The Weekly Review: Week 49

Blog Post of the Week

I loved Amalah's Valentine's Day Recap. First of all, I definitely need those bracelets. I thought it was only my husband and I who had that exact same exchange. Second, the story about her putting the baby to bed while listening to alarming noises from downstairs was hilarious. I read it at least twice and laughed out loud each time. I loved her description of her silent, gasping laughter when listening to her husband's description of the events because I do that too. Somehow, the pain of others often causes me to laugh (in a completely sympathetic, yet uncontrollable manner). I get that from my mother.

Ava this Week

First, the making silly faces at daycare has been a complete success. (Please don't let me saying that out loud jinx it.) Dropping Ava off at school takes a fraction of the time and is fun from start to finish. Now, if I were the type to be self-conscious I might feel a bit like an idiot sticking my tongue out, my fingers in my ears, crossing my eyes and bobbing up and down in front of that window while countless other parents walk by with their angelic children. I'm not though. I'm self-conscious about plenty of things, but all bets are off with children. I think other parents are pretty understanding.

Second, I have decided that Ava is an /l/ genius. This late-emerging sound that is the bane of so many children's speech journey has come so easily to her. She's even using some l-blends in conversational speech after working on them for only a couple of weeks. What is it about her wiring that makes some difficult sounds so easy for her (/l/, /s/) and some easy sounds so hard (/k/, /g/)?

Weekly Michael

Michael had his 4 year checkup this week (three months late). He was amazing. He charmed our pediatrician. He did wonderfully on the developmental checklist. We ran out of questions before we hit three negative answers. He was brave during the first and even the second immunization even though he was scared and he shook off the tears and moved on the second the stickers came out. I was so proud.

Our pediatrician evidently forgot that I'm an SLP and asked me if I had ever had his speech screened. So, his speech errors are becoming more noticeable and age-inappropriate. I told her that I was aware of the errors and was working on them. I haven't had him evaluated, because the errors he is making are still considered to be age appropriate according to school districts (who are crazy) and so he wouldn't be eligible for services. Therefore, I told her, I am handling it myself for now.

On a completely separate note, we have a computer program that lets Michael design and print his own "book". He insisted I staple it together just like a real book. I asked him to read it to me, expecting him to just tell me the story in his own words. Imagine my surprise when he read the story word for word to me only needing help once the first time he encountered the word Pierre. "One day, Pierre went to a park. Up in the sky he saw the sun. At the park, Pierre saw a cat. Pierre decided to fly a kite."

Weekly Procrastination Update

I have finally gotten started planning for Ava's birthday. We're getting her an art desk for her birthday. She loves arts and crafts, but right now all the art supplies are kept put away except during special projects. I want to make them available to the children all the time (well, not paint perhaps...) and so an art desk sounds perfect. I think she'll love it. Once I've decided on a "perfect" gift I have so much trouble waiting until the actual birthday to give that present.

Weekly Realization

Ava turns three in less than a week. Also in less than a week, all of our early intervention services cease and she'll have her first group session conducted by school district personnel. Somehow that snuck up on me. Oh how I hate transitions. I have such high hopes for this speech group though. I think the structure and use of the Hodson's Cycles Approach could work very well for her. It is sad to say goodbye to our early intervention therapists though. They've been part of our lives for a long time now. The transition seems so abrupt. We'll miss them.

Ava's Weekly Home Therapy Focus

Ava is continuing to do well with final /s/ and /sh/. We run through those relatively quickly alternating nights. Our main focus right now is on the /bl/, /pl/, and /fl/ l-blends and the /sn/ s-blend. Just this week we have also started /st/, /sp/, and /sm/. Ava does very well with the l-blends needing only moderate to light prompting. The s-blends are still quite difficult requiring significant prompting, but I can see the motor planning beginning to kick in for them. She finds them noticeably less difficult than ten days ago. I notice the difference in subtle ways. She still requires significant cueing, but she is less frustrated. It takes fewer attempts before we get a correct production. We can practice longer before she gets fatigued. We get more repetitions in during a 25 minute session than we did a week ago.

Michael has begun to notice the attention and praise Ava receives during our nightly speech therapy sessions and has asked to be included. This is a blessing in disguise. Ava's therapy becomes a little less intense when she shares her session with her brother, but now I get to do some official work with Michael on his errors. The final /s/ cards and s-blends allow me to address his interdental /s/ production. The /f/ blends allow me to address his /th/ for /s/ substitution.

When asked to keep his tongue behind his teeth for the production of /s/ ("keep the tiger in the cage") he can do it. He accomplishes this by clenching his jaw and keeping his teeth closed through the production of the entire word including during production of the vowel and other consonants. This seems less than ideal. Do any of you other SLPs have thoughts on this manner of production? He obviously needs to stabilize his jaw in order to produce the /s/ properly. Is it all right (for now) to let him maintain that position through production of the entire word, or should I discourage that? Any thoughts?

A Question You Don't Want Your Son to Ask His Preschool Teacher

We were sitting down to breakfast yesterday when Michael announced that when he grows up he wants to design a huge gun to blast tires in a junkyard. After a moment when my brain simply stalled attempting to formulate an appropriate response, I tried the following: "Well, actually, they usually recycle old tires into things like rubber mats and playground mulch like we saw on that show How Things Are Made. Perhaps you could design a huge tire recycling machine when you grow up?" After a millisecond of thought he rejected that idea. "No, I'll just design a really big gun."

Umm. Okay. I obviously needed a new strategy. "Well sweetheart. You can be anything you want to be when you grow up. You can learn all kinds of things at school." He perked right up at that suggestion and happily told me, "Great! I'll ask Miss Marlene to teach me to make a big gun at preschool tomorrow." At that point there was a huge awkward pause while I contemplated exactly the extent to which that strategy had backfired. Finally I stuttered, "No, don't ask Miss Marlene that..." and kind of trailed off. He came right back with, "Why not?"

Alrighty then... I launched into a huge discussion about how first you go through preschool where you learn letters and art and science and then grade school and high school where you learn reading and math and science and history and art and music.... And then, I explained, when you get to college you can choose to study what you want to be when you grow up. I told him that mommy learned how to be a teacher and a speech teacher. Daddy studied computers. Grandpa studied chemistry. His grandmother learned how to be a nurse. I then suggested that he could study to be an engineer who makes prototypes and plans for things to be built in factories.

At that point, I'm pretty sure he had stopped paying attention. Hopefully the huge long conversation will at least have distracted him from his original intention of asking his preschool teacher to teach him how to build a gun. A mama can hope, right?

Sometimes It's Just Normal

In retrospect, it is so clear that even as infants my children were not developing typical early communication milestones. The first smiles and laughs were not on schedule. We never really had cooing at all. Babbling was both very late and extremely reduced. This is for both children, not just Ava. In fact, all of those delays were even more extreme and exaggerated for Michael than for Ava.

Now Michael's speech started to kick in around the age of 15 months. It was odd. His first consonants were ones like /k/. He was using clicks in place of consonant sounds which was even more strange. I was so very worried.

In fact, I can remember having a conversation the night of Ava's birth with a fellow SLP about how concerned I was about Michael's speech. He was 15 and 1/2 months old that night. I know that it sounds strange that I just happened to be talking to a SLP on the night of my daughter's birth. However, that SLP was a close friend and former coworker who also happened to be a doula. She was my doula and with me for the birth of both of my children and so it was natural for us to be discussing Michael. She was there for his birth and she was a fellow SLP.

At 15 months all Michael had was a couple of vowels, a /k/, and a lot of clicks. However, by 24 months he was talking in 5 word sentences, had an age appropriate sound repertoire, and was intelligible enough that his speech was constantly commented on positively by strangers. It was such a relief. Over the course of those nine months, the worry I had carried in my heart for the first year and a half of his life faded and I was so grateful to let it go.

That history of Michael's delay followed by a remarkable recovery to above average was a huge part of why I delayed so long before acknowledging that Ava's speech was delayed. Then we fast-forward to the present day.

Now, at the age of 4, it is apparent that Michael does have some speech errors that are going to need intervention. He has a distorted interdental production of /s/, /f/, /v/, and /th/ that results in all of those sounds being produced in an identical fashion that is visually distracting and impacts his intelligibility on words that include those sounds. And so I worry.

I spend a lot of time worrying about speech. I worry about Ava's speech. I worry about Michael's speech. But sometimes, a speech error is completely normal - even adorable. Michael is completely convinced that one of his favorite foods is "grabioli" rather than "ravioli". I smile a little every time I hear him say that because it is such a normal speech error. I smile, and gently correct him. It is nice to occasionally engage in a correction that is without stress or subtext. Because sometimes it really is just normal.