Apraxia Therapy Materials: Kids Express Train Set 1 - Therapy Music

Therapy Materials Review: Kids Express Train Set 1 (KET Set 1)

This is a review of The Kids Express Train Set 1 (referred to from here on as KET Set 1 for short) created by Rachel Arntson, M.S., CCC-SLP. Rachel was generous enough to provide me with a complimentary copy of this set to review. At it's core, this product is music. It is therapy music. The KET Set 1 comes with two music CDs, a CD-ROM of therapy resources, and a manual.

Target audience

I'd say this music would be most appropriate for children between the ages of 12 months and 5 years of age. The music could certainly be listened to by younger and older children, but in a therapeutic setting I see it being used most with toddlers and preschoolers. There are always exceptions where the kit might be appropriate for older children.

The music and materials would be useful to therapists providing services in a clinic, school or home setting, and also to parents in the home. The music has a wide enough appeal that it could also easily be enjoyed in a preschool or daycare classroom as well.

Description of the Kids Express Train Set 1

This set contains two music CDs with 30 tracks. There are 25 unique songs with lyrics and 5 additional instrumental versions of some of the tracks. The set also contains a manual and a CD-ROM with additional materials. These songs are composed at a slightly slower rate and in a key that is high enough for young children to easily sing along. Adults and children are singing together and the cue, "Your turn." is built into each song. Each song provides many opportunities for children to imitate, often in sets of three repetitions. The topics covered by the songs and vocabulary used in the songs are accessible to young children.

• Imitation Station - CD1 The goal of Imitation Station is to encourage verbal imitation through singing with music and rhythm. There are 13 songs on this CD. I will list the song titles and the primary therapeutic objective of each song. I will also link to a song sample when available.
  
  
  1. Express Train - taking turns talking
  2. Animals - animal sounds
  3. Puppy, Puppy, Puppy - actions / puppy sounds
  4. Noisy, Noisy, Noisy - making noises
  5. Monkey Song - vowels / actions
  6. Dump and Fill - concepts of in and out
  7. Owie - actions / common vocabulary
  8. Milk and Juice - foods and choice questions (Sample here. Scroll down a bit until you get to the KET Set 1 section to find song sample.)
  9. Baby Blowing Bubbles - words / phrases (Sample here. Scroll down a bit until you get to the KET Set 1 section to find song sample.)
  10. Put the Sound on the End - ends of words
  11. Barefoot Toes - two-syllable words/phrases
  12. Go in My Car - vowels and the word, "go"
  13. Bye, Bye - two-word phrases / common objects
  
  The manual provides a brief description and 2-4 simple activities for every song on this CD. The CD-ROM has .pdf files that provide additional resources all of which can be printed (in both color or black and white). Those resources are:
  
  • Lyrics for all songs.
  • A list of speech and language goals and the specific songs that can be used to address them. Some language examples include action words and motor imitation (tracks 3, 5) and daily routines and social stories (tracks 6, 7). Phonemic awareness is addressed in track 10. Some of the speech goals include noises and animal sounds (tracks 2, 3, 4) and vowels/vowel combinations (tracks 5, 12).
  • A song request sheet. This sheet is like a pictorial table of contents. You print it and the child can choose which song they want to hear.
  • Follow-along sheets. These sheets are single or multi page sheets with the lyrics and pictures printed out to help the adult/child follow along with the song visually and sing along. (Available for all tracks except 6, 7, and 11.)
  • Flashcards. Some of the songs have the images from the follow-along sheets blown up into flash cards. (Available for tracks 3, 10, and 13.)
  • Activity sheets. These are fairly simple activity sheets available for about half of the tracks. They are more like a visual prompt for an activity rather than a worksheet designed to be completed with pencil and paper.
  
• Vocalocomotion - CD2 The goal of Vocalocomotion is to encourage verbal imitation through speaking with music and rhythm. There are 17 songs on this CD. The first 12 tracks are original (with one repeated at a slower pace) and the final 5 are instrumental only versions of a few of the first 12. I will list the song titles and the primary therapeutic objective of each song. I will also link to a song sample when available.
  
  
  1. Express Train - two-syllable combinations
  2. Hi - two-word phrases
  3. The New BMW - B, M, W in syllables (Sample here. Scroll down a bit until you get to the KET Set 1 section to find song sample.)
  4. Tongue Tip Time - T, D, N in syllables
  5. Let's Eat - foods
  6. Yee Haw - Animals / sounds
  7. Bath Time - body parts / bath words
  8. Hi - slow version - two-word phrases (Sample here. Scroll down a bit until you get to the KET Set 1 section to find song sample.)
  9. Row Your Boat - interaction song
  10. Put Them On - clothes
  11. Bouncy, Bouncy, Bouncy - interaction song
  12. Instrumental of The New BMW
  13. Instrumental of Let's Eat
  14. Instrumental of Yee Haw
  15. Instrumental of Hi
  16. Instrumental of Gonna Get You
  
  The manual provides a brief description and 2-4 simple activities for every song on this CD. The CD-ROM has .pdf files that provide additional resources all of which can be printed (in both color or black and white). Those resources are:
  
  • Lyrics for all songs.
  • A list of speech and language goals and the specific songs that can be used to address them. Some language examples include action words and motor imitation (track 12) and daily routines and social stories (track 7). Early emerging speech sounds in syllables are addressed (tracks 3, 4).
  • A song request sheet. This sheet is like a pictorial table of contents. You print it and the child can choose which song they want to hear.
  • Follow-along sheets. These sheets are single or multi page sheets with the lyrics and pictures printed out to help the adult/child follow along with the song visually and sing along. (Available for all tracks except 4.)
  • Flashcards. Some of the songs have the images from the follow-along sheets blown up into flash cards. (Available for tracks 2 and 8.)
  • Activity sheets. These are fairly simple activity sheets available for about half of the tracks. They are more like a visual prompt for an activity rather than a worksheet designed to be completed with pencil and paper.

How to Use the Kids Express Train Set 1

I think these songs can be useful in a wide variety of situations:

• Minimally verbal children - use the songs targeting animal sounds to try to get verbalizations.
• Children who are having difficulty imitating - music can often help you get children who are reluctant or unable to imitate in more structured therapy to verbalize.
• Home practice - this is wonderful for the car, or during a music time at home. Children are getting in speech practice while listening to music.
• Integrated intervention - If you are a school therapist doing any intervention in the regular classroom these songs would be ideal whole class activities.
• Individual or Small Group Therapy - These songs could be used as the core of a therapy lesson. Choose one or two songs and design your lesson around the song. Play the song two or three times during the session and use the activity pages.

Pros and Cons of the Kids Express Train Set 1

Pros:
The music is a wonderful therapy tool. The songs address a wide variety of early speech and language goals while providing you with a completely different type of activity to do with children.

The kit is applicable to a wide variety of settings and situations. It can be used with minimally verbal or even nonverbal children, children with early language goals, and children working on early speech production goals (early emerging consonants, single and multi-syllable utterances, two-word phrases, etc.). It can be used in the home, in a clinic or private practice, or in the schools.

The songs are also really catchy and well produced. My children, husband, and I all genuinely enjoyed listening to and singing along with the music. The children listened to several tracks two or three times in a row at their request the first time we listened to the CDs.

Cons:
The set is a little pricey at $39.99, but it is a pretty reasonable cost for two full CD's of therapy music plus goals/objectives and activity suggestions for each song. You also get several printables for each song as well.

It could be easy to get caught up in the music and forget to focus on getting enough speech repetitions from the kids. Some of the songs are heavy on participation from the kids and some are light. You'll want to balance the fun and usefulness of the music while still being focused on getting enough actual speech productions from your students.

Bottom Line

I like the KET Set 1 a lot. I would definitely recommend it as a great therapy resource to have for your practice.


There is a coupon code for the site. It is for $5 off any order. The code is KET201102.

Final K: Free Speech Therapy Articulation Picture Cards

Description

These articulation picture card sets are designed to be more comprehensive than the typical sets you might find elsewhere. The target audience for these sets are young children or children with more severe speech delays that need intensive practice with sounds at a one-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview set.)

Key Features

• This set includes 30 therapy cards with the target word and picture on the front, and the difficulty level and a carrier phrase on the back.
• The words are all VC or CVC in syllable shape.
• The words are simple and are easily understood by or easily taught to young children.
• Combines the target sound with all possible vowel sounds at least once.
• Words are sorted by difficulty level for an easy progression from easy to hard.

Permissions

I give permission to copy, print, or distribute this card set provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

Looking for Feedback

I would love to hear back from anyone who uses this card set. Let me know if you find errors or there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

More sets are on my Free Speech Therapy Articulation Cards page.

Card Sets

To download click on the image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

I recommend you print on cardstock and laminate for durability.

Initial K: Free Speech Therapy Articulation Picture Cards

Description

These articulation picture card sets are designed to be more comprehensive than the typical sets you might find elsewhere. The target audience for these sets are young children or children with more severe speech delays that need intensive practice with sounds at a one-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview set.)

Key Features

• This set includes 30 therapy cards with the target word and picture on the front, and the difficulty level and a carrier phrase on the back.
• The words are all CV or CVC in syllable shape.
• The words are simple and are easily understood by or easily taught to young children.
• Combines the target sound with all possible vowel sounds at least once.
• Words are sorted by difficulty level for an easy progression from easy to hard.

Permissions

I give permission to copy, print, or distribute this card set provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

Looking for Feedback

I would love to hear back from anyone who uses this card set. Let me know if you find errors or there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

More sets are on my Free Speech Therapy Articulation Cards page.

Card Sets

To download click on the image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

I recommend you print on cardstock and laminate for durability.

Preparing for an Evaluation?

Ava's evaluation is less than a week away. I'm beginning to think about how I need to prepare, if I need to prepare.

Some things are mundane. I need directions. I need to know what parking will be like. I need to figure out how long the drive will take given that I will be fighting rush hour traffic. I need to make sure someone can pick up Michael from school because Ava and I won't be done in time to get him. I need to pack a snack for her because we are supposed to be there all morning.

It is silly, but I want her to look nice. I need to pick a nice, but comfortable outfit. I need to allow enough time in the morning to feed her a good breakfast, dress her, and fix her hair.

And then there are the other considerations. Here in our state, in this district I've been told that the decision will be made that morning as to whether she qualifies. If she does, we will set up an IEP date that same day. I guess that means they plan to score all their tests and come to some kind of decision that same morning while Ava and I wait. If I want to be prepared to advocate for her, I need to be prepared to do so that same morning as the testing.

I'm not sure what that means exactly. I am going to write down my observations of her speech challenges at this time. I don't want to have to think under pressure. I want to be able to read off a list. Or perhaps just share that list with the team. I am thinking I should bring the ASHA position statement on Childhood Apraxia of Speech just in case. Oddly enough, I am having trouble thinking of other things that might be useful.

Does anyone have any suggestions? What should I bring with me to this evaluation/meeting? What should I be sure to think through ahead of time? What should I say/share? What should I not say/share? Any thoughts or comments would be appreciated.

Our first try with the final /k/ pivot phrase pages

I made the final /k/ pivot phrase pages a few days ago for Ava (and shared them with you). We sat down during our after dinner at home therapy session to try them. It looked like it was going to go well. She was excited about the new pages. They were bright, colorful, and looked new. She was excited about the treat she was going to earn. A necessity, as I've discussed. Things all went downhill from there.

Here was my reasoning for trying the pivot phrases. First, she was blasting through the pivot phrase exercises in the Kaufman Speech to Language Protocol Workout Book. All of those use early emerging sounds and she's pretty much got those now. She's even starting to add final consonants on the medial words in therapy without prompting. So, doing those exercises is good practice and review, but not challenging any more. Second, she was starting to get that final /k/ in single word practice at least 60-80% of the time. I really thought we might be successful at moving up to the pivot phrase level.

Well... not so much. I don't know if she was just having an off night, but she could hardly produce the final /k/ sound at the single-word level. The pivot phrases were a complete bust. I should have taped it. It was prototypical motor planning problems. No two attempts were the same. One time the /k/ would pop in at the beginning of the phrase even though she can't actually produce initial /k/ sounds. Another time, the /k/ would pop in in the middle of the word and then there would be random /t/ sounds thrown in for fun. Everything was disjointed and there would be long pauses while her system just struggled to sequence.

After trying for several minutes unsuccessfully to get some /k/ productions at the single-word level and watching her frustration increase exponentially I shifted gears. I simply used the picture prompts on the pages and made up 2-3 word phrases with them working on getting all the final consonants in the short phrases. At that point we were in familiar territory using all early emerging sounds and she was able to experience some success. Every so often I would probe the /k/ again, but without success.

I guess I'll try again in a few days. I hope someone else had more luck with these.

It's Coming and I Don't Have a Good Feeling About It

Our evaluation by the school district is coming up in a little over two weeks. Thursday they will send someone to observe her at school. Then two weeks later I bring her in for a morning of testing. I just don't think she'll qualify for further services.

She's doing so well. The occupational therapy has been nothing short of a miracle. She's trying new foods, tolerating stimulating environments, touching a wide variety of things without too much protest, and playing more with others. It is amazing and I am in awe at the transformative powers of occupational therapy. I'm not sure she needs much more OT.

Her speech is still full of errors, but her language is fine. Her teacher is just an amazing teacher and has a lot of experience with little ones and so doesn't have a lot of trouble understanding her at school. Most of what she has to say at school has a lot of context to help out. Her intelligibility is aided by her good coping skills. She will often try another way when her first attempt at communicating is unsuccessful. She also has good inflection, facial expressions and body language which helps boost her intelligibility. All of that is wonderful, but is going to work against her during this assessment. I suspect they will not qualify a child who isn't even three yet based on the presence of speech errors alone.

We'll just go and see what happens. But I'm not getting my hopes up.

Speech Therapy Update: Speech vs. Language

We saw Ms. J for therapy yesterday. It was the first time in about three months. Ms. J had some issues with her office space and wasn't seeing clients for a while and then we had some scheduling conflicts. It is amazing how time can just slip away.

Three months is a long time at this age. Ms. J was amazed at Ava's language. She's talking in full sentences. For her age, her sentences are complex and she is also doing well with grammar. To be honest, even when she had no words, I wan't super concerned about her language skills. She always understood exactly what was being said around her and was managing to be pretty expressive through body language and other non-verbal communication. Now that she's talking she has a lot to say.

Her speech, on the other hand, hasn't progressed a lot. After working with her for an hour, we were sent home working on mostly the same things. We're still working on that final /k/ sound. I think I hate /k/. Never once, did I imagine working on the same sound for months and months and months on end. However, I should note that it is finally coming in. It is guttural, but with prompting and multiple cues we can get a back sound instead of a front one. So now we're going to try to stimulate /k/ in medial and front positions as well.

So, in summary, language is great, intelligibility is moderate (pretty good in context to a familiar listener, but iffy under other circumstances), and speech is still our biggest area of concern.

Stimulability from a New Perspective

As I was taking a course dutifully working towards earning my 15 continuing education credits for this year I came across an interesting article that reminded me of several concepts in articulation/phonology treatment that I hadn't had time to think about recently.

In a nutshell, I was taught to address the error sounds a child is stimulable for first. That seems to make sense. In theory they would make progress faster and with less frustration than with sounds that are harder for them.

The article I read claimed that more recent research (I have not had time to look up the source articles yet, so take this with a grain of salt until I can confirm.) shows that often, children will acquire the sounds they are stimulable for on their own given time. Therefore, time in therapy should be spent on the sounds they are least stimulable for. If you spend 3 months establishing and working on /k/ and in the meantime, the /t/ which they were stimulable for pops in on its own, the child now has some mastery of two sounds at the end of that time period instead of just one.

This therapist chooses two targets to work on with a child at any given time. She chooses the two most complex sounds the child is not stimulable for that have the most contrast (voicing, manner, place). This is an entirely different model of choosing targets than I was taught to use, but the idea is intriguing.

I have two questions for any readers that might want to discuss this:

1. Have you encountered this approach to articulation/phonology therapy before, and what do you think?
2. If you agree that this approach has merit, do you think that this approach also applies to children with motor planning problems (apraxia)?

The problem with making assumptions about therapy materials.

I bought a therapy resource that was designed specifically to target early emerging sounds. Even better, the resource stated that it included 100 words per phoneme (20 one-syllable initial, 20 two-syllable initial, 20 two-syllable medial, 20 one-syllable final, and 20 two-syllable final). I thought to myself, "Why did I spend all that time designing my own early-emerging sounds card sets? There was already something out there!"

Well, I pulled it out the other day and excitedly flipped to the one-syllable final /p/ words to use with Ava. It was new. It was colorful. It was a spiral bound book that stands up like an easel. It was new and shiny. I had high hopes. There were 20 one-syllable final /p/ words. They were easy to find, and Ava was interested. However, I was able to use only 8 of those. I was so disappointed. Let's take a look at why.

First I had to eliminate all the words with blends (CCVC). That eliminated 6 words (stop, sweep, clap, step, scope, and grape). Then I had to eliminate the 6 words that began with phonemes that were too difficult for her (cup, cap, chip, drape, cop, and rope). That left me with 8 (soap, type, ape, top, shop, ship, map, and soup).

Of those 8 words, two began with /s/ and two began with /sh/. If your client is having difficulty with those phonemes you would be left with only 4 words to work on.

(If I apply these same criteria to my own final /p/ card set I am able to use 24 of the 30 picture cards in the set. I have to eliminate the 4 that begin with /k/ and the 1 /l/ and the 1 /r/.)

I encountered similar problems with the other one-syllable words. If you are going to design a set of cards designed to target early emerging sounds, it is not actually helpful to have so many of the words include sounds that emerge late or words that include more complex syllable shapes.

I suppose the moral of the story is to try to get a good look at the actual word lists in the materials you are about to spend your limited resources on. It is definitely possible that when you get a good look at what is included the set may not meet your needs.

Visual Aid:

1. cup
2. soap
3. cap
4. stop
5. type
6. chip
7. sweep
8. clap
9. step
10. scope
11. ape
12. drape
13. top
14. cop
15. shop
16. rope
17. ship
18. map
19. grape
20. soup

Try it for yourself. How many of these words would you actually be able to expect your child/client to produce accurately?

5-15-30 - Every Little Bit Counts

I suppose that sort of title usually applies to exercise. In this case I'm talking about speech practice. I've been attempting to incorporate therapy into our routine for months now. I've been largely unsuccessful.

Recently I've been motivated to try again. First I came up with a reinforcer that worked well - about three times. Then Ava decided that she'd rather skip speech even if she had to give up her treasured "colored cheerios". Apparently I wasn't destined to make one thing and have it work every time forever after. :-)

I admit. I hadn't even printed out all of my own card sets. Today I printed out two more. I'm stashing sets around the house. I'm trying to pull them out in those moments. You know, the ones where an activity wraps up sooner than you expected and you wonder how on earth you're going to make it through the next 5-15-30 minutes. Sure, she still whines a little, but I tell her that we can't do anything else until we finish a little speech. It doesn't take us long to go through a card deck and with more of them printed, she's seeing fresh pictures each time. If she's in a good mood and doing well, I'll do the card deck several times in a row. We'll say the words individually, say them with the prompts on the back, say them two-three times in a row, or pair them up and say them in pairs.

Taking speech in smaller, spontaneous chunks seems to be working better for us. I'm having to work to get Michael to not chime in when it is Ava's turn. Otherwise I can't hear her response well enough to give appropriate feedback. Other than that, it isn't a problem having him around during our practice sessions.

I'm not trying to teach anything new. I'm just trying to establish some final consonant usage in running speech. I'm working on that with the easiest consonants. I should take a baseline from some conversational speech so I can recheck in 2-3 weeks to see if we're getting any carryover at all. It would be a great experiment.

A Wayward Defender

I've been squeezing therapy with Ava in after her nap. She tends to wake up before her brother, so the time works fairly well. Yesterday, Michael woke up and came downstairs in the middle of our session and hung out nearby eavesdropping.

I have been working to get Ava to add in the "easy" final consonants (for Ava, /p, t/) at the end of the first word in a two word sequence or at the end of the second word in a three word sequence. So, we said, "wipe". Then, "wipe, wipe". Then, "wipe, wipe, wipe". That was fairly easy. So then we said, "Mama wipe". Also fairly easy. As soon as we add, "Mama wipe eye(s)" we lose the final /p/ sound in wipe. I was trying to get it back using visual, tactile, and gestural cues and she and I had gone back and forth several times.

Then, from behind me Michael piped up, "Mama! She SAID that!"

I love that his instinct is to defend his sister, but his timing wasn't the best. On the other hand, I did take a moment to explain to him what I was looking for demonstrating the difference and when I turned back to ask Ava to try one more time, she got it. Not a bad way to wrap the session up.

If You're Happy (Emotions Version)

I was first introduced to this idea several months ago by our Parents as Teachers home educator. I wanted to make our own version and couldn't remember the details so I did an online search for "if you're happy emotions" and found two helpful resources. This page shows the basic lyrics and some visual cue "faces" you can make. Another page gave me the brilliant idea to simplify the lyrics to make them more accessible to children with speech delays. Here's the project.

If You're Happy Song - Emotions Version with Visual Cue Cards

Making the Cue Cards

Group Planning

I sat down with the kids and drew a happy face. I asked them how the person felt and they responded "happy." I asked them "How else can people feel?" They responded "sad" and I asked how the face would be different if the person were sad. They told me a frown (and demonstrated for me). I made a sad face with a frown. We then worked together to discuss, demonstrate, and draw the other four emotions (sleepy, surprised, scared, and mad). We also chose the color for each emotion. I let the kids choose and so our colors are a bit unorthodox.

Make and assemble fronts and backs of Cue Cards

I then drew the faces on the circles and wrote the matching emotion and action on the back as a cue for myself when I was holding them up for the kids.

Identify Emotions / Sing the Song

There are a wide variety of activities to do with these cue cards.

1. Adult hold up the cards and leads the song.
2. Distribute the cards to the everyone (we had two each) and take turns holding one up and letting the person holding the card be the leader.
3. Use the cards to help the children learn to identify emotions (without singing) in flash card mode.
4. Have the children mimic the facial expression of the card you hold up.
5. Let the children make an expression and you try to guess which one they're making by holding up the matching card. They get to tell you if you're right or wrong. Get it wrong on purpose sometimes so they can enjoy telling you no.

Song Lyrics

You sing the song to the tune of If You're Happy and You Know it Clap Your Hands. If you are a teacher, parent, or early childhood educator who has no need to simplify the lyrics, just use the original wording. I'll give the simplified version in a bit.

Here are the originals:

1. If you're happy and you know it clap your hands...
2. If you're sad and you know it say "boo hoo"...
3. If you're mad and you know it stomp your feet...
4. If you're scared and you know it say "oh no"...
5. If you're sleepy and you know it take a nap (or close your eyes, or make a yawn)...
6. If you're surprised and you know it say "oh my"...

Here is how to simplify the lyrics:
If you are doing this activity with children who have speech delays, slow it way down and encourage them to sing along. (Or at least repeat "boo hoo," "oh my", and "oh no" when cued.) Once they have learned the song encourage singing by doing the activity where they get to hold the cue cards and lead the singing in turn.

If you're happy, happy, happy clap your hands.
If you're happy, happy, happy clap your hands.
If you're happy, happy, happy clap your hands, clap your hands.
If you're happy, happy, happy clap your hands.

If you're sad, sad, sad say "boo hoo".
If you're sad, sad, sad say "boo hoo".
If you're sad, sad, sad say "boo hoo", say "boo hoo".
If you're sad, sad, sad say "boo hoo".

And so on...

SLP Notes: This activity is great. You hit speech, language, vocabulary, and pragmatics all at once and can emphasize whichever is most important for your goals with a particular child. It can be adapted high (original version, fast pace, child led). It can also be adapted at a mid-level (modified version, medium pace, cued verbal participation). It can be adapted very low as well with modified version, slow pace, and only gestural participation or cued vocalizations (yawn, crying, snoring, exclamations of fear or surprise) to work on turn taking. Even using the activity to draw the child's attention to your facial expressions could help you work on eye contact if your goals are at that level. For vocabulary you get the emotions themselves, but also the parts of the face including eyebrows and terms like smile and frown.

I have NO IDEA!

The worry is so acute when they have no words and all the other children seem to be talking. Then, if you're lucky, you see progress when therapy begins and the feeling of relief is so profound. Sounds are better than silence. Single syllable words are even better than sounds. Two-syllable words or two-word utterances are even better than that. And then you get sentences, and lots of new words and you start to think it will all be okay.

Then there's a long plateau. Her immediate family understands her most of the time. I get a lot of practice, and at her age (2 1/2) she's almost always talking about something where I get some context clues. Being able to understand her most of the time gives me a false sense of security as well.

Lately, Ava is singing. It's adorable and a sign of great language development. Now, when I say singing, I don't mean the ABC song or Twinkle, Twinkle, Little Star. I mean just making up songs out of the blue.

She learned it from me. I make up songs about what we're doing all the time. If we're getting dressed I'll make up a silly song about putting on shirts and socks. If we're eating breakfast I'll make up a song about how our food tastes good to our mouth and then travels to our tummy to give us energy for the day. If the kids are running circles in the house I'll make up a song about how many laps they've managed to do. (I know, I'm a dork.)

A few days ago I noticed Ava starting to do the same thing. She made up a song about her baby and feeding her. Then she made up a song about going to the grocery store. I caught about one word in ten of those songs and only because I had some context to help with the guessing.

She's also making up songs about random thoughts in her mind. I can tell she's singing "words" and is super excited about whatever story she's telling. I can tell she wants an audience and wants to talk to me about her song. She's just bursting with pride at making up her own songs. I can see all of that clear as day.

And I have NO IDEA what the songs are about. None. It's killing me. It also makes me realize how unintelligible she is out of context and how very unintelligible she probably is to strangers. So sad. I must find more time for therapy.

Speaking of therapy, my new froot loop therapy reinforcer is working beautifully. She's bringing it over and asking to do speech just so she can have a froot loop snack. Whatever works! Being able to sit down with her regularly and get in sessions of a decent length is letting me get a better feel for her current skills and needs in terms of motor processing. Once I get things better sorted out I'll do a post on the topic.

Simple Homemade Therapy Reinforcer

Ava has an expressive speech delay (definitely a strong motor speech component and a significant phonological processing component). She sees an early intervention therapist weekly and we also see a local apraxia expert a little less often (once or twice a month on average).

(I'm getting to the therapy reinforcer, I promise.)

Even though I'm a certified speech therapist myself we don't do enough therapy at home. The therapist/client dynamic is hard between mother and daughter and I find her difficult to positively reinforce. Ava does respond well to froot loops. Froot loops aren't great for therapy rhythm though. It seems to take forever to chew one and she can't talk while chewing. Kind of counterproductive don't you think?

Then I had a great idea. It just popped into my head. The brilliant idea came as I was lying in bed. Working out the details in my mind stole at least half an hour of sleep, but it was worth it. So, the next day I made this:

I call it the Froot Loop Therapy Reinforcer. :-)

I pull a random froot loop from a bag after several repetitions (5-10 on an easy item, 1-2 on a harder one). She threads the froot loop on the matching color pipe cleaner. When she gets three of any one color she gets to eat them. It worked beautifully. It only takes a moment to pull one out of the bag and thread it but she likes that part so it is motivating. Then, every so often she ends up with three and gets to eat them (very motivating) and I can use those moments to mentally review what I want to do next or take a few notes.

It also has the benefit of working on color identification, color matching, and fine motor skills.

An alternative to froot loops would be threading color coordinated pony beads onto the pipe cleaners, but you just wouldn't eat them when the pipe cleaner was full. You'd need some other higher level reward (perhaps you could then thread three at a time onto yarn to make a bracelet for them to take with them at the end of the session).

Another advantage is that it is lightweight and can be folded flat for storage so if you travel for private practice or early intervention therapy, you could take it with you in a bag easily.

Here's how I made it.

1. Gather materials.
• Piece of cardboard.
• Piece of cardstock.
• Glue.
• Colored duct tape (optional).
• Pipe cleaners (red, yellow, blue, orange, green, purple).
• Tool to poke small holes in cardboard (I used a sewing pin).
2. Poke holes about one inch apart in a line across cardboard.

3. Cut pipe cleaners to about 2-3 inches long and feed them halfway through holes in cardboard.
   
   
4. Twist them together on bottom to hold them to the right length.
   
   
   
5. Cut cardstock to the same size as cardboard and glue cardstock to bottom of cardboard to hide the pipecleaners.
6. (Optional) Put colored duct tape along sides to make a pretty border and help prevent your edges from separating.
   
   

Inconvenience

I am basically a people pleaser by nature. It just clicked with me in childhood like a baby duckling imprints on its mother. We follow rules. That's a fundamental truth. We try to make the people around us happy. Another fundamental truth. Being an inconvenience or annoyance to others is to be avoided at all costs.

As an adult I realize that this simply isn't possible at all times. I know that. I know it isn't healthy or possible to feel a compulsive need to keep everyone around me happy all the time. You'd think raising two under two would have beaten that out of me, but dealing with children is somehow exempt from all of the above.

Then it turned out that Ava needs extra help. In order to get her the help she needs I have to be her advocate, translator, chauffeur, personal assistant, and liaison in addition to raising her to be an intelligent, caring, responsible adult who knows, without question, that she is loved. In order to be this advocate for her I have to do things I find uncomfortable.

Specifically, I am asking her preschool office staff and teachers to make some accommodations for her. She has been receiving speech at school. Her teacher has been wonderful about it. She even helped us get permission from some of the other parents in the room to participate so that her therapist can facilitate her communication in a small group. Overall, the school has been wonderful too, even providing a room for them to work in.

Ava's third birthday is on the horizon and the school district is preparing to evaluate her in December. They've called the school to set up an appointment to do an official classroom observation as part of that evaluation.

Last week her occupational therapist expressed a desire to observe her in the classroom during play and during her lunch at school. She and I tentatively set that up for next Tuesday. I mentioned that to the preschool director as I was heading to pick Ava up from her classroom and I got a distinctly chilly vibe. She said it was fine, of course, but the subtext was clear [enough is enough].

It was just a little thing. It was, perhaps, 30 seconds of my day. She didn't even say anything, it was just a negative, inconvenienced vibe. And yet I'm still thinking about it. It's because I want to please. I don't want to be that parent who is a nuisance.

I need to get over it. I'm sure this is just the tip of the iceberg. This journey with Ava will consist of many more moments when I have to push, or inconvenience someone. It's just the nature of this particular beast.

Speech Therapy Progress - So Slow

I realized that I haven't done a speech therapy progress update in almost 5 months. I can't believe that much time has passed. I've been doing fewer progress updates because there is less progress to report.

Last time I wrote a progress update I said that we were working on final consonants and that she was using /p/ and /t/ spontaneously about 30% of the time and we had pretty much no other final consonants. Now Ava is using final /p/ and /t/ spontaneously at least 60% of the time in phrases and sentences. She's also using or approximating most of the other early emerging consonants spontaneously at least 30-50% of the time. She can imitate final /s/ and /sh/ as well, but is not using those spontaneously.

We still don't have /k/ reliably. I'd say I've seen relatively little movement on this phoneme in 5 months time. Even in direct imitation with multiple cues she will substitute /t/ for /k/ at least 3/5 times. I am frustrated with the complete lack of progress on learning a velar sound.

Right now I feel like I understand Ava at least 90% of the time in context and at least 50% of the time if I have no context. I think she is significantly less intelligible to strangers. She is speaking regularly in 3-7 word sentences, but most of those are word approximations.

She has /p, b, t, d, m, n, h, f, j, w, s, sh, ng, and vocalic /r/ in her phonemic inventory.

I feel like her language growth has been phenomenal over the past few months. Sentence length and complexity, expressive vocabulary, and morpheme use has all improved significantly (as you would expect for a child of her age).

Speech progress has slowed and is becoming difficult to track. We have shifted out of the stage where we see rapid progress from beginning therapy. Now I am beginning to see that the remaining errors are significantly more stubborn and progress will be measured in small increments rather than leaps. It is disappointing, but not unexpected.

I know slow progress is much more typical of apraxia and motor planning problems than fast or even steady progress. It's just that when things moved so quickly at first I got my hopes up. I was hoping that she would be the exception rather than the rule. Why is there always another reality check just around the corner?

Speech Sample - Suspected Childhood Apraxia of Speech - 26 months

This is an audio clip from a video we took on 5-14-2011. Ava was 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, three weeks prior to this one, 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 half a minute. 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.

Here is the new sample:




In this audio sample Ava's utterances were:
What that?
What that?
This there.
Uh huh.
No I think get down.
No get down.
I think down.
Not think up.
Down.
No think down.
Down.
I say down.

Speech Sample - Suspected Childhood Apraxia of Speech - 25 months (2)

This sample was recorded three weeks after the last one I posted (4-26-11). She's picked up two additional consonant approximations. She's approximating /g/ and /s/ in this sample. What is interesting is that both of those sounds disappeared later. We are working on /s/ now, but I have to remind her to make it. She isn't really making the /g/ sound at all any more.

More important than individual sounds is that she's 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.

Transcript:
get down mama
get down mama
get down
get down
get down
uh huh
no mama get down
mama
mama scissors
dada scissors

Sunny Articulation Test App - One Day Sale

I have been keeping an eye on an articulation test for the iPhone/iPad called the Sunny Articulation Test. I wasn't willing to buy it at the usual price of $49.99, but today (10/9/2011) it is on sale for $21.99.

It is a qualitative test, not a normative test, so it will not tell you how your child/student/client compares to other children his/her age. However, it will test all phonemes in multiple positions of words. It allows you to easily record productions of each test item so that you can go back later and listen again. It has a screening mode and a full test mode. The screening mode has fewer words and you simply indicate right or wrong for each target phoneme. The full test mode has more words and you enter the type of error for each incorrect phoneme. The test automatically calculates errors and does some simple analyses (how many voiced sounds were incorrect, how many voiceless sounds were incorrect, how many plosives, etc.). You can also automatically generate and email a simple report.

I will do a more complete review once I have had an opportunity to actually use the program, but I wanted to let you know about the sale in case you've been looking for an articulation test for the iPhone/iPad.

Speech Sample - Suspected Childhood Apraxia of Speech - 25 months

This is a bit of a therapy session I was doing with Ava on 4-4-11. 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 C1V1C2V2 in syllable shape which is much more complex.