Ava Speech Update: Fall 2012

It's been a long time since I've talked about Ava's speech in more than a passing manner. Fall seems like as good a time as any to check in. It's been a long time and many of you started reading between my last update and this one so I'll begin with some background so you can understand how far she's come.

Ava was not talking at 22 months. She had a history of reduced babbling and an extremely limited phonemic repertoire (d, m, h and a couple of vowels). The only syllable shape she produced was CV. She used the word approximation "da" with an upward inflection for almost everything accompanied by pointing to the object she wanted. She could not imitate. She was beginning to give up on trying to talk at all turning to gestures instead.

At that point I abandoned the wait-and-hope-she-miraculously-catches-up approach and began to make phone calls. We briefly saw a local SLP who had put a flyer in the daycare who agreed that Ava's speech was significantly delayed and that she had many of the red flags for Childhood Apraxia of Speech. I called around and discovered that one of the national experts on CAS lives in our area and set up an appointment with her. We've been seeing her twice a month for well over a year and she's wonderful. We also had Ava assessed by early intervention, wrote an IFSP, and began receiving services. Finally I set up a program of home therapy with her.

At that point I knew Ava was delayed - really delayed. What I couldn't yet anticipate was prognosis. It would depend on how well she responded to therapy. Some children respond well to therapy and make progress quickly. In those cases, prognosis is pretty good. In other cases the children, parents, and therapists work hard, frequently and intensely and progress is still slow. In those cases, prognosis is poorer. You know you're going to have to work harder and longer. You know progress will be slower and that the child may not ever have typical speech. I didn't know which category Ava would fall into, but I feared, based upon how delayed she was that she would fall into the second category.

We were so lucky. Ava responded well to therapy. Really well. I was doing updates on the blog every 2-3 weeks and it was like I was describing a completely different child. First she was learning to produce new consonants and vowels. Then she added more complex syllable shapes. She went from one syllable to two and from one-word utterances to multi-word utterances. We went from almost no speech to lots of speech that was extremely difficult to understand because there were multiple errors in every utterance.

Slowly we worked on speech errors. Some sounds and categories of sounds she learned quickly and easily. /s/ and /l/ came relatively quickly even in blends. Now she uses them conversationally with no problem. Other sounds we've worked on for well over a year and they're still a struggle (/k/, /g/). As more sounds came in and fewer sounds are left that are in error she became easier to understand.

Right now she's intelligible most of the time. She struggles most with sounds produced in the back of the mouth. She fronts /k/ and /g/ producing /t/ and /d/ instead. She also fronts /ch/ and /J/. /th/ is produced as an /f/. There are plenty targets left to work on. The almost complete absence of back sounds certainly impacts her speech in a noticeable way. Her language helps her though. She's using long sentences in conversation. You usually have enough context from the conversation and from the rest of the words in the sentence to figure out the one or two words that would have been unintelligible in isolation. You can ask her to tell you a different way or give you a clue and she is able to rephrase her message to help you.

Ms. J (our local apraxia expert) has even suggested we take a hiatus from visiting her because Ava has made such great progress. We're stuck working on trying to break through on those back sounds and I can do that myself with her at home.

Ava is heading off to preschool next week and I am not worried about her speech significantly impacting her experience there. Yes, her speech is not typical, but she is understandable. I am so grateful that all her hard work has paid off. Prognosis is good. If we keep working, I expect that the remaining speech errors will be corrected in time. At some point, I truly think her speech will be typical. Until then, we'll keep working at it.

Fall Brings Change

I dropped the children off at daycare for the last time the other day. I've been driving to that daycare two days a week since the business opened in January of 2010. It is the end of an era for us. I was a little sad to say goodbye to all of the wonderful teachers that helped care for my little ones when they were little. In general I think that daycare teachers are under-appreciated and underpaid. Good daycare teachers are amazing.

We attended the preschool orientation at our local school district. Ava will have the same teacher Michael had last year and he's moving up to the pre-kindergarten room. It's only a half-day program. They're there for less than three hours. I want them to go mostly for the social connections with other children their same age. Also, it gives me some time to work on some projects that have been on the back burner for a while. I have mixed feelings about it though because I'm still strongly considering homeschooling beginning with Michael's kindergarten year.

Mostly I'm just resistant to change. I wonder what it will be like. Right now, several days a week are "home days" where the children and I have a relaxed rhythm to our day. Beginning next week I'll be dropping them off and picking them up from school on weekdays. Three days a week we'll have an additional after-school activity (speech twice for Ava and gymnastics once for both of them). The rhythm of the days will change. Some people love change. They find it stimulating and exciting and look forward to it. I like routines and familiarity. I'm sure that in a few weeks we will all settle in to the new routines and I'll look back at my current unease and think to myself that it was unnecessary. Somehow, knowing that still doesn't help my mental grumbling now.

I hope all of you weather your fall changes well and enjoy your new routines and adventures.

The Weekly Review: Week 72

Weekly Monumental Road Trip

We did it. My mom and I took my three and four year old children on a road trip to visit relatives in the New Orleans area. It took us a little over 12 hours to drive there and a little less than 12 on the way back. The children were wonderful. Both drives went very well. We spent entire days in swimming pools. We visited extended family many of whom went out of their way to make sure they got to see us in the three short days we were there. The children loved everyone and can't wait to go back.

As some of you may remember, I went a little lot overboard preparing for the car trip (car activities for young children, more car activities for young children, oh look, yet more car activities for young children, could I possibly need yet another set of car activities for preschoolers?, one more set of car activities for good luck). The sad part is that there are at least one more post full of activities I made that I ran out of time to post about. The good news is that the activities worked really well. The less good news is that I only needed about half of them. When I realized that I hand picked the best ones of the lot and passed those out first. I'll save the rest for the next trip.

At first I tried to micromanage. I would turn the tv off and give each child a bag. Let them play for 10-15 minutes and then instruct them to switch. Then have them clean up and return the bags to my mother before turning the tv back on until the next stop to stretch our legs. As it turns out, a much more relaxed approach worked better. We ran the tv most of the trip. Ava was more interested in the tv and less interested in the activities. Michael was very interested in the activities. We just let him play until he got bored on his own. Then he'd pack up the bag and ask for another one. Michael went through twice as many bags as his sister and that was fine. Letting him play while watching television worked better for Michael than forcing him to alternate between the two types of activities. Live and learn. His favorite activities were the make-a-wand kit, the geoboards, the duplo kits, and the notepad with stickers and pens.

Another focus on the drive was to keep things moving at all costs. We stopped only at rest stops and kept those stops to under 10 minutes. We stopped at every other rest stop instead of at each one. We timed gas stops to coincide with meals and my mom took the kids to the bathroom at the gas station while I filled the tank. Then we went through a nearby drive-through for food to eat in the car. For us, it was more important to keep the drive from stretching to 13 or 14 hours than it was to take a more leisurely approach to the stops and it worked well.

Ava this Week

Several people commented on our visit about how far Ava has come in the past six months both socially and in terms of her speech. She was much less shy and overwhelmed. She talked a lot and rarely had difficulty making herself understood. I was so proud of her and relieved to see her able to participate so well in the visit.

Weekly Michael

Instead of saying, "When I grow up..." Michael has taken to saying, "When I'm an engineer..." He has a long list of things he'll do when he's an engineer from telling me all the things he'll build for me, to the foods he'll eat and the games he'll play. He added something new to that list on the trip.

Michael saw his first roach on the trip. What can I say, it was a home in the deep south in a rural area. He also got to see his first roach get squished. Then we got to learn a great new vocabulary word in addition to the word "roach" - "guts". After that 60 second lesson in the wildlife of Louisiana we moved on and I didn't give it another thought until the next day when Michael came up to me and shared this nugget about his future: "When I'm an engineer I'm going to have an oach (roach) for a pet. I like them because they're so big." After a brief speechless moment I replied, "Sweetheart, when you're an engineer you can have whatever kind of pet you like, including a roach."

Weekly Weight Loss

So it's actually been two weeks since my last update in this area. Checking back I realize that I've lost all of 0.2 pounds in the past two weeks. To be honest, that's a little depressing. I'm reminding myself that this is a marathon, not a sprint. I'm reminding myself that I went on a trip during that time where I had less control over my food choices and I did a rather terrible job of staying hydrated and getting enough sleep. I'm reminding myself that this is about improving my health, learning new long-term habits, and reversing an upward trend rather than about a weight-focused "diet" and negative thoughts about my self-image. And so, it's ok. Next week is a new week.