It’s incredibly depressing. I looked up whether speech therapy is covered by our insurance policy. Essentially the answer is not unless your child has speech and then loses it due to head injury or stroke. They don’t cover developmental delays.
My understanding after doing a bit of research is that I can appeal that. I can argue that Ava does not have a developmental delay. A developmental delay implies that if left alone, she’ll eventually catch up on her own. That is definitely not the case. Ava has a neurological speech disorder. She will only catch up if she has intensive, specific types of therapy.
I’ve read that if you make the right kind of appeals with the appropriate insurance diagnostic codes (neurological disorder, lack of muscle coordination problem, etc.) and you have a lot of persistence and luck you can get some insurance coverage. To be honest, I read a little bit about the process, I get discouraged, and I promise myself I’ll look at it again next week. Well, that was three months ago.
This therapy stuff is expensive and it is putting a significant strain on our family’s budget. I’m already having to fight balancing budget needs with Ava’s need for intensive therapy. I think to myself, “Does she really need to see Ms. E twice a week, or would once a week be enough?” The real answer is that she definitely needs twice a week. Three times would be even better. I hate letting money dictate my decisions about what is best for my daughter, but that is a practical reality.
Having some insurance coverage would make a huge difference, but I don’t know where to start. I’m paying two different therapists out of pocket. Neither therapist submits to insurance for you. I don’t even know how to do it myself. I guess I need to find out. I understand that the appeals process can take months, so I suppose I should get started soon.
Thursday, March 31, 2011
Wednesday, March 30, 2011
The endless cycle of feeding
I thought the feeling that you barely finished feeding your child before it’s time to start again would be forever gone after breastfeeding. Not so much.
To be completely honest, I am not a kitchen person. I don’t have a history of enjoying cooking. I have no significant experience or skills or natural inclination to cook. To some extent, necessity is the mother of invention. I am interested in feeding my children healthy food. I made baby food when they were little. Michael ate pretty much everything. Ava not so much. I actually stopped making baby food and switched to finger foods pretty quickly because she just didn’t seem to like the baby food and it was a lot of work.
Now that they’re at the toddler / preschool stage I find myself in a serious rut. For breakfast they eat a banana, baby yogurt (whole fat, supplemented with iron) with some multi-grain baby cereal mixed in, or a relatively healthy cereal (Cheerios, Mini-Wheats, Kashi) dry. This is pretty much every day. Lunch is fish sticks and sweet potato fries, peanut butter crackers and carrots and grapes, and whole grain pasta with peas and parmesan. I’m having trouble thinking of more. Dinner is often some kind of pasta: spaghetti and salad or cheese tortellini and broccoli. If my husband takes over it might be pot roast or chicken from a crock pot. We tried hamburger helper. The kids won’t eat it so that was kind of a fail. Not really a nutritional win anyway.
There must be more simple, picky toddler friendly, quick meal ideas out there right? I came across a website devoted to healthy meals for small children. We found some ideas we like and were inspired to try for a very simple goal. We want to make one week of meals that we can regularly prepare here at home that minimize dependence on pre-packaged material, have some variety in all the food groups, and that the whole family will eat. (Ok. We had to give Ava a pass on three of the dinners. It just wasn’t possible. She'll eat leftovers or just the sides on those nights.) Just one week’s worth of meals. I’m willing to eat the same thing week after week. That’s what I’m doing now anyway really. Maybe we can eventually build up to a Week A and Week B plan, but let’s start small.
Here’s the current rough draft of the meal plan. We’re starting this week. Wish me luck. Tuesday and Thursday have no lunch because they eat at school. Friday’s lunch has a question mark because we usually meet my husband at work and all eat Chick-Fil-A for lunch on Fridays. The arrows to the right on Tuesday/Thursday/Saturday breakfasts indicate planning to eat leftovers from the day before.
So, does anyone have other suggestions? What are your “go to” meals? I could really, really use the help.
To be completely honest, I am not a kitchen person. I don’t have a history of enjoying cooking. I have no significant experience or skills or natural inclination to cook. To some extent, necessity is the mother of invention. I am interested in feeding my children healthy food. I made baby food when they were little. Michael ate pretty much everything. Ava not so much. I actually stopped making baby food and switched to finger foods pretty quickly because she just didn’t seem to like the baby food and it was a lot of work.
Now that they’re at the toddler / preschool stage I find myself in a serious rut. For breakfast they eat a banana, baby yogurt (whole fat, supplemented with iron) with some multi-grain baby cereal mixed in, or a relatively healthy cereal (Cheerios, Mini-Wheats, Kashi) dry. This is pretty much every day. Lunch is fish sticks and sweet potato fries, peanut butter crackers and carrots and grapes, and whole grain pasta with peas and parmesan. I’m having trouble thinking of more. Dinner is often some kind of pasta: spaghetti and salad or cheese tortellini and broccoli. If my husband takes over it might be pot roast or chicken from a crock pot. We tried hamburger helper. The kids won’t eat it so that was kind of a fail. Not really a nutritional win anyway.
There must be more simple, picky toddler friendly, quick meal ideas out there right? I came across a website devoted to healthy meals for small children. We found some ideas we like and were inspired to try for a very simple goal. We want to make one week of meals that we can regularly prepare here at home that minimize dependence on pre-packaged material, have some variety in all the food groups, and that the whole family will eat. (Ok. We had to give Ava a pass on three of the dinners. It just wasn’t possible. She'll eat leftovers or just the sides on those nights.) Just one week’s worth of meals. I’m willing to eat the same thing week after week. That’s what I’m doing now anyway really. Maybe we can eventually build up to a Week A and Week B plan, but let’s start small.
Here’s the current rough draft of the meal plan. We’re starting this week. Wish me luck. Tuesday and Thursday have no lunch because they eat at school. Friday’s lunch has a question mark because we usually meet my husband at work and all eat Chick-Fil-A for lunch on Fridays. The arrows to the right on Tuesday/Thursday/Saturday breakfasts indicate planning to eat leftovers from the day before.
So, does anyone have other suggestions? What are your “go to” meals? I could really, really use the help.
Tuesday, March 29, 2011
Fine Motor Activity - One
I came across this webpage on handwriting. The entire site has been fun to browse. I don’t even remember how I ended up at the site, but I'm glad I found it. The page has a great list of fun fine motor activities. Since I’m looking for fine motor activities to do with Michael, and fun activities to do with the children in general, I was pretty excited.
I decided to do the eye dropper art. I gathered eye droppers (something I had gotten months ago for art projects and never used), paper towels, cookie trays, food coloring, a cup of water, and ice cube trays before I called the kids over to the kitchen table. (Please excuse the blurriness of the picture. I didn't realize it was so bad, but at least it gives you an idea of what the prep looked like.)
I did a sanity check and decided propping the eye droppers in ice cube trays wouldn’t work and switched them out for empty baby food jars: two for Michael, two for Ava, and two for me. I brought the kids in and we talked about how water is clear but when we add the food coloring to it we can make it pretty colors. I let them choose the colors to make. Ava chose pink and green. Michael chose pink and yellow. I chose purple and blue. They loved watching the food coloring drop into the water and combine as we swirled.
Then I stuck an eye dropper in each jar and let them start. I quickly realized neither child knew how to use an eye dropper. Michael picked it up pretty quickly. Ava took a little more time but eventually got it. Michael didn’t have the patience (or fine motor control) to do only one drop at a time even when I encouraged him and showed him with my picture that you could do things like make flowers using one drop at a time.
He did stay engaged in the activity for nearly twenty minutes though which is a major accomplishment. Usually he’ll only do an art activity for a few minutes before getting bored/frustrated and wanting to quit. Ava loved it too. She actually remained at the table another ten minutes or so after Michael left to do another one.
I think the finished products are rather pretty. Mine is the one that looks vaguely like flowers. Ava’s are the small ones and Michael’s is the other large one.
I’m going to do this project again. We all enjoyed it and it’s good fine motor practice. Perhaps if I demonstrate how to make a train track or road or something like that he’ll be motivated to fine tune a little more?
I decided to do the eye dropper art. I gathered eye droppers (something I had gotten months ago for art projects and never used), paper towels, cookie trays, food coloring, a cup of water, and ice cube trays before I called the kids over to the kitchen table. (Please excuse the blurriness of the picture. I didn't realize it was so bad, but at least it gives you an idea of what the prep looked like.)
I did a sanity check and decided propping the eye droppers in ice cube trays wouldn’t work and switched them out for empty baby food jars: two for Michael, two for Ava, and two for me. I brought the kids in and we talked about how water is clear but when we add the food coloring to it we can make it pretty colors. I let them choose the colors to make. Ava chose pink and green. Michael chose pink and yellow. I chose purple and blue. They loved watching the food coloring drop into the water and combine as we swirled.
Then I stuck an eye dropper in each jar and let them start. I quickly realized neither child knew how to use an eye dropper. Michael picked it up pretty quickly. Ava took a little more time but eventually got it. Michael didn’t have the patience (or fine motor control) to do only one drop at a time even when I encouraged him and showed him with my picture that you could do things like make flowers using one drop at a time.
He did stay engaged in the activity for nearly twenty minutes though which is a major accomplishment. Usually he’ll only do an art activity for a few minutes before getting bored/frustrated and wanting to quit. Ava loved it too. She actually remained at the table another ten minutes or so after Michael left to do another one.
I think the finished products are rather pretty. Mine is the one that looks vaguely like flowers. Ava’s are the small ones and Michael’s is the other large one.
I’m going to do this project again. We all enjoyed it and it’s good fine motor practice. Perhaps if I demonstrate how to make a train track or road or something like that he’ll be motivated to fine tune a little more?
Monday, March 28, 2011
Nutriiveda for Apraxia?
So I was doing a bit of reading at the CHERAB website. This non-profit organization was founded by Lisa Geng who is one of the authors of The Late Talker book. I came across a page I linked to through their site with glowing anecdotal reviews about a new (to me) nutritional supplement. This site has been collecting testimonials and surveys from parents who have tried Nutriiveda and most have been positive.
I had never heard of it before, so I did a little web searching and discovered that this product is being primarily marketed as a meal replacement / weight loss product. That fact alone initially turned me off. I kept researching though. I came across this testimonial on a personal blog by another mom with a child who has apraxia. I re-read the description of the product and the information on the CHERAB website.
My decision about whether or not to try the product came down to two main points. First, just like with Omega-3 fish oils, there seems to be no downside and the possibility of hope. I hate to not try something that might help. Second, Ava is going through a terrible picky eater stage. She won’t eat any meat other than an occasional chicken nugget or fish stick and any veggie other than a carrot stick with dip. Supplementing her with something that has a great nutritional supplement aspect is appealing. One serving has 3 grams of fiber, 20 grams of protein, 100% of many vitamins and minerals, and only 5 grams of sugar.
So I ordered some. I’ll let you know what I think when I get it, and if and how it works over time.
I had never heard of it before, so I did a little web searching and discovered that this product is being primarily marketed as a meal replacement / weight loss product. That fact alone initially turned me off. I kept researching though. I came across this testimonial on a personal blog by another mom with a child who has apraxia. I re-read the description of the product and the information on the CHERAB website.
My decision about whether or not to try the product came down to two main points. First, just like with Omega-3 fish oils, there seems to be no downside and the possibility of hope. I hate to not try something that might help. Second, Ava is going through a terrible picky eater stage. She won’t eat any meat other than an occasional chicken nugget or fish stick and any veggie other than a carrot stick with dip. Supplementing her with something that has a great nutritional supplement aspect is appealing. One serving has 3 grams of fiber, 20 grams of protein, 100% of many vitamins and minerals, and only 5 grams of sugar.
So I ordered some. I’ll let you know what I think when I get it, and if and how it works over time.
Sunday, March 27, 2011
Songs and Rhymes – Therapy Techniques
Songs and nursery rhymes can be powerful tools for getting little ones with apraxia to verbalize. The singing activates different areas in the brain than those typically used in speech production and that often helps children successfully produce words.
I’ve been singing to my children since before they were born. I love singing. I enjoy it. I happen to like kids’ songs. What can I say? I’m an educator. So I usually sing kids’ songs to my children. I sing nursery rhymes like “Jack and Jill” and “Baa, Baa, Black Sheep.” I sing lullabies like, “Rock-a-Bye Baby,” and “Hush Little Baby.” I sing classic kids songs like, “Sing a Song of Sixpence” and “This Old Man.” We do preschool fingerplays like “The Itsy Bitsy Spider,” and “Twinkle, Twinkle Little Star.” The beautiful things about these songs are that they are predictable. They fascinate children. Rarely do I encounter a child that does not enjoy participating in a performance of kids’ songs. Ava knows almost all of these songs.
For the past few weeks I’ve been using the cloze technique (reading, or in this case singing, the first part of the sentence and then pausing to let the child fill in the next word) when singing songs with Ava and she has been filling in the missing words. So when we do, “Baa, Baa Black Sheep,” she fills in the words I’ve bolded.
And so in the 30-45 seconds it takes to sing this little song, she’s produced eight words. If you spend ten minutes singing songs from a nursery rhymes book (as we do every time we have an extended visit to the potty), you can get productions of 70-100 words. And they’re having fun the entire time. They don’t even know it’s therapy. You can incorporate this into reading time before nap and bedtime. You can do it any time really, just for fun. During car rides is another fun time to do this activity.
This activity isn’t about how perfect the production is. Obviously you’re not expecting to get perfect production of such a wide variety of words. It’s about making talking fun. It’s about them getting to participate in a fun verbal activity in a way they can be successful. It’s about just getting them to try. For example, Ava’s “lane” is pretty much just a long /a/ with no /l/ or /n/. But that isn’t the point. The point is the participation, attempts, and fun.
I’ve been singing to my children since before they were born. I love singing. I enjoy it. I happen to like kids’ songs. What can I say? I’m an educator. So I usually sing kids’ songs to my children. I sing nursery rhymes like “Jack and Jill” and “Baa, Baa, Black Sheep.” I sing lullabies like, “Rock-a-Bye Baby,” and “Hush Little Baby.” I sing classic kids songs like, “Sing a Song of Sixpence” and “This Old Man.” We do preschool fingerplays like “The Itsy Bitsy Spider,” and “Twinkle, Twinkle Little Star.” The beautiful things about these songs are that they are predictable. They fascinate children. Rarely do I encounter a child that does not enjoy participating in a performance of kids’ songs. Ava knows almost all of these songs.
For the past few weeks I’ve been using the cloze technique (reading, or in this case singing, the first part of the sentence and then pausing to let the child fill in the next word) when singing songs with Ava and she has been filling in the missing words. So when we do, “Baa, Baa Black Sheep,” she fills in the words I’ve bolded.
Baa, baa, black sheep,
Have you any wool?
Yes sir, yes sir,
Three bags full.
One for the master,
One for the dame,
And one for the little boy
Who lives down the lane.
Who lives down the lane.
And so in the 30-45 seconds it takes to sing this little song, she’s produced eight words. If you spend ten minutes singing songs from a nursery rhymes book (as we do every time we have an extended visit to the potty), you can get productions of 70-100 words. And they’re having fun the entire time. They don’t even know it’s therapy. You can incorporate this into reading time before nap and bedtime. You can do it any time really, just for fun. During car rides is another fun time to do this activity.
This activity isn’t about how perfect the production is. Obviously you’re not expecting to get perfect production of such a wide variety of words. It’s about making talking fun. It’s about them getting to participate in a fun verbal activity in a way they can be successful. It’s about just getting them to try. For example, Ava’s “lane” is pretty much just a long /a/ with no /l/ or /n/. But that isn’t the point. The point is the participation, attempts, and fun.
Saturday, March 26, 2011
Oral Apraxia
Quick Definition for those who don't know: Oral apraxia is difficulty with the motor planning involved in movements of the face, tongue, jaw that are not involved with speech. Examples include making a kiss, blowing bubbles, and sticking out the tongue.
We had a very interesting therapy session yesterday with our early intervention therapist. I mentioned that I was hoping to try to stimulate the /l/ sound a little because Ava needs to use it regularly in the name of someone close to her. Right now she substitutes the /y/ sound for the /l/. Her therapist suggested that we try to get her to lift her tongue up by holding a lollipop up near her upper lip and getting her to reach her tongue up to lick it. I thought it sounded like a fun activity and Ava rarely gets lollipops so she was going to love the activity.
It was incredibly hard for her. I know that Ava has some oral apraxia. I know she smiled late, blew raspberries late, and made kissing sounds late. I know she has trouble imitating things like sticking out her tongue, blowing bubbles, and biting her lip. I had never seen the struggle so clearly though. She just could not get her tongue to move up at all. She wanted to. She was trying so hard her whole jaw practically quivered. She tried to compensate by using her bottom lip to try to raise the tongue up which didn’t work at all. We finally got some success by bringing the lollipop down to her tongue and then having the tongue follow the lollipop up as we raised it a little.
Michael saw his sister getting a lollipop and wanted some too. We figured letting him do it would be a good model for her. He couldn’t do it either. His attempts looked exactly like hers. It’s fascinating that his speech is pretty good with no real signs of verbal apraxia at this point (even though his early development was worrisome), but he does have oral apraxia. I knew he couldn’t blow bubbles, but since he was talking just fine, I didn’t really examine the issue closer.
I’m not sure what the significance of the oral apraxia is. I haven’t really had a chance to process this new information. I need to think and then research a little. It doesn’t really change anything. Yes, I saw it more clearly today, but it has always been there. Perhaps though, I can use the new insight to find some new strategies for working with her. If nothing else, it very clearly reminds me why it’s almost impossible to teach her a new sound (for example /l/ by lifting the tongue or /f/ by biting the lip) by simply having her watch me do it and asking her to imitate the motion. She can’t. She really just can’t.
This is a striking example of why you can’t treat apraxia like other speech disorders. With an articulation disorder or a phonological disorder the children can watch you and imitate the oral-motor actions. Often, children with apraxia can’t. You need to use alternate strategies.
We had a very interesting therapy session yesterday with our early intervention therapist. I mentioned that I was hoping to try to stimulate the /l/ sound a little because Ava needs to use it regularly in the name of someone close to her. Right now she substitutes the /y/ sound for the /l/. Her therapist suggested that we try to get her to lift her tongue up by holding a lollipop up near her upper lip and getting her to reach her tongue up to lick it. I thought it sounded like a fun activity and Ava rarely gets lollipops so she was going to love the activity.
It was incredibly hard for her. I know that Ava has some oral apraxia. I know she smiled late, blew raspberries late, and made kissing sounds late. I know she has trouble imitating things like sticking out her tongue, blowing bubbles, and biting her lip. I had never seen the struggle so clearly though. She just could not get her tongue to move up at all. She wanted to. She was trying so hard her whole jaw practically quivered. She tried to compensate by using her bottom lip to try to raise the tongue up which didn’t work at all. We finally got some success by bringing the lollipop down to her tongue and then having the tongue follow the lollipop up as we raised it a little.
Michael saw his sister getting a lollipop and wanted some too. We figured letting him do it would be a good model for her. He couldn’t do it either. His attempts looked exactly like hers. It’s fascinating that his speech is pretty good with no real signs of verbal apraxia at this point (even though his early development was worrisome), but he does have oral apraxia. I knew he couldn’t blow bubbles, but since he was talking just fine, I didn’t really examine the issue closer.
I’m not sure what the significance of the oral apraxia is. I haven’t really had a chance to process this new information. I need to think and then research a little. It doesn’t really change anything. Yes, I saw it more clearly today, but it has always been there. Perhaps though, I can use the new insight to find some new strategies for working with her. If nothing else, it very clearly reminds me why it’s almost impossible to teach her a new sound (for example /l/ by lifting the tongue or /f/ by biting the lip) by simply having her watch me do it and asking her to imitate the motion. She can’t. She really just can’t.
This is a striking example of why you can’t treat apraxia like other speech disorders. With an articulation disorder or a phonological disorder the children can watch you and imitate the oral-motor actions. Often, children with apraxia can’t. You need to use alternate strategies.
Friday, March 25, 2011
The Weekly Review: Week Two
Blog Post I Enjoyed Most: I really liked this post on Balancing Everything. I’m a teacher and an SLP so education themed posts always interest me. I’m also fascinated by the idea of homeschooling. I don’t think I could do it, but I admire the people who do it well. This is a post by a mom who homeschools four children. She describes the activities they did during a week of science exploration. She includes great pictures of some of their projects.
Interesting Apraxia Article: Speech and Language Development in Infants and Young Children by Caroline Bowen. This isn’t actually an article about apraxia. It’s an article about speech and language development. You have to know what is typical before you can decide how worried you need to be.
Sibling Moment of the Week You know the kind of awkward hug you give an ex-boyfriend when you encounter them on the street and you aren’t even sure that’s the appropriate way of greeting them? Well, I missed the very beginning of the interaction, but I walked in on Ava and Michael giving each other a very awkward hug. Then they just kind of stood there for a second. So, I said something to the effect of, “Oh, are you guys wrestling? How fun!” They immediately started giggling and kind of pushing against each other. Michael promptly pushed Ava over and fell right on top of her. They both busted out laughing and scrambled back to their feet with Ava pleading, “more, more.” So they go through the awkward hug process again, and again Michael topples Ava right over landing on top of her. Much laughter ensued. This went on several rounds until the game was ended by Michael’s head connecting with Ava’s check hard enough to leave a bruise. So, it didn’t end well but it was still a beautiful five minutes. Those moments when my children are playing with each other (not both playing with me, but truly playing with each other) captivate me. I love watching them bond as siblings.
Michael’s Question: We were reading Mouse Soup at bedtime. Michael knows his letters and a lot of sound correspondences, so I’m doing a little pre-reading skills work during our reading time. For example, I’ll point to each word of the title as I read it. Then I’ll ask, “Which word is mouse?” Then I pointed to the “m” and said mmmm, the “ou” and said ow, and the “s” and said sssss. I just kind of skipped the “e” since I figured that explanation was a bit too complex for now. He never misses anything though and interrupted the beginning of the story to ask, “Mama, why is that E there at the end of mouse?” To be honest, I didn’t quite know how to answer him. I said something about how sometimes “they” add a silent e to the ends of words even though it really doesn’t make much sense. I was so proud that he thought to ask the question though.
Ava’s new favorite word: No. (and not) She loves using it in the typical toddler defiant fashion. She’s also using it in a large percentage of her sentences. She’s obviously exploring the concept and testing it out. So, she’ll say something like, “Ava pink shoes. No mama pink shoes.” Or, she’ll say, “Mama no tickle.” Now imagine a negative attached to most of our conversations and you get the idea.
Birthday of the Week: Happy birthday to my wonderful husband. It was the first year the children could understand and participate in celebrating the birthday of one of their parents. They had a great time blowing up balloons and “helping” me put the letters on the cake. We were getting ready to surprise Daddy when he came home from work, but the kids managed to let the surprise slip before he got around the corner to where he could see the kitchen table. It didn’t matter though. He loved it anyway.
Interesting Apraxia Article: Speech and Language Development in Infants and Young Children by Caroline Bowen. This isn’t actually an article about apraxia. It’s an article about speech and language development. You have to know what is typical before you can decide how worried you need to be.
Sibling Moment of the Week You know the kind of awkward hug you give an ex-boyfriend when you encounter them on the street and you aren’t even sure that’s the appropriate way of greeting them? Well, I missed the very beginning of the interaction, but I walked in on Ava and Michael giving each other a very awkward hug. Then they just kind of stood there for a second. So, I said something to the effect of, “Oh, are you guys wrestling? How fun!” They immediately started giggling and kind of pushing against each other. Michael promptly pushed Ava over and fell right on top of her. They both busted out laughing and scrambled back to their feet with Ava pleading, “more, more.” So they go through the awkward hug process again, and again Michael topples Ava right over landing on top of her. Much laughter ensued. This went on several rounds until the game was ended by Michael’s head connecting with Ava’s check hard enough to leave a bruise. So, it didn’t end well but it was still a beautiful five minutes. Those moments when my children are playing with each other (not both playing with me, but truly playing with each other) captivate me. I love watching them bond as siblings.
Michael’s Question: We were reading Mouse Soup at bedtime. Michael knows his letters and a lot of sound correspondences, so I’m doing a little pre-reading skills work during our reading time. For example, I’ll point to each word of the title as I read it. Then I’ll ask, “Which word is mouse?” Then I pointed to the “m” and said mmmm, the “ou” and said ow, and the “s” and said sssss. I just kind of skipped the “e” since I figured that explanation was a bit too complex for now. He never misses anything though and interrupted the beginning of the story to ask, “Mama, why is that E there at the end of mouse?” To be honest, I didn’t quite know how to answer him. I said something about how sometimes “they” add a silent e to the ends of words even though it really doesn’t make much sense. I was so proud that he thought to ask the question though.
Ava’s new favorite word: No. (and not) She loves using it in the typical toddler defiant fashion. She’s also using it in a large percentage of her sentences. She’s obviously exploring the concept and testing it out. So, she’ll say something like, “Ava pink shoes. No mama pink shoes.” Or, she’ll say, “Mama no tickle.” Now imagine a negative attached to most of our conversations and you get the idea.
Birthday of the Week: Happy birthday to my wonderful husband. It was the first year the children could understand and participate in celebrating the birthday of one of their parents. They had a great time blowing up balloons and “helping” me put the letters on the cake. We were getting ready to surprise Daddy when he came home from work, but the kids managed to let the surprise slip before he got around the corner to where he could see the kitchen table. It didn’t matter though. He loved it anyway.
Thursday, March 24, 2011
Good Luck
I feel like I’ve won the lottery. I know how astoundingly lucky we are that Ava has been so responsive to therapy (and fish oil supplementation?). I know that some children work just as hard, or harder, for months and see so much less progress. Their parents are right there with them feeling the frustration and fears too.
Three months ago all I knew was Ava had three words: /mo/ for “more”, /uh oh/, and /da?/ for everything else. I knew that she wasn’t even trying to talk anymore and was resorting to more and more gestures. I knew she didn’t even babble other sounds and that she couldn’t imitate. When she was evaluated by early intervention she tested at the 4 month old level. I had two different therapists besides myself tell me that Ava had many of the early red flag signs of apraxia.
I admit it. I panicked. As a speech-language pathologist I knew exactly what that meant. I knew we were dealing with a neurological motor planning speech disorder that can take several years of intensive speech therapy to address. And I so didn’t want that kind of struggle to be part of Ava’s life. I know hardships are a part of life, but she’s my baby and I didn’t want this one for her. I worked my way through the initial denial and then depression. I ended up in a productive place where I researched, planned and set up a therapy schedule for Ava.
I prepared my family for the worst. Severe apraxia seemed like a definite possibility given how behind she was. However, I told them that we wouldn’t know how bad it was until we saw how she responded to therapy. And it turns out, she responds well.
That changes things. The fear that she might still be using single words when she starts school is gone. Now, whether anyone will understand her…? We still have so far to go. By no means is her speech that of a typical two year old. But there’s been progress and that much is a profound relief.
Three months ago all I knew was Ava had three words: /mo/ for “more”, /uh oh/, and /da?/ for everything else. I knew that she wasn’t even trying to talk anymore and was resorting to more and more gestures. I knew she didn’t even babble other sounds and that she couldn’t imitate. When she was evaluated by early intervention she tested at the 4 month old level. I had two different therapists besides myself tell me that Ava had many of the early red flag signs of apraxia.
I admit it. I panicked. As a speech-language pathologist I knew exactly what that meant. I knew we were dealing with a neurological motor planning speech disorder that can take several years of intensive speech therapy to address. And I so didn’t want that kind of struggle to be part of Ava’s life. I know hardships are a part of life, but she’s my baby and I didn’t want this one for her. I worked my way through the initial denial and then depression. I ended up in a productive place where I researched, planned and set up a therapy schedule for Ava.
I prepared my family for the worst. Severe apraxia seemed like a definite possibility given how behind she was. However, I told them that we wouldn’t know how bad it was until we saw how she responded to therapy. And it turns out, she responds well.
That changes things. The fear that she might still be using single words when she starts school is gone. Now, whether anyone will understand her…? We still have so far to go. By no means is her speech that of a typical two year old. But there’s been progress and that much is a profound relief.
Wednesday, March 23, 2011
A Baby's Smile
We were at the park enjoying the spring weather. I was letting Michael and Ava climb on some bleachers when I noticed a ten month old baby crawling around in the grass nearby. The baby was adorable. She caught sight of my legs first and I saw her gaze travel upwards towards my face. She looked at me. I smiled at her and she smiled back. It was so natural and easy. It was fun and intrinsically rewarding to connect with a baby through eye contact and smiles.
It reminded me again that my own little ones did not do that when they were infants. Now, I’m not saying that they never looked at my face, or returned a smile. That would be an exaggeration. It just wasn’t as natural and as easy as it was with this stranger’s baby at the park. It’s hard to express, but it is so obvious to me that the connection that most babies make easily and naturally with the people around them did not come naturally for my children.
Even now, I’m having to explicitly teach Michael to look people in the eyes to connect with them. I’m teaching him to look in a person’s eyes when saying thank you or making a request. I think he’s slowly starting to realize how powerful that is.
Part of me reacts to seeing a beautiful baby by wanting another one of my own. But there’s the fear that I would be testing fate one too many times. Michael did not develop language, speech, or social skills typically, but has turned out mostly all right. He’s definitely within the typical range at this point and even ahead in some areas. Ava did not develop speech and language typically, and has what I can safely say at this point is a (thankfully mild) motor speech disorder. She’s making great progress and I am hoping that we can -maybe- catch her up by the time she starts kindergarten.
That’s two for two on atypical development though. Three is just not a gamble I’m willing to take with our lives even though I like smiling at the baby in the park. Besides, I’m not sure my husband and I could handle being outnumbered.
It reminded me again that my own little ones did not do that when they were infants. Now, I’m not saying that they never looked at my face, or returned a smile. That would be an exaggeration. It just wasn’t as natural and as easy as it was with this stranger’s baby at the park. It’s hard to express, but it is so obvious to me that the connection that most babies make easily and naturally with the people around them did not come naturally for my children.
Even now, I’m having to explicitly teach Michael to look people in the eyes to connect with them. I’m teaching him to look in a person’s eyes when saying thank you or making a request. I think he’s slowly starting to realize how powerful that is.
Part of me reacts to seeing a beautiful baby by wanting another one of my own. But there’s the fear that I would be testing fate one too many times. Michael did not develop language, speech, or social skills typically, but has turned out mostly all right. He’s definitely within the typical range at this point and even ahead in some areas. Ava did not develop speech and language typically, and has what I can safely say at this point is a (thankfully mild) motor speech disorder. She’s making great progress and I am hoping that we can -maybe- catch her up by the time she starts kindergarten.
That’s two for two on atypical development though. Three is just not a gamble I’m willing to take with our lives even though I like smiling at the baby in the park. Besides, I’m not sure my husband and I could handle being outnumbered.
Tuesday, March 22, 2011
Structured vs. Unstructured Therapy
Ava is changing at the speed of light. Her willfulness seems directly linked to her language ability. As her language abilities increase, so does her desire to have her way. She can express herself better and she wants her commands to be followed. I suppose it could also be those “terrible twos” I’ve heard so much about. Michael never really did the terrible twos – at least not like this. (Is there such a phrase as the “whining threes”? If so, he’s definitely doing that!)
It’s actually more annoying than cute. I’m finding it difficult to get Ava to sit down for structured therapy sessions. She goes into complete refusal mode and bribery with food no longer works. I’m needing to be more indirect and incorporate small moments of therapy into all of our daily activities.
For example, Ava will run over to her communication board and point to the yogurt calling out "yo-yo, "yo-yo, peas". She loves yogurt and wants it for breakfast and for her after nap snack. She can’t produce a /g/ sound. If I ask her to repeat the word with a /g/ in the middle she’ll just say “yo-yo” again. If I ask her to say, “yo-dirt” (because she can make a /d/ and some consonant in the middle is better than none at all) she’ll say “yo-dur”. The entire exchange takes no more than 30 seconds and yet it is a tiny bit of therapy. Then, as she eats the yogurt I find a way to fit that word in several more times. I’ll ask her, “More yogurt?” and make sure she says, “yo-dur” instead of “yo-yo” in response.
I never push her or try to correct words that she’s doing her best on. I’m trying to improve her pronunciation of words that I know she can do a little better. They don’t have to be perfect. They just need to improve in one way. “Yo-dur” has a /d/ instead of a /g/ in the middle and is missing the final /t/, but it is still closer than “yo-yo” so it’s an improvement.
I liked direct therapy. It’s just so much more intense than the unstructured therapy moments that occur during the day. I get maybe 5-10 practices of “yogurt” during the 15 minute snack. I could get 10-20 during 3-4 minutes of a structured session. I’m not giving up on the structured therapy. I’m going to get a little more creative. I’m going to try to sit down with a game and see if I can get her to work with me if we’re “playing.” I’ll let you know how that goes.
It’s actually more annoying than cute. I’m finding it difficult to get Ava to sit down for structured therapy sessions. She goes into complete refusal mode and bribery with food no longer works. I’m needing to be more indirect and incorporate small moments of therapy into all of our daily activities.
For example, Ava will run over to her communication board and point to the yogurt calling out "yo-yo, "yo-yo, peas". She loves yogurt and wants it for breakfast and for her after nap snack. She can’t produce a /g/ sound. If I ask her to repeat the word with a /g/ in the middle she’ll just say “yo-yo” again. If I ask her to say, “yo-dirt” (because she can make a /d/ and some consonant in the middle is better than none at all) she’ll say “yo-dur”. The entire exchange takes no more than 30 seconds and yet it is a tiny bit of therapy. Then, as she eats the yogurt I find a way to fit that word in several more times. I’ll ask her, “More yogurt?” and make sure she says, “yo-dur” instead of “yo-yo” in response.
I never push her or try to correct words that she’s doing her best on. I’m trying to improve her pronunciation of words that I know she can do a little better. They don’t have to be perfect. They just need to improve in one way. “Yo-dur” has a /d/ instead of a /g/ in the middle and is missing the final /t/, but it is still closer than “yo-yo” so it’s an improvement.
I liked direct therapy. It’s just so much more intense than the unstructured therapy moments that occur during the day. I get maybe 5-10 practices of “yogurt” during the 15 minute snack. I could get 10-20 during 3-4 minutes of a structured session. I’m not giving up on the structured therapy. I’m going to get a little more creative. I’m going to try to sit down with a game and see if I can get her to work with me if we’re “playing.” I’ll let you know how that goes.
Monday, March 21, 2011
Therapy Progress - Practice and Generalization
It’s been about a month since my last update on Ava’s speech therapy progress. This month her therapy sessions have been rather sporadic. Doctor’s visits, surgery, and a variety of illnesses have interfered with her therapy schedule. She’s seen Ms. J twice, Ms. A three times, and Ms. E four times. I’ve probably only worked with her about three times a week on average. So, there’s been less therapy overall, and the therapy has been a bit inconsistent. This winter has been hard on us.
This month she made the jump from talking with only one word sentences to frequently using two word sentences. She’ll occasionally use three or even four word sentences now too. For example she’ll say, “Ava no pink shoes.” She’ll also string together several two word sentences in a row to get an idea across. For example, she’ll say, “dada shoe,” “mama shoe,” “me no shoe.” The idea she’s trying to get across is, “Hey, why am I the only one here with no shoes on?” but she’s using the tools at her disposal to communicate the idea in a simpler way.
The jump to using more than one word at a time was huge and exciting. It opens up a lot of possibilities where communication is concerned. However, since that jump, progress is slowing down a bit. I’m not seeing huge changes week to week any more. That’s to be expected. She’s made some dramatic changes. She needs some time to just practice her new skills. She’s learning what it’s like to live in a world where she can talk to people and sometimes they can understand. She’s getting to have back and forth conversations with people for the first time.
About two weeks ago, Ava put two words together for the first time. Since then, she’s been practicing that skill. She combines things in new ways and puts new words together. She experiments with putting three words together. Her first two word phrases were adding an owner to an object (Papa house) and an adjective to an object (pink flower). One of her first three word phrases put both an owner and an adjective with an object (Papa pink flower). This week it’s all about negatives. “no, no, no” So she’s experimenting with adding a negative to her sentences. She said, “Ava no purple pockets,” when trying to explain that her purple jacket doesn’t have any pockets.
To summarize, Ava continues to amaze me. She’s made huge progress this month. Last time I wrote an update she was a one word kid. Now she can occasionally string together four. So much going on in that two-year old mind – I am thankful that she can now share some of it with me.
This month she made the jump from talking with only one word sentences to frequently using two word sentences. She’ll occasionally use three or even four word sentences now too. For example she’ll say, “Ava no pink shoes.” She’ll also string together several two word sentences in a row to get an idea across. For example, she’ll say, “dada shoe,” “mama shoe,” “me no shoe.” The idea she’s trying to get across is, “Hey, why am I the only one here with no shoes on?” but she’s using the tools at her disposal to communicate the idea in a simpler way.
The jump to using more than one word at a time was huge and exciting. It opens up a lot of possibilities where communication is concerned. However, since that jump, progress is slowing down a bit. I’m not seeing huge changes week to week any more. That’s to be expected. She’s made some dramatic changes. She needs some time to just practice her new skills. She’s learning what it’s like to live in a world where she can talk to people and sometimes they can understand. She’s getting to have back and forth conversations with people for the first time.
About two weeks ago, Ava put two words together for the first time. Since then, she’s been practicing that skill. She combines things in new ways and puts new words together. She experiments with putting three words together. Her first two word phrases were adding an owner to an object (Papa house) and an adjective to an object (pink flower). One of her first three word phrases put both an owner and an adjective with an object (Papa pink flower). This week it’s all about negatives. “no, no, no” So she’s experimenting with adding a negative to her sentences. She said, “Ava no purple pockets,” when trying to explain that her purple jacket doesn’t have any pockets.
To summarize, Ava continues to amaze me. She’s made huge progress this month. Last time I wrote an update she was a one word kid. Now she can occasionally string together four. So much going on in that two-year old mind – I am thankful that she can now share some of it with me.
Sunday, March 20, 2011
Doing too well?
Just when I think I have a handle on things, something new hits me out of the blue. Apparently Ava is doing so well, that she’s in danger of “graduating” from early intervention services. I didn’t even know that was possible. It’s a good thing no one is keeping track of all the things I don’t know.
I thought that once she qualified for services that she would automatically continue to receive them until she turned three years old. Then we’d have to re-evaluate to see if she qualifies for school-age services at that time. Ms. A, our early intervention therapist, just mentioned this in passing during our therapy session Friday morning. At the time, I was busy trying to keep Ava engaged and Michael from interfering too much and I didn’t really process the significance of what she was saying. Later, it occurred to me that I really should have asked more questions. I guess I’ll ask her what she meant when we see her next week. I’ll try not to worry too much until then. Worrying doesn’t do me any good.
I thought that once she qualified for services that she would automatically continue to receive them until she turned three years old. Then we’d have to re-evaluate to see if she qualifies for school-age services at that time. Ms. A, our early intervention therapist, just mentioned this in passing during our therapy session Friday morning. At the time, I was busy trying to keep Ava engaged and Michael from interfering too much and I didn’t really process the significance of what she was saying. Later, it occurred to me that I really should have asked more questions. I guess I’ll ask her what she meant when we see her next week. I’ll try not to worry too much until then. Worrying doesn’t do me any good.
Saturday, March 19, 2011
Macaroni Colors
On a whim, I decided to try coloring macaroni last night with the kids. I looked up the directions online (consensus was 2 tbsp of rubbing alcohol combined with lots of food coloring in a ziplock with 1 cup of macaroni - then pour out onto wax paper and dry overnight). I have lots of macaroni around. I just scooped some out of the macaroni bin I made a couple of months ago. The kids had a blast helping. They held the ziplock open while I added the rubbing alcohol and food coloring to it. They put the macaroni into the bag and then squished all the contents around once I sealed it. Then they oohed and ahhed over the results.
I learned several things.
I now have several trays of colored macaroni drying overnight. I'm not really sure what to do with them though. Any ideas for fun projects with colored macaroni? Anyone know how to overcome the problem with the macaroni being naturally yellow in order to make blue or purple macaroni?
I learned several things.
- This amount of liquid allows you to dye 2 cups of macaroni - not one.
- Do not use wax paper. It gets soggy with the extra liquid and then sticks to your macaroni. Use aluminum foil instead.
- When using blue food coloring, it mixes with the natural yellow of the macaroni for a result of green - not blue.
I now have several trays of colored macaroni drying overnight. I'm not really sure what to do with them though. Any ideas for fun projects with colored macaroni? Anyone know how to overcome the problem with the macaroni being naturally yellow in order to make blue or purple macaroni?
Friday, March 18, 2011
The Weekly Review: Week One
Blog Post I Enjoyed Most: I loved this post by Swistle. Technically, I’m cheating here because this post is over a week old, but I didn’t have a weekly review last week so I figure I get a pass on posting this one late. I laughed out loud when reading this post. Then I overheard my husband laughing out loud when I made him read it. It’s such a human mistake and Swistle does a great job of telling the story.
Therapy product I would buy if I weren’t on a budget: Word Flips. This is a great therapy product for apraxia. Ms. J. loaned it to us to use for our homework for the current two weeks. It’s great for apraxia, because you can work on the words individually, or mix them up to add complexity if your little one is ready for that. The words are separated into sections by place of articulation. You can combine individual words to make two syllable words or phrases (sew and pea make soapy).
Interesting Apraxia Article: Apraxia: Speech Therapy in Toddlers and Young Children by Sharon Gretz, M.Ed. This is a nice article about apraxia diagnosis and therapy with very young children.
Michael’s Mystery Question: Did he really eat a blue crayon at school as his teacher claims? Her evidence: blue mouth surrounded by crayon crumbs and missing crayon. He denies it, but the evidence seems pretty conclusive. He’s never, not once, tried to eat a crayon at home. In fact, he pretty much never eats anything that isn’t food. So, who knows? Maybe another child talked him into it?
Ava’s new favorite word: Hide. Whenever she can’t find something, she pauses and then says that it is hiding. So I ask her to find her shoes, and instead of looking for them she’ll just look at me and say, “Shoe hide.” So many things have been hiding this week. It’s been pretty cute actually.
Something I’m proud of: Coming up with the idea for Ava’s pillows and actually following the project all the way through. I think they’re adorable and Ava loves the pink one (just because it’s pink). She’s given the other one to Michael and so far they’ve had at least one pillow fight. Watching them learn to play together is a joy.
To give credit where credit is due, I was inspired to do a weekly review by the one posted every Friday morning on this blog. (Hmm. His webpage actually seems to be down at the moment, but it's the first time in the year or so I've been reading him that it's been down so I'm assuming it is temporary.)
Thursday, March 17, 2011
Daylight savings miracle
My children wake up early. They wake up with the light to be specific. So, in the middle of winter, near the solstice, they are sleeping till 7:30 or so which is wonderful. In the middle of the summer near the summer solstice they are waking around 5am!! Ava is particularly susceptible to the light and over the last month she moved from 6:30 to 6:15 to 6:00 and then started waking in the 5:00 hour. It’s driving me crazy. I need sleep too!! And she’s waking up cranky because she isn’t really getting enough sleep. Well, the daylight savings switch was wonderful. Saturday morning she was up at 5:45 am. Sunday morning it was 6:45 am. Just like that. I’ll take it.
Now, what can I do to manipulate things so that perhaps I won’t end up right back where I was a month from now? I have to find a way to keep her room dark. I tried it when she was little, but then even the slightest change was enough of a cue to get her up. I couldn’t block enough of the light for it to work. Maybe now that she's older, blocking most of the light will work? Also, then I didn’t have a sewing machine to use to make some light blocking tools.
I have a plan. Light gets into her room from two main sources: the window and under the door. I’m going to make one of those door draft stoppers to block the light from getting in under her door. Then I’m going to put up light blocking curtain liners. But instead of attaching them to her curtains I’m going to just cover the entire window opening. Seriously. If it works it’ll be worth it. I don’t care if we can’t open the windows any more. I’m thinking I’ll sew velcro to the light blocking liner and then glue velcro to the wall around the window and just stick it up there attached on all four sides. Ugly, yes. But it’ll be hidden by the curtains.
So that’s the plan. I’ll let you know if it works.
Wednesday, March 16, 2011
Screening Results - Always interesting
Each year, Missouri’s Parents as Teachers (PAT) program offers a free screening to each child enrolled in the program. Michael’s screening was Monday. This was the first year he got the “preschool” screening rather than the toddler developmental screening. Our PAT educator, Ms. S., came to our house to do the screening. She worked with Michael independently at the kitchen table while I kept Ava busy in the playroom. The screening probably took about half an hour. To be honest, I wasn’t paying close attention to the time so I’m not completely sure. Ms. S. told me that they don’t switch over to the preschool screening until the child is at least 3 years, 3 months old so Michael just made the cutoff to use the higher level screening.
The screening has three parts: a language section, a concepts section, and a motor section. This particular screening is used with 3, 4, 5, and 6 year old children. In fact, they’ll use the exact same form for the next two years so we’ll be able to track his progress from year to year. The language section covers personal data (do they know their name, etc.), a basic articulation screening, matching actions to objects, letters and sounds skills, rhyming, and simple problem solving. The concepts section covers body parts, colors, counting, shapes, positions (under, beside, etc.), and concepts (longest, full, cold, etc.). The motor section covers both gross motor skills (catching, jumping, hopping, etc.) and fine motor skills (building with small blocks, cutting, copying symbols, etc.).
So, Michael did an amazing job on the language and concepts sections. He performed at the 4, 5, and even 6 year old level on the questions on these sections. I am so proud of him. I knew he was a smart kid, but wow! It’s always nice to have independent confirmation.
In the motor section we saw an entirely different picture. He pretty much performed at the under three level or barely qualified at the three year old level for these skills. It’s strange. He can use a computer mouse completely independently. He can double click, single click, and move it to exactly where he wants it. He can build complex structures with duplos and the smaller legos. He can string beads onto a pipe cleaner. And yet he holds crayons and pencils in his fist like he’s trying to stab someone with them. He still doesn’t show consistent hand dominance. Sometimes he’ll use the right and other times the left. He isn’t interested in coloring for more than 2-3 minutes at a time perhaps because he finds it difficult. He does like to cut paper, but we don’t do it often and so he isn’t very precise. Perhaps I need to work art into our weekly schedule a little more often. And as far as gross motor is concerned I guess we need to work more on balance and catching. Hopefully spring will provide more opportunity to get outdoors and play physically some more. He also cannot pedal a tricycle yet.
I suppose, as I parent I do the things I like most. So we do a lot of singing, reading, talking, and playing with toys like legos, marble runs, trains, and puzzles. We don’t do as much art and physical play. I need to branch out more so that my children will have a more balanced skill set.
So, overall I thought the screening was great. It showed me that Michael is a smart little boy who has definite areas of strength and I’m so proud of him. It also showed me that I have an opportunity to focus on some new things that hopefully we will all enjoy while getting to practice some new skills.
Does anyone have suggestions of fun art activities that might work on some of those fine motor skills beyond simple coloring projects?
Tuesday, March 15, 2011
Look what I made!
First let me say that I am not, by nature, an artistic person. People who are genuinely creative are mystical beings who are worthy of my admiration. However, about a year ago I decided to buy a sewing machine. I didn’t know how to use one. I bought it almost on a whim. It’s shocking what curtains cost, really. I bought a beginner’s sewing book and did little projects like making a pincushion and a sewing machine cover. My first major project was the curtains for Ava’s room. I was quite pleased with myself actually given that I hadn’t touched a sewing machine since one small unit in high school home economics. I don’t make particularly beautiful things, but I like the idea of making practical ones. Here are my curtains (see picture – I made the curtains, not the valance).
Not so long ago we converted Ava’s crib to its toddler bed form. She was ready. We did it spontaneously though, so I hadn’t bought any “big girl” bedding. We still made it up just like her crib with her crib sheets. She sleeps in it holding her stuffed kitties and covered by one of her baby blankets. A couple of days ago I decided I’d try to sew a pillow for her.
I dug around in the box of old baby clothes and found a couple of old baby dresses. I cut them up for the material. I shredded all the scraps that were left over and a bunch of other scraps left over from other projects for filling. The scraps are mostly fleece so the stuffing is really soft and fluffy. I serged the edges of the material together leaving a small gap so that it could be filled. I turned it inside out, filled it with the cut up scraps of material using a funnel, and hand sewed the gap closed. Voila – pillow. Ava loves it! I finished it just in time for nap. She grabbed it from my hands and ran upstairs to her room to put it in her bed. She wouldn’t leave the bed to get dressed. I had to put her pull-up and pajama bottoms on her in the bed and she didn’t want her usual books and songs. She just went right to sleep that day. It was adorable.
Then I made a second one so that when one set of bedding is in the wash she can use the other one. I added a border to this one so it looks slightly more fancy than the first one. The first one is the pink one. The second one is the purple one. Ava, of course, won’t touch the second one because it is purple and not pink. She’s recently decided pink is her favorite color. And it’s icing on the cake that I did the entire project from stuff I had lying around the house and so it didn’t cost a penny.