Speech therapy

[bethben]

I have a 12 year old who still has pronunciation problems with "L" and "R".  He went through 3 years of speech therapy without having this problem corrected in his day to day speech patterns.  We did all the at-home homework and last year did daily work dictating to a computer (he had to keep trying until the computer got what he was saying close enough).  We gave up a little hoping it would correct itself as he got older - we also moved cross country so left all of the regular speech therapists (in the school) that he was used to.  

 

There are times his articulation is so bad that I can't understand him even after repeated attempts on his part.  His articulation seems to be getting worse.   The thing is, he can pronounce these letters, it just doesn't carry over.  He tends to not be a big talker and then spurts out all of his ideas really quickly.  He gets frustrated with me when I don't understand him or  try to get him to pronounce his "Ls" and Rs.  He also gets irritated when I tell him to slow down.  He's getting into those 12 year old years so mom's input is becoming suspect.   We don't qualify for public school speech assistance since they have specified that it has to affect his academic performance.  It doesn't.  He can usually annunciate well enough for people to understand what he is saying when he has to speak up in his co-op class.  I've listened in at times.

 

So, do we do another round with speech therapy at $50 a 1/2 hour - 4-8 times a month?  I want him to grow up to be an understandable adult - I'm not sure this even bothers him at all.  

Edited November 3, 2016 by bethben

[Arcadia]

My dad and my brother has that problem with L and R with both English and Chinese. I have a "heavy" R problem.

 

My dad is a naturally slow speaker so people could understand and guess easily what he is saying. My brother had braces from 12-16 years old and his pronunciation got much better.

 

For my extended family, it has to do with the way we roll our tongues (all native chinese speakers). So we do have to put effort when doing public speaking or oral exams.

 

It is hard to tell if continuing speech therapy would be worth it for your child. My parents opt for speech and drama class instead. My brother would have quailified for speech therapy since his teachers had trouble understanding but that resolved with braces.

[Clemsondana]

We're on year 5 of speech therapy and are finally fixing Rs. We go through a university, so we have a prof overseeing our therapy...I think she's had to work to figure out new things for us. One of her recent suggestions was to try to have him really focus on self-correcting Rs for 5 minutes at a time, 2-3 times per day. The short sessions are less frustrating for everybody. Good luck - I know how frustrating this is.

[kbutton]

Do you have PROMPT available within an hour or so drive? I would recommend an evaluation with a PROMPT therapist. My son has apraxia of speech, but not the classic, "can't speak" kind. He makes the wrong motor movements for the sounds he makes. It's my understanding that it can get worse over time, and it certainly did with my son. A conventional speech therapist with a reputation for working well with kids with apraxia totally missed his case, and then he started losing speech sounds he had been able to make. 

 

PROMPT has helped a great deal!  

[Black-eyed Suzan]

I second the PROMPT therapist recommendation. My son had 2 years of speech therapy for articulation and still could not make the R sound in any context. We've been working with a PROMPT therapist for close to 3 months and are seeing results. We drive 1.5 hours each way.

 

Another poster here suggested that my son may not hear his own speech errors. His brain corrects it for him. It makes self correcting very difficult. The benefit is that he is not self conscious about speaking.

[Elizabeth 2]

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Edited November 5, 2016 by Elizabeth 2

[Dmmetler]

I second finding someone trained in Apraxia/dyspraxia. I am 44 and still do not reliably have my /r/ sounds (and when I'm tired, I lose /l/ and /s/ as well. In my case, my brain hears what I mean to say, not what comes out, so in many ways, I had to learn many sounds the same way someone who is deaf does-by feeling the position of my tongue, etc and learning to control that, because I couldn't rely on my ears to monitor.

 

Years of speech therapy for articulation improved things, but never completely. The best gains were when I had a therapist who was very experienced in teaching students who had severe hearing loss from birth. Mostly, I learned to talk around those sounds and improve intelligibility in other ways. I was in my 20's and a grad student when I was identified as having dyspraxia, including dyspraxia of speech. I haven't bothered to try to find a therapist for me at this point, but having those sounds not remediate reliably through speech therapy is a major red flag that the problem is potentially motor, not articulation.

[kbutton]

I had to learn many sounds the same way someone who is deaf does-by feeling the position of my tongue, etc and learning to control that, because I couldn't rely on my ears to monitor.

 

dmmettler, your story is very interesting--it sounds so much like my son. Thanks for sharing. He has global motor issues, but not enough for a global diagnosis (we think it might be connective tissue disorder). 

 

For those not familiar with PROMPT, the therapist touches a person's face and jaw to help them feel the position of their tongue, jaw, lips, etc. They will also do work to help muscles that are too loose/too tight (in my son's case because his brain is recruiting muscles other than the "correct" ones in order to make the sounds). If using your breathing to talk correctly is a problem, they work on that too. And often feeding issues. It's pretty all encompassing.

[kbutton]

Another poster here suggested that my son may not hear his own speech errors. His brain corrects it for him. It makes self correcting very difficult. The benefit is that he is not self conscious about speaking.

 

Do you know if this is common with kids who have speech issues? Has your son had his hearing checked with an audiologist? I have been wondering if my son has conductive hearing loss (it makes it harder for you to hear your own voice--if you plug your ears, you can listen to yourself, but conductive hearing loss makes this more difficult). Anyway, my son has CAPD, but he can play piano by ear and has pretty normal hearing from sensorineuro testing. We recently realized that the audiologist did not test his conductive hearing (#$%^!!!). Anyway, what you are describing is what a friend told me happens with conductive hearing loss. Argh!

[redsquirrel]

IME, It's difficult to find a PROMPT therapist who works with older kids.  I have searched and searched for a PROMPT therapist who will agree to do therapy with a kid beyond pre-school age.  I was willing to travel within my state, NY and to PA for some summer therapy. Every single therapist I reached out to told me they only work with very young kids. I went through the PROMPT website to contact therapists and had no luck. And, NY and Penn are  big states with a lot of therapists. You might think I could find ONE, kwim?

 

I was told that those are the most difficult sounds and it can take a long time to get them figured out. Maybe contact a speech therapist and find out what his or her opinion is...especially with 12 year olds. I bet your kid's response is pretty common. Maybe find out if it would be better to attend for some brief 'tune up' sessions or wait until your kid is older, around 14 or 15 and maybe more self motivated.  The 11-15 years are notoriously tricky when it comes to such things. Sometimes an older kid is more willing to work with you.

 

[Crimson Wife]

Do you know if this is common with kids who have speech issues? Has your son had his hearing checked with an audiologist? I have been wondering if my son has conductive hearing loss (it makes it harder for you to hear your own voice--if you plug your ears, you can listen to yourself, but conductive hearing loss makes this more difficult). Anyway, my son has CAPD, but he can play piano by ear and has pretty normal hearing from sensorineuro testing. We recently realized that the audiologist did not test his conductive hearing (#$%^!!!). Anyway, what you are describing is what a friend told me happens with conductive hearing loss. Argh!

 

You can't have normal sensorineural hearing results with conductive hearing loss. Audiologists will typically only do bone-conduction testing if the pure tone testing shows abnormal results. See here: https://www.hearinglink.org/your-hearing/hearing-tests-audiograms/what-do-different-audiograms-look-like/

[Black-eyed Suzan]

Do you know if this is common with kids who have speech issues? Has your son had his hearing checked with an audiologist? I have been wondering if my son has conductive hearing loss (it makes it harder for you to hear your own voice--if you plug your ears, you can listen to yourself, but conductive hearing loss makes this more difficult). Anyway, my son has CAPD, but he can play piano by ear and has pretty normal hearing from sensorineuro testing. We recently realized that the audiologist did not test his conductive hearing (#$%^!!!). Anyway, what you are describing is what a friend told me happens with conductive hearing loss. Argh!

 

I don't know if it is common. My son has had a hearing screening at a local university, but not a full exam. I did not insist he be tested fully at the time, but now I wonder if I should have.

[kbutton]

You can't have normal sensorineural hearing results with conductive hearing loss. Audiologists will typically only do bone-conduction testing if the pure tone testing shows abnormal results. See here: https://www.hearinglink.org/your-hearing/hearing-tests-audiograms/what-do-different-audiograms-look-like/

I will look more closely at that. He does not seem to hear himself speak when his ears are covered (his speech degrades dramatically), which is what I was worried about (and the friend commenting is an audiologist, but in research, not clinical practice). He does have a couple of borderline scores on the sensorineural test.

[kbutton]

IME, It's difficult to find a PROMPT therapist who works with older kids.  I have searched and searched for a PROMPT therapist who will agree to do therapy with a kid beyond pre-school age.  I was willing to travel within my state, NY and to PA for some summer therapy. Every single therapist I reached out to told me they only work with very young kids. I went through the PROMPT website to contact therapists and had no luck. And, NY and Penn are  big states with a lot of therapists. You might think I could find ONE, kwim?

 

I was told that those are the most difficult sounds and it can take a long time to get them figured out. Maybe contact a speech therapist and find out what his or her opinion is...especially with 12 year olds. I bet your kid's response is pretty common. Maybe find out if it would be better to attend for some brief 'tune up' sessions or wait until your kid is older, around 14 or 15 and maybe more self motivated.  The 11-15 years are notoriously tricky when it comes to such things. Sometimes an older kid is more willing to work with you.

 

That's too bad. My son was 8.5 when he started--we were blown off two years prior by a more conventional SLP that said she knew PROMPT. She did zero PROMPT-related testing, I now know.

 

Our PROMPT SLP works with a variety of ages, but it typically skews young because they have pretty severe clients for the most part (most have little to no speech production).

[Crimson Wife]

I will look more closely at that. He does not seem to hear himself speak when his ears are covered (his speech degrades dramatically), which is what I was worried about (and the friend commenting is an audiologist, but in research, not clinical practice). He does have a couple of borderline scores on the sensorineural test.

 

Pure-tone testing has a margin of error of +/- 5 dB so a "borderline" score could actually be a mild loss. Conductive loss audiograms typically show either flat or rising configurations (as opposed to sensorineural loss, which often shows better hearing in the low frequencies sloping to worse hearing in the high frequencies). Bone conduction testing is certainly easy enough for an audiologist to do if you're concerned.

[Tanikit]

My DD5 (nearly 6) has had speech and mastication issues since she was a baby - she also went to a speech therapist from age 3 and I worked extensively with her at home, but lately she seems to be hearing less and less (or listening less) so I am interested to read this post - what was initially a C/K, G, QU, F, W, L, R, TH problem has been narrowed now to blends, L and R with C/K now recognizable but not quite correct. She is chewing better though still battles and has been underweight most of her life from eating too little - she also has no appetite and has been on appetite stimulants. My DD has never been diagnosed with a hearing problem but I have to say everything 3 times and often go down on her level and make sure she is facing me before I speak to her - I thought perhaps it was just the age she is at, but maybe there is more to it.

[kbutton]

My DD5 (nearly 6) has had speech and mastication issues since she was a baby - she also went to a speech therapist from age 3 and I worked extensively with her at home, but lately she seems to be hearing less and less (or listening less) so I am interested to read this post - what was initially a C/K, G, QU, F, W, L, R, TH problem has been narrowed now to blends, L and R with C/K now recognizable but not quite correct. She is chewing better though still battles and has been underweight most of her life from eating too little - she also has no appetite and has been on appetite stimulants. My DD has never been diagnosed with a hearing problem but I have to say everything 3 times and often go down on her level and make sure she is facing me before I speak to her - I thought perhaps it was just the age she is at, but maybe there is more to it.

 

The bold part is a lot like how my son's CAPD presents (he has other symptoms that are more definitive as well, such as trouble hearing with background noise and the rate at which he can take in speech).

 

The first part describes his speech and feeding issues also. He fatigued a lot while eating as a baby, but no one caught that there were feeding issues. He had reflux too, so it was all pinned to that. Anyway, we're finding out that his constellation of issues is also consistent with how speech and hearing issues present in kids who have a connective tissue disorder. I will also note that appetite issues are part of a constellation of things that can go along with connective tissue disorders.

 

Apparently there is a higher likelihood of having odd hearing issues as well.

 

Our evaluation for connective tissue disorder/Ehlers-Danlos syndrome is next summer (takes about a year to get in). 

 

If you are interested, here is the article I found on what EDS can look like in the speech realm. Our SLP found it very accurate for my son. http://www.newtons-online.net/histories/EDS%20Hearing,%20Speech%20&%20Languarge.pdf 

 

If any of this sounds like your kiddo, read broadly--the diagnostic criteria is the tip of the iceberg of symptoms and individual traits that can stem from EDS.

[kbutton]

Take two for the link: http://www.newtons-online.net/histories/EDS%20Hearing,%20Speech%20&%20Languarge.pdf

[kbutton]

Pure-tone testing has a margin of error of +/- 5 dB so a "borderline" score could actually be a mild loss. Conductive loss audiograms typically show either flat or rising configurations (as opposed to sensorineural loss, which often shows better hearing in the low frequencies sloping to worse hearing in the high frequencies). Bone conduction testing is certainly easy enough for an audiologist to do if you're concerned.

 

I sent you a PM. Thanks!