Speech Therapy Progress - So Slow

I realized that I haven't done a speech therapy progress update in almost 5 months. I can't believe that much time has passed. I've been doing fewer progress updates because there is less progress to report.

Last time I wrote a progress update I said that we were working on final consonants and that she was using /p/ and /t/ spontaneously about 30% of the time and we had pretty much no other final consonants. Now Ava is using final /p/ and /t/ spontaneously at least 60% of the time in phrases and sentences. She's also using or approximating most of the other early emerging consonants spontaneously at least 30-50% of the time. She can imitate final /s/ and /sh/ as well, but is not using those spontaneously.

We still don't have /k/ reliably. I'd say I've seen relatively little movement on this phoneme in 5 months time. Even in direct imitation with multiple cues she will substitute /t/ for /k/ at least 3/5 times. I am frustrated with the complete lack of progress on learning a velar sound.

Right now I feel like I understand Ava at least 90% of the time in context and at least 50% of the time if I have no context. I think she is significantly less intelligible to strangers. She is speaking regularly in 3-7 word sentences, but most of those are word approximations.

She has /p, b, t, d, m, n, h, f, j, w, s, sh, ng, and vocalic /r/ in her phonemic inventory.

I feel like her language growth has been phenomenal over the past few months. Sentence length and complexity, expressive vocabulary, and morpheme use has all improved significantly (as you would expect for a child of her age).

Speech progress has slowed and is becoming difficult to track. We have shifted out of the stage where we see rapid progress from beginning therapy. Now I am beginning to see that the remaining errors are significantly more stubborn and progress will be measured in small increments rather than leaps. It is disappointing, but not unexpected.

I know slow progress is much more typical of apraxia and motor planning problems than fast or even steady progress. It's just that when things moved so quickly at first I got my hopes up. I was hoping that she would be the exception rather than the rule. Why is there always another reality check just around the corner?

Apraxia Therapy Materials: Turn & Talk Early Sounds

Therapy Materials Review: Turn & Talk Early Sounds - Fun Practice with P, B, M, T, D, and N in Initial, Medial, and Final Positions of Words

This is a review of Turn & Talk Early Sounds. This easel book is published by Super Duper Publications. The book contains 600 illustrated words addressing the early emerging phonemes (p, b, m, t, d, n) in initial, medial, and final positions of one and two syllable words.

Target Audience

The publishers state that the target audience for the Turn & Talk Early Sounds book will be children from PreK-3rd grade. The pictures on the cards are appealing to children. I could see using selected sections with younger children who need practice on early emerging sounds as well.

Description of Turn & Talk Early Sounds

This product is a 11 inch by 4.5 inch spiral bound book with hard covers. The book has a built in easel so you can stand it upright. Inside you'll find an introductory section describing the contents of the book and giving tips for eliciting correct production of the target sounds. This section also includes a blank card you can use to write in the sounds in isolation or in VC or CV syllables with a dry erase marker if you want to work on the sounds at that level.

Phonemic Breakdown

The book has a tabbed section for each of the six phonemes: P, B, M, T, D, N.

Each section includes 100 words divided as follows:

• 20 Initial One-Syllable
• 20 Initial Two-Syllable
• 20 Medial Two-Syllable
• 20 Final One-Syllable
• 20 Final Two-Syllable

How to Use the Turn & Talk Early Sounds book

This book is going to be most appropriate for intense drill on these phonemes. Choose the section that addresses your goals and objectives for a child and use that section to drill. The pictures are fairly engaging, but you will probably need some motivational tool such as a turn at a game, sticker, or token.

Pros and Cons of the Turn & Talk Early Sounds book

• Pros:
• The Turn & Talk Early Sounds book is compact and easy to carry around.
• AT 100 words per phoneme, the Turn & Talk Early Sounds book includes a pretty good number of stimuli per phoneme.
• The five picture spread format allows you to do many repetitions easily. This is a great format for approaching therapy with apraxic children from a motor planning standpoint.
  
• The book is sturdy and has a built in easel.
• The illustrations are well done and appealing to children at a wide variety of ages.
• Cons:
• Although there are 100 words per phoneme, there are only 20 one syllable initial and 20 one syllable final pictures for each phoneme. Most of those 20 one syllable words are fairly complex including later emerging phonemes, vocalic /r/ sounds, and even blends. Therefore, if you are working with a child with a severe speech delay you may find this book to include stimuli that is mostly too difficult. My free articulation picture cards target these same phonemes at a simpler motor planning level, so if you need simpler look there.
• This book will work best for children needing a simple articulation approach to speech remediation. Most children with simple articulation errors are making errors with later emerging phonemes. This book may not address the phonemes you need most.

Bottom Line:

The Turn & Talk Early Sounds book is a good purchase if you need stimuli that address these early emerging phonemes. Just think carefully about whether the stimuli included here are actually going to be too difficult given that often children who need drill on early emerging phonemes are severely delayed and may have difficulty producing many of these stimuli because of the other phonemes included in the target words.

You might also be interested in the following products:

Apraxia Therapy Materials: Free Speech Therapy Articulation Cards

Apraxia Therapy Materials: Webber Jumbo Articulation Drill Book

Apraxia Therapy Materials: Word Flips

Apraxia Therapy Materials: Phrase Flips

Making and Painting a Textured Surface

This started out as a great OT activity. Take toilet paper and let the children rip it into little bits and fill a bowl with it. They absolutely loved that part.

Then you add glue. Lots of glue. I didn't measure, but I used at least 8 oz for the three bowls. Ask the children to mix the glue with the toilet paper (with their hands) until it turns to sticky mush. Listen to screaming and crying protests and end up doing much of the mixing yourself. (Or at least, that's how it went at our house.)

[I forgot to take a picture of what the glue/toilet paper mush looked like. Sorry!]

Then persuade the children to take the mush from the bowl and put it on paper to dry creating textured paper before they run off to wash their hands. If you have children with no sensory issues, this has so much potential. I made a snowman. You could make a mountain and lake. You could make anything really. It's pretty cool.

Let it dry for a couple of days until you remember to get back to the project.

Let the children paint the newly textured paper. They loved this part. I filled an ice cube tray with six different colors of liquid tempera paints and gave them brushes and let them paint. We experimented with dabbing it on the textured areas and different types of brush strokes on the plain paper. They had a blast. We spent about 45 minutes painting the textured paper and then moving on to several other pieces of plain paper before they were done.

Here's how the painted textured ones turned out.

A couple of notes should you decide to try this activity yourself. You need lots of glue. And lots of toilet paper. We used about half a roll of toilet paper and ended up with relatively little final product.