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. 

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. 

Unlocked

Two months ago, when Ava had barely three words, and yet could understand everything going on around her I could see the frustration building. She had so much she wanted to communicate and it was all locked inside her. In fact, I think it was her frustration that was making her so stubborn about even trying to imitate. She wouldn’t even try. That was why we started by giving her completely new ways to communicate. We used signs and the communication boards and you could just see the light in her eyes. She was so excited to be able to communicate successfully.

We also started working on her speech. I worked with her at home and she was seeing first one (twice a week for half an hour – private therapist), then two (once every two weeks for an hour – local apraxia expert), and now three (once a week for one hour – state early intervention therapist) therapists. Once she experienced the tiniest bit of success, and the praise and attention that went along with it, she began progressing quickly and steadily. She went from simply learning how to and being willing to try to imitate, to imitating single syllables with familiar sounds, to imitating single syllables with new sounds, to repeating multiple syllables with those sounds, to spontaneously trying familiar and new words, and finally to making some two and even three word utterances. The progress in speech alone is wonderful and gratifying.

What is amazing is the personality and confidence explosion that is taking place at the same time. It’s like I’m finally getting to meet my daughter and she’s finally getting to meet the people around her too. Her bond with her family members has intensified exponentially. She and her brother are communicating and playing with each other so much more. She’s trying to sing. She’s engaging in imaginary play. She’s initiating play with other children instead of pushing away every advance another child makes. Today, at her two year pediatrician visit, she went through all of the usual things (being weighed, measured, having her ears examined and her heart listened to, etc.) with a minimum of protest. The last time we went, the doctor and I could barely hear each other over the constant screaming. Today we were able to carry on a conversation without raising our voices at all.

The changes are fairly dramatic and almost all positive. Fine, I probably could do without the loud and gleeful shouts of “no” which she seems to use just because she thinks it’s fun. Seriously, there’s an amused gleam in her eye. She obviously finds it entertaining. But overall I’m delighted to see her personality unlocked and I like the little girl I’m finally getting to know.

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.

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.

Completely unrelated rant

I admit it. Where cell phones are concerned I was remarkably reluctant to enter the modern world. I have had one for about 12 years, but it was a pre-paid phone that I left off all the time. I kept it with me only for the purpose of making outbound calls in an emergency. I turned it on once a month or less. My husband hated not being able to reach me when I was out, but I was stubborn on the issue. I didn’t want to mess with it. I thought being on the phone when out was rude.

Then I had children and realized that I needed to be available. I needed the person with my children to be able to reach me. So that simple necessity, combined with an iphone has made me a changed woman. I still use the phone as little as possible, particularly when I’m out, but it is turned on and always near me. I absolutely love to read books on it. I also play a few games. I use the calendar. I take pictures and videos of my children. I occasionally make or receive calls.

I still have the same phone number for my cell phone that I’ve had since I got my very first cell phone. I like the number. I’m attached to it. A couple of years ago, Ava’s first summer, I began receiving debt collection calls on my cell phone. The calls are for Michelle D. I am not Michelle D. After hanging up on the automated message about 20 times over a period of about a month, my husband finally called the number back, spoke to a real live person and had my number removed from their database.

A few months ago I began receiving debt collection calls for Michelle D. again on my cell phone. I have no idea if it’s the same company, but it’s still an automated message. My only option, if I am not Michelle D., is to hang up. At first they called once every couple of weeks. Then it was once a week. The past few days they’ve called 3-4 times a day. If you call the number back you always get routed to voicemail. I’ve left 2-3 messages. My husband has left 3-4 messages. The calls aren’t stopping. I can’t get a real person on the line. This is becoming more than an occasional nuisance, and I can’t seem to do anything to stop it. Shouldn’t this be illegal? Anyone have any ideas?

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

• 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.

Lost

On a sad note, we realized a couple of nights ago that one of our kitties is lost. She must have slipped out of the house earlier in the week when the weather was nice and we were playing outside. We had left the door open. Things have been so crazy this week with the illnesses, hospitalizations, and surgeries that we didn’t even realize she was missing for a couple of days. I feel terrible. We’ve searched the house and the neighborhood, but there’s no sign of her. Our chances of finding her seem poor. She was a great kitty. I'll miss her.

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.

Doubt

Ava has been making progress quickly. It’s a blessing I am truly grateful for. However, an interesting side effect is that people (family, friends) are beginning to ask me if I perhaps over-reacted. Perhaps Ava is just a late talker after all. Perhaps she’ll catch up just like Michael did. Ava's swift progress combined with questions from others and the reluctance from other professionals to officially diagnose began to make me doubt myself.

So I went to our home videos. I wanted to compare Ava’s speech now (about two months after she first started making progress) to Michael’s speech at that same point – two months after he first started making progress. That would be when he was about 18-19 months old. It was interesting. Most of the time his speech sounded very much like Ava’s speech right now. He didn’t have any final consonants either. He was using mostly one word utterances. But, and this is a big but, when he did combine words he easily put two to three words together. Neither word sounded exactly like the adult version of the word, but they were combined easily and you could tell them apart. You could tell that he was saying two different words and combining them with no difficulty. That is a huge contrast with Ava. She has to work to try to combine words. When she tries they usually all come out the same. This is not typical.

Michael did not develop on a typical timeline, and his early history was atypical, but once things finally got started they followed a typical developmental pattern. That is a late talker. That is a delay, not a disorder. Ava is different. She needed therapy (and possibly fish oil supplementation) to get started. And now that things are started, the development does not look typical. This is disorder, not a delay. I don’t know yet what the future holds for her. The great progress so far gives me hope that her disorder (suspected CAS) is on the milder end of the spectrum. I am sure, however, that this is a disorder and not a delay. I am not over-reacting. I will continue to do everything in my power to help her. Both my professional and my mama instincts tell me that. And my research confirms it.

Our house = Plague ground zero

So, as I discussed, Michael had some kind of stomach bug last week. It hit him last Friday night to be exact. I didn’t mention it at the time, but my husband and I came down with it Sunday night. We thought Ava had escaped because she was at her my parents’ house Friday night. They even kept her Saturday night too to try to protect her. I didn’t know I was sick yet on Sunday so we had therapy with Ms. J that morning and our playdate. I found out later that Sara got sick this past week. Then Ava got sick anyway Monday night. So far, this bug had proven to be extremely contagious. But at that point we thought we were clear. No one had been sick since Monday night.

Thursday my mom had the day off so she spent the morning with us. The other set of grandparents were coming in to town this past weekend to celebrate Ava’s birthday with us. The party was planned for Saturday morning. Ava spent Saturday night at my parents’ house again so we could decorate. Saturday morning early my parents called asking us to come get her. My mom had the bug. My parents were going to have to miss the party. Mom had to have picked it up at our house Thursday morning even though no one was sick any longer.

So if you’re counting we now have infected all four of us, a playdate friend, and my mother. Victims = 6. We did warn my husband’s parents. But they had driven 8 hours to spend some time with us so they came. It was wonderful. We had a delightful party. The children and the grandparents played beautifully together. We spent all day Saturday and Sunday together. We had plans to go to a children’s museum together Monday. Nope. Both of my husband’s parents got sick last night. My dad got sick too. Now we’re up to 9 victims. Seriously, this thing has a 100% infection rate.

Everyone else had a terrible 5-8 hours and then several days of low appetite/energy. My mom, on the other hand, is now in the hospital. In an isolation room. She’s not getting better. Three days in her symptoms are still severe. I feel terrible. I’m worried.

So, due to a bug that passed through our household last weekend and we thought had passed, we managed to put my mother in the hospital and infect three other grandparents as well. Two of those grandparents drove 8 hours for the privilege. Not our most successful weekend ever.

Two years ago today

Two years ago today I held Ava for the first time. Happy second birthday to my little girl. It's such a cliche, but I fall in love more every day.

Fish Oil Supplementation

I first read about Omega 3 fish oil supplementation in The Late Talker book. They devote an entire chapter to the topic. As an SLP I am frustrated that there isn’t more research out there and I would hesitate to recommend something with so little research. As a parent of a child with suspected apraxia I have a completely different opinion. There’s almost no evidence of harm, and the possibility of hope. Why not try anything that might help?

Here are some of the articles I have found on the topic in addition to the Late Talker book. Read them and decide for yourself.

• Dyslexia, Dyspraxia and ADHD – Can Nutrition Help? This article nicely summarizes some of the actual research out there on fish oil supplementation and disorders. Note that in this article the term dyspraxia does NOT refer to apraxia of speech.
• Essential Fatty Acids This is a generic article on fish oil supplementation.
• Long-Chain Polyunsaturated Fatty Acids and Learning Disabilities This article talks about some of the research on fish oil supplementation and learning disabilities.
• Syndrome of Allergy, Apraxia, and Malabsorption: Characterization of a Neurodevelopmental Phenotype that Responds to Omega 3 and Vitamin E Supplementation This is a research article published in the Journal of Alternative Therapies in 2009. However, this research study did not have a control group, so although as a parent I am encouraged and interested, as an SLP I am still not convinced.
• The Omega Wave This is a pretty interesting news article on fish oil supplementation and learning disability, but it is just a news article, not a research article.
• Nordic Naturals Ultimate Omega LiquidThis is the product we eventually decided to use. We are not giving the recommended dosage for an adult. I am not going to tell you what we’re giving, because I’m not comfortable giving dosage advice. Make your own decision after reading the research yourself and consulting with your pediatrician.

You might ask how on earth we get our two year old to swallow a fish oil liquid. The answer is that we don’t. We disguise it as an after dinner “special treat”. Sometimes we mix it in with a couple of tablespoons of lemon flavored yogurt. Sometimes we mix it with raspberry sherbet. Sometimes we mix it in with those yogurt drinks they make with kids. She doesn’t even know it is there. Getting her to eat it is usually no problem at all.

The product is not fishy at all. If it tastes fishy or smells fishy it has spoiled. We store our bottle in the freezer to extend its shelf life.

Is it working? Who knows? Ava’s progress has been amazing. But we started the supplementation at pretty much the exact same time we started therapy. Who knows if it is the therapy or the Omega 3s or both?

Poll #1 results

So, 9 people responded to the last poll asking why they visited my blog. 8 of those people were here because they have a child with apraxia. So now I have a new poll up. I'm wondering how old your child with CAS is (or suspected CAS). Answer if you feel comfortable doing so. :-)

A new power put to use

Ava is learning to communicate and she loves it. She feels empowered. She can ask for the specific food she wants to eat. She can request the specific television show she wants to watch. She can ask her mama or daddy to drop what they’re doing and come play. She can tell her brother “no”. So many things are now possibilities that weren’t before. Mostly this is all good. However…

She’s also about to turn two. We’re celebrating her birthday this weekend, in fact. You know what they say about two. It often involves the words “terrible” and “tantrums”. Combine the explosion in her ability to communicate with the natural nature of a two year old and you get a child who has discovered how to protest. Loudly. At great length. Complete with tears and wailing. For example, we came in from a walk. Ava wanted to go back outside and I told her that we couldn’t because it was time to get dinner ready. She sat in front of the door and cried for 15 minutes. Then she finally noticed that I wasn’t paying attention and gave up. This is happening more and more frequently. Now it tends to be at least once a day.

Ava is also developing a mama thing. When she asks for milk she wants me to get it for her. If she needs to potty she wants me to take her. When it’s time to get ready for bed she wants me to read the books. And you should see the performance when I leave her at school two mornings a week. At first we indulged her. It didn’t seem like a big deal to just have me take her to the bathroom instead of her daddy. But then it got worse. The insistence on mama instead of daddy started coming more often and the protests became more dramatic. Now, she will simply refuse to use the bathroom unless it’s me. Even if my husband carries her to the bathroom and places her on the potty, she won’t go. The child certainly knows her own mind. I’ve seen her hold it for more than two hours rather than go for her daddy.

I don’t really know what to do about any of this other than to refuse to indulge her. Surely this is a stage that won’t last forever?

The secret and the consequences

I have discovered the secret to getting my children to enthusiastically finish off an entire bowl of carrots (or cucumbers or celery) and then come begging for more. First, provide dip. Second, give it to them before the meal. Serve it when they’re hungry, but you haven’t finished getting dinner ready yet. I put out a bowl of raw veggies with a side of dip and they go to town. If I serve it with the meal they’ll eat one or two. If I serve it before the meal they’ll polish off a whole bowl and ask for more.

I did this the other day, but told them “no” when they asked for seconds. I wanted them to be hungry for the rest of the meal. A few minutes later they wandered into the kitchen hands and faces covered in ranch dip. Since they were out of carrots they had just decided to finish off the dip with their hands. Sigh. I said to Michael as I was wiping off his hands, “In the future, we do not eat dip with our hands.” He asked, “Is this the future?”

A magical 90 seconds

Imagine, if you will, a play place at the mall. In it there is a small rowboat divided into two sections by a small bench to sit on. On one side of the bench, nestled in the spot where the feet would go if you were sitting on the bench, is a young girl perhaps 2 ½ or 3 years old. Ava crawled into the other side facing the bench and the girl.

Now, what would usually happen here is that the other child would make some sort of friendly advance towards Ava. She would respond by screaming and turning away as if she’d been attacked in some way and I would have to apologize to the parent and explain that Ava reacts that way to everyone. I promise. Their child had been perfectly polite – friendly even. Then Ava would run/crawl/climb away as quickly as possible while I try to explain to her that the other child was just trying to be nice.

This time was different – wonderfully different. The other little girl glanced at Ava, only briefly, and smiled and then began drumming on the bench. Ava smiled back and began drumming too. They were playing together. Both laughing. Making eye contact. When one would stop, the other would start again and more laughter and drumming ensued. At one point the other little girl stood up saying, “Up!” and Ava immediately mimicked her standing up and saying “Uh!” And then they both sat down and drummed some more.

Then two other little girls tried to climb in too and broke the magic spell. At that point things were way too crowded for Ava and she left. The whole thing couldn’t have lasted more than 90 seconds, but they were a magical 90 seconds.

Imagine, other parents take such things for granted.

Playdates

Our neighborhood is filled with little boys. One little boy, who lives up the street, is only six weeks older than Michael. Let’s call him Justin. I ran into Justin’s family during one of the walks I took with Michael his first summer when he was only six months old or so and I was desperately trying to stop the crying. By the time the boys were about a year old we were doing regular weekly playdates. It’s great. They’re a wonderful family and I’ve enjoyed watching the boys go from babies that played near each other to little boys who are beginning to play with each other.

At two (almost), as you all know, I felt Ava was also ready for regular playdates. And just last week through pure luck I stumbled upon a little girl right here in our neighborhood only a few months older than Ava. Let’s call her Sara. Sara even goes to Ava’s daycare and when Ava turns two in another week she’ll be moving into Sara’s class. So the girls will be together two mornings a week until Sara moves up to the next class. Sara’s mother is really nice and we set up our first playdate this past weekend. The girls seemed to have fun. They’re a little too young to really play together, but they played nicely in the same space with the same toys. We have another playdate set up for next weekend. I hope we can continue to get together with this family. They seem nice and it is such a gift for a child to have a friend that lives nearby. Hopefully I’m planting that seed.