, 2016 by OhElizabeth

[Crimson Wife]

First thing I would do is to have an Ear, Nose, and Throat doctor experienced with ankylglossia (tongue-tie) examine him. Articulation issues can be the result of it and the pediatrician may not catch it. All 3 of my kids had it but my son was late-diagnosed because his was not as prominent as his big sister's was. It's a super-simple procedure to fix and literally takes about 30 seconds.

 

If it's not tongue-tie (or if the articulation does not improve within a few months after the procedure), then I concur with OhE about having an eval by a PROMPT-certified speech therapist.

[PeterPan]

Good SLP should have checked that too.  

[Crimson Wife]

Good SLP should have checked that too.  

 

SLP's should check but it's not mentioned in my articulation disorders textbook. Not sure if the professor will mention it in the lectures since I won't take the course until summer semester. There is a section on "tongue thrust", but from what I can tell in glancing over that section, it's a different issue than ankylglossia/tongue-tie.

 

[Syllieann]

I think it's great that you're having him checked, and you should continue with that, but it's also possible that there is nothing wrong and he's just a late talker. My 2 yo had similar scores at that age. Actually, I think expressive was the 1st percentile. He even did the thing like yours with repeating the proper number of syllables but only with one or two sounds. Teaching him to sign was incredibly helpful. He will turn 3 next month and is up to normal in expressive, though his articulation is still a little below normal. Our pediatrician checked for the anotomical issues mentioned above with the tongue and ruled that out for us. Maybe there are subtler cases that would only be able to be detected by specialists though. Your evaluation probably already ruled out autism, and you already ruled out hearing problems. If you are able to get a second opinion from a different SLP, that might help too, either to confirm there at no other issues or to suggest that there may be. Try to relax a little for the next 6 months. The book, "late talking children," helped me put things in perspective while I was waiting, worrying, learning Asl, and scheduling therapies. If he is 2 and 1/2 and hasn't started making progress, you might begin looking far and wide for other issues. Your Ds is getting therapy in the meanwhile so you're already doing something to help. I would hate to miss an opportunity to help in early intervention, but I wish I hadn't spent so much of that precious toddler time researching and worrying. Somewhere there is a balance, I'm sure.

[PeterPan]

You might just call a PROMPT therapist to sort it out.  Our SLP talked with us for an hour on her dime before we started.  There are just some characteristic patterns, things that happen.  They'll discuss with you how he eats, how he motor plans other things with his mouth, etc.  A trained therapist can easily distinguish apraxia from a developmental delay.  If it's apraxia you don't want to wait on therapy 6 months.  

[PeterPan]

SLP's should check but it's not mentioned in my articulation disorders textbook. Not sure if the professor will mention it in the lectures since I won't take the course until summer semester. There is a section on "tongue thrust", but from what I can tell in glancing over that section, it's a different issue than ankylglossia/tongue-tie.

 

Our regular SLPs were in his mouth for that and the ps SLP looked too.  Don't know when it gets taught, lol.  I'm just saying the tongue HAS to lift so they HAVE to check to see if the dc is tongue-tied, lol.

[Crimson Wife]

Our regular SLPs were in his mouth for that and the ps SLP looked too.  Don't know when it gets taught, lol.  I'm just saying the tongue HAS to lift so they HAVE to check to see if the dc is tongue-tied, lol.

 

My kids all had the clipping done before any were ever seen by a SLP so there was no need to check. I'm not sure whether the SLP's we've used typically check for tongue-tie or not.