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rainbowmama

Profound Speech Issues

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My kid is intelligible. People understand him. He was recently diagnosed with a severe articulation disorder: the gfta-3 placed him in the lowest .1%. He had his hearing tested at birth and as a preschooler, but it came back normal. He can play music by ear. He tests at the top 1% on standardized tests. However, given the severity of the articulation disorder, I've asked to talk to his pediatrician about underlying causes. Is there anything in particular I should want tested? Has anyone else been through this?

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Most SLPs are not going to be trained completely to diagnose apraxia. There's a very specific test (the VMPAC) you'd like run. A PROMPT therapist (SLP with extra training in apraxia) can run it.

 

Did the SLP give you a % intelligibility? And how old is he?

 

Did the SLP run screening tools for ASD or anything else? It may be the SLP saw flags for developmental issues and is wanting the referral for evals. 

Edited by PeterPan

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Child is eight. I did not get an intelligibility %. I just don't notice anyone ever having trouble understanding the kid, and I don't have problems, either. The SLP did not run anyting for ASD or anything: just recommended that I get a consult for an ortho earlier than later (dentist wanted to wait until more adult teeth came to see if the spacing issues resolved.)

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I just saw this..... okay, my 9-year-old also scored really low on this test this year. I was very surprised. He is also intelligible!!!!!

 

Okay, here is what the speech therapist said: a new version came out, and she had to count off multiple times for basically the same error. She said the scoring would have her mark off multiple times, where in the past she would not have marked off the same error so many times.

 

Anyway -- basically, he does really have delayed articulation for a 9-year-old, but it is not objectively that bad. It doesn't effect his ability or desire to communicate. My older son would get so frustrated but my younger son doesn't get frustrated.

 

Anyway -- I would ask the speech therapist if it could be the new testing guidelines? I also could have misunderstood the speech therapist, I am not 100%.

 

Anyway -- my son has autism and so I don't have an "I wonder why?" situation.

 

With my older son, who also had severe articulation issues, there was never really "a reason." And he talks fine now. But -- he had difficulty with learning to read and with handwriting. He had trouble telling apart the sounds of consonants and that was a big reason for his articulation being poor, but then -- what was the reason for that? -- who knows.

 

If you have reading issues look at dyslexia programs on the sooner side, though.

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Child is eight. I did not get an intelligibility %. I just don't notice anyone ever having trouble understanding the kid, and I don't have problems, either. The SLP did not run anyting for ASD or anything: just recommended that I get a consult for an ortho earlier than later (dentist wanted to wait until more adult teeth came to see if the spacing issues resolved.)

 

Sounds like the teeth are part of the problem? I wonder if the teeth are one of several mild skeletal or facial dysmorphisms that prompt referral for other disorders. There are many things that prompt broad screenings that don't pan out to be anything, but they are often the only way serious things are discovered when there is no family history. Dysmorphic features are one of those, and dental issues fall into that bucket. Many "dysmorphic" features are benign, and many are attractive--don't get hung up on the term. It's surprising how many little things about teeth, jaws, ears, etc. are associated with potential issues.

 

I am underlining and italicizing the salient details because I don't have time today to go back and be less meandering...so sorry!

 

My weird story...my son has some articulation issues. Weird hearing stuff (auditory processing problems), but also very musically inclined and can play music by ear. High IQ. Clumsy but until recently, not clumsy enough for a global diagnosis of developmental dyspraxia or developmental coordination disorder. History of feeding issues (very slow eater, would fatigue eating as a baby, etc.). We finally had a PROMPT eval after being blown off by a standard SLP who supposedly knew PROMPT and is an apraxia specialist. Well, he has "apraxia" in the sense that his issues are motor based, and in his case, it comes from a lack of jaw stability. The term apraxia is pretty broad and normally associated with kids who cannot produce speech. It's really just about any motor issue associated with speech. 

 

Anyway, my kid has a high, narrow, arched palate and a mess of a mouth (supernumerary teeth also!). He is a mix of head-to-toe too tight or too loose ligaments and loose, dislocate-on-their-own joints. We finally got a connective tissue disorder diagnosis (one that has some serious implications beyond joints and teeth). Some of the joint issues were not readily evident when he was little because they didn't hurt, and we didn't hear or see the joints going into and out of place (even therapists didn't see it readily). 

 

You might want to peruse some good connective tissue sites and see what symptoms might describe your son. Many of the connective tissue disorders are benign or have far more benign presentations than severe ones, so I don't want to scare you. Diagnostic criteria for several have been tightened up to catch the serious stuff, and then the less serious stuff falls into a different diagnostic bucket now. 

 

Because of our unusual experience (and the more common experience of friends whose kids have pretty benign connective tissue problems), I would not blow off a suggestion for some kind of developmental issue related to teeth and articulation. One of those terms or even two doesn't seem odd. But putting developmental with the other two makes me think the SLP might be noticing something that she can't quite explain, but she knows it warrants attention or that a developmental ped, etc. might sort more of it out. "Developmental" often rings bells in parents' heads about IQ concerns or autism, but it is a broad term in therapy circles. Getting the correct referral is necessary though, so you might want to ask the SLP questions or do some digging on your own.

 

Key terms: joint hypermobility, Marfan Syndrome, Ehler's-Danlos Syndrome, Loeys-Dietz Syndrome, Mixed connective tissue disorder, polycystic kidney disease

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Child is eight. I did not get an intelligibility %. I just don't notice anyone ever having trouble understanding the kid, and I don't have problems, either. The SLP did not run anyting for ASD or anything: just recommended that I get a consult for an ortho earlier than later (dentist wanted to wait until more adult teeth came to see if the spacing issues resolved.)

 

Oops, this is what I meant to quote. 

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I've seen stats that a high percentage of kids with autism with "articulation" problems are actually having praxis (motor planning causing speech problems). It's very common to have overall bits of dyspraxia in spectrum, but getting the praxis component of speech problems diagnosed is, as Kbutton found, challenging. SLPs are given very general training in it, so you'll hear them saying stupidity like "when he could do /p-t-k/ so I figured it wasn't praxis..." Seriously. Or another, who specializes in autism and has 30 years of experience and who should know better, literally told me that she would diagnose apraxia AFTER MY KID STARTED TALKING. She was relying on outdated generalizations that you could diagnose apraxia based on how the kid sounds after he starts talking. This too is hogwash and incorrect. 

 

As Kbutton found, there's a range of how kids with praxis issues will present. They can quantify oral and verbal motor planning with a VMPAC. There's no reason to be left guessing or going on vague generalizations. And it's correct that if a person has only done the intro level of training for PROMPT that their understanding is superficial at best. You want to look for someone certified or who is at least working on getting certified and committed to the process. It takes a number of years to get. 

 

We had an SLP who kept talking about his teeth, but frankly it was to cover up that she had nothing contribute and didn't know anything about what was going on. They don't have anything to say about the actual problem, so they talk about the teeth. Maybe the teeth are a problem, but they aren't THE problem, the main problem. 

 

I'll just toss out something here. Sometimes the presentation is not so much poor intelligibility, but it's that the kid is having to work SO HARD at his speech that he's talking very little. So to say well people don't ask him to repeat things might also reflect that he's not talking a lot. I don't know, just a thing that can happen. There's not just one way kids roll with speech problems. Some will hyper-talk and go really fast. Some will just talk a lot less. Some talk anyway and are just oblivious to the social feedback of their low intelligibility. My ds was that last category, on the spectrum and not noticing that people were picking on him or that he was not intelligible. But for a kid to be very self-aware and naturally maybe talk less or recede, that would make sense. We're talking about a whole person here and it's going to affect them as a person.

Edited by PeterPan

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He talks a lot, and very quickly. His SLP says that children at eight who still have articulation disorders will score very low, just because all of their sounds should be in by now. She also thinks that he has some anatomical issue causing the articulation issues, especially possibly a tongue tie. I took him to the dentist, though, and the dentist couldn't find anything. We have an ortho consult coming up. On the official treatment plan submitted to insurance, it estimates therapy taking about six months. In conversation, she says that she think speech therapy might b needed as long as the unknown anatomical issue exists. I am in the process of scheduling a second opinion, but I'm feeling pretty discouraged.

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He probably has apraxia. That would be a way it presents. You go to the PROMPT Institute website, use their provider locator, and call everyone within say a 3 hour drive. I drive 2 hours each way, have for years. Regular speech therapy is worthless, totally worthless, for the motor planning problems of speech. Your SLP is already telling you she doesn't know jack how to help him. 

 

Look for someone certified in PROMPT or who is at least working on getting certified. A level 1 trained person doesn't even know enough to eval correctly, let alone implementing the full methodology. I know as much as a level 1 person. Seriously.

 

Yes, if the issue is motor planning, then one way he'll mask it is by talking very quickly, which covers over his lack of control. A PROMPT-trained therapist is someone who is an SLP who has additional training in the motor planning of speech. It's a really specialized thing, which is why I have to drive. When I started, it was hard to find. Now it's getting more common, as more SLPs get trained. They have a test, the VMPAC, and they can test his oral and verbal motor planning to demonstrate whether there is a motor planning problem underlying the speech issues. Without that, you're just guessing.

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I would read about tongue jaw disassociation. It can be a retained reflex

 

Also search for a very good SLP who specializes in aticulatio to give you a better diagnosis ans speach recomendation. They all specialize in different things.

 

If your child is it inteligible but you want to work on fluency and biofeedback you might consider forbrain. I don't have experience with it but my nephew had huge success with it.

 

Sent from my SM-N910V using Tapatalk

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