Tuesday, May 31, 2011

Memorial Day, Birthday, Visits

I hope everyone had a wonderful Memorial Day. It was the last day of our family visit. We had a great visit. It was a nice balance of activity (zoo, restaurants, outdoor play) and just hanging out at the house (lots of erector set building, good conversation, and general horseplay with the children). Ava joined in the conversations with everyone else. It was really the first time we've had houseguests since Ava's started talking so much. She did a pretty good job of communicating. Most of the time, our guests were able to figure out what she was trying to say. I took comfort from that.

We spent some time outside in the sprinkler. Traditionally, my children are extremely suspicious of sprinklers and treat them with great caution. Today, we seemed to break through and the kids started to run through the sprinkler and laugh and giggle with glee. I loved watching them play. As I looked back at the pictures I realized how similar in size the kids look right now. I understand why people occasionally ask us if they are twins. There were many things that were difficult about having children 15 months apart, but it is starting to pay off now. I love watching them play together and talk together more and more as peers.



(Yes, Michael does indeed have his swim pants on backwards. He did that after a trip to the bathroom. When we pointed it out to him he said, "I like them that way." We just let it go. It gives the pictures that special, unique touch.)

Yesterday was also my birthday. We didn't do anything spectacular to celebrate, but my husband made sure my day was special in little ways that all added up. First, he let me sleep in. Several times during the day he took care of things (lunch, putting the kids down for nap) letting me have a few quiet moments to myself. Those things sound little, but around here they are much appreciated. It was a nice, quiet birthday.

Monday, May 30, 2011

Erector Set Marathon

Michael's godmother is in town for the holiday weekend and she brought him an Erector Set! He loves it. For the past three days he wants to play with it every spare moment. Of course, what that actually means is that he requests that an adult build something for him. The chosen adult spends 45 minutes building the requested model while he plays with random extra parts. The instant the model is done he plays with it for five minutes and then immediately disassembles it. We have at least convinced him that it is polite to ask the builder if it is all right before he begins deconstruction.

Here are just a few of the models he disassembled shortly after they were completed. We all had fun though.

Sunday, May 29, 2011

Going to the zoo.

We have a wonderful zoo in town. Admission is even free. We took the kids several times last summer, but Ava was still a baby really. I'm pretty sure she didn't remember it at all.

We went yesterday and it was wonderful. We have family in town and so the ratio was four adults to two kids which is always nice. The weather was cloudy and cool which is actually better than blazingly hot and sunburn-inducing sunny. Neither child is taking a morning nap any more which allowed us to stay from 8am till noon for the first time.

Highlights of the day included the expression on Ava's face during the carousel ride. It wasn't her first one ever, but I think it's the only one she remembers. She loved it and the smiles and squeals of excitement were priceless.

The children were bored by most of the animals to be honest, but even the kids were excited to see the baby elephant playing in a pool of water. The water came up to about the chest of the baby elephant. The elephant was jumping up so that its two front legs were out of the water and then splashing down. It also would dive totally under the water and jump back up in a huge splash. The pool of water was extremely close to the fence so the view was perfect. You wouldn't have wanted to be closer to be honest. The whole thing couldn't have lasted more than five minutes, but it was amazing.

Saturday, May 28, 2011

Car Seat Dilemma

There's been a lot of press recently about keeping children rear-facing in car seats longer. The statistic that is most powerful for me from the New York Times article is that "children under 2 are 75 percent less likely to suffer severe or fatal injuries in a crash if they are facing the rear." More and more often I am reading recommendations that you leave your child rear-facing until they reach the height and weight limits of your particular car seat. Depending on which car seat you buy, that can easily be until your child is four or five years old.

I had read similar recommendations when I was researching moving Michael from his infant seat to a convertible car seat back in 2008. At that time, I decided to buy the Radian 80 car seat because it would allow us to keep Michael in a five point harness until he was 80 pounds!! It also had the highest weight and height limits for rear-facing. Well, he's three and a half years old and still rear-facing. Ava is a little over two and she's rear-facing as well.


All of a sudden it occurred to me that I'd better check those height and weight limits, because I simply hadn't thought about it for a long time. We were just going on autopilot. Well, as it turns out, the weight limit for rear-facing on our model is 35 pounds. Michael currently weighs 33 pounds.

We have two choices. We can turn his car seat around. He'll remain in the car seat forward-facing in the five point harness until he's 80 pounds. That's a really long time. Or we can buy the newest version of the Radian 80 which has increased its weight limit for rear-facing to 45 pounds. That's the highest available in the US. The 50th percentile for 45 pounds is 5 1/2 years old. Buying the new seat would allow us to keep Michael rear-facing for at least another year and probably longer.

It's safer. We don't mind having him rear-facing. He doesn't mind being rear-facing. His sister is rear-facing and it is convenient to have them both facing the same direction. Pretty much the only negative is having to buy a new, very expensive car seat when I didn't expect I'd need to.

  1. What do you think about the new recommendations to keep children rear-facing until at least 2 years of age and preferably to the weight limits of your car seat (depending on the seat, until your child is five years old)?
  2. Do you think keeping Michael rear-facing for at least another year is worth buying a new Radian?

Friday, May 27, 2011

The Weekly Review: Week Eleven

Blog Post that Puts All of My Weekly Accomplishments Put Together to Shame:

Jessica at Balancing Everything posted about her new kitchen table. You know. The one she made. Enough said.

Weekly Blog Post that made me laugh:

Swistle describes the possible thoughts school personnel have when writing school dress codes. Trust me. This post is really funny.

Guilty Pleasure of the Week:

So, when I didn't like our second attempt at chocolate chip cookies and we had no other treats in the house I put a couple of spoonfuls of brown sugar in a bowl and ate that as my dessert. It was actually quite yummy and completely did the trick at calming down my craving for sweets. Still, I ate a couple of spoonfuls of sugar straight. Probably not something to be proud of exactly.

Michael's Questionable New Behavior of the Week:

Outright defiance. Sigh. He engages in some kind of behavior I wish to stop. Often, he knows before he even starts that the behavior is unacceptable (throwing heavy objects around the room, for example). When asked to stop he pretends to not even hear the request and simply continues on as if I'm not in the room. Seriously? Where is this behavior coming from and how do I stop it?

Ava's Cuteness of the Week:

At bedtime and naptime, the last thing I do as I'm shutting Ava's door is to say, "Good night sweetheart!" and make two kissing noises. This week she has started making kissing noises back to me. I love it.

Project of the Week:

I am responsible for our public library system obtaining two new very nice children's picture books. I am trying to use the library instead of buying books for the children. I discovered a very sweet series of books about a Mole and his friends, Rabbit, Hedgehog, and Squirrel (by Jonathan Emmett). The library had two books in the series, but Amazon told me that there were two more that the library didn't own. Our library's website has a form to request new books. I requested the two other books (No Place Like Home and Diamond in the Snow) in the series several weeks ago, and they appeared on my reserved list this week. I picked them up from the library yesterday. I was quite pleased. The other two books in the series are Bringing Down the Moon and The Best Gift of All.

Thursday, May 26, 2011

Be Prepared

With a two year old and a three year old you have to find the right balance when discussing extreme weather. You want them to take it seriously, but to not be terrified.

Ironically, my kids know what a "twister" is because of an episode of Wonder Pets. They enjoy singing the line, "They go round, round, round picking stuff off the ground." They know that sometimes there is a tornado warning which means that there might be a tornado nearby.

Last night a series of storms pushed through our area and we decided we needed to upgrade our plan of going to the basement with the kids and huddling in the darkness at the bottom of the stairs. We cleaned out the basement closet and put blankets, pillows, flashlights, snacks, water bottles, and a couple of just-in-case diapers in there. We also loaded up the iPad with episodes of Handy Manny.

Of course, by the time we got all that done, the storms had pretty much passed through, but by then the kids were excited about the "hidey cave" and so we went down there anyway and watched an episode of Handy Manny just to test it out. The kids loved it and protested when it was time to leave.

All in all, it was a pretty good upgrade of our What to Do When There's a Tornado Warning Plan and a great dry run. Now we just have to figure out what to do with all the stuff we pulled out of that closet and tossed into the center of the basement.

Wednesday, May 25, 2011

Chocolate Chip Cookie Recipe Needed

Does someone have a great chocolate chip cookie recipe they'd be willing to send me? We lost ours. In our first year of marriage we made the best from scratch chocolate chip cookies. Then I got pregnant with Michael. Then we moved in the third trimester and three months later Michael arrived. Ava arrived 15 months after that. We went almost four years without even looking for that recipe.

A couple of weeks ago, unable to locate the recipe, my husband tried the recipe on the Toll House Chocolate Chips bag. Definitely not the recipe we wanted. Then we tried the one from the Better Homes & Garden cookbook. Also not right.

So now I'm looking for suggestions.

Please?

Seriously?

First I wrote about how I really did need to find Ava a regular playmate.

Then I wrote about the miraculous discovery only a few days later that a little girl Ava's age lives only a few houses away in our neighborhood.

We had one very nice playdate and then a few weeks later we had another very nice playdate. We seem to have some difficulty coordinating regular playdates, but I can live with irregular.

Then one day last week as I was driving by their house on the way to ours...


Tuesday, May 24, 2011

Apraxia Therapy Materials: Doodle Buddy iPhone / iPad App

Doodle Buddy is another iPhone / iPad app that can be a wonderful way to elicit speech or sound effects from your child. The program is free, but is overrun with really obtrusive ads. You can choose to pay $0.99 to remove the ads from the application.

This program does many things all of which can be used as a therapy activity.

  • It is a drawing program. (Please don't laugh at my lack of artistic skills.) You can draw things for your child to label. Alternately, you can follow their instructions and draw what they tell you to. If they say "car," you do your best to draw one.

  • The program has "stamps". There are tons of little pictures that your child can transfer to the screen just by choosing the one they want and then tapping as many times as they like. Even better, each stamp has a sound effect. So the frog croaks, the crying face cries, the dog barks, and so on. Your child can label the stamp or imitate the sound effect. Even if they are non-verbal and using signs, you can wait until they make the sign for "more" before you let them put more stamps on the page. Here is a sampling of the stamps available. There are many more than would fit on one page.

  • There are backgrounds and themed stamps to go along with them. Some come with the program. Some you have to "buy" with points. If you are willing to install a few free programs on your machine you can get more points for free to get additional themes.

    So you pull up a background. Backgrounds (themes) include dinosaurs, cars, beach, farmyard, lake, princess, space, underwater, winter, spooky house, doghouse in backyard, desert, and more. You make up a story about the picture adding stamps as you go along. You get your child to repeat words that are part of the story. Here are some examples.

    Farm: Mama chicken was at the farm today. (insert chicken, have child say, "chicken"). She had three baby chicks with her. (insert three baby chicks counting, "one, two, three") They were lonely! They wanted to play with some friends. (toss in a couple of sheep and practice saying, "baa") I could continue, but you get the idea.


    Here are examples of the lake and princess themes as well.


  • My kids particularly enjoy the haunted house theme, the cars theme, and the farm theme. I'm sure your kids will have their favorites too. Really, the possibilities for using this program as a therapy tool are only limited by your imagination. (I make up really boring stories when put on the spot, but the kids don't seem to care. I get lots of speech and vocabulary practice in and that is all that really matters.)


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Monday, May 23, 2011

Counterproductive?

We're trying to rebuild our deck and therefore we have a ton of random pieces of cut-off wood lying around. I had a brilliant idea to drill some holes in a piece of wood and let the children play with the block of wood, some wood screws and a couple of screwdrivers.
  1. They loved it.
  2. Michael gets to play with a screwdriver and screws in a sanctioned way.
  3. Hmm... do I really want to give him additional, sanctioned, practice with a screwdriver? (See this and this for reasons that this activity is possibly counterproductive.)

NutriiVeda vs NutriiVeda Achieve Comparison

Our first shipment of NutriiVeda Achieve arrived. As expected the product now comes packaged in a resealable 30-serving foil pouch rather than in two 15-serving canisters. The flavor is now French Vanilla rather than Vanilla. Here is a chart highlighting the main nutritional differences between the old NutriiVeda formula and the new NutriiVeda Achieve formula.


The differences I see as most significant, nutritionally are the reduced sugar, added fiber, and added sodium. Although interesting, the added Omegas are not super significant for me because they come from plant sources rather than fish sources making them less appropriate as a supplement for apraxia. Also the dosage is less than generally recommended as a therapeutic dose.

I tried it myself. I do believe that the new NutriiVeda Achieve formulation results in a creamier "shake" (mixed with skim milk) than the original formula. I also think that the new formulation is a little more subtle than the old one. To be honest, I personally disliked the old one. I'm not in love with the new one, but I dislike it less. I found the old one difficult to mix into milk without ending up with lots of big clumps. The new one has the same problem.

The original NutriiVeda mixed beautifully into yogurt. It almost disappeared in terms of texture. If anything, it seemed to make the yogurt a little bit thinner. The new NutriiVeda Achieve seems to mix into the yogurt and give it a creamier, thicker, fluffier texture a little like a mousse.

When I gave it to the kids (occasionally I feed the mix to both kids - it's just simpler that way) Michael immediately noticed the change. He said, "This is a new yogurt. It tastes different. It tastes salty." Now, yes, the new NutriiVeda Achieve does have sodium while the old one did not, but you're also taking the word of a 3 1/2 year old that it tastes salty. I'm not sure he uses the term accurately. That might just be the only word he knows to describe a change in taste. On the other hand, they added sodium and removed over half the sugar content. It may actually taste saltier to him.

He continued to comment on the change as he consumed the bowl. He ate it, but I'm not sure he liked it. Ava ate hers and did not comment on the difference. We've only had one serving so far. I'll let you know if the difference in taste (or texture?) becomes a problem.

Bottom Line The new NutriiVeda Achieve is significantly different in taste and texture from the old NutriiVeda formula. I like the concept of increased fiber and reduced sugar, but I also need Ava to eat it. We'll see if she continues to eat the new formula. I'm not super fond of the increase in sodium. My opinion of the added Omega 3 and Omega 6 from plant sources is neutral.

Sunday, May 22, 2011

Free Themed Preschool and Toddler Activities

I stumbled upon a website with a great set of free activities. The authors have created themed sets of learning activities for toddlers and preschoolers. The reproducibles are downloadable in .pdf form. I downloaded all of them because I'm a collector and I'm like that.

I decided to start with the Transportation Theme Pack because transportation is popular with both my children. I did not print out every activity included with the pack because I didn't feel like my two and three year olds were ready for the letter tracing and writing activities just yet. I did print out the matching transportation picture/word cards, the shadow matching activity, the tracing lines activities, the 3-piece puzzle cards, the bus size sequencing activity, the counting cards, the left and right sorting cards, and the beginning-sound word cards. I printed most of them on cardstock and I may even laminate them. Here is a picture of some of the pages right after I printed them and a picture of the materials once I cut them out.



We have already tried the shadow matching activity and the number cards. The kids enjoyed them. They identified the vehicles and their colors. They practiced counting and matching. Michael worked on number recognition and Ava worked on her speech a little ("on top"). We had fun and there are several more activities left. You could easily play with the materials for a week, put them away for a while and pull them back out again in a couple of months and do it all again.

The Preschool Packs currently available are:

The Tot Packs currently available are:


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Saturday, May 21, 2011

Reality Check

When we started all of this Ava had too little speech to give her any kind of formal articulation assessment. You can't ask an essentially nonverbal child to label pictures in a book so that you can score how well they did making sounds. Now that Ava has so many words her early intervention therapist and I decided to give her an articulation test to see where she is.

The Goldman-Fristoe Test of Articulation 2 is very simple in concept. It is a book of pictures. Your child labels the pictures and the Speech-Language Pathologist transcribes how your child pronounces each word exactly as your child says it. The test is designed so that after all of the pictures have been pronounced your child has attempted to pronounce every consonant sound (and some blends) in every position (beginning, middle, end) of words in which they appear in the English language.

We gave the test to Ava. It took us two sessions. There are a lot of words on the test and it is hard to get a two year old to focus. She did better than I expected. She got sounds on the test that she doesn't usually get in regular conversation. I was feeling pretty good about the whole thing.

Then I scored the test. She got a standard score of 72. That's equivalent to the 7th percentile. That means that 93% of children her age perform better than her on this test. Wow! Seeing that number was a huge reality check for me.

I've been so focused on all the improvements. She's made amazing progress since we started getting her help. She had no words. Now she had more than I can count. She went from one-word utterances to two and three-word phrases. Now we are frequently hearing four and five-word sentences. She was a pretty silent toddler who wasn't even trying to talk any more - a toddler who had to resort to gestures and pulling me around to ask for what she wanted. Now she talks all the time. She communicates with her parents, grandparents, brother, teachers, and friends. She even talks to herself. She tries to sing and hum. I was proud. I was excited.

Now, with this new number (7th percentile!) I am sad and discouraged again. I know that this new information takes nothing away from all of her accomplishments. I do know that. I know that this new information is a valuable reality check. It gives me information I can use to go forward and plan our next steps. As a speech-pathologist the test results are interesting, valuable, and even a little exciting. As Ava's Mama, those test results make me sad. They are a reminder of her struggle and the long road that is still ahead of us. Reality really stinks sometimes.

Friday, May 20, 2011

How did he do it?

First there was the redecoration of the room. Then there was the disassembly of the dollhouse. Then, following today's adventures in not-napping, we discover this:


Notice the new gold knob on the lower drawer. So, where exactly did he acquire the new knob?


And where did he put the old knob?


But here's the thing. How did he do it this time? There was no screwdriver in the room!

We obviously need to get this boy some kind of outlet! We're thinking erector set maybe?

The Weekly Review: Week Ten

Funny Blog Post I completely agree with:

Kristen at Motherhood Uncensored wrote a hilarious post about her philosophy of motherhood. Check it out first for the humor and second for the nuggets of wisdom hidden within.

Blog Post that made me want to give the author a big hug

Mona at kirida dot com recently wrote a post about her pediatrician recommending that she have her son evaluated for autism. It was a touching post. I thought she did an amazing job of expressing the awfulness of having to wait to be evaluated for a diagnosis.

In August 2010, Mona wrote a post about her son's speech and her feelings of protectiveness that really resonated with me. I think I found it so meaningful because I was already ignoring so many red flags about Ava. This post perfectly expresses so many of my own feelings about Ava. Then, and now, it helps me feel less alone.

Website Resource of the Week:

Therapy Fun Zone is a website full of great OT and PT activities. Even if your child doesn't need PT or OT help, the activities are still a lot of fun. I'm going to start with this one as soon as I get to the store for gumdrops and toothpicks. Fair warning though: the website is incredibly slow and each page takes several seconds to load. I feel like I'm on a modem. Second, the pages are poorly designed and an email signup form shows up at the top of each page so you have to scroll down to see the actual article. The activity ideas (complete with pictures) are worth putting up with the technical issues though.

Sibling Moment of the Week:

The children have large stuffed armchairs. Their game of the week (intended to give me a heart attack) is to tip an armchair on its side, climb on top together, and then slowly shift their balance so the whole thing tips over tumbling them onto the floor in a heap. Laughter from the two of them fills the air and they work together to tip the armchair back over again so they can start over.


Quote of the Week from Michael:

Michael has coined the phrase, "Visitor Day" for the day of the week that we usually have friends come over to play. He'll say, "Is tomorrow visitor day Mama?"

Ava's Quote of the Week:

"Come sit with me, Mama!"

Project of the Week:

I was happy to get my three part series on Apraxia Therapy Principles finished and posted.

Thursday, May 19, 2011

Another Perspective (On NutriiVeda) Is Always Valuable

We've been trying NutriiVeda with Ava. I'm frustrated by the lack of anything other than anecdotal evidence of improvements, but given that lots of parents are seeing improvements with their children I had to try it. Tentatively, I feel like we've seen an increase in the amount of speech from Ava, and in the length of her sentences since we started using NutriiVeda about six weeks ago.

However, NutriiVeda is expensive and there is no scientific evidence. I came across a well written post on the blog of another mother with a daughter who has Childhood Apraxia of Speech. She tried NutriiVeda with her daughter for three months and did not feel like she saw significant improvements. She saw no regression when she stopped using the product. Check out her post on NutriiVeda. If you're thinking about trying NutriiVeda, you should read the opinions of people who tried it and didn't like it in addition to the posts of all the parents who love it.

While on the topic of the Apraxia Adventures blog, I really identified with her post on her son learning to kiss as well. I am way too familiar with that bittersweet feeling of being happy and sad (jealous!) at the same time.

Since both of my children have oral apraxia, I feel it when I see another woman's baby look at me and smile - so easily and naturally. I enjoy the smile. I enjoy the sweetness of it. And then I wish I had been able to experience that with my children. I wish it had been natural and easy. Or recently, I watched a video of a toddler Ava's age being interviewed by her mother about things like her favorite toy, food, game, etc. The video was adorable as was the toddler. Her speech was so clear. The sentences were so long. I want that ease for Ava. Will I always see other children through the lens of what I want for Ava?

Bah! Enough of this self-pity and sadness. Overall things are good. Improvements abound. I refuse to dwell overly long on depressing thoughts. I'll just share them briefly and then move on.

Wednesday, May 18, 2011

Six!!!

Ava loves cucumber and dip. She ate all the cucumber on her own plate (about 1/4 of a rather large cucumber). Then she eyed Michael's plate and asked if she could have his cucumber. He had already decided that he wasn't going to eat his, so he gave his cucumber to Ava. That quickly disappeared too. At this point, the girl had consumed half a cucumber.

She looked down rather pitifully at her plate and said, "No more on Ava's blue plate!" Six!! That's a six word sentence from the same little girl who had only three words in her entire vocabulary four and a half months ago. I'm practically speechless myself in awe and gratitude. (Standard disclaimer: No, that sentence was not pronounced "correctly" with every sound present, but all the words were there and I could understand them.)

Childhood Apraxia of Speech Therapy Fundamentals: Part 3 - Methods and Content

Childhood Apraxia of Speech (CAS) is neurological speech disorder that causes children to have difficulty with the motor planning, sequencing, and programming necessary to produce volitional speech. Therapy needs to address the core problem of motor planning for speech in the most effective way possible. Every child is different, so therapy must be customized. Therapy for a young child who is nonverbal will be different from therapy for an older child who is using multi-word sentences, but the speech is hard to understand. However, the basic underlying fundamentals of therapy for apraxia are going to be similar. These underlying fundamentals are based on current research and professional consensus.

What methods are used during therapy for Childhood Apraxia of Speech?

When reviewing the most effective methods for treatment of children with Childhood Apraxia of Speech there seems to be a unifying theme and that is neurology. CAS is a neurological disorder. The areas and pathways in the brain that are typically responsible for the motor planning of speech are not functioning properly. The purpose of therapy is to retrain those areas to be more efficient at their job and to recruit other areas and pathways in the brain to help when possible. The best way to enlist other areas of the brain to help out is to take a multisensory approach to therapy.

Multisensory Stimulation Techniques

Typically speech involves listening to a speech stimulus and responding appropriately. This uses specific areas in the brain that are separate from the areas that listen to and enjoy music. The speech listening pathways are different from the areas involved in watching and interpreting visual signals. The speech listening pathways are different from the sensory receptors that feel touch on the skin.

What does all of that mean for therapy? It means that when you use multiple sensory pathways when trying to stimulate speech, you recruit other areas of the brain to help out the speech areas that are struggling. So, the speech therapist may use music to try to elicit speech productions to enlist the help of the part of the brain that listens to and enjoys music. The speech therapist may use tapping (tapping, clapping, or snapping with each syllable) to enlist the part of the brain that involves rhythm and basic math. Tapping draws the attention to each separate syllable in a way that simply saying them separately does not. You can use tapping to engage multiple pathways by gently tapping the child's hand or leg along with the syllables which also engages the part of the brain that senses touch. The speech therapist may use visual hand signals paired with specific speech sounds to enlist the part of the brain that interprets visual signals. The speech therapist may use touch on the child's face to cue certain speech sounds or movements.

For children who are nonverbal, often big body motions like swinging on a swing or bouncing on an exercise ball paired with music can help elicit some first sounds. The therapist will try to engage different senses to find one type of stimulation that helps or a combination of stimulation methods that help elicit speech.

Manipulate rate

Sometimes slowing down speech can help. Doing things more slowly allows more time for motor planning. Your therapist may incorporate practice with slowing down speech production to try to help your child be successful at producing speech targets.

What does a speech language pathologist teach children with Childhood Apraxia of Speech?

This is an incredibly complex topic. I'm just going to try to give you a basic overview of the type of things your therapist will think about when choosing goals for your child.

Your therapist will choose targets for your child based upon their professional expertise, their assessment of your child's current skill level, their knowledge of which targets would be age-appropriate, what the child is stimulable for, and their assessment of your child's most pressing needs. (Your child may be missing 10 age-appropriate sounds, but one particular missing sound makes him or her really hard to understand. That would be the sound to work on first.)

When working with children with Childhood Apraxia of Speech therapists are usually following a therapy principle called a series of successive approximations. Essentially, the therapist starts with what your child can do and treats that as correct. Then they try to get that a little closer to "correct" and treat that new level as correct. Once that is well established, they make it a little harder and call that new level correct. For example, your child might be saying "ba" for "bottle," but not very often. First your therapist will treat that as correct, and just get your child to do it more often. Then the therapist will make the task a little harder and try to get your child to say "baba." Now "ba" is considered to be incorrect and "baba is considered to be correct. Once "baba" is well established the difficulty would be increased again to "bata." And so on.

Specific therapy targets will vary widely from child to child. The targets may include specific consonant or vowel sounds, eliminating a speech habit (like leaving off consonants at the ends of words), increasing the number of words in your child's vocabulary, increasing the types of syllables your child can use, and increasing your child's utterance length (from no words to one-word utterances, from one-word utterances to two-word phrases, from two-word phrases to three-word phrases, etc.).

Summary

Your therapist will carefully choose individualized targets for your child based upon their assessment of your child and their professional expertise. They will slow down their rate of speech and your child's rate of speech to allow for extra processing time. They will use multisensory therapy techniques in order to engage as many areas of the brain as possible to improve speech production. They will start with what your child can do and gradually increase their expectations over time as your child improves.

You just finished Part 3 of a three part series on Childhood Apraxia of Speech Therapy Fundamentals.
Read the other two parts of the series:

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Tuesday, May 17, 2011

Apraxia Therapy Materials: Talking Carl iPhone / iPad App

If you have access to an iPhone or iPad there are a lot of apps that can be used to elicit speech from your little one. One in particular that can work well with a child at any stage is Talking Carl. (Note: There are other "talking" apps as well. Most are free or 99 cents. Just be sure to try a couple and choose the one you like best before you try it with your child. Some of them are not appropriate for children.)

Talking Carl is an interactive little monster with big eyes and a big mouth. He will giggle when tickled, and complain when poked. Children almost always crack up laughing themselves when they tickle or poke Carl. If you have a nonverbal child, just being able to get a giggle or an "ouch" in sympathy is good speech practice.


The other key thing Carl does is listen to what your child says when they talk into your phone and then repeat their words back to them. So if your child says, "Hi!" Carl will repeat, "Hi!" Carl will repeat anything the child says. If you are looking for a fun way to get your child to talk, this might do the trick for you. Check it out.

Here is a short YouTube video that demonstrates most of the things Talking Carl does (except the giggling). I chose this one because it was short, but did a nice demonstration of the speech repetition (not in English, but still a good demonstration).



You might also be interested in the following articles:

Childhood Apraxia of Speech Therapy Fundamentals: Part 2 - Types and Variability of Practice

Childhood Apraxia of Speech (CAS) is neurological speech disorder that causes children to have difficulty with the motor planning, sequencing, and programming necessary to produce volitional speech. Therapy needs to address the core problem of motor planning for speech in the most effective way possible. Every child is different, so therapy must be customized. Therapy for a young child who is nonverbal will be different from therapy for an older child who is using multi-word sentences, but the speech is hard to understand. However, the basic underlying fundamentals of therapy for apraxia are going to be similar. These underlying fundamentals are based on current research and professional consensus.

How is therapy for Childhood Apraxia of Speech structured?

We've already discussed the fact that therapy for a motor planning problem needs to involve lots and lots of practice. The next question is how to structure that practice in order to get the best results.

Blocked versus Random practice

Blocked practice is practicing one target at a time, over and over again. This is where the therapist starts when trying to teach something entirely new. If you have a child who can't make a /b/ sound and you are trying to teach it, you are going to practice /b/ over and over again in blocks until the child experiences some success. A blocked practice structure is great at establishing a new skill, but doesn't carry over well outside of the therapy session. When the child begins to perform well in a blocked structure the therapist will move to a random practice structure.

Random practice is when several targets are practiced during a single activity. Now the therapist will practice that same /b/ sound, but will also throw in one or two other sounds the child can make too. The therapist will switch between the two or three sounds randomly. This increases the motor planning demands of the task because the child has to switch between different targets. It also makes the task a little more like real world speech demands when you are not saying the same sound over and over and over again.

Variability of practice

Therapy practice needs to vary in speech context, social context, and environmental context. Targets need to be practiced in multiple speech contexts. That /b/ needs to be practiced at the beginning, middle and ends of words. It needs to be practiced in multiple syllable structures. It needs to be practiced in phrases, sentences, and in conversation.

Therapy practice needs to vary in social context as well. Practicing a /b/ with the speech therapist is different than practicing it with Mama or Grandpa. Practicing a /b/ in a speech therapy session or during a practice session at home is different than practicing every /b/ word that comes up when reading a bedtime story with Daddy.

Finally, variability can also include environmental variation. The child should be working to improve their production of speech targets in therapy, at home, at the grandparent's house, in the car, at the grocery store, at school or daycare, etc.

The greater the three kinds of practice variability the better the child will internalize the new target and be able to use it spontaneously in a variety of contexts. This is why the participation of the parent is so important. The speech therapist cannot achieve social and environmental variability by him or herself. The practice the parents do at home and out and about during their daily life is an essential part of the therapy picture.

Summary

Therapy sessions for Childhood Apraxia of Speech need to involve lots and lots of speech productions. When learning something new, the therapist will used a blocked practice structure and only target that new skill. Once your child learns the new skill, the therapist will switch to a random practice structure and randomly switch between the newly learned skill and some old ones in order to improve performance when the demands of the task are harder. The speech skills also need to be practiced in different speech contexts, social contexts, and environmental contexts. Home practice is essential for this variability in practice.

You just finished Part 2 of a three part series on Childhood Apraxia of Speech Therapy Fundamentals.
Read the other two parts of the series:

You might also be interested in the following articles:

Monday, May 16, 2011

A Little Bit of Innocence Lost

A while back, I got Ava a box of assorted hair accessories hoping that three kinds of hair bands, two kinds of hair clips, and two kinds of barrettes all in 6 colors each would fascinate her enough to persuade her to let me put a barrette in her hair.


Instead she calls them all her treasures, the box they came in her "treasure box", uses the hair bands as bracelets, and thinks it's hilarious to put the hair clips on all her fingers at once. Well, at least it was entertaining.

A couple of months ago, when I was trying to persuade Ava yet again that these things were HAIR accessories by putting them in my hair, Michael decided that it was great fun and wanted me to put them in his hair. It was adorable. We all had fun. Ava though Michael looked great while still completely resisting participating herself.

Today I got the box back out for yet another try. My mom was over and snuck a hair clip into Michael's hair from behind. After asking her to take it back out he said, "I'm not a girl. I don't want those in my hair." I was actually completely surprised. I've never said anything like that around the house. He must have gotten that from school. It isn't that I want him to wear pink hair clips forever. I'm just sad that a little bit of innocence has been lost. He thought it was fun before and it was fun. Now he won't participate in that fun any more because someone at school told him hair accessories are only for girls. He's growing up so fast.

Childhood Apraxia of Speech Therapy Fundamentals: Part 1 - How Much and How Often?

Childhood Apraxia of Speech (CAS) is neurological speech disorder that causes children to have difficulty with the motor planning, sequencing, and programming necessary to produce volitional speech. Therapy needs to address the core problem of motor planning for speech in the most effective way possible. Every child is different, so therapy must be customized. Therapy for a young child who is nonverbal will be different from therapy for an older child who is using multi-word sentences, but the speech is hard to understand. However, the basic underlying fundamentals of therapy for apraxia are going to be similar. These underlying fundamentals are based on current research and professional consensus.

How much therapy is usually necessary to treat Childhood Apraxia of Speech?

Intensity of Speech Therapy

It is essential that a child with Childhood Apraxia of Speech get as many opportunities as possible to actually produce speech. You cannot improve motor planning skills if no speech production is happening. Therapy for CAS needs to focus on getting as many speech productions as possible from the child during each session. A child is not improving their motor planning skills when they are just listening or watching the therapist or other children. For this reason, it is usually recommended that speech therapy sessions be individual (one-on-one) rather than group (one therapist with several children). It is also recommended that the therapist stay very focused on having the child practice rather than on having the child listen and watch while the therapist "teaches". Therapy for Childhood Apraxia of Speech needs to be very intense.

Frequency and Duration of Speech Therapy

Children with Childhood Apraxia of Speech typically need a lot of therapy to show improvement. One study (Campbell, 1999) showed that "the children with apraxia of speech required 81% more individual treatment sessions than the children with severe phonological disorders in order to achieve a similar functional outcome."

The professional organization of speech language pathologists, the American Speech Language Hearing Association (ASHA) reports that, "There is emerging research support for the need to provide three to five individual sessions per week for children with apraxia as compared to the traditional, less intensive, one to two sessions per week (Hall et al., 1993; Skinder-Meredith, 2001; Strand & Skinder, 1999)." ASHA's technical report also states that, "In view of the Committee's information indicating that children are being enrolled for treatment of CAS at increasingly younger ages, careful consideration should be given to the length of the therapy session. If repetitive practice of speech-motor patterns is targeted in a therapy session, many children in the younger age ranges can remain engaged for only a maximum of 30 minutes per session."

Given a choice, therapy for Childhood Apraxia of Speech should be broken into many shorter sessions per week rather than one or two long sessions per week. This makes sense from a motor planning perspective. You will learn a new motor task (just like riding a bike) faster if you practice a little almost every day rather than practicing for several hours only once a week.

Summary

Ideally, therapy for Childhood Apraxia of Speech should be individual sessions 3-5 days a week. Those sessions should be focused on getting as many productions from the child as possible. Sessions should be no longer in length than the amount of time the child can focus on intense practice. These guidelines are most important when the Childhood Apraxia of Speech is judged to be severe.


You just finished Part 1 of a three part series on Childhood Apraxia of Speech Therapy Fundamentals.
Read the other two parts of the series:

You might also be interested in the following articles:

Sunday, May 15, 2011

Eloquence via the Written Word

Sometimes I feel something and I can hardly figure out how to explain it to myself much less figure out how to explain it to others. And then, being able to express yourself well in writing is taking it to a whole different level. Michelle at earlymama.com has written an amazing post in the form of a letter to her young son Noah about the importance of being happy. I agree with her wholeheartedly. You should read this. It's beautifully written and so true.

Saturday, May 14, 2011

Oral Apraxia - Mealtime Consequences?

I have a question for those of you with children who also have oral apraxia. Oral apraxia is problems with the motor planning of non-speech movements like sticking out the tongue or blowing kisses or bubbles. Both of my children have oral apraxia. Ava has both oral apraxia and childhood apraxia of speech. Michael just has oral apraxia.

I have noticed that both children often seem to bite themselves while eating. Several times a week someone will end up in tears during mealtime because they've bitten their tongue, inside of the mouth, or lip. I was wondering if this is pretty typical for toddlers and preschoolers or if you have noticed the same thing happening with your children with apraxia. Any thoughts?

The Weekly Review: Week Nine

Well, I completely forgot to post my weekly review yesterday, so here it is one day late.

Blog Post I Thoroughly Enjoyed:

Linda at All & Sundry shared a quote by an author that I am completely unfamiliar with from a book that I've never heard of. Nevertheless I thought the quote was a very accurate description of early motherhood. Check it out here.

Sibling Moment of the Week:

I loved watching Ava sit on the sidelines cheering Michael on as he went down the makeshift water slide we created using the hose and the slide on our playset. Even though she didn't want to slide herself, she loved watching Michael go down and clapped and cheered every time he hit bottom.

Quote of the Week from Michael:

Michael says to me "I love you the mostest of everyone."

Ava's Quote of the Week:

"More on back Dada!" when asking her Daddy for yet another piggyback ride.

Incomplete Project of the Week:

Remember when I shared my idea for an alphabet border with you about six weeks ago? At the time I had finished A, B, and C. Well, so far I have only completed two additional letters: D and F. Yes, I have only done two more in six weeks. And even then I skipped E because I haven't figured out how to make an eagle yet. But my D and F are beautiful and I will eventually finish the project. Really!

Friday, May 13, 2011

Disassembly

You might remember my post about Michael's redecoration of his room and my regret at overreacting to what was actually a pretty creative effort on his part. Well, I did slightly better this time when I discovered his efforts at disassembly.

I walked into the basement playroom and was astounded to discover our beautiful wooden dollhouse in pieces. I couldn't even figure out what I was looking at at first. The garage had been completely taken apart. The roof had been removed and disassembled. The screws holding the floors in place had been removed on one side so that they had fallen making it look like the dollhouse had been the victim of an earthquake.



The words that escaped my mouth in a tone of shocked horror were, "Who did that to our dollhouse?!?" Michael's instant response was, "I don't know!" At this point I was saved from another overreaction by the fact that I was still trying to figure out what on earth had happened exactly. I thought perhaps someone had fallen into the dollhouse and broken it? I was silent for several moments while I just tried to mentally process the scene.

Michael apparently interpreted my silence as evidence that I wasn't too upset about it and volunteered something to the effect of, "I used Daddy's screwdriver." At that point my brain went, "Ohhh....I get it now." (Inside my head a voice was still babbling, "Oh no, look. Look! Look what he did to the dollhouse. When? When did this happen? Wow!")

I took a deep breath and said, "First of all, wow Michael. That was a lot of really impressive screwdriver work. You have to be really, really good with a screwdriver to take all of that apart. But.... Well, some toys are take-apart toys. Toys like your crane truck, or your airplane, or your toolbench - those are take-apart toys. And some toys are stay-together toys. Some toys mommy and daddy work really hard to assemble and they are supposed to stay together and not ever be taken apart. Our dollhouse is a stay-together toy. From now on, we should only use screwdrivers to work on take-apart toys. You and Daddy are going to need to make a special project of reassembling this dollhouse later."

I felt pretty good about how I handled the situation. Michael is obviously really good with a screwdriver. I wonder if you can buy some sort of woodworking sets that involve assembling things (a simple dollhouse or birdhouse or car....) with wood and screws that we could get him that it would be all right for him to assemble and disassemble himself. I should look into it.

Wednesday, May 11, 2011

The True Problem with being Sick

It is true, I suppose, that you can adjust to just about anything. I've been sick so often this winter that I've adjusted to the actual symptoms of being sick. They just don't bother me as much as they did at first. So I go another few days with sinus congestion or a cough or a sore throat. Post nasal drip, body aches, runny nose, and sneezing all get to be old hat. I'm certainly not saying I enjoy it. I'd much rather be healthy. I'm just saying that it's hard to get all worked up and self-pitying about it after the 15th time.

The thing that bothers me about being sick it the effect it has on my parenting. My children are actually at a pretty great age these days. When I am healthy, I sleep well and wake up energized. I look forward to spending the day with my children. The time flies by and we do all of our regular activities and some bonus ones too just because we are all enjoying our time together. There's a positive feedback loop. The kids are in a good mood because I'm in a good mood and I am in a good mood because they are in a good mood. When small conflicts crop up, they stay small because no one (mama) over-reacts and blows things out of proportion.

All of that seems to disappear when I'm sick. I am tired and cranky. Waking up and facing the day with the children seems more like a chore than a pleasure and privilege. The hours creep by. I pass the time by letting them watch television more than I'd like. They are cranky because I am cranky. I get even more cranky because they are cranky. We do hardly any fun activities and just get through the day as best as we can. That's what I regret most about all the time I've spent sick this winter. I feel like the illnesses are stealing some of my quality time with my children. That is the true problem with being sick.

Here's hoping for a healthy spring and summer.

Tuesday, May 10, 2011

NutriiVeda Achieve - Reformulation of NutriiVeda

NutriiVeda has been reformulated. The claim is that it is richer and smoother with better flavor. They are now calling the flavors French Vanilla and Dutch Chocolate instead of Vanilla and Chocolate. They have also changed the packaging. Now it will come in a single 30-serving resealable pouch rather than the two 15-serving canisters.

I cannot find much information on the specifics of the reformulation. So far the company has not released the new nutrition panel. The website looks exactly the same to me except that they have changed the pictures to show the new packaging rather than the old packaging. I should get my first shipment of the new formula by the end of next week. I'll let you know more then.

We have been using the original NutriiVeda for about 5 weeks now. Originally Ava was getting about one scoop a day. We're now using closer to one and a half to two scoops per day. I continue to see improvement in Ava's speech. She is continuing to talk more frequently. She's using longer sentences and trying to string several sentences together to tell a single story. All of that is new. It is possible that she would be making these same improvements without the NutriiVeda, there is no way to tell. It certainly isn't hurting though. As always, I also take comfort in the nutritional boost that the NutriiVeda provides for my picky eater too.

Monday, May 9, 2011

Mother's Day Recap 2011

I hope you all had a wonderful Mother's Day. I slept in a little and then came downstairs to discover two vases the children had made for me. Their daddy took them to an activity at Lowe's on Saturday where they made "surprises" for Mother's Day. Turns out the vases were the surprises. Daddy filled them with flowers from the yard before I came downstairs. There was also a very sweet card and my favorite special occasion treat. A local restaurant has the best apple pie ever and I only get one on special occasions. It was a beautiful way to start the day.


My parents came over and we all enjoyed a decadent lunch and then took the children out in the yard for a couple of hours before nap. The slide on the playset had gotten extremely hot in the sun and we decided on a whim to try to cool it down with the hose. That turned into a giant water slide adventure. Daddy climbed into the playset to turn on the hose every time Michael climbed back up. Michael probably went down that slide 50 times. He loved it. Ava tried it once, but it was too fast when wet for her. She couldn't control her landing and decided to just sit on the sidelines and cheer her brother on. We all had a blast.

After getting the children down for nap we had apple pie and ice cream for dessert. It was a really nice family centered Mother's Day.

As an almost completely unrelated tangent, I took this picture in the backyard today. It's two baby birds hungrily awaiting the return of their mother. You're looking at the nest from below. The nest rests under where our deck used to be before it rotted away and had to be demolished.

Sunday, May 8, 2011

Speech-Language Pathology Topics: Voicing Pairs

Here's a quick speech lesson of the day. Don't you always want a speech lesson on Mother's Day? (Happy Mother's Day everyone!)

Say, "Ssssssss" out loud like you're making a snake sound. Draw it out as long as you can and while you're doing it place your hand on the front of your throat near your adam's apple. Now say, "Zzzzzzzzz" out loud like you're making a bee sound. Draw that one out as long as you can too while keeping your hand on your throat.

The first thing you should notice is that your throat vibrates while you make the /z/ sound, but it does not while you make the /s/ sound. That is because /s/ is a voiceless sound. You can make the sound without vibrating your vocal chords. The reason you feel your throat vibrating when you make the /z/ sound is because it is a voiced sound. You have to vibrate your vocal chords to make the /z/ sound. Other than that one difference, voicing, the /s/ and /z/ sounds are made in exactly the same way. You raise your tongue tip near the roof of your mouth behind your teeth and blow. So /s/ and /z/ are a voicing pair. They are two sounds made in exactly the same way except that one is voiced and one is not.

There are lots of voicing pairs. /t/ and /d/ are voicing pairs. /t/ is voiceless while /d/ requires vibrating your vocal chords. /p/ and /b/ are voicing pairs. /p/ is voiceless while /b/ requires vibrating your vocal chords. /k/ and /g/ are another example. /k/ is voiceless while /g/ requires vibrating your vocal folds.

What does any of this have to do with apraxia? Well, making a voiced sound is a more complicated motor task. To make a /b/ you have to do everything you have to do to make a /p/ and then coordinate vibrating your vocal chords at the right time for the right duration. So often, children with apraxia will find voiceless sounds easier. /t/ and /p/ are often easier than /d/ and /b/. Just another example of how complicated the motor planning of speech is and why our children sometimes seem to have trouble with a sound or word for no reason when there really is a reason after all.

Saturday, May 7, 2011

Friday Night Fun

So many things enter your life with parenthood. Love, tenderness and pride. Fear and worry. Responsibility and fatigue. Many you are prepared for, and some you are not. You get through them all. Sometimes with grace. Sometimes not so much.

And then there's the illness. The neverending illness. I do not exaggerate. I'm pretty sure that we have not gone more than one to two weeks since October with everyone in this household being well. I personally have not gone more than a week and a half since January without being sick. I had heard that having children in daycare often involves them bringing home bugs, but this is getting ridiculous. They are only there two mornings a week.

Last night my husband entertained the children while simultaneously getting a quote to replace our rotting deck, played with the children in the yard, and then fed them dinner. All by himself. I spent 2 and 1/2 hours at my doctor's office walk-in clinic and then waiting for my prescriptions at Walgreens. Diagnosis this time: Bronchitis.

Someone tell me this ends. Please. Tell me that I am not going to spend three out of every four weeks for the next 16 years sick.

Now I'm off to drink more hot tea and to try not to cough too much.

Friday, May 6, 2011

Magic Tree House Progress Chart

Michael and I have been reading the Magic Tree House books. The books are about siblings Jack and Annie who discover a Magic Tree House that travels through space and time to destinations found in books. The series is very well done and Michael is really enjoying them.

There is a companion website for the books where children can track their travels through the series in a virtual passport. They collect a virtual stamp for each book's location by answering questions about the book. Michael is really too young to enjoy collecting virtual stamps and the questions are a little hard for a three year old. I was kind of disappointed because I was hoping that the passport would be a fun enrichment activity that we could do together in addition to reading the books. (They advertise the passport in the back of each book which is how I knew about it.)

As I was wandering the sections of the website for teachers and parents, I discovered a welcome packet that included some bookmarks and a book list that has small images of every book cover.

I decided to make Michael a physical version of their passport. A Magic Tree House Progress Chart, if you will. I printed out the bookmarks and the book list on cardstock. I used the bookmarks and some title art to decorate a cardstock Magic Tree House themed blank progress chart and taped it to his closet door. I then cut out the pictures of the book covers we had already read. He loved sticking the books to the chart and excitedly talked about the books as we put each one on the chart.


He couldn't wait to start reading the new book and is already talking about how we get to put another book on his chart when we finish reading it.

The Weekly Review: Week Eight

Blog Post I Thoroughly Enjoyed:

I very much enjoyed Julia's most recent post. First, she often has pictures of her absolutely adorable children and this post is no exception. Second, she tells a very entertaining story about a marital debate. My favorite quote from the story, regarding her husband, is "putting the passive in our passion and the aggressive in our aggregate since 1996."

Apraxia Article of the Week:

A while back I wrote a post about Apraxia and Infant Bonding. I was talking about how I felt like the fact that both of my babies have oral apraxia might have had an effect on my ability to bond with them when they were little. I had never really seen any article mention such a thing, but I had lived it. And it made sense to me logically. This week I stumbled upon an apraxia article that begins by talking about this very thing. (The title of the article doesn't immediately scream "pertinent to this topic", but give it a chance.)

Sibling Moments of the Week:

  • Michael pushing his sister on the swing.
  • Michael asking Ava, "Do you want to go play in my room?" and Ava responding, "O-tay!". Watching them run off up the stairs together.
  • Watching the two of them on either end of a string playing tug-of-war.
  • Trying to decide if the two of them encouraging each other into an ever increasing fury of splashing in the bathtub was a good thing or a bad thing.

Quote of the Week from Michael:

"Mama, I need just one more hug!" from the doorway of his classroom as I drop him off at school.

Ava's Contrariness of the Week:

Finally, we got a barrette in Ava's hair. We snuck it in when she wasn't paying attention and for two adorable hours she had a pink bow in her hair. When she finally noticed it, she was hysterical until I managed to pull it out. I put it in my pocket. Five minutes later she insisted I give her bow back. She didn't want to wear it, mind you. She just wanted to hold it.

Incomplete Project of the Week:

Sorting through over 100 dvds we no longer want collecting dust and figuring out which of three different online vendors offers the most money for each dvd. This involved typing in the 12 digit UPC number for each dvd into each website. Next step is to print out the quotes, sort the physical dvds, box them, and ship them off.

Thursday, May 5, 2011

Amazing Library Experience

I've mentioned this before in passing, but it is worth saying again. Our county library system is amazing. First, their entire catalog is online. I can browse by author or keyword or even call number. I choose up to 25 books from anywhere in the county to place on hold and they are delivered to my local library. I get an email when they have arrived. I browse the call number "board books" for Ava and the call number "JE Readers" for Michael. I've also placed children's cds and dvds on hold.

It gets even better though. They have a hold shelf. I don't even have to go to the counter. I simply walk over to the hold shelf, find the books I've requested all waiting for me together in one spot and walk over to check out.

The county recently upgraded their technology to some sort of wireless system. All the librarians have to do to check you out is place a small pile of books on a pad and the entire pile is scanned at once. I thought that was pretty amazing but then they installed self checkout kiosks. I am in and out of the library in five minutes. I walk in, putting my returned books in their slot, and then walk over to the reserve shelf near the door and grab my new set of books. Then I self checkout and leave. I'm trying to remember to request new books every Sunday night and pick up the new set every Thursday on the way to pick the kids up from preschool.

Absolutely amazing. Have any of you had good experiences with your local libraries?

Social Dynamics

I try hard to find playmates for my children. Michael has a weekly playdate with a boy up the street who is only 6 weeks older than he is. We've been getting together regularly for at least a year and a half. They are a wonderful family and it has been pretty amazing to watch their relationship develop from two babies playing side by side to two boys who run off to play independently. Ava is just starting to get together regularly with a little girl in our neighborhood who is only 4 months older than she is. So far, they mostly just play in the same space, but that is fairly typical for a couple of two year olds playing together.

I have a friend too. We've known each other since before marriage and children. Now she has a little girl,Cara, who turned four just a few weeks after Ava turned two. She is 8 months older than Michael and almost exactly two years older than Ava. We try to get together on a weekly basis too. It's great that the kids get along, but mostly, we just want to get together ourselves.

Usually, Cara and Michael play together. That was especially the case before Ava started talking. Or all three children would play independently. When they came over yesterday though, a whole new dynamic appeared. The two girls went off together. Cara was actively engaging Ava and trying to make her laugh. They were tickling and wrestling and just being silly. They climbed on the playset together. In fact, every time one wandered off, the other would follow. The girls played together for extended periods of time while Michael ended up a bit neglected.

I was torn. It was amazing to watch the girls playing together even with the two year age gap. The communication, enjoyment, and togetherness was like something that had been gift wrapped for Ava and it was beautiful. At the exact same time, I hurt for Michael. He was trying to get in on the fun, he really was. But somehow he just ended up sidelined. The girls weren't deliberately leaving him out. They were just interested in different activities.

I suppose that when Ava tags along on Michael's playdates she is the one sidelined, but somehow that doesn't make me as sad because the pair playing together are age matched. It was just fascinating to watch gender and personality determine the playmates more so than age. Social dynamics start so very young.

Wednesday, May 4, 2011

Free Everyday Math iPhone / iPad apps

McGraw-Hill is offering all of their Everyday Mathematics iPhone / iPad apps for free until May 6 in honor of Teacher Appreciation Week. There are ten of them. They are pretty much only going to be useful for school-age children, but free is free and I can save them for a couple of years until Michael and Ava are ready for them.

Shadow Play

Ava was playing with her shadow in the basement playroom. She was standing on a step stool and the setting sun was coming in through the basement window lighting up the wall. Ava noticed her shadow and was delighted. She waved and played with it for several minutes and her Daddy was able to catch it on film. I stole the pictures from him and put them together so you could see.

Tuesday, May 3, 2011

Speech-Language Pathology Topics: Complexity of Motor Planning - An Example

Childhood Apraxia of Speech is a neurological disorder of the motor planning of speech. Here is one small example of how complicated that motor planning can be.

You might think that a /b/ is a /b/ is a /b/. Or you may have thought, correctly, that making a /b/ at the beginning of a word is different than making a /b/ in the middle or at the end of a word. But it gets even more complicated than that.

Say the word "book" five times in a row out loud, but before you say it the last time, freeze your mouth in the position it is in when you are about to make the /b/ sound. Your mouth should be pursed a little, almost like you're about to give someone a kiss.

Now say the word "bee" five times in a row out loud. Again, stop before you say it the last time freezing your mouth in the position it is in when you are about to make the /b/ sound. Your lips should be pressed together, almost like you just put on chapstick or lipstick and are spreading it evenly around.

Even though the words "book" and "bee" both begin with the /b/ sound, the motor planning for producing the /b/ is very different. For the first /b/ in the word "book," the motor planning involves the muscle motions necessary for lip rounding (because the following vowel is a rounded vowel). For the second /b/ in the word "bee," the motor planning involves the muscle motions necessary for lip spreading (because the following vowel is a vowel that involves lip spreading).

The difference between those two initial /b/ sounds is just one small example of how complicated motor planning really is. I just thought the example was interesting and I wanted to share.

What to do with an old baby wrap?

I was trying to think of creative ways to use a few old baby wraps I have lying around and I came up with this. We're redoing the basement's drop ceiling so I have access to the guts of the ceiling. I tied the wrap in a loop to a 2 by 4 in the ceiling. Voila. Instant indoor swing.

Michael likes to lay in it on his tummy and twist himself around until the swing won't turn any more. Then he picks up his feet and twists until he's so dizzy he can't stand. Ava likes to sit in it and be twisted and left to untwist, or to be pushed in traditional swing style. At the moment these activities are closely supervised because Ava sometimes gets tangled in the swing when she tries to get out on her own. I pick it up out of their reach when I'm not in the room.

It's a ton of fun though and certainly a better use of an old baby wrap than leaving it lying folded in a drawer.

Here's a picture of Ava in the new swing. Sorry it is so blurry. The swing was moving pretty fast. At least it gives you the idea. And just for fun, here's a picture of Ava in a different baby wrap when she was only three weeks old.

If anyone has any other great ideas for what to do with an old baby wrap, speak up. I'd love to hear them.

Monday, May 2, 2011

No problem.

Last night at dinner Ava was wandering the kitchen with one of her Daddy's wrenches. She walked up to him and said, "Look Dada! Look." He replied, "Yes baby. Could you put that on the table for me?" Ava walked over to the kitchen table and plopped the wrench right down on the edge of the table. She said, "No problem Dada!"

It completely cracked us up. I'm not sure she knew why we thought it was so funny. Did she get that from me?

Ms. J and Magic

I haven't spoken much about Ms. J recently. She's the local apraxia expert we're fortunate enough to be seeing twice a month. We saw her again yesterday morning. She is so good. She has amazing one-on-one sessions with Ava. I shamelessly eavesdrop through the door. She takes my 26 month old little girl and gets her to work on her speech for 50 minutes straight and enjoy it the whole time.

She's also magical. I will go and she will tell me work on something (the one I remember most is "work on two-word phrases"). I will tell her, "Sure!" while thinking to myself, "Yeah, right! There's no way Ava will be doing that in the next two weeks, she isn't even close." Every single time, Ms. J has been right. Every single time. She was right about the two word phrases. She was right when Ava first started being able to imitate final consonants. She was right about using the hand signals.

Well, this time she told me to work on the /k/ sound. I've been trying off and on to stimulate a /k/ production from Ava. I'll say, "Say /k/." Ava will respond, "/t/". Every time. She just can't make a /k/ or /g/ in the back of her mouth. Think about it for a second. Try to explain how to make the /k/ sound. It would go something like this:
  1. Bring the back of the tongue up to the roof of your mouth so that you completely block all air flow from your mouth. Leave the front of your tongue down.
  2. Build up air pressure behind your tongue.
  3. Now, let the air out in a little explosion by dropping the back of your tongue down. If you do it right, it will make a /k/ sound.

Ok. Now imagine trying to explain that to a two year old. Just not possible. So, when we're trying to stimulate a sound a child isn't making we have to use indirect methods. Sometimes you're lucky and the child can imitate the sound even though they aren't using it on their own. Or sometimes it is a sound that is easy to see, like /m/, because you make the sound with your lips. Then you might be able to help the child make the sound by showing them how. But /k/ is made in the back of the mouth. You can't just have the child watch you.

Ms. J took an indirect approach to getting Ava to make a sound in the back of her mouth. Essentially she had Ava open her mouth wide. Then she used a tongue depressor to hold down the tongue tip which will often force the back of the tongue up. Ava hated the tongue depressor and was happy to open her mouth wide if only the tongue depressor stayed put away. Then Ms. J had Ava imitate a kind of growling, "scary" sound. With the mouth wide open and the head tilted slightly back, making that noise is a giant step towards making a /k/ sound because you're making a sound way in the back of the mouth by moving the back of the tongue up. That's the first step we needed. Hopefully over the next two weeks I will be able to use that technique to shape a true /k/ sound from Ava.

If you had asked me two days ago if I thought there was even a possibility of getting a /k/ out of Ava in the next couple of weeks I would have said, "No way, absolutely not." One visit with Ms. J later and I think there's a distinct possibility. Magic I tell you. Magic.
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