Two-word combinations begin

I swear my daughter must be sneaking out of bed in the middle of the night to read my blog. She reads it to find out what I’m saying she can’t do. Then she proceeds to do that very thing over the next few days simply because she loves proving me wrong.

Just last weekend I was doing some research watching some old home videos trying to see differences between the speech development of Ava and Michael. The major thing that stood out to me was the ease with which Michael could combine words. Ava struggled to do so. A couple of days later I wrote a post on the topic.

Since then, Ava has begun combining words. Frequently. Many times each day. She will do it in imitation succeeding about half the time. She’ll also do it spontaneously. Last Saturday morning, when we picked Ava up from my parents’ house, my dad said, “Listen to what Ava can do.” He told her, “Say Papa house.” Ava then repeated, clear as day, “Papa (small pause) house.” I was amazed and excited and so proud. We heaped praise upon her. As we were driving home the little show off then said, “Mama house.” It was the beginning of something new.

We were walking into her school where they’ve decorated the entryway for spring with construction paper flowers. Ava stopped, pointed, and said, “Pink flower. Red flower. Purple flower.” Seriously! Who is this child? She likes to label things by owner. So, “Mama shoe. Dada shoe. My shoe.” She even said, “Mama no shoe,” once. It’s crazy.

Now, I don’t want to give the impression that all of this is coming out perfectly or easily, or that she is successful all the time. It’s still pretty obvious that combining words takes effort. Many speech sounds are being left out and the words don’t at all sound like adult pronunciations would. She also doesn’t succeed all the time. Often, when asked to say a two word sentence the words will still come out as two of the same word. And she still uses one word sentences most of the time. However, this is a huge breakthrough. She is using two word phrases some of the time. I guess the tapping and encouragement made sense for her. I can’t believe this is the same child that scored at the four-six month old level in speech and language only two months ago.

So what does this mean? Well, I still believe that we are dealing with a disorder. The history is too atypical for the speech problems to be a simple delay or just due to the hearing loss due to the fluid in her ears. I do think, at this point, that I feel fairly safe in saying her disorder is on the milder side. Children with a severe disorder work just as hard, and don’t have the same kind of response to intervention. If I had spent two months working intensively with Ava and had seen very little progress that would indicate a more severe disorder. Given the extent of her delay two months ago, I feared something quite severe. I told my family that I wasn’t going to make any predictions though until I saw how responsive she was to intervention. I told them I’d know more in 3-4 months. Only two months later I can say that she’s been very responsive so far and that is a very good sign.

We’ll continue to work with her. She still needs to fine-tune many vowels. She’s missing lots of consonants as well. I’d like to try to start to get her to add final consonants to the ends of her words. And, of course, we want her to continue to use those two word phrases and to add more of them gradually increasing to three or even four word sentences. I’ll consult with Ms. J this weekend and let her expertise guide me in determining which of those things is most important and guide me in how to best achieve those goals.

You might also be interested in the following articles:

Apraxia Therapy: Two-Word Combinations

Surgery

Ava’s surgery went well. It was a stressful day for everyone though. We needed to be at the hospital by 6:15 am. We couldn’t give her anything other than clear liquids and nothing after 5am. So we woke her up at 5:00 in the morning and gave her some apple juice. Then we dressed her and popped her in the car for the ride to the hospital. Michael spent the night and then the morning with his grandfather (my mother was still in the hospital).

Ava pitched a fit when they put on her identification bracelet. Then she pitched another fit when they took her vitals. Then we got to wait. They decided to give her something for her anxiety because they couldn’t imagine her separating from us any other way. It worked beautifully. A loopy toddler is actually cute and a bit funny. They took her back to surgery and as I understand it, they put her under first with the mask before putting in her IV. If she were only having the tubes put in, they wouldn’t have needed the IV at all.

Putting in the tubes went smoothly. She still has a lot of fluid in her right ear although the left was clear. We definitely made the right decision about the tubes. It’s been 2-3 months solid now that she’s had fluid in one ear and maybe both. That has a huge impact on hearing. After her ears were drained they did the hearing test. The audiologist said her hearing is great which is wonderful news.

When I got to the recovery area Ava was in a groggy panic. They let her wake up without me and with the IV still in and strapped to her hand and arm. She was extremely upset about the IV. They apparently wanted to leave it in until they were sure she wasn’t going to throw up. I asked them to take it out and explained that she wasn’t going to calm down until it was out. After that it was just a matter of giving her some juice and graham crackers and waiting an hour or so until they let us go home.

We were home by lunch and Ava was eating a cheese roll up as if nothing unusual had happened that morning. Overall, a decent experience. I’m grateful everything went well. It’s good to know she can finally hear because all the fluid is gone and that the tubes will keep it from building up in there again. It's also good to know for sure that there isn't an underlying hearing loss separate from the fluid in the middle ear issue.

So now, we can move on with therapy knowing that Ava can hear us clearly.

Apraxia and infant bonding

This topic is a touchy one for me. I think it is because it ties in to my opinion of myself as a mother. I was always good with kids. Good with babies. I had lots of younger cousins and entertained them at family gatherings well before I was old enough to babysit. Once in high school and through the first two years of college I did a ton of babysitting. Then I chose to work with children as my profession.

I just assumed I’d be a wonderful mother. Before Michael was born I imagined bonding with him as an infant. I imagined he’s be comforted by my arms, voice, and face. I imagined playing peek-a-boo, singing songs, exchanging smiles and baby-talk. What I got was a baby who cried almost nonstop for 8 months. He didn’t seem to be comforted any more by me than by anyone else. He didn’t smile on schedule. He didn’t laugh on schedule. He preferred looking past me at the lights behind me rather than looking into my eyes. We never played peek-a-boo. He didn’t babble. I thought people were exaggerating when they talked about bonding with their infants. I thought they were reading things into their children’s behavior that weren’t there. I just didn’t realize exactly how different Michael’s early development was.

Ava followed only 15 and a half months later. She was a little more typical. She didn’t have the fascination with lights and the eye contact avoidance. She didn’t cry as much. She did seem to prefer her parents somewhat to others. In comparison, she seemed like such an easier baby. In retrospect, she still didn’t smile, laugh, coo, or babble on schedule. We still didn’t have that give and take, that positive feedback loop that leads to the early bonding so many people have with their infants.

My husband and I just thought we weren’t baby people. We didn’t realize that we were having a perfectly normal reaction to the fact that our children weren’t as socially interactive as a typical infant. It’s hard to bond with a baby that doesn’t smile at you. It’s hard to bond with a baby that doesn’t play the typical back and forth infant games like peek-a-boo and other finger plays. Without that interaction, bonding is just more difficult and will happen slower.

When I was watching home videos I came across one of Ava when she had just started to smile. She was almost 4 months old. It was difficult to get her to smile, and when I did it was in response to tickling (a physical stimulus), not in response to a social overture. She almost seemed to be struggling. I can remember that Michael’s first laugh was in response to being thrown up in the air and caught again – also in response to a physical stimulus. And he was much older.

Looking back on it now, I think much of this could be related to the apraxia. The late smiles and laughs and the lack of babbling are all early red flags for apraxia. I never really reflected on the impact that has on the parent’s relationship with their baby – and their confidence in themselves as a parent.

Has anyone else had a similar experience? It would make for an amazing research study.