SLP Mommy of Apraxia

Category: Childhood Apraxia of Speech

  • She observes more than we know.

    It started with the name disintegration at Thanksgiving.  My concerns about her writing were brought up to the staff as she flitted playfully around her preschool room while we talked.  I cried and I made tough decisions.

    She noticed.

    I didn’t know it at first.  It started out innocently with her asking when she would see Dione (her private OT) again.  I told her I had to apply for more funding and then we could see her.  I figured that was the end of it…..but it came up again.

    ” I need to see Dione,” she said again randomly one day.

    Me: “Oh I know honey, I’m still waiting on funding and hopefully we’ll see her soon.”

    Weeks passed.

    Again out of the blue she says one day, “Mommy.  I NEED  to see Dione.”

    Me: “Oh sweetie, I know.  Hopefully soon.  I applied and now I’m just waiting to hear back.”

    Crying.

    “MOMMY!! BUT I NEED TO SEE HER.”

    Me looking confused, “honey, what’s wrong?  why?”

    Ashlynn talking through tears, “because I need to practice my yetters (letters).”

    With my heart breaking in two I give her a hug.  I tell her that her letters are perfect, and that she always works so hard and she has nothing to worry about.

    That got me thinking though.  I am the FIRST one to defend her receptive language, her comprehension.  However, apparently I’m also the first one to talk about heavy things in front of her and just assume she was too busy being a kid to notice.  Not true…..apparently.

    Fast forward a month.  Her dad had a bad day at work.  Nothing catastrophic, but a pretty tough day. I was relaying it to her grandma (her dad’s mom) one day when she dropped her off for me to take Ashlynn to school.  Ashlynn seemingly oblivious, was playing on the curb and sidewalk, jumping down, climbing up, being a kid!

    I took her to class and the kids have to “check in.”  They get their name and place it under a feeling picture.  Ashlynn ALWAYS picks happy.  She is happy!  However, today, she placed it under sad.  “Ashlynn” I say, “you put your name under sad?”

    “Yeah, I sad mommy”  she said.

    “You’re sad??  Why?” I asked.

    “I sad for daddy…for his work,” she said.

    I absolutely folded.  What’s worse, I would have never known she felt sad about what I was telling her grandma if she hadn’t of “checked in” right after that.

    Are typical kids able to express these feelings, or do they just stuff them too?  Stuff situations they don’t understand, or is it because of Ashlynn’s apraxia?  My mom made a good point that Ashlynn would have probably brought it up “out of the blue” eventually like she did her OT and letter concerns.

    Maybe.

    I don’t know.

    All I know, is my child is so much more than you see, what I see, what anyone sees.  A five year old shouldn’t have to worry about needing help for writing, or worry that her daddy had a hard day at work.  It makes me wonder what else she worries about of which I have no idea.

    I love this meme: “Don’t underestimate me because I’m quiet.  I know more than I say, think more than I speak and observe more than you know.”

    I will try to never underestimate you again, Ashlynn.  You were born to move mountains.

    thinks more

  • Strategies to promote speech and language in the pre-verbal or minimally verbal child with Apraxia

    Strategies to promote speech and language in the pre-verbal or minimally verbal child with Apraxia

    The great thing about speech and language, is that it a task that can be worked on in any activity.  Familiar routines in the home provide the perfect platform for encouraging speech and language, because this “routinized language” is predictable and context based.

    A fellow SLP and mommy of apraxia, Kim from Landonjourney.blogspot.com and I teamed up for Part I in my series of parent strategies to promote speech at home.  We wrote a list of some of the most effective strategies to encourage early speech in the pre-verbal child, including those with Childhood Apraxia of Speech (CAS).  Part II in the series will focus on strategies for the verbal child with CAS.

    Parents ask a lot, “How do I get my child to practice speech at home?”  Well, we are here to tell you, you don’t need worksheets and flashcards.  Basically, with kids who are minimally verbal, we look for opportunities to model and encourage functional language.  Functional language refers to language the child is more apt to use frequently throughout their day, or may be highly motivating to them.

    With kids who have apraxia, not only do we think just about functional language, but words that also contain simple syllable structures.    These are some of our favorite strategies and targets and how we incorporate them:

     

    Powerful motivators:

    As moms, Kim and I know that when you have a child who is nonverbal, you anticipate their needs for them.  After all, our babies can’t tell us when they hurt, or where they hurt if they are crying.  They can’t tell us they’re hungry or thirsty; and if they have global apraxia like our kids, they may even have trouble pointing to communicate to us that way.  However, as SLP’s we know that kids need to be motivated to communicate.  If we keep anticipating their needs, they never have a reason to really force themselves to try at something they know is hard for them anyway.   As the parent, you are truly the best person to encourage them to try, even when it’s hard.

    Teach and pair signs with a verbal model:

    Some worry that teaching sign will inhibit speech; however, as long as you make sure to always pair sign with verbal models and give verbal reinforcement after the child uses a sign, sign language can be a powerful bridge to helping the child say it once they begin speaking.

    • “help” “more” “go” and “bye” are good beginning signs to teach. Always provide a verbal model when you sign to your child, but encourage your child to sign, and reinforce any attempt by repeating the word and modeling the sign before giving your child what they want.

    Cloze activities:

    • Cloze activities are great for our kids with CAS because their mouth/body gets ready to respond, and the response is familiar. It reduces cognitive allocation and helps get the motor plan “set.” We do cloze for everything.
      • “Turn the music (pause) ” on, and wait for “on.”
      • “Ready, set (pause)” go!  We do “go” at every green light and I start the sentence and he tries to finish it. This has helped him feel more success at speaking “on command.”
      • “One, two _____” three!
      • Sing nursery rhymes and pause before the last word.  Ashlynn and I would sing “The Itsy Bitsy Spider” and “The Wheels on the Bus” and I would pause before some words that had simpler syllable structures.  For example “down came the rain and washed the spider (pause) out.” or “The wheels on the (pause) bus go round and round.”
      • Read repetitive story books, pausing before the predictable repetitive words.  To read more about repetitive books and to get a free download on how to use them visit my on repetitive books that are great for apraxia.

        • Keep reading for more cloze ideas. 

    Require your child to respond to your yes/no questions:

    • assessing your child’s understanding (i.e. Do you want to go outside?) can often be done with simple yes/no questions before your child is verbally able to respond more.
      • I require my child to answer yes/no questions in anyway he can. Before he could nod/shake his head (difficult for motor planning), I modeled the response based on how I knew he reacted.  Do you want help? (giggle giggle). Yes (nodding my head), I want help. I had to physically move his head before he was able to do this. Now, I will say “yes” or “no” and wait.  This has also helped my son to be able to say yes/no, and they are words we have targeted often. 

    Focus on functional words:

                (These are some of our favorites, but individualize them for your child!)

    1. Bye-bye

                * Bye bye is good because it can also signal the end to an activity if the child cannot say “more.” We say bye to each activity, place, and even to our toys at bedtime.  This works on the motor planning for waving, and then saying bye bye.

    1. In

                * Emphasize each time you put them in: bed, the bath, car-seat, highchair, stroller, park swing.

    * Model when pouring a drink in their cup etc.

    1. Out

                * Emphasize each time you take them out of: crib, bath, car-seat, highchair, stroller, park swing

    * In the kitchen, model each time you take food out of a container, the fridge, a cupboard.

    * In the bathroom, model when squeezing out: toothpaste, shampoo, tissue, diaper wipes, etc.

    1. On

    * Emphasize each time you put music on, water on, lights on.

    * In the bath, “ok let’s turn the water (pause) on.

    1. Down

    * Emphasize when going down the stairs, getting them down from highchair, putting them down,                                       when something falls down, playing “Ring Around the Rosie,” etc.

    * Use a cloze procedure here too, “uh oh! The cup fell (pause) down.” Or “We all fall (pause)                                                down.”

    Again, these are some of our favorites, but work with your SLP to determine your own that work for your child.  Other suggestions:

    Uh oh

    Hi

    Nigh-Night

    More (Mo)

    Child’s age

    Mama

    Dada

    Put

    Done

    Do

    Set activities to song:

    • Based off of research done with melodic intonation therapy, music can provide a bridge to stimulate language.
    • Have fun and make up your own silly songs set to melodies you already know, to make it easy.
      • During bath time, I would sing a body parts song to Ashlynn set to the tune of “Mary Had a Little Lamb”:
        • “Now we’re washing Ashlynn’s hands, Ashlynn’s hands, Ashlynn’s hands, Now we’re washing Ashlynn’s hands while we are taking a bath.”  You can use a cloze procedure here too: “while we are taking a (pause) bath.” 
    • To get on demand phonation, something that is hard for our kiddos,  set songs to Row, Row your Boat and change it to:
      • Row, row, row your boat, gently down the stream, if you see your feet, don’t forget to scream. For my son, this song works to assess areas that he often can’t tell me/show me on command, but in a song, he gets his body ready and is more interested/able to do so.

     Repeat and reinforce spontaneous utterances.  

    • If your child says a sound or word, try to say it back at them and encourage them to say it again.  On demand speech is hard for our kids, so getting them to imitate back to you might be easier when you first imitate something they just said.
      • Ashlynn had a “go to” sound “a dah” that she said for everything.  I would tell her, “a dah?  dah dah, dah, dah” and see if I could get her to say it again on demand.  If she did, then I would change the vowel and see if I could get that on demand, “a dee, dee, dee, dee.”  Play around with sounds and have fun with your child.  This should be a low stress activity and just seem like fun to your child.

    Praise and Encourage ALL communicative attempts           

    • Our kids know talking is hard. A little bit of praise goes a long way!

    Laura Smith M.A. CCC-SLP is a speech/language pathologist in the Denver Metro Area specializing in Childhood Apraxia of Speech.  CASANA recognized for advanced training and expertise in Childhood Apraxia of Speech, she splits her time between the public schools and the private sector.  She is dedicated to spreading CAS awareness.  Her passion is fueled by all of her clients, but especially her own daughter who was diagnosed with Childhood Apraxia of Speech.  For more information visit SLPMommyofApraxia.com  

    Kimberly Haas-McEneny M.S. CCC-SLP, mom to two boys: one with CAS and the other with suspected CAS.  Kim is a Bilingual SLP practicing in Syracuse, NY at the Syracuse City School District. She blogs about her experiences with being both a mom and SLP at landonjourney.blogspot.com

    Parent strategies

     

  • What exactly is CAS?

    What is Childhood Apraxia of Speech?

    Definition and characteristics

    Childhood Apraxia of Speech is a speech disorder that results from difficulty with programming, planning and sequencing the precise movements needed for clear speech.

    The American Speech/Language Hearing Association (ASHA), denotes three main characteristics that must be present for a diagnosis of CAS.

    • Inconsistent production on consonant and/or vowels in repeated productions of syllables and words.
      • An example of the word doggy for my daughter who has apraxia ended up being produced doddy, do-yee, daddy, da-yee.
    • Difficulty sequencing syllables and words of increasing complexity.
      • The child might be able to say “dada,” but when words or added like “my dada” the child might say ‘da-da-da.’
    • Errors with prosody
      • Prosody can include syllable stress, and kids with CAS might stress the first syllable in each word: BAnana instead of baNAna or may give equal stress to every syllable BA-NA-NA.
      • Can include difficulty with volume control.  This was definitely true with my daughter.  She could not be loud even when she tried in her younger toddler years.
      • May have prolonged sounds and prolonged pauses, possibly giving the child ad staccato sound to their voice

    Other soft signs that should be considered include:

    Speech

    • Vowel errors and/or reduced vowel inventory
      • May have a tendency to reduce vowels to the schwa (uh).  For example, buh-buh/bye bye.
    • Groping
      • The child’s mouth seems to make a lot of unnecessary movements while they “grope” for the correct placement
    • Loss of words or sounds that were previously produced
    • Consonant omissions in the initial position of words
    • May be more successful with automatic versus volitional speech
      • A child may say “mama” but then when asked to repeat “mah” may be unable to do so correctly
    • Limited babbling as a baby, or limited sound variation in their babbling
    • Typically comprehends much more than they can speak

     Non-speech

    • Oral apraxia (difficulty planning and executing non-speech oral motor movements
      • May have trouble blowing raspberries, puckering, sucking out of straw or blowing out a candle
    • General awkwardness or clumsiness
    • Limb apraxia
    • Low muscle tone

    Who diagnoses Childhood Apraxia of Speech?

    According to ASHA, a qualified Speech/Language Pathologist is the IDEAL professional to diagnose CAS.  However, diagnosis can be tricky, so you want to make sure you find an SLP who has experience and/or specializes in CAS.  Currently, CAS is both over-diagnosed and under-diagnosed, so don’t be afraid to ask questions to gauge your SLP’s experience and knowledge of it.  A good SLP will not mind being asked questions about their experience with CAS or answering questions related to it.

    The Childhood Apraxia of Speech Association of North America provides an advanced training for SLP’s who already have extensive experience in the disorder called the Childhood Apraxia of Speech Intensive Institute.   You can read more about my boot-camp experience here:

    What should therapy for CAS look like?

    There are many programs out there that say they are geared toward the treatment of CAS.  There is a growing body of evidence that the principles of motor learning affect the most change.  In short, you should be seeing:

    •    frequent repetitions of target sounds or words (mass practice)
    •    feedback that is specific.  The SLP should be giving them feedback such as “you’re lips were open, not closed,” rather than just “good job” “try again” or “that was great.”
    •    carefully chosen speech targets that take into account the child’s current phonetic repertoire and then practicing a variety of movement gestures (sound to sound, syllable to syllable, word to word) with these sounds.
    •    Cues – can be visual (SLP may pop her hand out for /p/) verbal (close your lips and use your humming sound), or tactile (SLP may use physical touch cues on the child like in PROMPT).

    For a great description on what parents should look for in CAS treatment, see my interview the executive director and founder of apraxia-kids.org Sharon Gretz.

     

    For a detailed description of DTTC, a therapy approach for apraxia, see my interview with Dr. Ruth Stoeckel from the Mayo Clinic.

     

    A note about the school-age population

    Since I have spent most of my 10 year career in the schools, I think it’s important to also address some symptoms SLP’s may see that vary slightly from toddler presentations.

    By the time a child with CAS reaches Kindergarten, an SLP may run into three scenarios:

    • The child who has almost resolved due to intense and appropriate early intervention
    • The child who is still struggling significantly with motor planning, and is very unintelligible.
    • The child is still essentially non-verbal

    In scenario one, a child’s speech may be highly intelligible, with only residual articulation errors evident like a lisp, or an /r/ distortion of substitution.  It’s important to review the file closely and see what prompted the initial diagnosis of CAS.  This is important, because children may have additional issues after the CAS is resolved.  With one particular 4th grader, his speech only contained persistent errors with three speech sounds; however, his sentence formulation, grammar and syntax remained very problematic.  What is syntax?  One element is to correctly sequence the words in a sentence.  If a child had difficulty with the planning and sequencing of sounds, it ‘s not far off to think he/she may also have difficulty sequencing words correctly in a sentence.  I treated him differently and used the principles of motor learning to guide his treatment, unlike my other kids with an expressive language delay that never had an apraxia diagnosis.

    Other issues may include: pragmatics, narrative language, and persistent prosodic errors.

    In scenario two, a child may be speaking but is highly unintelligible.  By this age, they might actually have a vast repertoire of sounds, and actually be able to produce most sounds correctly in isolation.  One year I had a five year old walk through my school door.  One day he took out an alphabet BINGO and proceeded to name all the letters and letter sounds correctly in isolation.  However, this kid could not string two sounds together or consistently.

    In scenario three, the child may still be essentially nonverbal.  Until the child can commit to a motor speech exam, meaning he can or will at least attempt to imitate a variety of sounds and movement gestures, a definitive diagnosis cannot yet be made.  Aside from using Assistive Technology which can eventually facilitate speech, I would recommend starting with a functional core vocabulary book you two can make together that includes highly motivating syllables or words the child can work toward using sounds in his current repertoire.  With one five year old I had, he could only produce bilabials (b,p,m) and and /n/.  We started with word and word approximations to help him be more successful:  i.e. 1. no 2. bah/ball 3. mah-mah/mama etc.  Then we drilled them using the principles of motor learning that included massive amounts of repetition, involving visual and verbal cues, using specific feedback.

     

    CAS is a complicated disorder that is many times over-diagnosed and under-diagnosed.  In addition, the treatment approach varies from other traditional speech sound disorders.

    For resources I recommend the apraxia-kids.org webiste.  There is a wealth of information for parents and professionals.

    To find  CASANA certified SLP’s see the professional friends directory on the apraxia-kids webiste.

    Laura Smith is a speech/language pathologist in the Denver Metro Area specializing in Childhood Apraxia of Speech.  CASANA recognized for advanced training and expertise in Childhood Apraxia of Speech, she splits her time between the public schools and the private sector.  She is dedicated to spreading CAS awareness.  Her passion is fueled by all of her clients, but especially her own daughter who was diagnosed with Childhood Apraxia of Speech.  For more information visit SLPMommyofApraxia.com

    CAS

     

     

     

     

  • The Gingerbread Man Speech/Language Activity/Companion Pack

    The Gingerbread Man Speech/Language Activity/Companion Pack

    Slide1

    The Gingerbread Man is a classic story that all my kid’s love.  It is a repetitive style book, and as you know, I love using repetitive books in therapy!  The first page has some pictures to cut out and use while reading the story as props.  You can even glue them onto popsicle sticks if you’re so inclined!

     

     

    Slide3

     

    Next, if you’ve bought any of book companions, you know what a fan I am of sequencing activities.  This one contains one too with sequencing grid.

    Slide4

     

     

     

     

     

     

     

    The mini book in this unit works on “where” questions and teaching early spatial concepts.  The child glues the gingerbread men on a preceeding page in the correct places in the mini book.

     

    Slide6

     

     

    The next four pages contain 8 sets of rhyming words in picture and written form for you kids to match or play with to work on early phonemic awareness skills.

     

    Slide7

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    The last two pages have sentence stem activities for repetitive practice for regular past tense and an irregular past tense verb using the story vocabulary.Slide12

    Slide11

     

     

     

    To get this activity, go to my TpT store!

  • What exactly DO I want to hear at parent teacher conference?

    What exactly DO I want to hear at parent teacher conference?

    I had Ashlynn’s Fall parent-teacher conference for this, her last year of Pre-K.   The teacher gave me a HUGE packet for Pre-school standards for my review, and said she didn’t need to go through all of it.

    Um…okay.

     

    She showed me a picture Ashlynn had drawn the first day of school of a person with her name on the paper, and then another current picture of a person with her name on it.  There was improvement in both.  Okay…..cool.

    Then she said she had an idea to work on the morning routine.  Every morning the kids are to complete a series of 4 steps before the parents leave.  1.) Hang up Coat 2.) Wash Hands 3.) Check in 4.) Write name.

    Despite three months of doing the same thing, Ashlynn always comes in, gets distracted, and needs physical prompts to do each one.  She seems absolutely oblivious to verbal prompting.  It’s not ignoring either.  She is just so engrossed in what the other kids are doing, she loses focus.

    So,back to the teacher’s idea.  She wants me to physically take her to each station instead of verbally prompting her, to hopefully just get Ashlynn successfully completing the routine, and then we can add language.

    Ok….not a problem.

    She seemed relieved I agreed.  I mean, honestly, I’m not too wrapped up in the routine.  I need to know if my baby is making progress.  Is she going to be ready for Kindergarten?  What do I need to be doing at home?

    She really couldn’t pinpoint one thing.  Just kinda said Ashlynn is getting a lot of services to try and catch her up.

    She did say Ashlynn is engaging in collaborative (not just parallel) play, and is using her imagination to make up things.

    Okay….that’s good.

    Oh, and then she said she usually has the kids change seats on the carpet, but she thinks it would be best to keep Ashlynn in the front so she’s not as distracted.

    Okay…sounds good.  She should be getting preferential seating per her IEP, so…. I mean….how is my baby really doing?

    Sigh.

    I don’t know what I want.  The whole thing was underwhelming.  No rave reviews, but then no suggestions on how to help her.

    Not at that meeting anyway.  I gleaned plenty when I finally had a chance to read through the skill sets.

    Let me just pick one out here:

    Early Literacy Skills Assessment:

    Out of 14 pre-literacy skills, Ashlynn has four boxes checked.  🙁

    Damnit.

    FOUR!!! out of FOURTEEN!!!

    It makes me want to cry.  Nevermind, I am crying now.  It’s not fair.

    So, I’m going to tackle those skills.  Comprehension, Phonological Awareness, Alphabetic Principle, and Concepts about Print.

    That’s just reading FYI

    Cody is going to tackle the math part….and that’s a whole other list of checks she doesn’t have that I just can’t bear to look at again.  Thank God my husband is amazing and helps lift some of the burden.

    Stupid Apraxia.  Stupid Apraxia.  I hate apraxia.  I hate this damn disorder.  I HATE IT.  I HATE IT.

    Okay, tantrum over.  Put on your big girl panties Laura.  You don’t see Ashlynn crying about all the work there is to do.  In fact, she’s looking at your right now with alphabet cards in hand ready to learn.

    Alright bug, bug.  We haven’t come this far to raise our white flag yet.  Like I said in my post at the beginning of the year, “Bring it on.  We’re going to give it everything we got.”

     

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  • “Oh my goodness!!” Ashlynn turns 5!

    “Oh my goodness!!” Ashlynn turns 5!

    The day started long before the AM. Preparations were in place to decorate the house after Ashlynn went to bed.

    This year was different though.  When I left to leave while Cody was putting her to bed, she asked me where I was going.

    “Mama?  Where you going?”

    Though I tried my best to cover, she asked,

    “You going for my birthday?”

    Freeze time.

    My daughter has ALWAYS been astute and observant, but we usually could play it off and nothing more was said.

    SAID.

    That’s the thing.  Nothing more was said, but Ashlynn has been watching all these years.  I think, wait, I KNOW she knew what was going on.

    We celebrated her birthday this morning.  My son has been getting up at 3 AM every morning for the past two weeks, so I was sleeping in a chair in his room when I heard noise outside.  I walked out and saw Ashlynn gasping for breath.  No, she wasn’t in trouble, she saw the balloons in the hallway!

    She’s seen these before, but today, she could EXPRESS that she really SAW them.  I had my phone on me and starting rolling the film.

    Me: Ashlynn, what do you see?

    Ashlynn: Oh…my….GOODness. (dancing through balloons looking at her decorations)

    Ashynn: Whose presents are these?

    Me: Those are YOUR presents!!

    Ashlynn: Who give them to me?

    Me: Mommy and Daddy!

    Ashlynn: Yeah?  Look!  It’s my jerjay Jace (dang assimilation…if you’re an SLP, you would find this fascinating, especially since she can say “birthday”

    Jace: It’s your birthday today?

    Ashlynn; Yes, it is!

    Me: How old are you Ashlynn?

    Ashlynn showing ten fingers: This many!!!

    Me: Say, “I’m five!”

    Ashlynn in excited fashion: “I’m five!!!

    A little later on,

    Ashlynn: Mama, where’s my cake?

    The last two years I made her a cake, but this year I decided to buy her a pretty Minnie ice cream cake that we hadn’t picked up yet.  I was surprised she asked where it was.

    Take that apraxia!

    As the morning rolled on, I was folding clothes when my husband came into the room, eyes red. Emotional. But before I explain why, it’s important to know the back story.

    A couple weeks ago we were discussing what to get Ashlynn for her birthday.  My husband always has it in his head to get our kids a BIG gift.  He remembers the BIG gifts from his childhood…and some he even remembers what age he was when he received them.

    I don’t remember my big gifts.  I remember gifts, usually practical.  I love gifts, but for example, on my list for Ashlynn’s gifts I had: long sleeve shirts, winter coat, robe, socks….(follow Cody’s “really?!?” face).

    Ashlynn just isn’t into BIG gifts.  For some reason, she loves cards.  Any cards.  Trading cards, flash cards, alphabet cards, playing cards….cards.

    I told Cody, if he wanted to get her a BIG gift, he should get her cards.  Buy her a binder she could decorate and put in pocket protectors.  He did…begrudgingly.  But it’s true. It’s what she wants.  We took her to the toy store THREE times, and she just wasn’t crazy about anything.

    Okay, so back to his red eyed confession.

    Cody: Ashlynn just said “thank you daddy” unprompted.

    Me: Really?  For what?

    Cody: Buying her cards. She’s never said thank you unprompted before.

    Take that apraxia!!

    As the guests arrived, her Grandma and  Grandpa  were two of the first people in the door.  She excitedly ushered her grandpa to her swing where she got him to push her.  I remember a time my dad came to visit and she wasn’t really talking.  She said ‘hi’ but that was about it.  He left that day and told my mom he wasn’t sure Ashlynn knew he was.  You can read about that story here.

    The thing is, Ashlynn always knew who he was.  She knew he’s the guy who plays ball and boats with her. She knew, but because she couldn’t say, he left feeling the way he did.

    All those are distant memories now.  She asked him “you push me on the swing?”  and they were gone.

    As she was opening gifts, she was telling everyone “thank you” in a big loud voice.  She opened up a box that had a hoodie in it that she saw in the store shopping with me and told me it was pretty.  This was her face opening it up.  I think she liked it 😉

    Another shirt she opened had the word Princess written on it.  I asked her who calls her princess.  As she looked up and scanned the crowd, her eyes stopped on her other grandpa that was there. She smiled and pointed at him, saying his name.  He later reported what a cool moment that was.  Verbal confirmation that Ashlynn has always known all along just what has been going on.
    This year, singing Happy Birthday and blowing out candles all came easy.  That milestone was met last year.  
    The best came at bedtime.  I read her a bedtime story, prayed, and then kissed her goodnight.  She was holding the card book Cody gave her.  She told me, “Mommy!  These are my decorations.”  (She was pointing out her room decorations that have been on her wall since basically she was born).  Yes, honey, those are you room decorations. “Yep, just like my decorations for my birthday.”  
    She is starting to retain, recall, and generalize higher vocabulary.  I smiled.  Then she pointed to her card book.  
    Ashlynn: Daddy gave this to me
    Me: Yes, he did
    Ashlynn: That was nice of him.  You get him so I say thank you?
    Me: You bet Ashlynn.
    And that’s how we are kicking apraxia’s butt!
    Happy 5th Birthday Ashlynn!  May you continue to find your voice and voice your thoughts, hopes, and dreams.
    Love,
    Mommy