Tuesday, April 26, 2011

Ava's Speech - What next?

Ava's speech continues to improve in subtle ways. She's talking all the time. Her sentences are often multi-word sentences. She's a full conversational partner in the household. She listens to the conversations around her and tries to participate. She initiates new conversations. She is trying to sing songs. Slowly she's starting to use consonants in the middle of words and put some on the ends of words. Her vowels are usually correct now. The consonants that are missing are still missing, but they are consonants you wouldn't necessarily expect a young two year old to be using like /f, v, k, g, r, l, ch, J, s/. She still has difficulty with more complex syllable structures like C1V1C2V2, but those would be difficult for many typically developing early two year old children too.

She looks so different from the child who less than four months ago had only three "words", very few sounds, couldn't imitate, and scored at the 4 month old level on the early intervention speech and language assessment. She had so many of the items on the checklist for early red flags for Childhood Apraxia of Speech.

Now her therapists are starting to hint that she's looking more and more age appropriate. They're starting to say that the remaining issues she has look more like articulation or phonological issues than apraxic issues. This is exactly why Speech-Language Pathologists are reluctant to diagnose Childhood Apraxia of Speech this early.

If Ava had/has Childhood Apraxia of Speech it is mild. Anyone with moderate or severe CAS would have improved much more slowly. She's in an odd place. She's outgrown many of those "early red flag" signs (although her history of those red flags will never change). She's not quite old enough for the classic signs of Childhood Apraxia of Speech to show up yet.

We're in an odd limbo place. She's made great strides that have brought her to a place that is almost age appropriate. You could argue that we could stop therapy or go to therapy fewer times a week. After all, I am a speech therapist and I'm working with her at home too. I'm also able to monitor her for signs of backsliding. However, it took therapy multiple times a week over several months (and possibly multiple kinds of supplements) to achieve those improvements. I don't want to stop too early. She wasn't making any improvements before the therapy (and supplements).

I'm just not sure what to do. Continue therapy for now? Reduce therapy and see if she's still improving or at least maintaining her skills? Stop therapy for a while and wait to see if she falls behind again?

What do you guys think?


  1. You are so lucky that she is making such great progress...my little guy is the same age and we have yuck, ruck (for truck)and more - those are the only words he will do unsolicited. We're now at 3 hours of therapy a week and we see some initial sounds, but only if we push for it. Last week after 15 minutes of the SLP being here, he took her hand, pulled her towards the door and gave us the sign for "go". When we push him, he will instead come over and hug and kiss us so we will stop making him try to say the initial sound...it's so frustrating.

    I would keep up with the therapy - I think with all the progress she's made, it can't hurt to maintain - and if she still qualifies for EI, then I would utilize their services. If she does end up having a phonological/artic issue, then you already have services in place.

    Thank you for all of your things you post - I enjoy reading some of your tidbits of information of what can also be helpful for my son.

  2. Hi! I just found your blog and I love it. Thank you so much for sharing all your stories. I have a little boy who is almost 22 months old. He is only saying maybe 3-5 words, most of which are not clear. I took him in to early intervention a couple of weeks ago, and they are sending a developmental specialist to my home twice a month starting in May.

    I have been really worried about him. I read the book "Late Talkers, What to do if your Child Isn't Talking Yet" cover to cover. I haven't noticed any other problems other than speech.

    My question for you is, what do you think about the fish oil and NV supplements? Do they really work? Which one have you found to be better? The fish oils or the NV, or both combined? I'm unsure of what to do, or whether it is too soon to get him started on these. What advice can you give?

    Thanks! :)

  3. Gentle Blue: I know we're lucky. I am so grateful. You have to do everything right (getting the right kinds of therapy) and you just have to be lucky. We were so lucky that Ava's apraxia was on the mild side. How long has your little boy been receiving speech services? It took Ava a little while before she started to respond. For a while, the more we pushed, the more she resisted. Then it was like a light bulb turned on for her and she realized that this talking thing was great because she could finally get what she wanted. Also, have you tried some communication boards? They worked really, really well for us when Ava only had a few "words".

  4. Paice Family: Welcome! I'm glad you've found the blog and are enjoying it. And thanks for taking the time to say hi. Congratulations on getting therapy started.

    Oh, you had to ask about supplements. :-) I'm so torn on that. As an SLP, I really want solid research data before recommending that parents spend their money on supplements. These supplements are not cheap!

    As a parent I'm absolutely using them. Other than the expense, there are no significant disadvantages to trying them. They have health benefits other than the possible speech improvements. And they might help speech. I couldn't not try it with Ava. I wanted to give her every chance I could. That was the personal decision my husband and I made after reading what little evidence there is.

    Fish oil vs. NutriiVeda? Tough one. We started Ava on the Omega 3 fish oil supplements at the exact same time she started speech therapy. She made amazing improvements in a pretty short period of time, but who knows how much of that was due to the Omega 3 fish oil, and how much was due to therapy? We started NutriiVeda just a few weeks ago. I do think I saw some additional improvement in the quantity of her speech attempts after starting NutriiVeda. But all of this is purely anecdotal evidence. I couldn't swear either made a difference. I'm sorry. I wish there was some solid evidence that would give all of us an answer.

    I suppose I feel that if you do some research yourself and you are comfortable with the idea of supplementing your toddler and you can afford the cost of the supplements without needing to sacrifice other things he needs, then why not try it? It can't hurt and has the potential to help.

  5. Hey! I just found your blog and I love it! I'm a graduate student studying to become a speech pathologist. I've had a little kiddo for two semesters now who we suspect has CAS, but we've never officially diagnosed. We only say he "has characteristics consistent with CAS." When I started seeing him he was using a PECS-style book to communicate a lot of wants and needs. He just turned 4 and has improved *so* much within the past year. He is pretty intelligible to a familiar listener and can say numerous common phrases and words (obviously he has high motivation to say words he's interested in -- he astounded me today when he started talking about his "telescope"). But in my therapy plan, I'm also a little at a loss at where to go from here.

    He has almost all age appropriate sounds (still working on a couple of vowels that he reduces), but all of his communication breakdowns occur during increased complexity and connected speech level. I've utilized a pacing strategy to encourage him to slow his rate of speech down. But it's really hard to get kids to focus when they're talking about things instead of imitating Artic cards :P

    Anyways, I'm really glad I found this blog, and I may recommend it to the mother of the kid I'm seeing. Any useful advice or information you find out about working on CAS in increased complexity situations would be great!


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