Apraxia versus late talker toddler

[prairiewindmomma]

My toddler relative has fewer than 10 words at a point when he “should” have about 75. Toddler is silent…too often…some babbling but not much. I have been pointing it out for a while, but have been blown off because denial, iykwim. Pediatrician has been slow to act but parent is slowly coming to the realization that there are lots of red flags going up.

SL-P experts, tell me what parent should be looking for and asking. If ped doesn’t refer, parent is likely going to self refer. Parent wants to know what she should be looking for. 
 

Hearing screen?

Tongue tie check? 
 

@PeterPan, can u please chime in? All of the apraxia bells are going off in my mind. 

[PeterPan]

1-Call the county early childhood services (whatever they call it in your area) because they will call, screen, and begin services immediately.

2-Do not armchair diagnose because you will miss important signs and things that need to be looked into by assuming you know the explanations.

3-Autism should always be on the table. I'm sorry, but it should be. Apraxia almost never occurs in isolation and what you're describing is *some* kind of developmental issue. 

4-Time for a new ped. That's appalling if a ped is not concerned that a dc is behind on acquiring language. 

https://www.asha.org/slp/schools/prof-consult/norms/ 

https://identifythesigns.org/wp-content/uploads/2017/09/ASHA_Year1to2.pdf

https://www.cdc.gov/ncbddd/actearly/pdf/FULL-LIST-CDC_LTSAE-Checklists2021_Eng_FNL2_508.pdf

So you're not *only* looking at the number of words. Yes there are some minimums, but animal sounds and non-standard words count as words. 

2 hours ago, prairiewindmomma said:

some babbling but not much.

That's a good sign!!! Babbling is a stage in the motor control of speech development. Other important things like cooing, blowing raspberries, how they eat, etc. are going to be on those CDC lists I linked. Granted there's a range of severity in apraxia, but the presence of babbling is a REALLY good sign.

They definitely need the early intervention screenings, because something is going on. I wouldn't tell them apraxia, because that doesn't even sound like what you're describing. Typically red flags for apraxia (not exhaustive) are a lack of typical childhood language motor development (cooing, babbling, etc.), fatiguing when eating, puffy/angel/cherub cheeks (again, indicating the low usage and lack of development), DROPPING words, as well as of course failing to acquire. 

5-Look for an SLP trained in a play based approach such as Hanen or Play Project. 

2 hours ago, prairiewindmomma said:

Hearing screen?

Tongue tie check? 

Should have been screened as an infant and he's not that old. It's fine to check them again, sure, but that's not the most logical explanation. There would be issues with feeding, nursing, etc. with the tongue tie. My ds, whom I was constantly complaining about on here saying he was always hungry (and who needed to start solids unusually early because he was HUNGRY) turned out to be somewhat tight with a certain type of tongue tie. It's all controversial and at first they were talking clipping. We've done a year now of myofunctional work and his palate development is back on track and eating dramatically better; he has gone from 50th percentile to 95th for height, some pretty serious make-up growth!! 

While I agree those things happen, they don't explain what this parent is seeing. It quacks, it's a duck. Name the duck. If the duck has blue feathers or extra cute feet, eventually you identify those two. Just don't fail to call the duck a duck.

Developmental ped might be better for the mom at this point. Or even just someone who actually reads the current standards. This is not a time to delay or wait and wonder. This is the time to get *engaged* and *connect* with some resources of people who can get things on track and train the parent and give the parent good advice. That Play Project or Hanen will be a solid recommend, and the types of people doing that (typically SLPs, some OTs or behaviorists) are going to be good additions to her team. 

I would do whatever she can make happen through the county AND do things privately. More is more better, and early identification through the county will open up a few more doors. She might think she doesn't want them, but they will smooth things over the next few years as she works within the system to advocate. It's just reality and it's something nobody told us. ASK FOR HELP.

[PeterPan]

2 hours ago, prairiewindmomma said:

I have been pointing it out for a while, but have been blown off because denial,

Fwiw we see it sooner because we know what it looks like. So technically they are doing studies on identifying early early (9 months, etc.), but really this kinda toddler, becoming more clearly discrepant time is pretty common. I wouldn't knock her too hard or fault her. 

She's got a long road. 

[PeterPan]

2 hours ago, prairiewindmomma said:

“should” have about 75.

There are actually different cutoffs. I was looking for the charts and didn't find them, but the number to get service with the county might be different than with a private SLP. I'm thinking (don't quote me) it was something like the private SLPs wanted to see 100 words at a certain age but at the same age our county said they'd begin at 50. Or it could have been flipped. That was a long time ago thankfully, lol. 

Point is, you push for intervention with both, but the county doing it is sort of a cover your butt, better safe than sorry. They're big on teaching the parent and there's a lot of data about the GOOD the parents can do by GETTING THIS TRAINING. 

Seriously, the number one thing she can do to help her child is to get this professional help and ASK THEM FOR HELP. Ask them what she can do at home! She (or whomever has the most time) can begin to have very intentional interactions that may help get Junior moving forward. The county is going to want that and the Play Project and Hanen people are all about that. This is something she can feel good about, even if maybe she's  not at the point of wanting "diagnoses" and therapy. Let them help her learn ways she can interact that will get these steps going. 

[KSera]

4 hours ago, prairiewindmomma said:

My toddler relative has fewer than 10 words at a point when he “should” have about 75. Toddler is silent…too often…some babbling but not much. I have been pointing it out for a while, but have been blown off because denial, iykwim. Pediatrician has been slow to act but parent is slowly coming to the realization that there are lots of red flags going up.

SL-P experts, tell me what parent should be looking for and asking. If ped doesn’t refer, parent is likely going to self refer. Parent wants to know what she should be looking for. 
 

Hearing screen?

Tongue tie check? 
 

@PeterPan, can u please chime in? All of the apraxia bells are going off in my mind. 

How old is dc? The lack of babbling and few words are potential red flags, but I'd also be curious about other aspects of dc's development and what kind of words are present and how they sound. Are there any other oral motor challenges? Can dc blow bubbles? Imitate facial expressions? Imitate tongue motions someone else makes? Does that ability get better or worse looking in the mirror? Are the current words spoken always said with the same errors, or do they vary?

Hearing screen, yes. Tongue tie I would probably wait until dc is in speech. Unless it were super severe, I wouldn't expect it to be the cause of few words. I would expect it to interfere with articulation, but not language itself, if that makes sense (mine with the worst tongue tie had the most precocious language development of all my kids).

 

Early Intervention can be hit or miss. It's a good place to start, but I wouldn't have that be the only thing if parent isn't satisfied. My dc with apraxia started with EI and the entire focus was on teaching me how to interact and facilitate speech as a parent. Which would have been great if I were a parent who didn't know how to do that, but there was literally nothing they suggested to me that I didn't already do--super, super basic stuff of repeating and expanding speech, etc. We pretty quickly moved onto private speech, which has been much more useful.

1 hour ago, PeterPan said:

Autism should always be on the table. I'm sorry, but it should be. Apraxia almost never occurs in isolation and what you're describing is *some* kind of developmental issue. 

Autism should absolutely be considered, but apraxia definitely does occur on its own sometimes. Autism is a common co-occurring factor, but there are lot of kids with apraxia who are not autistic. Mine is not (I do have a different kid that is, incidentally, but this one has no signs of that whatsoever and has his apraxia mostly resolved now at 4. Not entirely, and I expect we will be doing speech for at least another year (maybe more? I don't know. Mostly articulation therapy at this point). I became concerned with this one's speech development around 9 months, and by 18 months was pretty sure we were headed for an apraxia diagnosis and started evaluations and therapy).

 

Best wishes to your relative and dt!

 

[prairiewindmomma]

I agree there are likely other things going on as well…other motor and oral motor delays at a minimum….and I gave parent EI screening contact info over a year ago. I am just now seeing willingness to screen on only the speech front.

It’s super frustrating to watch.

 

[KSera]

1 hour ago, prairiewindmomma said:

I am just now seeing willingness to screen on only the speech front.

Starting with the speech front is a good start. The SLP will almost certainly have worked with plenty of kids with other developmental delays, and while he/she can't diagnose any other disorders, they can advise that the parent take the child for further evaluation if they see other red flags.

[PeterPan]

2 hours ago, prairiewindmomma said:

I gave parent EI screening contact info over a year ago.

So the child was <1 at that point? That's really young. Even getting identified before 2 is unusual.

Are you a mandatory reporter? Is there evidence of neglect? 

Sometimes we just shut up and watch. I know people like this where it's obvious the kid is on the spectrum and they haven't figured it out yet. It will come eventually. 

[kbutton]

Just a heads-up...the CDC (I think) changed their early warning signs information. There is a speech practice that works with homeschoolers a lot that is very upset because they think it will cause even more delays in children getting necessary language intervention. (Rooted in Language--they have a Facebook page.)