Good Luck

I feel like I’ve won the lottery. I know how astoundingly lucky we are that Ava has been so responsive to therapy (and fish oil supplementation?). I know that some children work just as hard, or harder, for months and see so much less progress. Their parents are right there with them feeling the frustration and fears too.

Three months ago all I knew was Ava had three words: /mo/ for “more”, /uh oh/, and /da?/ for everything else. I knew that she wasn’t even trying to talk anymore and was resorting to more and more gestures. I knew she didn’t even babble other sounds and that she couldn’t imitate. When she was evaluated by early intervention she tested at the 4 month old level. I had two different therapists besides myself tell me that Ava had many of the early red flag signs of apraxia.

I admit it. I panicked. As a speech-language pathologist I knew exactly what that meant. I knew we were dealing with a neurological motor planning speech disorder that can take several years of intensive speech therapy to address. And I so didn’t want that kind of struggle to be part of Ava’s life. I know hardships are a part of life, but she’s my baby and I didn’t want this one for her. I worked my way through the initial denial and then depression. I ended up in a productive place where I researched, planned and set up a therapy schedule for Ava.

I prepared my family for the worst. Severe apraxia seemed like a definite possibility given how behind she was. However, I told them that we wouldn’t know how bad it was until we saw how she responded to therapy. And it turns out, she responds well.

That changes things. The fear that she might still be using single words when she starts school is gone. Now, whether anyone will understand her…? We still have so far to go. By no means is her speech that of a typical two year old. But there’s been progress and that much is a profound relief.

A Baby's Smile

We were at the park enjoying the spring weather. I was letting Michael and Ava climb on some bleachers when I noticed a ten month old baby crawling around in the grass nearby. The baby was adorable. She caught sight of my legs first and I saw her gaze travel upwards towards my face. She looked at me. I smiled at her and she smiled back. It was so natural and easy. It was fun and intrinsically rewarding to connect with a baby through eye contact and smiles.

It reminded me again that my own little ones did not do that when they were infants. Now, I’m not saying that they never looked at my face, or returned a smile. That would be an exaggeration. It just wasn’t as natural and as easy as it was with this stranger’s baby at the park. It’s hard to express, but it is so obvious to me that the connection that most babies make easily and naturally with the people around them did not come naturally for my children.

Even now, I’m having to explicitly teach Michael to look people in the eyes to connect with them. I’m teaching him to look in a person’s eyes when saying thank you or making a request. I think he’s slowly starting to realize how powerful that is.

Part of me reacts to seeing a beautiful baby by wanting another one of my own. But there’s the fear that I would be testing fate one too many times. Michael did not develop language, speech, or social skills typically, but has turned out mostly all right. He’s definitely within the typical range at this point and even ahead in some areas. Ava did not develop speech and language typically, and has what I can safely say at this point is a (thankfully mild) motor speech disorder. She’s making great progress and I am hoping that we can -maybe- catch her up by the time she starts kindergarten.

That’s two for two on atypical development though. Three is just not a gamble I’m willing to take with our lives even though I like smiling at the baby in the park. Besides, I’m not sure my husband and I could handle being outnumbered.

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.