Sunday, May 1, 2011

Subtle Problems are Harder to Explain

I was talking with our early intervention therapist about Ava's speech trying to figure out what it is that still worries me. Ava is doing so much better. She looks more age appropriate. That is good, of course, but I know both as an SLP and as her mother that there is something there I need to pay attention to.

Yes, Ava is still missing individual sounds (k, g, f, v, r, l, etc.), but all of those sounds develop late anyway and aren't always present in a young two year old anyway. And, some of them are starting to emerge a little. I'm seeing hints of an /f/ and hints of a /k/ for example. So, I'm not crazy worried about the missing sounds. Sure, the fact that they're missing makes her harder to understand, but in a relatively age appropriate way.

Yes, she still exhibits quite a few phonological processes. The big ones are final consonant deletion (leaving off those final consonants) and syllable reduction (taking a three syllable word and saying it as a two syllable word). Again, phonological processes are a normal part of speech development, and it isn't too age inappropriate for her to still be exhibiting some. It's particularly reasonable given that she's only been talking at all for a grand total of three and a half to four months. So, to summarize, I'm not too worried about the phonological processes either.

What I do see are signs of a motor planning problem - apraxia. I have a little girl who has a lot to say. She understands what she hears. She has a great vocabulary. She wants to put together 4-5 word sentences which is pretty darned good for a just turned two year old. However, whenever the syllable structure gets complicated she struggles. Whenever she tries to put together over three syllables she struggles. Whenever she's trying a new word or sentence structure that is complicated she struggles.

Yes, her motor planning problem is mild, but it is definitely there. And, more importantly, it is holding her back from her potential. I think without the apraxia she'd be startlingly articulate. As it is, she struggles to express everything she'd like to. I'm told that she's extremely quiet at school and hardly talks at all. At home she's trying to talk all the time, but she doesn't at school. Is it a confidence issue? It is because the processing demands are higher in a higher stress environment? Is it just her personality to be shy at school? I don't know, but I want her to get to a point where she is able to say everything she wants to and she isn't being held back by the apraxia.

And so we will continue to work on it. It is so easy to get distracted by the sounds she can't say or the phonological processes she exhibits, but the bigger issue is definitely the motor planning. The best strategies I've found to help with the motor planning problems are the tapping and the visual prompts. We'll stick with using those in context to help her say the things that she wants to say. And we'll see how her speech continues to develop over the next several months.

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