Speech Sample - Suspected Childhood Apraxia of Speech - 23 months

This is an audio clip from a video we took on 2-12-2011. Ava is 23 months old. At this point Ava was about six weeks into receiving speech services. Ava and I were laying on the floor and she was making some observations about the striped shirt I was wearing.

In the last audio sample, four weeks prior to this one, Ava produced 10 utterances in a little under a minute. Those utterances included four different words. She used one consonant (/d/) and three vowels (/Ɛ/, /Λ/, /OƱ/).

Here is the new sample:




In this audio sample Ava's utterances are:
"brown" /baƱ/
"brown" /baƱ/
"black" /bæ/
"brown" /baƱ/
"white" /wæ/
"two" /tu/
"there" /dæ/
""black" /bæ/
"more" /mɔ/
"no, no" /noƱ noƱ/
"yeah" /jæ/
"no, mama" /noƱ mama/
"no" /noƱ/

That's 13 utterances total in just over a minute. Two of them are two-word utterances. Nine different words are used. She went from using one consonant to using seven. In the last sample she used three vowel sounds and in this one she uses six vowel sounds. In four weeks, Ava made huge strides in her speech.

Speech Sample - Suspected Childhood Apraxia of Speech - 22 months

This is an audio clip from a video we took on 1-15-2011. Ava is 22 months old. At this point she had been evaluated by early intervention and had begun seeing a private SLP twice a week for 30 minutes. I was not yet working with her in any structured way and we had not begun receiving services from early intervention yet.

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

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





As you can see she had made significant progress in a month. In the first video and audio sample Ava was mostly saying "there" over and over. In this audio clip you hear "there"(deh) "no"(oh) "yeah"(eh-uh) and "uh-oh". That's three vowels and one consonant. Still, it is four distinct utterances.

Speech Sample - Suspected Childhood Apraxia of Speech - 21 months

I decided to go back into the family video archive and try to pull some audio files that are representative of Ava's speech at different points in time. I've already posted something recent and a video from November of 2010 when Ava was 21 months old.

Here's something from about three weeks later (12-19-2010). Ava has found something interesting on the floor. It looks like a sticker of an eye that has fallen off of something and she is pointing to it and "talking" to her Daddy about it.

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

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

Keep in mind that she is almost two years old here.

They Called

Our diagnostic evaluation is officially scheduled. December 15. I spoke with the coordinator of the diagnostic team that will be evaluating Ava. They'll be sending someone out to her school the week before her evaluation to observe her and then we are supposed to allocate all morning starting at 9am for the actual evaluation.

I was nervous as soon as the person on the other end of the line identified herself, so my initial impressions probably aren't super accurate, but I didn't get a great vibe. I can't even quite pinpoint why exactly. I just got the feeling somehow that she already didn't think Ava will qualify.

My thoughts scatter in so many different directions when I think about the evaluation and they're all contradictory. First, I feel I'm embarrassed because I might be wasting their time - Ava probably isn't severe enough any more to continue to qualify for services. The next moment, I'm scared that I'll get that same terrible feeling I've gotten after her initial evaluation and after her formal articulation test. The one that sinks down to the pit of my stomach when I realize how far behind her peers she still is. I worry that she'll do too well and then I feel guilty that I can possibly want her to do poorly. What kind of thought is that for a mother?

I need to just relax. The evaluation is almost three months away. It doesn't do anyone any good to spend those three months obsessing over what may or may not happen. And ultimately, whatever happens, it will be fine. Everything will work out.

It is so easy to dispense such advice, even in my own mind. Now to just follow that good advice...

Is it that I don't remember?

I had the privilege of holding a three week old little girl last night. As she snuggled in my arms I watched all of the fleeting facial expressions and listened to the grunts and snuffles and sighs. It was so sweet.

I don't remember my babies being so expressive so young. To be honest I don't remember them being so expressive even much older. Is it that I just don't remember? Is it that I was too sleep-deprived and stressed to notice? Or does the apraxia start to show so early if you know what to watch for? Do the problems with motor-planning show up even as tiny infants? Apraxia is neurological in origin. Presumably it is there from birth. How does it impact their infancy and our introduction to motherhood?

Nine Months Ago

After listening to Ava sing the Itsy Bitsy Butterfly, I found myself trying hard to remember what she was like before.

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

At 21 months of age, you want most typically developing children to have a spoken vocabulary of at least 10-24 words. By 24 months of age you want to see 50 spoken words and some two-word combinations. You also expect those words to contain almost all vowel sounds and a wide variety of consonants. You would expect a typical history of cooing, laughing, smiling, and babbling as an infant.

Ava did not have a typical history of cooing, laughing, smiling, and babbling as an infant. At 21 months she used no more than 4 different vowel sounds and 3-4 consonant sounds. Her spoken vocabulary at that time is well represented in this video I took one day (11-30-2010 to be exact) while we were reading a story before bed. She had about three words: "de" (that or there), "uh" (used in a variety of ways for emphasis), and "oh no".

I remember taking this video. It was after I had finally accepted that there was a problem and I needed to pursue getting Ava evaluated. I took the video thinking it might be helpful to show it to someone because I knew she often wouldn't "talk" at all in front of strangers. As it turned out, I never used the video for that purpose, but I wanted to share it now. It is a good representation of what Ava's expressive language looked like before we started intervention.

Itsy Bitsy Butterfly

I asked Ava to sing to me the other day. We were sitting on the mostly finished deck in our swing. Using the front facing camera on my iPhone I managed to capture quite the concert. First I got her version of the ABC song twice. Then I asked for the Itsy Bitsy Spider, then Row, Row, Row Your Boat, and finally Hush Little Baby. It was so adorable.

Here is a small audio clip from the concert. (Yea! I finally figured out how to post audio!) She decided to sing the Itsy Bitsy Spider as the Itsy Bitsy Butterfly instead as she explains at the end.

Apraxia Therapy Materials: Kaufman Speech to Language Protocol Workout Book

Therapy Materials Review: Kaufman Speech to Language Protocol Workout Book

This is a review of the Kaufman Speech to Language Protocol Workout Book. The book was developed by Nancy Kaufman, MA, CCC-SLP. Nancy Kaufman is a nationally acclaimed expert in apraxia who has developed assessment and treatment materials in the area of apraxia. The book is 127 pages and is a 9" x 13" spiral-bound hardcover book. This book contains 16 different motor-speech "workouts" and some great resource pages in the beginning of the book on a variety of useful topics. Just like with the Kaufman Kit Level 1, the Workout Book focuses primarily on the consonants /m, p, b, t, d, n, and h/.

Target Audience

The target audience for the Kaufman Speech to Language Protocol Workout Book will usually be children between the ages of two and six. The pictures in the book were designed with those ages in mind. The book will be most useful for children who are struggling with producing simple syllable shapes and need to focus on the early emerging consonants /p, b, m, t, d, n, h/.

Description of the Kaufman Speech to Language Protocol Workout Book

This is a 9" by 13" spiral-bound hard back book with 127 pages. The book begins with resource pages on a variety of topics followed by 16 different types of activity pages. An SLP could pick up this book and use it with clients with very little advance preparation. I believe this book would also be useful to parents for home practice.

• Introductory Pages and Resources
  The book begins with some great explanations and resources:
  
  • Description of the Kaufman Speech to Language Protocol
  • Treatment Tips for Establishing First Words
  • Introduction to the Mutt Family (characters used both in the workout book and the treatment kit)
  • Explanation of Word Approximations
  • Discussion of Vowels
  • Pictorial Guide to Hand Signal Cues for Vowels
  • Vowel Workout
  • Pictorial Guide to Hand Signal Cues for Consonants
  • Discussion of Other Cueing Techniques
  These resource pages are very well done and are written in a way that is easy to understand and very useful. These first 26 pages add significant value to the person trying to use this book to help children with severe speech delays.
  
  Here is an example of one of the resource pages:
  
  
  
  
• Workouts
  The next section of the book consists of 16 "workouts". These workouts are exercises designed to easily elicit many practice productions of specific motor-speech combinations. Each workout begins with an explanation of the targeted skill (for the SLP) and is followed by activity pages that are well designed and engaging even for very young children. The workouts address the following topics:
  
  • Reduplication (CVCV)
  • Consonant Vowel (CV)
  • Same Initial Consonant Pivot Phrases with CV
  • Pivot Phrase "Open"
  • Naming Function: Noun-Verb-Object
  • "I Want" Pivot Phrases to Request Objects
  • "I Want To (Verb)" to Request Actions
  • Final Consonant Inclusion of /p, t, k/
  • Simple Bisyllabics (C1V1C2V2) plus CVC
  • Naming Action: Noun-Verb-Object
  • Sequence Stories: Noun-Verb-Object
  • Present Progressive Structure
  • Short Stories
  • Scripting Functional Language
  • Click here to see sample pages. (You may have to reload page after it opens.)

How to Use the Kaufman Speech to Language Protocol Workout Book

This book is a wonderful resource for any SLP. The early workouts are perfect for beginning work with children with severe speech delays. The later workouts are great for generalization of speech skills and are also great for working on expressive language skills as well. The book is compact, portable, and reproducible. It is a great investment.

Pros and Cons of the Kaufman Speech to Language Protocol Workout Book

• Pros:
  This book is sturdy, has great reference information, and has 16+ ready-to-go activities that are appealing and useful for a wide variety of speech and language students. The book takes you from eliciting single consonants and vowels to generalizing early emerging sounds in phrases and short sentences.
• Cons: The book is expensive. It only addresses early emerging consonants.

Bottom Line:

This is a great investment. The cost is high, but not completely inaccessible and worth every penny. You get a product that is educational for you, includes ready-to-go activities, is appealing to children, and is useful for a fairly wide variety of clients. It is also accessible and useful for parents that want to do extra practice at home for children with severe speech delays or expressive language delays.

You might also be interested in the following articles:

Apraxia Therapy Materials: Kaufman Speech Praxis Kit 1 (Basic Level)

Apraxia Therapy Materials: The Big Book of Exclamations

Apraxia Therapy Materials: Webber Jumbo Articulation Drill Book

Preparing for an Evaluation - Gathering Phase

First we had our second IFSP meeting about six months after the first. Shortly thereafter we had our transition meeting to talk about the steps necessary to transition from early intervention services to the evaluation necessary to see if Ava will qualify for services from the school district.

The evaluation is supposed to take place within three months of the transition meeting and the IEP meeting (if one is necessary) should be held within 30 days of the evaluation. So a clock is ticking. Before the evaluation is held, the evaluation team has to gather a lot of information. They get information from Ava's school (her current daycare teachers). They get information from her early intervention speech therapist and occupational therapist. They get information from the Parents as Teachers program about the screenings they've done. At the transition meeting I signed a lot of forms authorizing the release of information from one person or organization to the school district so that they can begin to gather all of that information.

Of course, nothing ever goes easily and smoothly. They need to know one very simple piece of information. They want to know if Ava can hear. We know she can. When they put the tubes in her ears they did an ABR when she was still under sedation and she passed. I need to find that paperwork and get it to the school district. The ENT's office says that the hospital will have those records. So, I called the hospital and they won't even tell me if they have the information I want until I sign a release form. The release form that I got in the mail today lists several types of information I could be requesting, but the results of a hearing test is not on the form. What a pain. I just need a person to look at a folder and tell me that they have that piece of paper. Then I need to give them permission to send a copy of that piece of paper to someone else. I haven't figured out how to accomplish that yet.

I'm half tempted to just ask the Parents as Teachers program to re-screen her hearing and send that paperwork to the school district rather that try to figure out how to get the hospital to give me what I want. However, knowing my daughter, that wouldn't be simple either. It's always something isn't it?

OT Evaluation Report

Our OT evaluation addressed two main areas: sensory and feeding. Therefore her OT report covered those two topics.

The sensory issues were addressed through a standardized sensory profile administered via parent report. Essentially, I answered a lot of questions about Ava. The profile covers auditory processing, visual processing, tactile processing, vestibular processing, oral-sensory processing, low registration, sensation seeking, sensory sensitivity, and sensation avoiding.

Ava scored in the typical range for vestibular processing, low registration, and sensory sensitivity. She also scored in the typical range for tactile processing, but the OT commented that Ava does seem to have some tactile processing hypersensitivity (doesn't play with food, play-dough, messy art materials, etc.). She responds slightly less than normal to auditory and visual inputs. She responds more than normal to oral inputs (food). She also scored high in sensation avoiding. She withdraws in group situations, avoids noisy places, avoids foods with strange textures, resists being touched by anyone other than very familiar family members, etc.

Nothing in the sensory profile was surprising. That makes sense, because the results were based upon my own observations. I am anxious to begin therapy and see how the OT recommends addressing her sensitivities.

As for feeding issues, again, the report was mostly a summary of my answers regarding Ava's food avoidances and preferences. The only new information was that her gag reflex is not overly sensitive. Again, I am interested to see where therapy takes us. The report itself didn't reveal anything earth-shattering here either.

I am mostly looking forward to beginning her OT therapy to see what that therapy will consist of and how much it helps. I want to help her with her eating issues for obvious reasons. I need to help her with the sensory issues for two reasons. The first is social. I don't want her hypersensitivity to prevent her from being able to socialize normally. The second reason is her speech. With apraxia, the greater the processing demands, the more difficult speech is for our children. So, when Ava is in an environment that is overstimulating for her, her system is so busy trying to deal with that overload, that her speech tanks. I hear her communicate so much less when we are out, when she is at school, and when we have a lot of people around. If we can start to work on that hypersensitivity to her environment, perhaps her speech will improve in these settings.

A Jealousy I Want to Let Go

This morning was beautiful. The weather was springlike. It was sunny, but cool with gentle breezes. We took the children to the zoo and had a wonderful time. Mid-morning we stopped at a set of benches for a snack. The children climbed on some rocks and we rested a while. As we were sitting there, a mother stopped to sit with her 7 month old baby in a stroller. They were adorable. They exchanged smiles and giggles. The baby babbled and blew raspberries. I just sat there insanely jealous of the experience I never had. I need to let it go. Yes, I didn't get to do the infant bonding, smile exchanging, babbling baby thing. Yes, that sucks. However, life isn't perfect, and I have two wonderful children. I shouldn't let seeing other wonderful babies and happy mothers cast a shadow on my day.

We have a children's book: Zen Shorts by John J Muth. It is a story about three children who meet their new neighbor who is a panda. Each child visits the panda individually and is told a short story based on a zen principle. One of the stories is about two monks. One monk is old and wise while the other is young and still learning. After observing a rather spoiled woman ungratefully waiting for help from her two servants, the older monk carries her on his back across some water in her path and she goes her way without thanking him. The two monks continue on their way. The older is content while the younger spends the next several hours fuming until finally he asks the older monk why he isn't angry. The older monk tells the younger monk that he left his burden behind hours ago (the lady) and asks the younger monk why he is still carrying his burden (his anger).

I think of this short story every time I have this experience of being jealous of a happy mother with her smiling, babbling infant. I want to be the older monk, not the younger. I visualize letting go of a dark balloon filled with cloudy smoke and watching it gently drift away into a sunny sky until it disappears from my sight. I try to imagine the jealousy floating away and myself feeling lightness and a sense of relief and just letting that negative emotion go.

I'm not having much success so far.

IFSP - Transition Meeting Edition

I was pleasantly surprised by the transition meeting. Of course, my expectations were low, so I had lots of room to be pleasantly surprised.

So here's the summary of how the transition process works (here in my area, at least). Approximately six months before your child turns three a transition meeting is scheduled. You meet with your Early Childhood Service Coordinator and a representative from your local school district's special education program. (In our case our Parents as Teachers teacher was also there to give information about our specific school.) The purpose of the meeting is to familiarize you with the steps involved in transitioning from Early Childhood Services to School-Age services and to get your signature on a bunch of forms that allows the school district to talk to a variety of people (your early childhood SLP, OT, any preschool teachers you might have, any doctors that might have pertinent information, etc.).

The process, as I understand it, will go like this: About three months before Ava's third birthday I will take her to be evaluated. I will find out on that day if she will qualify for services. If she does not qualify, she will continue to get services through Early Intervention until the day before her third birthday and then it will be my responsibility to arrange (and pay for) any services I feel she might still need at that time. If she does qualify, we will hold an IEP meeting within 30 days of the evaluation to decide what services she will receive once she turns three. Then, when she turns three she will begin to receive those services.

Potential service options will be individual speech or OT sessions, a special preschool program, or both. If we get individual therapy sessions, instead of coming to our home we would bring her to our local school for those appointments. If the IEP team decides the preschool program is appropriate we would bring her to school either two or four days a week. If she gets both, the SLP and or OT would see her in the preschool classroom or possibly pull her out of class for therapy.

Because Ava's birthday is in March, there is a final twist. The IEP team might decide that it is too close to the end of the school year to transition her at that time. If so, the schools would contract with her current early childhood therapists and pay them to continue to see her until the fall.

Everyone at the meeting was very professional and extremely nice. They seemed genuinely interested in Ava and her best interests. They seemed to understand her specific issues (speech and sensory) and how they interact and effect her life. They seemed to want to help. Now we just have to wait and see how the evaluation goes and if she will qualify.

So, in summary, the transition process looks like this:

1. Hold transition meeting (6 months before 3rd birthday).
2. Have child evaluated by school district (3 months before 3rd birthday).
3. If child qualifies, hold IEP meeting (2 months before 3rd birthday).
4. Transition from getting services from early childhood to getting services from school district (on 3rd birthday).

Initial H: 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 or simple two-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview sets.)

Key Features

• Initial and Final sets include 30 one-syllable words that begin or end with the target sound.
• 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.
• Describes the progression from most intense prompts to least intense.
• Provides a simple carrier phrase for every word.
• A gestural prompt for the target sound is explained.
• A list of therapy activities is included.
• Includes 30 therapy cards with the target word and a picture on the front,
  and the difficulty level and the carrier phrase printed on the back.

Permissions

I give permission to copy, print, or distribute these card sets 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 the word sets. Let me know if 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.

Instructions for printing and using the cards are included in the set.

NutriiVeda - Four Month (and final) Update

I haven't done a NutriiVeda update in quite some time. Before I give my final thoughts on the supplement, here's some basic information about how we used it. We never used a full two scoops a day, as recommended. The most we ever managed was about 1 1/2 scoops a day. For the first two months or so I was pretty consistent about getting that amount into Ava on a daily basis. After that we used the product fairly sporadically.

When we first started using the product I thought I saw an improvement in Ava's speech. I thought she was talking more often in longer utterances. Looking back, I'd say that the improvement was likely due to a developmental spurt or due to the speech therapy services she was receiving.

When we went on a family visit for about a week and Ava did not take the supplement I noticed no change in her speech and language. When we came home and began taking the supplement again I still noticed no change. After that, our use of NutriiVeda became more sporadic and I didn't put the same effort into getting it into her daily.

Now, Ava also has some suspected sensory issues. We haven't had our OT eval yet. One of the ways this effects her is to make her an extremely picky eater. I like the nutritional profile of the NutriiVeda as a meal replacement. It is high in protein and low in sugar. Several times a week I mix it into some yogurt and I feel good about giving it to her for purely nutritional reasons.

We are still buying the product. The company will let you call and delay the autoship for a month. We do that every other month. So, we're buying the product every other month instead of every month and we're doing that for nutritional reasons rather than because we feel it has had a significant impact on Ava's speech.

After having tried it, with high hopes, this is my final opinion:

If you can afford it, and want to try it, go ahead and try it. Many parents have reported that it works for their child and you can't know if it will help you unless you try it. However, unless the results are dramatic and you are positive that the product helped improve your child's speech, your money would be better spent on additional speech therapy or perhaps some speech therapy products to help you with home practice.

Final N: 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 or simple two-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview sets.)

Key Features

• Initial and Final sets include 30 one-syllable words that begin or end with the target sound.
• 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.
• Describes the progression from most intense prompts to least intense.
• Provides a simple carrier phrase for every word.
• A gestural prompt for the target sound is explained.
• A list of therapy activities is included.
• Includes 30 therapy cards with the target word and a picture on the front,
  and the difficulty level and the carrier phrase printed on the back.

Permissions

I give permission to copy, print, or distribute these card sets 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 the word sets. Let me know if 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.

Instructions for printing and using the cards are included in the set.

Initial N: 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 or simple two-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview sets.)

Key Features

• Initial and Final sets include 30 one-syllable words that begin or end with the target sound.
• 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.
• Describes the progression from most intense prompts to least intense.
• Provides a simple carrier phrase for every word.
• A gestural prompt for the target sound is explained.
• A list of therapy activities is included.
• Includes 30 therapy cards with the target word and a picture on the front,
  and the difficulty level and the carrier phrase printed on the back.

Permissions

I give permission to copy, print, or distribute these card sets 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 the word sets. Let me know if 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.

Instructions for printing and using the cards are included in the set.

Do you think we'll look back...?

Do you think we'll look back ten years from now and wish we could tell our past selves to relax? Tell that past self that it really will all be ok?

Even now, only six months after our first official evaluation, I wish I could go back to the me that was sitting in front of the computer writing that first post while wiping tears away that things will get better soon. The worst of my fears on that day are not going to come true. Ava can talk. She does not have severe apraxia and we're seeing relatively quick progress. The intensity of those first emotions does fade. Life has moved forward and we have found a new equillibrium.

We are raising a daughter for whom talking is difficult rather than a natural miracle like it is for the rest of us. She needs help and practice to learn to talk and that process will be measured in years rather than in months. I've accepted that. It is simply our new reality. Our lives are so complex and are made up of so many events that the speech issue is really only one small part of the whole. And the whole picture of our lives is a good one. I really do believe that in my heart.

Then there are the fears that creep in late at night, or after a particularly difficult day. At those time I wonder if I'll look back at the day I wrote this post and wish I could tell her that there are unanticipated struggles ahead and that I need to be more vigilant.

Initially, I was nothing but grateful over the extra OT services Ava will be receiving. As it sinks in that she is receiving those services because experienced professionals believe that there is a whole additional area of concern I had previously missed, I find myself struggling again to adjust.

I can wrestle with all these thoughts endlessly, but the bottom line is that Ava is always the same. She is my daughter. She loves me and I love her. A new opinion, service, or diagnosis does not change who she is. Like all other children she needs love, space, encouragement and excellent teachers to help her learn and grow into the best person she can be. I will continue to provide her with those things to the best of my ability and let the future take care of itself.

Our First, and Only, 6-Month IFSP Meeting

Unlike IEPs, IFSPs are reassessed twice a year. Our 6-month IFSP meeting was held Monday morning. I was nervous going into that meeting. Ava has made great strides and I was a little concerned they would tell me that she didn't qualify for services any more.

As it turns out, I didn't need to worry quite so much about that. I was careful to stay focued on her needs rather than her successes, but I did not exaggerate her needs. The main ones I see right now (in no particular order) are:

• The more stress she's under, the more difficulty she has communicating. So, when she's upset or hurt, that is when she tends to lose her words. Those moments are exactly the ones in which you need for her to communicate the most.
• Although Ava is making many communication attempts at home, she is reluctant or unable to communicate at school with her teachers and peers. At school she'd often rather go without than try to tell someone what she needs. At school she doesn't even try to talk to the other children in the classroom. That situation just breaks my heart and I desperately want to see improvement there.
• As an SLP, I continue to recognize the comprehensiveness of the speech delay in terms of intelligibility, but early intervention won't really write goals for specific speech sounds or intelligibility issues because there is such a wide range of normal at this age. That doesn't make it less valid, just something out of the scope of early intervention apparently.

So, we reviewed her speech progress and discussed her speech needs rewriting her goals and continuing her in speech therapy for an hour a week. If our therapist's schedule permits, she will actually see Ava at school in order to facilitate her communication and speech there. I will obviously continue to work with Ava here at home.

The big story of the IFSP meeting, however, is that we veered off into an entirely new direction. My service coordinator sent me a questionaire ahead of time and one of the questions was about my areas of concern for Ava. Almost on a whim, I wrote in a couple of non-speech items that have been bugging me for a while now. Honestly, I was expecting to bring them up and be reassured that they were within the normal range for kids her age. That's not exactly the way it went.

I've noticed that Ava is really sensitive to noise. The sound of the washer or dryer running will bother her enough while she is watching television in another room for her to leave the tv, run around the corner and down a hallway and shut the door to the laundry room. The flushing of the toilet in a restroom bothers her. Her hands clap over her ears and she recites, "loud, loud, loud" until the sound stops. Her father's electric razer will get the same reaction. We took the kids to their first movie (Winnie the Pooh) and I spent the entire time with my hands over her ears trying to reassure her that it really was all right.

Another issue is her picky eating. It is getting worse and worse and seems to be related to texture. She doesn't like to touch things that are messy and if her hands do get messy she immediately wants a napkin. She doesn't like to be touched or restrained. When other children approach her she gets really upset and reacts almost as if she's been hit. Washing her hair and face is pretty traumatic because she reacts so poorly to the washcloth and tilting her head back.

Well, to make a long story a bit shorter, we've added an hour of occupational therapy to her services. They feel like some OT might make a big difference with her feeding and bathing issues and other sensitivities.

I've never been closely involved with occupational therapy services before and so this will be a whole new area for me. I am hopeful that they can help Ava to be less sensitive and to experience the world a little more comfortably and fully. That would be such a gift to her.

All in all, a useful IFSP meeting. Next up: transition meeting and scheduling our first occupational therapy session.

Thoughts about IFSP Meetings

In order to qualify for services, children need to meet specific criteria. That's necessary. I get that. No one wants to provide therapy to children who don't really need it, and we can't afford to treat everyone who is even a little delayed, so you set a criterion and treat the children who need it the most. It is practical and theoretically fair if the same criteria are applied to everyone.

However, when the system is set up in this way it causes stress and tension. Parents want therapy for their children and are nervous about qualifying. When the time comes for a new meeting, the parents are hesitant to celebrate their child's successes because they are afraid they may no longer qualify for services that are still very much needed.

So, instead, you focus on all of the areas in which your child still struggles. It makes the meetings more than a little depressing. And although early intervention can be a wonderful experience and resource for families (it is for us), the time frame for early intervention ends so early. Ava will have been in the early intervention program for only a little over a year and then she will age out.

Then you have to start the whole process over again with your local school district and their criteria are even harsher. At yesterday's IFSP meeting, our service coordinator mentioned that next month we will need to hold a transition meeting. The purpose of that meeting, as I understand it, is to introduce us to the school district people that will be handling evaluating Ava to see if she qualifies for their services when she turns three.

And so time, and the special education processess, marches on.

(more on how our IFSP meeting went tomorrow)

Final M: 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 or simple two-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview sets.)

Key Features

• Initial and Final sets include 30 one-syllable words that begin or end with the target sound.
• 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.
• Describes the progression from most intense prompts to least intense.
• Provides a simple carrier phrase for every word.
• A gestural prompt for the target sound is explained.
• A list of therapy activities is included.
• Includes 30 therapy cards with the target word and a picture on the front,
  and the difficulty level and the carrier phrase printed on the back.

Permissions

I give permission to copy, print, or distribute these card sets 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 the word sets. Let me know if 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.

Instructions for printing and using the cards are included in the set.