Helping 3 year old with phonological disorder

[SeaConquest]

My youngest DS (turned 3 in August) has been in speech therapy since he was 2. He qualified for an IEP for speech with the school district, as well as for private therapy through insurance. He currently gets therapy for 40 minutes 3 times/week. He also attends a very high quality preschool M-F from 9-1.

He talks nonstop (!!!), and has a ton of expressive and receptive language. The only issue is intelligibility. He can produce many sounds above age level, but still drops a lot of middle and final consonants and puts sounds in the wrong places. He is also an incredibly stubborn/strong-willed personality, and is becoming resistant to working with me/his therapists on sounds.

He enjoys using the iPad, and has been playing around with Reading Eggs and Teach Your Monster to Read. He says that they are too hard for him, and I would tend to agree with him. He doesn't seem to be picking up phonemic awareness as quickly as his older brother.

How can I help him? He doesn't want to work with me to produce sounds, but he will use the apps. Are there some that would be more appropriate for him, given his phonological disorder? Other than the Leapfrog videos, anything that you recommend to build these skills?

Thanks so much.

Edited September 10, 2016 by SeaConquest

[desertflower]

I'm not an expert on the subject, but I have been using a book titled Phonemic Awareness in Young Children: A Classroom Curriculum for someone I know who has a speech problem all this person's life.

 

I really like the book. So far most activities does not require a bunch of kids to do together.

 

This book was also recommended by another well trained minder.

 

I'll be following, so I can get more ideas.

[Monica_in_Switzerland]

No real ideas, but he might like the games Endless Alphabet and Endless Word Play.  They are a little lower level than Teach Your Monster but equally cute and silly.

[SeaConquest]

No real ideas, but he might like the games Endless Alphabet and Endless Word Play.  They are a little lower level than Teach Your Monster but equally cute and silly.

 

Yes! I forgot to mention that he has those and loves them. Thank you.

[MistyMountain]

I used a sounds of speech app. It shows what the mouth looks like for various sounds. My ds was like that and he had a really good speech therapist that did something similar to LiPs and it really helped his later phonemic awareness. He went from no one understanding him to actually sounding very articulate for his age now because of that. I am not sure what age you could do something like LiPs with. I am doing hearbuilder with my youngest and I think it is helping with phonological awareness. I sit with her and do it because some of it was very hard and she needed help through. I might wait till he was a little older for something like that.

Edited September 10, 2016 by MistyMountain

[PeterPan]

http://forums.welltrainedmind.com/topic/613836-iep-meeting-this-week-i-am-clueless-please-advise/

 

This is your thread from back in June where we suggested you get a 2nd opinion from a PROMPT therapist to see if there's an underlying motor planning problem.  You can have a phonological processing problem (dyslexia, which my ds has) and NOT have the extreme amount of speech problems you're describing.  What you described in your June thread reeked of apraxia and the amount of traditional therapy they prescribed and the outcome is pretty typical.  He's doing substitutions based on what he can motor plan.  It's probably a motor planning problem, not just dyslexia.

 

Maybe it's just dyslexia, because dyslexia is phonological processing.  But given his cherub cheeks, the speech delays, and the substitutions, I'd be wanting a 2nd opinion from an apraxia expert.

[SeaConquest]

http://forums.welltrainedmind.com/topic/613836-iep-meeting-this-week-i-am-clueless-please-advise/

 

This is your thread from back in June where we suggested you get a 2nd opinion from a PROMPT therapist to see if there's an underlying motor planning problem. You can have a phonological processing problem (dyslexia, which my ds has) and NOT have the extreme amount of speech problems you're describing. What you described in your June thread reeked of apraxia and the amount of traditional therapy they prescribed and the outcome is pretty typical. He's doing substitutions based on what he can motor plan. It's probably a motor planning problem, not just dyslexia.

 

Maybe it's just dyslexia, because dyslexia is phonological processing. But given his cherub cheeks, the speech delays, and the substitutions, I'd be wanting a 2nd opinion from an apraxia expert.

Thanks, OE, for your thoughts. I don't want to give you the impression that I'm ignoring your advice. Ronen has been evaluated by the SLP who qualified him for EI, his EI SLP (who had level 1 PROMPT training), the school district's two screening SLPs (who qualified him for an IEP), the SLP at Kaiser (who qualified him for private therapy -- which I sought because of the suggestions in the last thread), and his two current SLPs (one with the school district and one with a private clinic, who has level 1 PROMPT training). Everyone has agreed that he has a phonological disorder, and none have said apraxia. I'm not sure at this point what else to do. He's becoming resistant to therapy, refuses to make sounds he can do, and I'm struggling to find ways to help him. He has improved tremendously. Perhaps, my expectations are just unrealistic.

 

Also, because of the last thread, I did hire an advocate, who was helpful in formulating the IEP. He's currently getting therapy from the school district twice per week for 40 minutes. There are currently no other kids in his time slot. His weekly appointments with the private clinic are also individual.

Edited September 11, 2016 by SeaConquest

[PeterPan]

Well, fwiw, level 1 PROMPT training isn't complete at all, and I've heard other stories of incorrect diagnoses by level 1 trained people.  I would suggest you consider calling someone certified or instructor level, broadening to a less than practical drive (2-4 hours), just to discuss whether there's anything to warrant the trip.  The difference in level of expertise will be ASTONISHING.

 

Your compliance issues sound like something you're going to need behavioral help with.  For us it meant ABA.  Yu can think about the perspective of the child.  He's super, super bright, and he's only motivated to participate to the extent it gets him what he wants.  He's gotten what HE wanted (basically ability to communicate his wants), so he no longer cares to participate.  Our SLP said this often happens, and it's a hill you have to work through.  We went through a stage of it. Their lives have to be structured to where they DON'T GET what they want unless they do what you want.  

[Mom28GreatKids]

Yep, my dude with Apraxia balks at prompting for sounds/words he thinks he knows. And he is still FAR from having g age appropriate speech. We brought our behavior therapist to speech therapy and it has made a WORLD of difference in his compliance there. The woman (BT) is a miracle worker. So, I agree with OhE that behavior support might be your next step.

[SeaConquest]

I just watched some YouTube videos of apraxia, and I think you might be right.

 

This little girl is closest to how he sounds, dropping final and middle consonants -- the "monkey bars" portion is dead on.

 

 

"He's doing substitutions based on what he can motor plan." This rang especially true for me. 

 

I am going to make some calls tomorrow and see what else we can do to help him. I feel so lost with all of this. Thank you so much for sharing your experiences.

 

 

[PeterPan]

The main thing is get a certified or instructor level PROMPT therapist.  Ours talked for a full hour on the phone before we ever went in.  And if you have to drive, even a LONG WAY, do it.  Your level 1 therapists can learn and continue their training. People are getting trained and access is exploding.  A GOOD EVAL, by someone really, really experienced will be worth the drive.  Then you can decide how to handle the actual therapy.  You'll have options.  The first hurdle is getting an accurate diagnosis.

 

I'm glad you're moving forward with this.  It's a hard transition, and you're probably going to have some more hard transitions.  Waiting and hoping don't change anything.  Action, INFORMATION, that makes a difference.  

 

If you need help talking through your options, tell us where you are (even privately) and we'll go through the map with you.  Their provider map is really screwy right now.  Hopefully you'll find someone who is certified without a problem.  Some of their listings just are not complete, so it's ok to call someone farther and say hey I really like you but also is there anyone closer to me I don't realize who is working on getting certified...  

[PeterPan]

Yeah, that video is, well I can't watch it.  Look at the cherub cheeks.  You can hear she's not moving her mouth, and it shows in the lack of oral tone.  And yeah, odds are if that dc had traditional therapy she has "sounds" and they're like see, she has sounds, it's just a phonological disorder.   :glare:

 

So yes, make the call, flee the ship.  People in our state drive 2-3 hours each way for therapy.  This is a rare problem even in the world of speech problems, and it's worth driving for an EXPERT.  You'll get more results in less sessions with the expert, and they'll teach you how to do it to carry it over at home.

 

Fwiw, if it is apraxia, well anyways I guess get the eval first and then cross that hurdle.  Basically I was just going to say you'll have less therapy sessions (hallelujah) but want to have 20 minutes a day where you're working with him.  Really, if you're doing PROMPT, the more access you have to him to work on the goals the better.  Has he had a private psych or developmental ped eval?  With the level of non-compliance you're having, that's what I'd be wanting next.  Then you could get some behavioral services in the home, get that going, and you'd be another 20 minute time slot in that.  You'd be fresh because they'd be doing some of the work.  

[Lecka]

Both my sons had/have phonological issues, of the kind helped by the speech therapy that is similar to LIPS (and traditional speech therapy).

 

They are nothing like the girl in the video.

 

Just for a data point, lol.

[MistyMountain]

My ds would leave off endings and his intelligibility at 3 and 4 was very poor but that girl seems more mumbly like she is using her mouth less especially with longer phrases she tries when you can really hear that then he did. He also had difficulty making sounds but when he learned them his speech improved as well as his vocabulary because he could now say things that were too difficult. When he learned sounds he would often be disfluent with them but he did not have as much difficulty as the monkey bar thing once he worked on things. When his speech was still bad he did often not participate with his therapist especially in the beginning.

[SeaConquest]

Just wanted to update: I requested the school district evaluate him for apraxia. They brought in the apraxia specialist for SD Unified, who has advanced prompt training. She determined that he did not have apraxia. His private preschool also brought in a SLP to evaluate and also said phonological disorder and not apraxia.

 

He is now 3 years, 3 months old, and is making substantial improvement. He is going to individual speech therapy 3 times per week, and although he is still delayed, he can now say a huge number of new sounds (in the right places too!)

 

He has also been enjoying Reading Eggs. Thank you for all the advice and support. :)

[Lecka]

Yay, awesome!!!!!

[Daria]

Just to clarify, the kind of phonological disorder being discussed here, is a form of articulation disorder.  It's different from the phonemic processing problems that go on in dyslexia, although there are many kids who have both.

 

Apraxia is one form of speech disorder, but kids can have difficulties for intelligibility for other reasons as well.  SLP's look for the patterns in kids' errors, and watching their behaviors when they struggle, as well as other oral motor skills, to distinguish between a kid who has apraxia (difficulty initiating and planning for movements of the articulators), articulation (difficulty moving the articulators into certain positions, or sequences of positions), or phonological processing disorder (difficulty distinguishing between, and producing similar sounds).  

 

 

[Crimson Wife]

A couple of books that I had to get for school that are pricey but useful:

 

Eliciting Sounds by Wayne Secord.

The Late Eight by Ken Bleile