Data and Diagnosis

Let's take some snapshots.

Ava just shy of two years old. No words. Three consonants and one vowel in her phonemic inventory. Not able to imitate. History of reduced babbling. Lots of red flags for Childhood Apraxia of Speech.

Ava at three. Decent phonetic inventory. Speaking in multi-word sentences. Significantly reduced intelligibility. Exhibiting many age inappropriate phonological processes. Diagnosis would look a lot like a phonological processing disorder with a motor-planning (apraxic) component.

Ava at 3 1/2. Intelligibility is improving. Many phonological processes are resolving - even the ones that are still age appropriate (cluster reduction, stopping of stridents, etc.). It would be difficult to describe Ava's speech problems as a phonological processing disorder at this point. She has numerous speech errors which are resistant to intervention due to the underlying motor planning component (stubborn, stubborn velars).

Same kid. Same neurology. The "diagnosis" looks different at different points. We get so hung up on a label. We need them for insurance and schools. Parents and SLP's tend to like them too. It is more important to understand the characteristics of the speech at that point in time and to have a plan to remediate the current spectrum of problems. Then you have to periodically re-evaluate with an open mind and be responsive to change.

Fascinating stuff.

(Typically, you'd never administrate the same instrument three times in five months. In this particular case it was done because of the timing of Ava's IEP. They assessed her at intake, at the end of the school year, and then at the beginning of this school year. The results are not simply an artifact of retesting though. She has indeed made progress in the areas noted. It's pretty amazing actually.)

Soliciting Opinions on Age of Acquisition Guidelines

It's terribly hard to qualify a speech-only child based upon specific articulation errors because the age range for age of acquisition is so wide. However, for the sake of this discussion, let's set aside the issue of qualification and just discuss treatment. You have a (hypothetical) child enrolled in therapy. You've been treating them for some time, and the only errors they have left are "age appropriate." Do you continue to treat or discharge that client from therapy?

Or, let's say you have a child with a frontal lisp on /s/ production that is very noticeable, but they're only 4-5 years old. Do you treat the lisp? I'm inclined to treat. I feel like letting certain errors go just tends to set them in stone, so to speak. By the time the errors are finally age inappropriate, the mispronounciations are fully habituated and harder to treat than they would have been if you had addressed them earlier.

I was hoping to get some other opinions. Have any of you encountered situations where children with a history of speech errors that need treatment had "age appropriate" errors resolve on their own without treatment as the child ages? I'm prompted to ask because of Michael.

Michael had a tendency to produce a wide variety of sounds interdentally. /f/, /v/, /s/, and /z/ were all produced with significant tongue protrusion. Given his abnormal speech history (almost completely absent babbling, no vowel productions or "cooing" until over 8 months of age, no words at all until 15 months...) and his sister's more significant speech issues, I decided to treat. /s/ and /z/ are pretty much completely resolved, and /f/ and /v/ are well on their way although still problematic in conversation. At 4 1/2, problems with /f/ are now age inappropriate, but that's the only speech error he has that currently would "qualify" for treatment.

I could step back now. I could work gently, but persistently on /f/ and /v/ when they come up naturally in conversation and just take a wait and see approach on the final remaining errors (/f/ for /th-/ and /d/ for /th+/). /th/ is a sound that would never qualify for treatment at 4 1/2. Given the history, would you wait and see if the /th/ resolves on its own or would you work on it?

The Weekly Review: Week 74

SLP Resource of the Week

Heidi at Mommy Speech Therapy put together a really nice free downloadable articulation screener. Two pages contain 46 picture prompts. Results are tallied on simple, attractive scoring sheets separated into phoneme organized by age of acquisition. This is definitely a resource worth checking out.

Ava this Week

My little girl is loving preschool. Up until the very last day, Ava protested being left at daycare. She didn't look forward to it and clung to my legs when I dropped her off. She was fine, but she didn't love it. Now, she loves school. She looks forward to going, and doesn't even watch me go when I walk out of her door. The preschool teacher and teacher's assistant in her room are wonderful and do an amazing job of making the children feel welcome in their room. They have a routine in place for the children's arrival which works really well for Ava. She knows exactly what to do when she walks in and looks forward to the routine. I am enjoying watching her do well at school.

Weekly Michael

Michael is also doing really well in his new pre-kindergarten classroom. I was worried he'd be jealous of Ava moving into "his" old room, but he hasn't worried about it at all. He's much more social this year. He has a group of friends that he enjoys playing with and when they all walk out at the end of their morning they walk out together in a group and head over to me talking all the while. Some of their topics of conversation are... interesting. The waiting area at the school has some benches and one has a memorial on it for a teacher who died a few years ago. Several of the boys are convinced she's buried under the bench and I have to reassure them every day that there isn't a body under their feet. Michael also announced that they've all chosen his future bride. I, shamefully, have forgotten her name. I have been informed that Michael will be getting married to her though. It's fun and rather entertaining to watch the social "skills" of a group of four year olds emerge.

Weekly Weight Loss

I'm down a somewhat inexplicable 1.5 pounds this week. I haven't really done anything different. I'm still walking the calorie/activity tracking path trying to stick pretty closely to my allocated number of calories per day. I'm guessing that "natural variations" in weight just happened to swing in my favor this week. Still, it's encouraging to see things continue to head in the right direction. I'm down about 10 pounds from where I started. Not bad at all.

Weekly Special Event

Our entire household is excitedly anticipating visitors this weekend. My husband's parents are driving into town to see us for an extended weekend. They are wonderful people who adore their grandchildren and are adored in return. We'll spend one day out on the town visiting a children's museum and having lunch out. The agenda for the other two days is still up in the air, but I know we will enjoy their company. I will be taking a blogging hiatus during their visit. I should be back early next week. I hope you all have a wonderful weekend too.