Ava's Speech - What next?

Ava's speech continues to improve in subtle ways. She's talking all the time. Her sentences are often multi-word sentences. She's a full conversational partner in the household. She listens to the conversations around her and tries to participate. She initiates new conversations. She is trying to sing songs. Slowly she's starting to use consonants in the middle of words and put some on the ends of words. Her vowels are usually correct now. The consonants that are missing are still missing, but they are consonants you wouldn't necessarily expect a young two year old to be using like /f, v, k, g, r, l, ch, J, s/. She still has difficulty with more complex syllable structures like C1V1C2V2, but those would be difficult for many typically developing early two year old children too.

She looks so different from the child who less than four months ago had only three "words", very few sounds, couldn't imitate, and scored at the 4 month old level on the early intervention speech and language assessment. She had so many of the items on the checklist for early red flags for Childhood Apraxia of Speech.

Now her therapists are starting to hint that she's looking more and more age appropriate. They're starting to say that the remaining issues she has look more like articulation or phonological issues than apraxic issues. This is exactly why Speech-Language Pathologists are reluctant to diagnose Childhood Apraxia of Speech this early.

If Ava had/has Childhood Apraxia of Speech it is mild. Anyone with moderate or severe CAS would have improved much more slowly. She's in an odd place. She's outgrown many of those "early red flag" signs (although her history of those red flags will never change). She's not quite old enough for the classic signs of Childhood Apraxia of Speech to show up yet.

We're in an odd limbo place. She's made great strides that have brought her to a place that is almost age appropriate. You could argue that we could stop therapy or go to therapy fewer times a week. After all, I am a speech therapist and I'm working with her at home too. I'm also able to monitor her for signs of backsliding. However, it took therapy multiple times a week over several months (and possibly multiple kinds of supplements) to achieve those improvements. I don't want to stop too early. She wasn't making any improvements before the therapy (and supplements).

I'm just not sure what to do. Continue therapy for now? Reduce therapy and see if she's still improving or at least maintaining her skills? Stop therapy for a while and wait to see if she falls behind again?

What do you guys think?

Easter 2011

We had a wonderful Easter. I hope you had a great day too.

The morning began with the children discovering their Easter baskets. They enjoyed the candy and small toys included in their baskets. I had found some small pinwheels and included one in each basket. I didn't really think about it at the time, but they are a great oral motor activity. Ava had a lot of trouble getting her pinwheel to spin, but didn't give up. Of course there's always that one item that is more popular than all the rest. The kids loved the M&M filled gumball machines. They were the first things the children spotted and it was hard to get them to put the gumball machines down long enough to even look at the Easter baskets.

Mid-morning my parents arrived and the entire family participated in dyeing and decorating Easter eggs. Everyone had fun. We began by dyeing them and just as Michael was getting bored with the activity the first set were dry. He loved decorating them. We used the stickers in the egg dying kit and when those ran out I pulled out some art materials and glue and we used those too.

A couple eggs were cracked and therefore the children got to try hard-boiled eggs for the first time. I don't like hard-boiled eggs and never make them. So my kids had never tried them. My parents like them though and were able to set a good example. Michael refused to try a bite at first, but he'll do anything for his grandpa and eventually tried some. He eventually took a few bites of the white, but never tried the yolk. Ava finally decided she'd try a bite after feeling left out of all the attention Michael was getting. She spit the bite back out without even chewing it. I think she was startled that it was cold and didn't like the texture at all. I was pretty impressed she took a bite at all and praised her for trying it.

After lunch (breakfast for lunch - yummy) we were invited to a neighbor's house for an Easter egg hunt. The rain forced the hunt inside. This was the first year the children were old enough to really participate in an Easter egg hunt. Michael loved it. His bag was full at the end of the hunt and he thoroughly enjoyed discovering what was inside the eggs. Ava seemed a bit confused by it all, and entertained the adults by refusing to put any egg in her bag that wasn't pink. If she found a egg of any other color she'd toss it to the floor and practically run away. I slipped a purple one in her bag thinking it was close enough, but when she found it the purple one got tossed too. The other children were wonderful and began bringing all their pink finds to her for her bag.

It was a great family day and we all had a wonderful time.

The Campaign Against the Mama Phase

About a week ago I complained about the over-the-top Mama phase Ava is going through. A very nice commenter, JR Morber, made some well thought out suggestions. She said that they used a combination of strategies to fight a Mama stage with her son. I'm going to summarize her suggestions in list form.

1. Mama should be a little less effective at meeting the child's needs. Slow down. Make them wait.
2. Refuse to respond to small requests unless Daddy can do it.
3. "Pro-daddy praise campaign."
4. Special Daddy-only activities.
5. Re-arrange routines so that Daddy is taking the major role in care whenever possible.
6. Resist stepping in during Daddy-child interactions.

It sounds like a thorough, well thought out plan. And it sounded like a lot of work. At the time I thought that things weren't bad enough to put that much work into trying to fix the problem. I was just hoping that eventually the phase would pass.

Well, things continued to get worse over the next several days. Then one morning Ava pitched a fit just because her Daddy said "hi" to her during a moment that she thinks of as a Mama time (getting her from her room when she wakes up in the morning.) That was it. We immediately adopted JR Morber's plan.

We're about two and a half days into the plan. Essentially, if my husband is home, he takes point with Ava. When she protests we make some excuse about Mama being busy and then I just leave the room so I'm not an audience for any complaints. Daddy has been making extra efforts to (although he's always good) be funny, nice, and entertaining. Daddy has dressed her, put her down for nap and bed, put her into the carseat and taken her back out, played with her during play times, helped her at the dinner table, etc. It's working beautifully. We're already seeing a big change and it is wonderful.

Thank you, thank you, thank you to JR Morber if you're reading this.

We'll keep this up for several more days and then hope that the good will towards Daddy lasts when we go back to taking turns with the children.