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Things to help with preschooler's articulation


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Hi all, my DD3 has been attending SLP since she was 2. We recently had an evaluation done as part of an initial IEP meeting and she's basically scoring at 1% for articulation for her age level. She has a lot of issues with consonants. As an example, "taco" and "Costco" sound the same as she's not saying the initial consonants or the /st/ part of Costco. The SLP has made a lot of progress in getting her to say sentences and we're working on /f/ and /s/. For instance, we've gone from her asking "mo!" to "I wa mo, mommy!" Most of the homework from the SLP has been to encourage her to speak slowly and using syllables and sentences, which is definitely working, but I'm wondering if there's anything else we could be doing at home.

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Yeah, with scores that low, you're going to wonder if the diagnosis is correct. SLPs do NOT have the training to work on apraxia correctly and you'd need a specialist both for diagnosis (answering the question of whether it is, demonstrating the motor planning issues) and the treatment.

PROMPT requires significant training to do correctly (intro, advanced, and bridging courses) and there's a lengthy certification process. You can try their directory to find someone. https://www.promptinstitute.com/search/advanced.asp

Don't just ask someone if they do PROMPT, because they'll say they prompt, which isn't at all the same. If they're doing Kauffman, not the same. If they're doing flashcards, even worse. Even they got the training free from some course on the internet (yes, this is a thing), that's pretty telling.

What systems is the SLP trained in? What is she attempting to do?

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Yeah, school district just says "articulation disorder" while the SLP has mentioned apraxia before. We had some concerns about DD's hearing and were just able to resolve them over the summer.

The SLP is not PROMPT trained. No flash cards (thank goodness, can't imagine my daughter putting up with that), more like, having her do "beaver teeth" to make the F sound, and then playing a game where she has to use the initial "f". She's pretty old school but we've been going to her for many years (my older kid has HF ASD and also had a speech delay, though not articulation related) so there's a bit of an emotional connection there, for both myself and the kids.

There's several "PROMPT trained" SLPs near by, though it seems like the only certification listed is "introduction to PROMPT."  Would that be enough to effectively diagnose it? 

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First, have the child evaluated by a good pediatric dentist or ENT for tongue tie. If there's a posterior tie, it may not be obvious and until it's released, you can go YEARS in speech therapy with very little improvement (BTDT with my 2nd).

I would also recommend making sure the child can do auditory discrimination among the various consonants. You mention f vs. s and those were some of the consonants that my hard of hearing child struggled with due to her high frequency hearing loss (which we believe went undetected for at least 2 years and possibly up to 4). Her articulation errors cleared up within a few weeks of getting a cochlear implant (aside from developmental ones like /f/ for /th/).

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7 hours ago, lasulliva said:

There's several "PROMPT trained" SLPs near by, though it seems like the only certification listed is "introduction to PROMPT."  Would that be enough to effectively diagnose it? 

What happens if you widen the search circle? What I would do is find someone who is certified for the initial eval, even if you have to drive an obscene distance to get it. I drove 2 1/2 hours every week for years for my ds' apraxia therapy, so driving it one time for 3-4 hours seems reasonable. Do that eval with the BEST PERSON you can find, ideally certified. Then, depending on those results, hook up with someone closer.

And when you pick that person, look for someone who has done intro and is at least signed up for the next level and saying they want to get certified. Sometimes what happens is people talk the course to get CEUs and have zero plan on implementing it or getting good at it. No, Intro alone is not enough to make them competent in PROMPT. However if they've done Intro and they're working on Bridging and continuing their education, they will grow as a therapist right along with your dc and be fine. That will work out fine. 

The other thing to know is that PROMPT is unusual in that they only want 1-2 sessions a week of therapy and they want to train *you* to carry it over at home. So this is fabulous for you because you can take advantage of your time with her to work on the skills (using the motor planning inputs they'll teach you) and you won't be running to therapy constantly.

Let us know how it goes! It's kind of a horrible thing to get diagnosed, but it's way better to get it diagnosed than not. And the other thing you can do, if you get it diagnosed privately, is to sue your school district to compel them to get their SLP trained in PROMPT. I'm not joking. This is how you'll get it and get it done by the school. She has made almost no progress (measurably, by the numbers) with the speech therapy traditional methods so you get a lawyer and demonstrate that she needs better methods to fit her diagnosis, boom. And that works, again, because the SLP can grow with your dc, getting a new level of training each year or even Intro and Bridging in one year.

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23 hours ago, Crimson Wife said:

First, have the child evaluated by a good pediatric dentist or ENT for tongue tie. If there's a posterior tie, it may not be obvious and until it's released, you can go YEARS in speech therapy with very little improvement (BTDT with my 2nd).

I would also recommend making sure the child can do auditory discrimination among the various consonants. You mention f vs. s and those were some of the consonants that my hard of hearing child struggled with due to her high frequency hearing loss (which we believe went undetected for at least 2 years and possibly up to 4). Her articulation errors cleared up within a few weeks of getting a cochlear implant (aside from developmental ones like /f/ for /th/).

 

She had a tongue tie that was clipped soon after birth, and her pediatric dentist examined it at her last appointment. She's going back in soon so I'll have her double-check it. She's seen an audiologist (though I question whether it was a good one since she didn't notice DD had ear infections at the time!). She's had several ear infections over the past year, though they do eventually clear up (we usually need to do 2 repeat ear checks, so 20-ish days after we initially notice the symptoms). She's pretty stoic so it's only in the past few months that she's been able to tell us that her ears hurt. I'm not convinced that she doesn't have hearing loss. This sounds weird, but there's something about the tone of her speech that reminds me of friends I know who are Deaf or heard of hearing. For the auditory discrimination, would that be checked by an audiologist?

The one thing that makes me think it isn't apraxia is that her errors are consistent. The substitutions are always the same, same for the consonants she drops and how she simplifies words. She also doesn't seem to be really.. groping? I think was the word I saw in some videos I've watched of kids with apraxia. She just says what she thinks the word is, no extra mouth movements, and if I don't understand it (which happens a lot, as you can imagine) she'll keep repeating it until I finally figure out what she's saying.

21 hours ago, PeterPan said:

What happens if you widen the search circle? What I would do is find someone who is certified for the initial eval, even if you have to drive an obscene distance to get it. I drove 2 1/2 hours every week for years for my ds' apraxia therapy, so driving it one time for 3-4 hours seems reasonable. Do that eval with the BEST PERSON you can find, ideally certified. Then, depending on those results, hook up with someone closer.

 

I was able to find two in a somewhat reasonable distance who completed Bridging over the summer. Our insurance situation will be changing in the next month, so I'm more at the stage of figuring out what to pursue next, but it seems like something to pursue along with the audiologist, if only to rule it out.

Thank you all for the advice! I've spent a lot of time googling and watching videos, and you have all been immeasurably more helpful!

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3 hours ago, lasulliva said:

The one thing that makes me think it isn't apraxia is that her errors are consistent.

You know, there are things SLPs say that just aren't correct. My ds' errors have been consistent, because he either had the motor planning or didn't. He never did groping either. 

The praxis is something a fully trained PROMPT therapist will have no trouble demonstrating if it's there.

3 hours ago, lasulliva said:

She's pretty stoic so it's only in the past few months that she's been able to tell us that her ears hurt. I'm not convinced that she doesn't have hearing loss. This sounds weird, but there's something about the tone of her speech that reminds me of friends I know who are Deaf or heard of hearing.

Given that you have quite a few flags for things going on, have you been talking with your ped? Have you wondered if she's on the spectrum? Having a parent wonder if the dc is deaf is on screeners for ASD, which you probably already know. It's why we took my ds in, because he wasn't responding. He didn't have hearing loss but he did have ASD. The audiologists saw it but couldn't say anything. They just said to assemble a good team, that I was doing the right things.

Has anyone run an ADOS on her? There are some ps IEP teams that are ADOS-trained, which is why I ask. Ours isn't, sigh, but it's increasingly common. You can just flat bring up the question. Prosody issues, flat affect, sensory differences, communication problems, issues with responding, you're ticking off a lot of boxes here. And if you're used to how it looked in your ds, it might look different this time.

3 hours ago, lasulliva said:

I was able to find two in a somewhat reasonable distance who completed Bridging over the summer. Our insurance situation will be changing in the next month, so I'm more at the stage of figuring out what to pursue next, but it seems like something to pursue along with the audiologist, if only to rule it out.

Ooo, completing Bridging is STELLAR!!! So if I could suggest, make the intake appointment now while your insurance settles. There may be a wait, even 1-3 months. Or just call and find out what the wait is, kwim? If the wait is 1 week, you could get it done under your current insurance.

The SLP will be able to tell if there are patterns of missing sounds or articulation issues that reflect hearing loss. I'm all for audiology, but you already said you had that done, right? At that age part of it is completely computerized, where they put the sensors in and the computer does the work. So they didn't screw it up. It's fine to get another audiology eval, but there may be other answers unfortunately.

So I would not delay the SLP eval with one of those more qualified PROMPT therapists while waiting for the audiology. You've already had audiology and can move forward. I think the other thing you desperately need to do at this point is have a sit-down with your ped about some global evals to get some better explanations for the patterns and issues you're seeing.

Keep plugging. You've got this. Sometimes it's hard to do this again when you've already done it with one, but you know how. 

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12 hours ago, PeterPan said:

You know, there are things SLPs say that just aren't correct. My ds' errors have been consistent, because he either had the motor planning or didn't. He never did groping either. 

 

The IEP team screened her for autism (not ADOS, I think, though my brain is mush so I'll have to dig out the IEP report) and she didn't meet enough of their criteria. She's incredibly sweet and social with adults initially, makes eye contact, etc. It's only with kids her age (or with adults after she's gotten comfortable with them) that things really fall apart, and we're still not sure if it's just because most kids her age get frustrated with not being able to communicate with her or if she's on the spectrum. She's got enough red flags that we scheduled an appointment in January with a developmental pediatrician.

You're right about the SLPs. I reached out to one this morning and we'll see when she can fit us in. It's funny because on the one hand, there's definitely a "been there, done that" feeling, but the resources I have in place for her brother aren't necessarily what works best for her, either.

Thank you again!

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1 minute ago, lasulliva said:

She's got enough red flags that we scheduled an appointment in January with a developmental pediatrician.

That sounds really wise. Girls are funny. They can pass the ADOS and be on the spectrum. They just present differently. And the things they're listing as signs she's not are just not signs. My ds is great with adults, completely makes eye contact (or completely doesn't), and is socially motivated. And when he's used to me or whomever he's with, they have one set of data. You put him with some random stranger who walks in the house, and you see this TOTALLY DIFFERENT PICTURE. I had a worker from the county come out a few years ago to confirm his county disability services funding, and she just needed to confirm he had autism. Never asked a question about it, haha, because when she walked in he spoke to her in echolalia for 10 minutes straight!!! I kid you not, lol. Does he do that with me? Nope. But is it there, lurking, waiting to come out when he gets maxed out and his ability to MASK is uncovered? Yup. 

4 minutes ago, lasulliva said:

I reached out to one this morning and we'll see when she can fit us in.

Keep us posted on how it goes! :)

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