Monday, September 17, 2012

Case Study of Apraxia - Audio Samples from 21 - 30 months

About a year ago I pulled a bunch of speech samples from home videos and posted them on the website. A lot of people had trouble making the audio links work so I'm reposting them now in a single post for anyone who is interested in hearing what Ava sounded like just before starting therapy and through the first few months of progress. These samples begin with a short video taken at 21 months of age just before she started therapy. There is a monthly audio sample between 21-26 months and then a final sample at 30 months.

Let's begin with a frame of reference for this age group. Even dated research used a cutoff criteria of not having a spoken vocabulary of at least 50 words by the age of two to qualify children as "late talkers". More current research shows that the average number of words girls produce at 24 months is 346 and boys produce 252. A vocabulary of below 92 for girls and 63 for boys puts a 24 month old at the 10th percentile.

This is one speech delayed child with suspected Childhood Apraxia of Speech. As I know now, Ava's apraxia is mild and she made (and is continuing to make) swift progress in therapy. Do not listen to these samples and think that your student/child should sound just like Ava at the same age. All children are different. Their speech problems are different and their responses to therapy are different. I'm reposting these because I remember searching for some examples when Ava was first being diagnosed and wanting to hear some examples of other children who were struggling with severe speech delay. This is just one example of what a speech delay sounds like and the way the speech changed over time with excellent therapy. She went from almost no sounds/words at 21 months to singing a fairly recognizable rendition of a nursery rhyme at 30 months. I wanted to document that progress.

It has come to my attention that Blogger posts these videos/audios in flash format which does not play in Safari (on the iPad/iPhone) so you'll need to view/listen to these on a PC. Sorry!

Speech Sample - Ava - 21 months old - Childhood Apraxia of Speech before therapy

This is a video I took while reading a book with a 21 month old Ava before bed. At this time she had about four consonants, three vowels, and four "words" in her spoken repertoire. It was fairly obvious that she would be getting anywhere near 46-342 more words in the next three months. This is a good example of how to use picture books to encourage a speech delayed child to vocalize. Turn the book reading into a "conversation" by asking questions and pausing for a contribution from your child.

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Speech Sample - Ava - 21 months old

Here's something from about three weeks later. Ava has found something interesting on the floor. It looks like a sticker of an eye that has fallen off of something and she is pointing to it and "talking" to her Daddy about it.

This was taken about two weeks before she was evaluated by early intervention, about four weeks before a private SLP and I began speech therapy, and about six weeks before she began receiving speech services through early intervention.

It was however, after I had accepted that there was a significant delay and that I needed to schedule evaluations. I began to consciously try to encourage more vocalizations and one method of doing that is to "echo" back what you hear from your child. You hear my husband doing that with Ava during this clip.

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Speech Sample - Ava - 22 months old

Here's something from about one month after the last sample. At this point Ava had qualified for early intervention services, but hadn't begun receiving them yet. I was not yet doing structured speech therapy with her at home, but she had seen a private speech therapist for a few sessions.

Ava was laying on a blanket and I put my head beside her. She was quite offended that I was trying to share her blanket and was trying to persuade me to move off. She keeps pointing to a spot off of the blanket and telling me to move "there" while I keep pointing to a spot on the blanket and insisting that I stay. After quite a bit of back and forth I tell her I'll get off if she says "please" (we had taught her the sign for please and I'm actually asking her to use the sign). She uses the sign and I move.

During this interaction I am focusing on getting as many conversational turns in as possible without frustrating her. I've made the situation into a game where she is vocalizing over and over for me. In this one minute interaction I get 10 utterances and a sign. There -may- have even been one two-word utterance of "No, there!", but I can't swear that she really intended two words of if her Daddy and I were reading too much into that one.

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Speech Sample - Ava - 23 months old

Again, this is about one month after the last sample. At this point Ava was about six weeks into receiving speech services. Ava and I were laying on the floor and she was making some observations about the striped shirt I was wearing.

This speech sample shows a great deal of change. At 22 months, Ava produced 10 utterances in a little under a minute. Those utterances included four different words. She used one consonant (/d/) and three vowels (/Ɛ/, /Λ/, /OƱ/). In the 23 month sample she produces 13 utterances total in just over a minute. Two of them are two-word utterances. Nine different words are used. She went from using one consonant to using seven. In the last sample she used three vowel sounds and in this one she uses six vowel sounds.

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Speech Sample - Ava - 25 months old

This is about six weeks after the last sample. It is a bit of a therapy session I was doing with Ava. We were using a few of the Kaufman Cards. She had just turned 25 months old.

In the previous sample, Ava used the following consonants: /b, d, t, m, n, w, j/. All but one of those (mama) were used in one-syllable CV words.

In this sample Ava produces five different two-syllable words. Four of them were imitated correctly and one was imitated incorrectly, but still with a two-syllable non-reduplicated word. She uses /b, d t, p, m, n, h/ in this sample. She has added the /p/ and /h/ syllables in the six weeks since the last sample. She has also moved from productions that were primarily the CV syllable shape to productions that are non-reduplicated CVCV in syllable shape which is much more complex.

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Speech Sample - Ava - 25 months old

This sample was taken three weeks after the last one. Ava is almost 26 months old. The most striking thing to notice here is how Ava moved to using multi-word utterances. In this sample she produces 10 utterances. 2 of those are one word (both two-syllable). 5 of those are three words (4 syllables per utterance). One utterance was four words long (5 syllables)! This is a huge increase in average sentence length in three weeks.

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Speech Sample - Ava - 26 months old

This is the last monthly sample I have. It was taken about three weeks after the last one and Ava is 26 months old. At this point Ava was about four months into receiving speech services. Ava was asking me to get something down from a shelf.

In the last audio sample Ava produced 10 utterances in a little under half a minute. Those utterances included seven different words and ranged from 1 word (two syllable) utterances to 4 word (five syllable utterances). In this sample, Ava produces 13 utterances in a little under 30 seconds. These utterances include 12 different words and range from on word (one syllable) utterances to 5 word (5 syllable)utterances. The average number of words per utterance in the last sample was 2.2. In this sample it increased to 2.42. More importantly, there was significantly more diversity to the utterances in this sample.

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Speech Sample - Ava - 30 months old

This is a short audio clip I pulled from a home video of Ava singing to me as we were swing on a deck swing. I was using the front facing camera on my phone and Ava was entranced at watching herself sing. First I got her version of the ABC song twice. Then I asked for the Itsy Bitsy Spider, then Row, Row, Row Your Boat, and finally Hush Little Baby. It was so adorable.

Here is a small audio clip from the concert. She decided to sing the Itsy Bitsy Spider as the Itsy Bitsy Butterfly instead, as she explains at the end.

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3 comments:

  1. Replies
    1. Just for you. :-) Good luck with the eval!

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  2. This is amazing. Ava has made so much progress in 9 months. Thank you so much for sharing. It gives me hope.

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