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.
Showing posts with label therapy. Show all posts
Showing posts with label therapy. Show all posts
Saturday, March 26, 2011
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.
Sunday, March 13, 2011
After two word combinations start - What's next?
You’ve finally gotten to the point where you’re hearing some two or even three word combinations. It’s wonderful and every time you hear one a scene not unlike a New Year’s celebration unfolds in your mind. So, what’s next?
You have so many choices here, and they will vary from child to child. I’m just going to walk you through my mental processes where Ava is concerned. I could choose to work on specific sounds she’s still missing. She has no /k/, /g/, /z/, /l/, /J/, /f/, /v/, ... I could choose to work on final consonants. She doesn’t use any. So “dog” is /da/, “milk” is /mi/, “book” is /buh/, and so on. The way I would approach that would be to choose words that end with a sound I know she can make and try to get her to imitate putting that final sound on the word. However, I’m not going to do any of those things.
They wouldn’t be bad things to work on exactly, but those aren’t the right choices from a motor speech perspective. Remember when I talked about why apraxia therapy needed to be different from other kinds of speech therapy? Some therapy is designed to address specific missing or mispronounced sounds (articulation therapy). Some therapy is designed to address patterns of errors like the fact that Ava is dropping all consonants at the ends of words (phonological processing therapy). And then there’s the motor speech therapy that is best for apraxia.
Ava has trouble with motor planning. Combining syllables and words is difficult and effortful. Even though she can do it successfully some of the time now, it tends to be through the use of carrier phrases or words and phrases that we use a lot and are over-practiced. Or they are combinations that are very simple from a motor planning perspective. So, for example, “mama’s milk” /ma ma mi/ is pretty simple because the consonant is the same and she only has to change the vowel. That’s just like “baby” /ba bee/ and “banana” /nah nuh/ are fairly simple for the same reason. It’s the same consonant with only a changed vowel.
The next step we’re going to focus on, therefore, is to stick with working on two syllable or two word phrases, but to try to make them more complicated. Try combinations where the vowel is the same, but the consonant changes (beanie, beady, kiwi, teeny, teepee). Then try combinations where both the vowel and the consonant changes (pony, kitty, me too, my toe, no way, see me). So that’s the idea. Casually, through the day, I’m still very much doing all of the things I talked about in my therapy techniques to stimulate two word phrases post. During my focused therapy sessions, I’m trying exercises to increase the complexity of the two word or syllable phrases she can produce.
Saturday, March 12, 2011
Therapy Schedule
Our schedule has finally settled down. From start to finish, it took about two months from when I started to make phone calls to experts asking if I was worrying too early, to having Ava’s therapy schedule in its current final form. That’s pretty quick. I feel lucky. I’ve read stories from many other parents talking about it taking much longer. In that time we had Ava evaluated by our state’s early intervention program. She qualified. We had our IFSP meeting and a therapist was assigned. We also found two different private therapists. We had her hearing evaluated unsuccessfully twice, found out she had fluid in her ears, had surgery to put in PE tubes, and during surgery had a hearing test done to confirm that she can hear.
So, this is what the complete picture looks like now. I do focused therapy one-on-one (with no brother around) with Ava at least three days a week for about 30-45 minutes. My therapy is guided by Ms. J. Ms. J. is a local therapist who is an expert in apraxia. She has a private practice but she only sees her private clients two weekends a month. So Ava works with her for an hour twice a month and then she tells me what to focus on for the next two weeks. Once a week for an hour we receive services from Ms. A who is our early intervention therapist and a former student of Ms. J (who works at a university). In addition, Ava gets pulled out of her preschool program twice a week for half an hour by Ms. E., the first local therapist, I contacted.
Tuesday, Thursday – 30 minutes at school with Ms. E
Friday – 60 minutes at home with Ms. A
Every other Sunday – 60 minutes at private practice office with Ms. J
At least three weekdays / week – 30-45 minutes with mama SLP at home
It’s a bit of a patchwork quilt and in an ideal world I would love a bit more consistency, but it seems to be working so I’m not complaining. That’s what we’re doing right now. If you’d like to share, I’d love to know what you guys are doing with your little ones.
Thursday, March 10, 2011
Sometimes I just want to be me
In an alternate reality I live in a world where I am completely selfless, well-rested, and perfectly healthy. In that reality, I have the energy and enthusiasm to devote hours of my time to my children. I would play with them, do enrichment activities with them (cooking, art, music, physical play, literacy, etc.), and make sure that Ava and I get at least 30 minutes of direct, targeted therapy time every day.
In this reality, our household has spent more time sick this winter than well. This makes everyone tired and cranky in addition to the actual symptoms of the current illness (stomach bugs, colds, sinus infections, pink eye, etc.). I seem to be operating on a constant sleep deficit which is being exacerbated by Ava’s desire to wake with the sun. In our area, the sun is currently beginning to show up before 6am. And, to be perfectly honest, I am selfish. I want some time to call my own. I want some time separate from my children. I want to read, or blog, or play a game, or do a craft activity, or have a quiet moment where I do absolutely nothing. As a stay at home mother, I am with my children from the moment they wake till the moment they go to sleep all seven days a week. As much as I love them, that is a lot of time to spend with a two year old and a three year old who don’t know the meaning of independent play yet.
Each day, Ava wakes from her afternoon nap at least an hour earlier than her brother. This is supposed to be her therapy time. It’s the perfect time to do it in theory. She’s well rested and with a small snack, well fed. Sometimes I just don’t want to. I’d rather let her watch tv while Michael finishes his nap. This effectively extends my afternoon break from about one hour to about two. But I feel doubly guilty about this desire. First, tv is the root of all evil (ok, not really, but how many articles do we read about how bad tv is for our children?). Second, it’s her THERAPY. It should be non-negotiable. I shouldn’t even be considering letting it go. It doesn’t matter that she’s getting it elsewhere anywhere from three to five times a week. I have the skills to supplement her therapy myself. I should be doing it. Boy do I hate the word “should.” Anyway, sometimes I just want to be mama (and an imperfect one at that), instead of being a therapist.
And that’s my confession of the day.
In this reality, our household has spent more time sick this winter than well. This makes everyone tired and cranky in addition to the actual symptoms of the current illness (stomach bugs, colds, sinus infections, pink eye, etc.). I seem to be operating on a constant sleep deficit which is being exacerbated by Ava’s desire to wake with the sun. In our area, the sun is currently beginning to show up before 6am. And, to be perfectly honest, I am selfish. I want some time to call my own. I want some time separate from my children. I want to read, or blog, or play a game, or do a craft activity, or have a quiet moment where I do absolutely nothing. As a stay at home mother, I am with my children from the moment they wake till the moment they go to sleep all seven days a week. As much as I love them, that is a lot of time to spend with a two year old and a three year old who don’t know the meaning of independent play yet.
Each day, Ava wakes from her afternoon nap at least an hour earlier than her brother. This is supposed to be her therapy time. It’s the perfect time to do it in theory. She’s well rested and with a small snack, well fed. Sometimes I just don’t want to. I’d rather let her watch tv while Michael finishes his nap. This effectively extends my afternoon break from about one hour to about two. But I feel doubly guilty about this desire. First, tv is the root of all evil (ok, not really, but how many articles do we read about how bad tv is for our children?). Second, it’s her THERAPY. It should be non-negotiable. I shouldn’t even be considering letting it go. It doesn’t matter that she’s getting it elsewhere anywhere from three to five times a week. I have the skills to supplement her therapy myself. I should be doing it. Boy do I hate the word “should.” Anyway, sometimes I just want to be mama (and an imperfect one at that), instead of being a therapist.
And that’s my confession of the day.
Wednesday, March 9, 2011
Mini Review - First Hundred Words
This is a mini-review of First Hundred Words. Each time we see Ms. J (not including our initial visit), she sends something home with us to work on. The first time she sent home the book First Hundred Words with the instruction to use it to work on two word phrases.
This book isn’t simply a picture book like so many vocabulary oriented books. It is actually similar in concept to the Big Book of Exclamations. It consists of a series of two page spreads that feature a family in scenes that would be familiar to a young child. I’ve returned the book to Ms. J, so unfortunately this will only be a mini-review.
From what I can remember the picture spreads include a waking up scene, breakfast scene, bath scene, park scene, and bedtime scene just like the Exclamations book, but this book is longer and includes several other scenes as well. Because I don’t actually have the book any more I can’t tell you all of them, but one was a swimming pool scene and another was a drying off/getting dressed after the pool scene. These picture scenes are an entirely different illustration style from the Exclamations book, but I like them and there are so many details to find and discuss. This book is also much more reasonably priced than the exclamations book and is available in paperback which is a little easier to handle. I would definitely recommend it.
Here is a link to an article called Babies, Books and Speech Development. This is an article that reviews the Big Book of Exclamations and also gives some nice specific tips for using books to help encourage speech development. The article is definitely worth reading.
This book isn’t simply a picture book like so many vocabulary oriented books. It is actually similar in concept to the Big Book of Exclamations. It consists of a series of two page spreads that feature a family in scenes that would be familiar to a young child. I’ve returned the book to Ms. J, so unfortunately this will only be a mini-review.
From what I can remember the picture spreads include a waking up scene, breakfast scene, bath scene, park scene, and bedtime scene just like the Exclamations book, but this book is longer and includes several other scenes as well. Because I don’t actually have the book any more I can’t tell you all of them, but one was a swimming pool scene and another was a drying off/getting dressed after the pool scene. These picture scenes are an entirely different illustration style from the Exclamations book, but I like them and there are so many details to find and discuss. This book is also much more reasonably priced than the exclamations book and is available in paperback which is a little easier to handle. I would definitely recommend it.
Here is a link to an article called Babies, Books and Speech Development. This is an article that reviews the Big Book of Exclamations and also gives some nice specific tips for using books to help encourage speech development. The article is definitely worth reading.
Monday, March 7, 2011
Two word combinations – Therapy Techniques
Making the jump between one word utterances and two word utterances is huge, especially for a child with apraxia. I wanted to describe in more detail the many things you can do to try to facilitate the transition to using two word utterances.
First I want to talk about scaffolding. This is just a fancy way of saying that you’re only going to try to facilitate something a little harder than what your child can do on their own. If they can’t imitate at all, you’re not going to ask them to suddenly repeat a five word sentence. Start where they are and try to help them do something just a little harder. When they can do that, then do something just a little harder, etc. For the purpose of this discussion I’m going to talk about a child who can imitate single words and is willing to do so, but is having trouble imitating a two word utterance. The first thing you want to do is make sure you’re modeling two word utterances. Try to simplify your own speech to the two word level and use lots of two word phrases yourself. Also, whenever your child uses a word, repeat it back increasing it to a two word utterance. For example, if your child says “dog,” you say, “Yes! Big dog!” This is called expansion. You are expanding their one word sentence into a two word sentence.
Children with apraxia have trouble with motor planning. Research has shown that therapy is more successful when it is multisensory. Try to stimulate them as many ways as possible. One way to do this is to use a tapping technique. Use your hand to tap out two syllables as you say them. So, “big dog” should be said simultaneously with two taps of your hand on your knee (or claps, or snaps). If your child will tolerate it, tap gently on their knee, or hand, or arm. Or help them to clap the syllables themselves. Also try using a singsong voice. So say, “biiiiiiig dog”.
This might sound counterintuitive, but encourage signs and gestures. Typically developing children combine single words with a gesture before they start using two word phrases. So, if they want to tell you “daddy’s shoe” they might say “dada” while pointing to his shoe. One of Ava’s first two “word” combinations was saying the word “more” out loud while making the sign for milk. It’s a stepping stone to saying two word phrases and it can be very effective. As another example, spread your hands wide as a gesture for big while saying the word “ball”.
So, you’re scaffolding, modeling, expanding, and combining gestures with signs and still don’t feel like you’re making progress. Make sure you slow it down. We often don’t realize how quickly we’re speaking. Make sure that you slow your speech down. It gives them extra processing time. Also try being more direct. You can tell them, “Say, biiiiiiiig dog!” It sounds simple, but sometimes it can help. Be careful with that though. If your child gets defensive, don’t push.
You can also put a long pause in between the two words. Again, it gives them extra processing time. It also shows them that it is ok if it takes them a long time to get that second word out. When Ava is trying a new two word phrase that it hard for her, there’s a huge pause between the first and second word. You can see her working at getting that second word out. I think it helps if you model that pause to begin with. Only put the pause in if necessary though, and phase it out as soon as possible.
Use carrier phrases. I deliberately taught Ava the word mine. In a household with two young children that seems like a tactical error (and boy does she use it a lot these days), but I wanted her to then use the word “my ______” . Once you teach the carrier word, it can then be combined with so many other words. “My shoe. My hat. My milk. My cup. Etc.” This one works particularly well because you can make it into a game and get lots of repetitions. So, she says, “My shoe.” You playfully return, “No, mama’s shoe!” She indignantly returns, “My shoe!” You continue back and forth as many times as you can. As another example, Ava’s very first two word combination was “Papa house.” Then she used house as a carrier word. She said, “Mama house, my house, papa house, dada house, etc.”
Don’t limit these activities to a 15 minute speech practice time per day. Do them all the time. Incorporate them into different activities. Do this when you’re reading books, giving them a bath, during snacks and meals, during play with toys and during an art activity. The more variety the better. Do these things in as many settings as possible – at home, in the car, at school, in a restaurant, at the mall, at the grandparents’ house. If possible, teach the other adults around you to use these techniques. Mom, dad, grandparents, and siblings can all be encouraging speech development. In fact, even though I was working on this all the time myself, it didn’t pop in until she spent the night at her grandparents’ house doing all these things in a completely different setting with different people.
So, quick summary.
Two word utterances - Therapy techniques
Good luck! Let me know what you think. Let me know if any of these work for you, or if you have other techniques I can add to this list.
First I want to talk about scaffolding. This is just a fancy way of saying that you’re only going to try to facilitate something a little harder than what your child can do on their own. If they can’t imitate at all, you’re not going to ask them to suddenly repeat a five word sentence. Start where they are and try to help them do something just a little harder. When they can do that, then do something just a little harder, etc. For the purpose of this discussion I’m going to talk about a child who can imitate single words and is willing to do so, but is having trouble imitating a two word utterance. The first thing you want to do is make sure you’re modeling two word utterances. Try to simplify your own speech to the two word level and use lots of two word phrases yourself. Also, whenever your child uses a word, repeat it back increasing it to a two word utterance. For example, if your child says “dog,” you say, “Yes! Big dog!” This is called expansion. You are expanding their one word sentence into a two word sentence.
Children with apraxia have trouble with motor planning. Research has shown that therapy is more successful when it is multisensory. Try to stimulate them as many ways as possible. One way to do this is to use a tapping technique. Use your hand to tap out two syllables as you say them. So, “big dog” should be said simultaneously with two taps of your hand on your knee (or claps, or snaps). If your child will tolerate it, tap gently on their knee, or hand, or arm. Or help them to clap the syllables themselves. Also try using a singsong voice. So say, “biiiiiiig dog”.
This might sound counterintuitive, but encourage signs and gestures. Typically developing children combine single words with a gesture before they start using two word phrases. So, if they want to tell you “daddy’s shoe” they might say “dada” while pointing to his shoe. One of Ava’s first two “word” combinations was saying the word “more” out loud while making the sign for milk. It’s a stepping stone to saying two word phrases and it can be very effective. As another example, spread your hands wide as a gesture for big while saying the word “ball”.
So, you’re scaffolding, modeling, expanding, and combining gestures with signs and still don’t feel like you’re making progress. Make sure you slow it down. We often don’t realize how quickly we’re speaking. Make sure that you slow your speech down. It gives them extra processing time. Also try being more direct. You can tell them, “Say, biiiiiiiig dog!” It sounds simple, but sometimes it can help. Be careful with that though. If your child gets defensive, don’t push.
You can also put a long pause in between the two words. Again, it gives them extra processing time. It also shows them that it is ok if it takes them a long time to get that second word out. When Ava is trying a new two word phrase that it hard for her, there’s a huge pause between the first and second word. You can see her working at getting that second word out. I think it helps if you model that pause to begin with. Only put the pause in if necessary though, and phase it out as soon as possible.
Use carrier phrases. I deliberately taught Ava the word mine. In a household with two young children that seems like a tactical error (and boy does she use it a lot these days), but I wanted her to then use the word “my ______” . Once you teach the carrier word, it can then be combined with so many other words. “My shoe. My hat. My milk. My cup. Etc.” This one works particularly well because you can make it into a game and get lots of repetitions. So, she says, “My shoe.” You playfully return, “No, mama’s shoe!” She indignantly returns, “My shoe!” You continue back and forth as many times as you can. As another example, Ava’s very first two word combination was “Papa house.” Then she used house as a carrier word. She said, “Mama house, my house, papa house, dada house, etc.”
Don’t limit these activities to a 15 minute speech practice time per day. Do them all the time. Incorporate them into different activities. Do this when you’re reading books, giving them a bath, during snacks and meals, during play with toys and during an art activity. The more variety the better. Do these things in as many settings as possible – at home, in the car, at school, in a restaurant, at the mall, at the grandparents’ house. If possible, teach the other adults around you to use these techniques. Mom, dad, grandparents, and siblings can all be encouraging speech development. In fact, even though I was working on this all the time myself, it didn’t pop in until she spent the night at her grandparents’ house doing all these things in a completely different setting with different people.
So, quick summary.
Two word utterances - Therapy techniques
- scaffolding
- modeling
- expansion
- tapping
- singsong
- combining words with gestures
- slow it down
- be more direct
- use carrier words and phrases
- use techniques in different activities and settings and with different people
Good luck! Let me know what you think. Let me know if any of these work for you, or if you have other techniques I can add to this list.
Tuesday, February 22, 2011
Early Intervention Therapy
We’ve had two sessions with our Early Intervention therapist, Ms. A. now. I'm not sure how it works elsewhere, but here in Missouri, the early intervention therapist comes to your house. Other than the fact that I'm forced to clean, it is super convenient. She's coming once a week for an hour as we decided in our IFSP meeting.
Ms. A is great and I like her a lot. She’s already building a rapport with Ava and Ava is working well with her. She’s given me some new tips that work well with Ava. Ava is right at the border between one syllable utterances and two syllable utterances. We’re all trying to work with her to try to get her to make that jump up. Ms. A introduced tapping. It’s simple, but it really helps Ava hear that she needs to be producing more syllables. Nana (for banana) is two taps. Mo mi (more milk) is two taps. Right now, she can say more. She can say milk. She cannot say more milk. But if you tap, she’ll try. It usually comes out mo, mo. But at least she’s trying to imitate both words.
Another idea she had was to use an exercise ball during therapy. Children with apraxia often have more success with speech productions when they are paired with movement. So she put Ava on the ball and did Row, Row, Row Your Boat with her. The song was super slow and she rocked Ava back and forth with each word. By the end of the song Ava was trying to sing along. It was adorable.
Right now, the therapy sessions are more indirect and play based than I’d like. Therapy based on motor planning principles is all about getting lots and lots of productions, and you just can’t get as many productions in play based therapy. I’d love to see Ms. A begin to incorporate a more structured part of the therapy session at some point, but so far they’re really just getting to know each other. It will come. And if I want that to happen I’ll have to figure out a way to keep Michael occupied elsewhere. But overall, I’m pleased. It’s an excellent beginning.
Ms. A is great and I like her a lot. She’s already building a rapport with Ava and Ava is working well with her. She’s given me some new tips that work well with Ava. Ava is right at the border between one syllable utterances and two syllable utterances. We’re all trying to work with her to try to get her to make that jump up. Ms. A introduced tapping. It’s simple, but it really helps Ava hear that she needs to be producing more syllables. Nana (for banana) is two taps. Mo mi (more milk) is two taps. Right now, she can say more. She can say milk. She cannot say more milk. But if you tap, she’ll try. It usually comes out mo, mo. But at least she’s trying to imitate both words.
Another idea she had was to use an exercise ball during therapy. Children with apraxia often have more success with speech productions when they are paired with movement. So she put Ava on the ball and did Row, Row, Row Your Boat with her. The song was super slow and she rocked Ava back and forth with each word. By the end of the song Ava was trying to sing along. It was adorable.
Right now, the therapy sessions are more indirect and play based than I’d like. Therapy based on motor planning principles is all about getting lots and lots of productions, and you just can’t get as many productions in play based therapy. I’d love to see Ms. A begin to incorporate a more structured part of the therapy session at some point, but so far they’re really just getting to know each other. It will come. And if I want that to happen I’ll have to figure out a way to keep Michael occupied elsewhere. But overall, I’m pleased. It’s an excellent beginning.
Thursday, February 17, 2011
Therapy Progress – Speed of Light
My last update on Ava’s speech therapy progress was almost exactly three weeks ago. At that time I had only been working with her for about 2 and ½ weeks and her progress was amazing. I commented that in terms of her speech she looked like an entirely different child than before I started working with her.
Three weeks later and she continues to make progress at an almost unbelievable rate. I keep waiting for the other shoe to drop. I’m so glad I’m blogging about all of this because otherwise I wouldn’t believe it myself. I have dropped down to more like an average of 4 sessions a week (in addition to the therapy she’s getting from others). Real life keeps interfering. Ideally I’d work with her every single day, but sometimes it just doesn’t happen.
So, three weeks ago she’d imitate easy things when bribed by food and spontaneously about half the time. She was using /d/, /m/, /h/, /s/, /n/, /sh/, /t/, /w/, and /b/ (not all clearly, but trying). She had a limited number of vowels but refused to even try new ones. She was using CV syllable structure and could imitate simple CVCV syllables (mama, dada). She was using 15-20 “words”.
Fast forward three weeks and she’s moved up to a whole new level again. She’s added more consonants including /p/ and /y/ (the sound at the beginning of yellow) and gotten much better at some of the ones she was just starting on three weeks ago.
She’s also making progress on her vowels. Her productions of the ones she already knew are getting cleaner and she’s adding new ones like the short /i/ and the long /e/. More importantly, she’s willing to work on them now. Before I couldn’t get her to even try a new vowel.
She’s using CVCV syllable structure spontaneously. Our family members finally have names. We’re “mama” “dada” “papa” and she has approximations for her own name, her brother’s name and her grandmother. (And that still hasn’t grown old. She loves calling us by name and does it frequently just because it makes her happy. It makes me happy too.) Even more impressive, and just in this last week she’s starting to be able to do CVCV words where the vowel changes. So she can do “nanuh” for banana. Or “babi” for baby. They’re messy, and the vowels aren’t pure, but you can tell she’s trying to make the two vowels sound different. Occasionally they will just pop out clear as day, but most of the time they’re messy.
Before she was using 15-20 words total. Now I truly couldn’t count. She’s spontaneously attempting new words. Her receptive language is great and always was. She knew the words for things, she just couldn’t say them. Everything was locked inside. Now she’ll just try. What pops out of her mouth often sounds a little like what she’s trying for, but I’m mostly guessing from context. The point though is that she’s trying on her own. She just looks at something, or wants to talk about something she sees on tv and just tries to tell us about it. It shows such a gain in confidence on her part.
Seriously, if I were working as a professional (rather than as a mother in this case) and evaluated Ava six weeks ago, then three weeks ago, and today and then I put those evaluations side by side I wouldn’t think they could possibly come from the same kid. I’m humbled and grateful and amazed at what she has accomplished. In fact those words don’t really fully express how I feel about all the progress.
Why is it working? It is the fish oil? You have to wonder at least a little. Is it a matter of lots of the right kind of therapy at the right time? Would she have gotten better anyway if we had just left her alone? Is it that her speech problem is just really responsive to intervention - so once we started working with her the problem that looked so severe turns out to be milder? Am I getting excited too early because a plateau is just around the corner? We’ve come so far. And there’s still so much left to do. And I’m scared this is some kind of fluke that will be taken back. I’m trying hard to not be too hopeful. Which sounds odd, but it’s true.
Three weeks later and she continues to make progress at an almost unbelievable rate. I keep waiting for the other shoe to drop. I’m so glad I’m blogging about all of this because otherwise I wouldn’t believe it myself. I have dropped down to more like an average of 4 sessions a week (in addition to the therapy she’s getting from others). Real life keeps interfering. Ideally I’d work with her every single day, but sometimes it just doesn’t happen.
So, three weeks ago she’d imitate easy things when bribed by food and spontaneously about half the time. She was using /d/, /m/, /h/, /s/, /n/, /sh/, /t/, /w/, and /b/ (not all clearly, but trying). She had a limited number of vowels but refused to even try new ones. She was using CV syllable structure and could imitate simple CVCV syllables (mama, dada). She was using 15-20 “words”.
Fast forward three weeks and she’s moved up to a whole new level again. She’s added more consonants including /p/ and /y/ (the sound at the beginning of yellow) and gotten much better at some of the ones she was just starting on three weeks ago.
She’s also making progress on her vowels. Her productions of the ones she already knew are getting cleaner and she’s adding new ones like the short /i/ and the long /e/. More importantly, she’s willing to work on them now. Before I couldn’t get her to even try a new vowel.
She’s using CVCV syllable structure spontaneously. Our family members finally have names. We’re “mama” “dada” “papa” and she has approximations for her own name, her brother’s name and her grandmother. (And that still hasn’t grown old. She loves calling us by name and does it frequently just because it makes her happy. It makes me happy too.) Even more impressive, and just in this last week she’s starting to be able to do CVCV words where the vowel changes. So she can do “nanuh” for banana. Or “babi” for baby. They’re messy, and the vowels aren’t pure, but you can tell she’s trying to make the two vowels sound different. Occasionally they will just pop out clear as day, but most of the time they’re messy.
Before she was using 15-20 words total. Now I truly couldn’t count. She’s spontaneously attempting new words. Her receptive language is great and always was. She knew the words for things, she just couldn’t say them. Everything was locked inside. Now she’ll just try. What pops out of her mouth often sounds a little like what she’s trying for, but I’m mostly guessing from context. The point though is that she’s trying on her own. She just looks at something, or wants to talk about something she sees on tv and just tries to tell us about it. It shows such a gain in confidence on her part.
Seriously, if I were working as a professional (rather than as a mother in this case) and evaluated Ava six weeks ago, then three weeks ago, and today and then I put those evaluations side by side I wouldn’t think they could possibly come from the same kid. I’m humbled and grateful and amazed at what she has accomplished. In fact those words don’t really fully express how I feel about all the progress.
Why is it working? It is the fish oil? You have to wonder at least a little. Is it a matter of lots of the right kind of therapy at the right time? Would she have gotten better anyway if we had just left her alone? Is it that her speech problem is just really responsive to intervention - so once we started working with her the problem that looked so severe turns out to be milder? Am I getting excited too early because a plateau is just around the corner? We’ve come so far. And there’s still so much left to do. And I’m scared this is some kind of fluke that will be taken back. I’m trying hard to not be too hopeful. Which sounds odd, but it’s true.
Wednesday, February 9, 2011
Book Review – The Big Book of Exclamations
Quick Disclaimer – I bought this book myself from Amazon and am not being compensated in any way for this review.
This is a review of The Big Book of Exclamations by Teri K. Peterson with illustrations by Chris McAllister. I found this book because it is one of the first books to come up when you do a search for “apraxia” at Amazon.com. This book is not a parent resource in the way that The Late Talker was.
This book is meant to be “read” with your child. I put the word “read” in quotes, because the book is not a storybook. It is designed to teach you how to use a picture book to prompt speech, and lots of it, from your child. This teaches you to interact with a child and a book the same way I was taught to do it as a speech-pathologist during a therapy session. You can then apply the same concepts to any other picture books you are reading with your child. The idea is to spend five or ten minutes (or even longer) on each two-page spread. You don’t need to read the entire book in one sitting. It’s about the two of you enjoying the book, pictures, and conversation. It’s about your child having fun talking about the book. Literally – talking about the book. How often does your child get to do that? You can easily adjust the difficulty level up or down just by modifying what you say from two words at a time to one word at a time. Or from a word like “baby” changed to “be be”. You want to model the exclamations yourself and then pause to let your child participate too. Encourage it. Play with it. Laugh at the silly things the characters are doing and the silly things your child gets to say. Have fun telling the dog, “no no” over and over again.
Why then, did I buy the book if I already know how to interact with a child and a book in this way? Well, because this book is dense. Each two-page spread is crammed full of tons on things to talk to your child about. The pictures and concepts covered are perfect for an emergent talker. I wanted the pictures. They’re great.
Let’s talk about them in more detail. First, you can see a sample page here at the book’s website. Ok. The book begins with two two-page spreads on how to use the book. However, the true beauty of the book emerges in the following six two-page spreads.
At the end of the book the author includes two additional two-page informational spreads. The first is about typical language development and the second is about what to do if you have concerns.
When I tried it with Ava she loved it. She was engaged by the picture on the cover of the book and we spent several minutes just talking about the cover. The book worked exactly as described. We spent a half hour or so on the first three two-page spreads. She did get antsy after the first couple of pages. It’s not like a storybook that hold their attention because they like the story itself. It’s more of an interactive activity. I would plan on using the book for no more than 15-20 minutes at a time. It would certainly be worth it even if you were only using it 5-10 minutes at a time. Pick it up, talk about a couple of pages and then put it away and save the next set of pages for the next day.
I hesitated to buy this book because I thought $20 was a bit steep given that I already know how to read this way with my children. The content is definitely worth the price of admission though. I’ll use this book happily with Ava as often as she’s interested. I would also use it in therapy sessions with any child in the 12 month – 2 ½ year age range and perhaps even with children older than that where appropriate.
I have one small criticism though. This is a book meant to be read with a very young child cuddled in your lap engaging with the book. Yet it is a hardback book with paper pages and is rather large and unwieldy. Also, some of the illustrations disappear into the binding. I found it a little difficult and uncomfortable to hold when reading it with Ava. I wish the book were available in a ¾-size board book form. I would actually pay $5 or $10 additional dollars to get the book in that format and consider it an investment.
This book was not available through my local library system. I’ll admit that I did not check out local bookstores. Amazon does however, carry the book and so you can find it there for sure if you are interested.
Bottom line: Highly recommended.
This is a review of The Big Book of Exclamations by Teri K. Peterson with illustrations by Chris McAllister. I found this book because it is one of the first books to come up when you do a search for “apraxia” at Amazon.com. This book is not a parent resource in the way that The Late Talker was.
This book is meant to be “read” with your child. I put the word “read” in quotes, because the book is not a storybook. It is designed to teach you how to use a picture book to prompt speech, and lots of it, from your child. This teaches you to interact with a child and a book the same way I was taught to do it as a speech-pathologist during a therapy session. You can then apply the same concepts to any other picture books you are reading with your child. The idea is to spend five or ten minutes (or even longer) on each two-page spread. You don’t need to read the entire book in one sitting. It’s about the two of you enjoying the book, pictures, and conversation. It’s about your child having fun talking about the book. Literally – talking about the book. How often does your child get to do that? You can easily adjust the difficulty level up or down just by modifying what you say from two words at a time to one word at a time. Or from a word like “baby” changed to “be be”. You want to model the exclamations yourself and then pause to let your child participate too. Encourage it. Play with it. Laugh at the silly things the characters are doing and the silly things your child gets to say. Have fun telling the dog, “no no” over and over again.
Why then, did I buy the book if I already know how to interact with a child and a book in this way? Well, because this book is dense. Each two-page spread is crammed full of tons on things to talk to your child about. The pictures and concepts covered are perfect for an emergent talker. I wanted the pictures. They’re great.
Let’s talk about them in more detail. First, you can see a sample page here at the book’s website. Ok. The book begins with two two-page spreads on how to use the book. However, the true beauty of the book emerges in the following six two-page spreads.
- Wake Up! Good Morning! This scene has a mommy and daddy entering a nursery with a toddler aged boy and toddler aged girl to wake them up in the morning. There’s a pet dog and cat in the scene along with lots of nursery toys including cars, blocks, planes, and farm animals. The pictures have captions in key areas prompting you (the parent) to use key words like, “Hi, baby”, “beep, beep”, “uh-oh,” and “no no”.
- Eat! Eat! This scene is of the family getting ready for breakfast. You have the mama, daddy, children and pets again and now you add a grandma. Again, there is lots going on here. You have all the items typically present in a kitchen, some playground equipment out a window, fruit on the counter, and much more. Captions include, “hot, hot”, “all done”, please”, and “dirty”.
- Ready to Go! This scene shows the family in the foyer getting ready to go out. All of the previously introduced family members are present and now we add grandpa. In addition to the typical things you’d see in such a scene like a door, stroller, stairway, side table, phone, pictures in frames you have lots of action. Captions include, “bye, bye”, “wait, wait”, Dada help”, and “run, run”.
- The Park! This scene shows the entire family at the playground. You have a slide, swing, bubbles, people playing ball and Frisbee, and even a birthday party going on in the background. Captions include, “swing, swing”, “up up up”, “pop pop pop”, and “weeeeee”.
- Bath Time! Wash! Wash! This scene shows the mama and daddy giving the children a bubble bath. It’s a great bathroom scene. Captions include, “oh, oh, duckie”, “owie, “no bite”, “pop”, and “sh- sh- shhh”.
- Bedtime – Goodnight This scene shows the entire extended family again in the nursery getting the children ready for bed. You’ve got a bedtime story, dim lights and the moon shining in through the window. Captions include, “shhhh- papa stay”, “stop”, “look, my book”, and “ni ni dada”.
- The final page is a picture of the family waving good-bye to the readers and the page opposite is full of captions about being all done and wanting to read again.
At the end of the book the author includes two additional two-page informational spreads. The first is about typical language development and the second is about what to do if you have concerns.
When I tried it with Ava she loved it. She was engaged by the picture on the cover of the book and we spent several minutes just talking about the cover. The book worked exactly as described. We spent a half hour or so on the first three two-page spreads. She did get antsy after the first couple of pages. It’s not like a storybook that hold their attention because they like the story itself. It’s more of an interactive activity. I would plan on using the book for no more than 15-20 minutes at a time. It would certainly be worth it even if you were only using it 5-10 minutes at a time. Pick it up, talk about a couple of pages and then put it away and save the next set of pages for the next day.
I hesitated to buy this book because I thought $20 was a bit steep given that I already know how to read this way with my children. The content is definitely worth the price of admission though. I’ll use this book happily with Ava as often as she’s interested. I would also use it in therapy sessions with any child in the 12 month – 2 ½ year age range and perhaps even with children older than that where appropriate.
I have one small criticism though. This is a book meant to be read with a very young child cuddled in your lap engaging with the book. Yet it is a hardback book with paper pages and is rather large and unwieldy. Also, some of the illustrations disappear into the binding. I found it a little difficult and uncomfortable to hold when reading it with Ava. I wish the book were available in a ¾-size board book form. I would actually pay $5 or $10 additional dollars to get the book in that format and consider it an investment.
This book was not available through my local library system. I’ll admit that I did not check out local bookstores. Amazon does however, carry the book and so you can find it there for sure if you are interested.
Bottom line: Highly recommended.
Monday, February 7, 2011
Macaroni Fun
So a few weeks ago our Parents as Teachers educator came by for our home visit. She brought an activity where she had a small bin filled with macaroni and measuring cups and the kids could dig and pour. She also brought small wooden animals to bury in the macaroni for them to find. They loved it!
I decided to make one for us on a grander scale. I bought a big bin and 30 pounds of pasta in bulk. The kids played with it for over an hour along with a visiting guest. It’s like an indoor sand table, but with less mess. Even when the macaroni gets scattered it is easy to scoop back up and put back in. If you do the activity on a large blanket it is even easier.
It would be easy to incorporate some speech practice too if you’re doing it one-on-one. You can target in, out, up, down, more, big, little, etc. You could also use (bury them and then dig them back out) small dolls or lego figures for mama, dada, baby, and other family members. You could use small animal figures for animal sounds like moo, baa, neigh, etc. If you’re working on colors you can incorporate different color cups and practice your color words. If you’re working on two word phrases it’s even better because you can do mama in, daddy out, uh oh baby, moo up, baa down, etc. Fun and speech all at the same time.
I decided to make one for us on a grander scale. I bought a big bin and 30 pounds of pasta in bulk. The kids played with it for over an hour along with a visiting guest. It’s like an indoor sand table, but with less mess. Even when the macaroni gets scattered it is easy to scoop back up and put back in. If you do the activity on a large blanket it is even easier.
It would be easy to incorporate some speech practice too if you’re doing it one-on-one. You can target in, out, up, down, more, big, little, etc. You could also use (bury them and then dig them back out) small dolls or lego figures for mama, dada, baby, and other family members. You could use small animal figures for animal sounds like moo, baa, neigh, etc. If you’re working on colors you can incorporate different color cups and practice your color words. If you’re working on two word phrases it’s even better because you can do mama in, daddy out, uh oh baby, moo up, baa down, etc. Fun and speech all at the same time.
Thursday, January 27, 2011
Speech Therapy Progress
I’ve been doing therapy with Ava about 5 days a week for two and a half weeks now. She’s made a lot of progress. We’ve also been giving her the fish oil supplement for about that same amount of time. Draw conclusions from that information as you will. We’re not an ideal test of which one is helping because we started both together.
Before we started I could not get Ava to imitate at all. She simply would not respond to a request to “Say _____.” Or at least, she’d only very rarely imitate. Now she’s pretty willing to imitate. Ok. I admit it. I’m bribing her with food. With food she’s willing to try most of the time. Without food, at other times of the day, she’s willing to imitate only about half the time.
Before we started Ava was only using three consonant sounds /d/, /m/, and /h/. Now I’ve been able to get her to produce /s/, /n/, /sh/, /t/, /w/, and /b/. That’s a huge difference. She learned them during our sit down therapy sessions, but she’ll use some of those sounds at other times during the day. She’ll use /n/ in “no” when you remind her. She’ll make /s/ as a snake sound just for fun when she’s in the mood. She’ll use /b/ in “book” (without the final /k/) to ask for a book when she wants one. So there’s been a huge change in her number of consonants. I consider this area to be a big win.
No significant progress in vowels. The ones she already had she will still work with. Some of her consonants she can only produce with certain vowels, not others. The vowels she doesn’t have she won’t even try. That child has a will of steel.
Before we started Ava communicated mostly with gestures, grunts, vowels, and a few Consonant/Vowel (CV) productions like /da/ for “ that”, /mo/ for “more”, and /ya/ for “yeah”. Now she’s using words and sign language when she can. She can imitate CVCVs like “mama” and “dada”. She has so many more words (all without their final consonants though). Off the top of my head, she has “more,” “milk,” “no,” “hat,” “hot,” “meow,” “moo,” “book,” “uh oh,” “ow,” “up,” “yeah,” “down,” “out,” and “help.” These are all words she’ll use spontaneously. I’m not even counting the ones she’ll imitate when I’m working with her but she’s not using at other times. I know there are more, but I can’t think of them right now. It’s pretty amazing to find myself in a position where I can’t even list all of the words she’s saying off the top of my head.
Before we started I could not get Ava to imitate at all. She simply would not respond to a request to “Say _____.” Or at least, she’d only very rarely imitate. Now she’s pretty willing to imitate. Ok. I admit it. I’m bribing her with food. With food she’s willing to try most of the time. Without food, at other times of the day, she’s willing to imitate only about half the time.
Before we started Ava was only using three consonant sounds /d/, /m/, and /h/. Now I’ve been able to get her to produce /s/, /n/, /sh/, /t/, /w/, and /b/. That’s a huge difference. She learned them during our sit down therapy sessions, but she’ll use some of those sounds at other times during the day. She’ll use /n/ in “no” when you remind her. She’ll make /s/ as a snake sound just for fun when she’s in the mood. She’ll use /b/ in “book” (without the final /k/) to ask for a book when she wants one. So there’s been a huge change in her number of consonants. I consider this area to be a big win.
No significant progress in vowels. The ones she already had she will still work with. Some of her consonants she can only produce with certain vowels, not others. The vowels she doesn’t have she won’t even try. That child has a will of steel.
Before we started Ava communicated mostly with gestures, grunts, vowels, and a few Consonant/Vowel (CV) productions like /da/ for “ that”, /mo/ for “more”, and /ya/ for “yeah”. Now she’s using words and sign language when she can. She can imitate CVCVs like “mama” and “dada”. She has so many more words (all without their final consonants though). Off the top of my head, she has “more,” “milk,” “no,” “hat,” “hot,” “meow,” “moo,” “book,” “uh oh,” “ow,” “up,” “yeah,” “down,” “out,” and “help.” These are all words she’ll use spontaneously. I’m not even counting the ones she’ll imitate when I’m working with her but she’s not using at other times. I know there are more, but I can’t think of them right now. It’s pretty amazing to find myself in a position where I can’t even list all of the words she’s saying off the top of my head.
Subscribe to:
Posts (Atom)
