SLP Mommy of Apraxia

Tag: parent of apraxia

  • 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

     

  • A tale of two roles: navigating my role on both sides of apraxia.

    A tale of two roles: navigating my role on both sides of apraxia.

    I first met a fellow mommy of apraxia at the Denver Apraxia Walk.  She was pleasant with kind eyes, and said she felt her 5 year old son needed a change up in speech therapy services.

    The next week her son was scheduled for therapy at the private clinic in which I work.

    In most cases, I have my parents come with their child into my office.  I NEED them to see what I see.  I NEED them to do what I do.  They are with their child the most, and they are completely capable of carrying over what I am doing, as long as they know WHAT I am doing.

    Normally the child might be somewhat distracted by the parent; however, this day, I was the one distracted.  Not by my client, but by his mom.  There isn’t one word to describe her face, but there were multiple adjectives rolled into one: worry, anxiety, fear, hope.

    These are only a few, and honestly, they killed me.

    I understood more when she said she had successfully home schooled 4 other children, some even in college.  I admired her.  She not only stayed home and raised her kids, but she taught them school as well.  Their entire childhood development rested on her shoulders and she had done a good job.

    But her baby.  Her last child.  This one was different.

    I felt her pain.  I absorbed her worry.  I took responsibility for her hope.

    I knew I could help her son.  He wasn’t receiving the right therapy.  That was evident from his first session.

    I was so moved, I came home and told my husband.  I described her face and how it was hard for me to take because I kept absorbing all of her emotions.

    It’s hard to watch a mother visibly show almost every emotion I went through with Ashlynn’s dx, but then be able to turn that off and be the professional SLP I need to be.

    I recently watched an initial video I took when I saw him.  Again, though I was trying my hardest to focus on him, I couldn’t help but look at his mom in the background.  The worry on her face is tangible.  I just want to yell out, “I will help him mom.”  “Slow down.”  “Stop worrying.”  “He is going to be okay.”

    Unfortunately, I know saying all of those things is like telling the sun not to rise.  A mother’s worry cannot be extinguished.

    Last week though, something was different about her demeanor.  A softness was in her face. Upon further questioning, I discovered her oldest daughter came home from college and told her she saw a difference in her little brother’s speech.

    That’s all it took.  Outside validation from an inside source.

    I’m sure that doesn’t mean she’s still not worried, but I hope a small weight, even if ever so tiny, was taken off her shoulders.

  • Did I cause her apraxia?

    Did I cause her apraxia?

    It starts with a question: 
    Did I cause her apraxia?  I know I’m not the only mom to wonder this, or worse, believe this.  This is where the guilt sets in.  It set in early and would tap on my shoulder in the shower, at lunch, or when I was trying to go to bed.

    Even though I’m an SLP, and I tell parents all the time that the speech delays are not their fault, I still felt like somehow I must have done something wrong.  Maybe my C-Section had something to do with it.  Could it have been the petocin, the pain meds, the stress? Maybe if I had only taken my pre-natal vitamins more strictly and just dealt with the fact they made me sick.  Then, after she was born, maybe I didn’t talk to her enough.  Maybe I didn’t give her enough attention.  Maybe it’s because I went back to work and she was sad her mom wasn’t there full time.  Maybe it’s because I talked to her TOO much.  I was trying TOO hard to make her talk she never had a chance to just be herself.

    Ugh, enough already!  It’s exhausting to feel this way.  It’s exhausting to go through every scenario in my mind wondering if there was something else I could have done, not done, tried to do.  She has apraxia and the truth is, there is nothing I could have done to prevent it.

    I know it’s not my fault, but….is it really not my fault?
    Now, I just have to believe this. That’s the hard part. I’m not alone because I read stories almost daily on my support group page of parents wondering if it was the c-section, should they have breastfed or breastfed longer?  Was it the food they ate, a cold they got, a toxin they were exposed to……the list goes on.  Theories with no basis that mothers will beat themselves up over.  Well, I want to tell you to stop it.  I know it’s hard, I know it’s still in the back of your mind, but if our thoughts become our truths, then this thought process is a cancer.   Further more, it doesn’t matter.  It doesn’t change the fact your child or my child has it.  What does matter are our actions right now to make it better.  To fight for our child and help them through it.

    How I actually banished the guilt
    I have finally shed my guilt over it, and the credit is due to my son.  My typically developing son who is so eager to be older and to grow up.  He learns things and picks up things without me literallymighty doing anything.  He is 18 months and already sings his ABC”s.  I have NEVER worked on this song with him. That’s how easy talking is supposed to be.  Despite my daily dose of the alphabet song with Ashlynn well into her third year, she only could sing it at 3 1/2.  My son, on the other hand, picked up the iPad, listened to it on repeat for a couple days, and started singing it.  I remember watching a video on facebook of a friend’s  2 year old when Ashlynn was the same age and crying thinking what a bad mom I was.  This little girl was younger than Ashlynn, singing her ABC’s and I’m supposed to be an SLP no less and still my little girl wasn’t singing it.

    Last night we were eating noodles for dinner.  My four year old with apraxia kept resorting to using her fingers, and I kept prompting her helping her to use her fork.  It’s hard to pick up spaghetti noodles that need to be scooped rather than stabbed.  I briefly looked back at my son in his highchair, and he was not only scooping up the noodles like a pro, but he was stabilizing the bowl with his other hand to steady it.  I looked at this situation in awe.  Again, I have maybe once showed my son how to scoop with a fork instead of stab, and here he was, doing it as well, if not better, than Ashlynn.  That’s how easy it’s supposed to be.  He picked that up without any special help from me, and even after years of practice with Ashlynn, she still has a hard time.

    I start to realize even more, her progress or lack of progress or slow progress is apraxia’s fault.  It’s not my fault or her fault.

    This morning I was asking my kids what they wanted for breakfast.  I threw out two ideas to my son and he shook his head and said ‘no.’  I have never taught him the word no.  I never had to teach him that instead of stomping his feet and throwing a tantrum, he could simply say, ‘no.’  He just does it.  There was a time that the child throwing tantrums instead of saying ‘no’ was my daughter at 2 1/2.  Myself, my husband, and my mother-in-law literally had to tell her for months to stop and say “no.”  Yes, that happened.  I actually had to teach a child to say “NO.”  Chances are if you have a child with apraxia, you have been there done that.

    If you are a mother and are looking for something to fault, then I suggest you personify apraxia and fault the disorder.  It’s not your fault.  You hear me?? It’s NOT your fault.  Even if you have two kids with it, it’s still not your fault.  Stop the guilt.  Stop the obsession with trying to figure out why your child has it.  It doesn’t matter anyway.

    I say this to you again as a parent AND an SLP; talking should be easy.  Though it is a highly complex skill that parents only fully realize when they see their child struggle, a child should talk regardless of what you did or didn’t do.

    I just want to say one more thing.  I think parents get the message that it’s their fault when the SLP (myself included) gives them suggestions for home.  These suggestions might be to make their child grunt or make some type of sound or word approximation everytime they want something.  Don’t let them get away with saying a sound wrong that you have heard them say correctly in therapy.  Don’t let them point and give them what they want when they can say a word for it etc. etc.

    I want to tell you we say these things not to fault you.  Parents of typically developing children didn’t make their child talk.  Their child just naturally did so.  Don’t listen to your family member, or well meaning friend or whomever, tell you it is your fault because you never made them talk.  Children don’t have to be made to talk.  I really  BELIEVE this now with my son.  My pivotal moment occurred when I realized I have never made him talk.  He talks so much I can’t make him stop talking. In fact, the one time I did try to teach him a word I was trying to get him to say “Jake” when requesting the show “Jake and the Neverland Pirates,” since Jake would be easier to say.  Well guess what?   He didn’t say Jake, he said pirates instead and has continued to do so.

    So there you go.  I am the same mom, the same SLP I was with him as I was with Ashlynn;  and I am here to tell you I tried my DANGDEST to get her to talk.  I did everything I knew how to do as a professional.  Guess what though?  She has APRAXIA.

    Yes.  Apraxia.  I’ve channeled all that guilt and blamed it on Apraxia.  I wish you the same!

  • “I Will Wait” Struggles have made victory that much sweeter.

    Ashlynn’s progress continues to grow by leaps and bounds.  So many times I catch myself smiling and my eyes well up with tears to see her knock down all of her obstacles.

    Last month she learned to jump for the first time at 3 1/2.  At the beginning of the year, it broke my heart to watch her try on a classroom trampoline.  On their turn, all the other kids exuberantly bounced away.  When it was Ashlynn’s turn, all she could do was march.  Now, she is not only exuberantly bouncing, but she is catching air in my kitchen, on my patio, and even on her bed.  I was scolded for jumping on the bed, but I don’t care if she busts every spring and I have to buy  her a new one.  It’s worth it.  It’s all worth it.  Every penny spent, every happy and sad tear shed, every minute in therapy; it’s all worth it!  
    She also sang to a song that she had never heard before in the car last week.  Mumford and Son’s “I Will Wait” song was on the radio.  I was singing to it, and all of a sudden I heard her.  Her little voice filling the car with the chorus.  There are no words to describe the feeling.  I will buy the CD and put the album cover in her baby book. 
    These little triumphs, so sweet when  you have a child with a developmental delay.  She has taught me so much.  We may have had challenges, but we experience something so much sweeter when there are victories.  We appreciate all the little things so much more.  We never take for granted, not even for a second, her talking, her jumping, her SINGING.  

  • Ashlynn’s at four words! Update

    Ashlynn is literally making leaps and bounds in her speech.  Sometimes, I feel like we are actually having a mini conversation.  I think the greatest aspect is her being able to tell me where she’s hurting, or even tell me what she wants to eat.  She tries to repeat everything now, and even has some sponteaneous four word utterances! 

    The past week, her new thing was “too” as in, “Ashlynn go ni night too?”  or “Ashlynn eat dinner, too?”  That counts as four words!  Yeee haw!!  She’s also said, “I want more ketchup.”

    This past month, after hard work from both her SLP’s and myself, she marks every final ‘t’ ‘p’ and ‘n’ consonant.  Getting to that point though, wasn’t easy.  Practicing CVC words, you could see her brain thinking as she groped for the correct sound.  She needed a visual and verbal cue every time.  For example, when saying “hat” she would say,
    ha       t.  The pause time could be up to 3 seconds, which doesn’t sound like a lot, but is when you are talking about speech.  Now she has it down though!  Such a small step, but so big at the same time!  Having a child with apraxia makes one wonder how we ever learn to talk at all?? 

    She puts chapstick on her “yip”, and has Jace sit in her “yap.”  She puts a “hat” on her head, and drinks with a “sup.”  She can tell me perfectly “I want down” and that she wants “out” or to put something “in.” 

    She also gets tickled by everything and laughs “Silly_____.”  My favorite is of course, “Silly Momma” but “Silly baby”  and  “Silly Daddy” are pretty popular around here too.

  • Oral apraxia

    Looking back, there were SO many signs that told me Ashlynn had apraxia. Before she even spoke, there were things she couldn’t do that I knew wasn’t normal. However, my family, my husband’s family, and even my husband told me she would do it on her own time, or all kids develop differently, or to stop being so critical of her. Despite my training and perhaps wanting to believe them, I ignored these signs even though deep down I knew something was wrong.

    What were these early signs?

    For one, Ashlynn never blew raspberries. To this day, and she is almost three, she still can’t.
    Ashlynn couldn’t blow out candles or blow bubbles, and to this day, she still can’t.
    It took until she was almost two to learn how to drink from a straw, and even now she frequently sputters and chokes when drinking.

    Well meaning family members told me I was being too picky about these things, but my mommy instincts were right.

    Other signs were feeding issues. For the most part, Ashlynn was a great nurser. However, poor nursing can be an early sign. She also did really well when I introduced puréed solids. After that, her feeding issues became more complex. She struggled with masticating or chewing her food and then swallowing it. This oral motor sequence was very difficult for her to learn.  I was scared to death to even give her Cheerios when she was 9 months to a year because she would immediately swallow them.

    When family members or friends would offer crackers or other food items, I would panic. However, I was told by everyone, including my husband that I was babying her. How would she ever learn if I didn’t let her eat it? I was so frustrated thinking I was being paranoid and being a helicopter parent already, but guess what? I KNEW my baby better than anyone, and if I just would have listened to and trusted myself, she might have got help sooner.

    Other signs of oral apraxia which she has include: not being able to lick her lips, not being able to spit out food, stuffing or overfilling her mouth, and not being able to pucker her lips for a kiss 🙁

    What really makes me mad, is my college training didn’t train me in this. These are things I have learned just on my own. Of course one could argue that graduate school teaches us how and where to find these answers, and of course our ongoing professional development requirements provide opportunities to learn this, but its not enough. Every SLP needs to know this stuff!

    I had a professor, Patty Walton, for my undergrad and grad degree here in Denver who taught a stuttering class. It was the only class she taught because she had a full time private practice with a focus on stuttering. She said that what she realized, is SLPs were graduating without any knowledge on how to treat stuttering. She might have been an expert, but she at least wanted SLPs to have a basic knowledge in the treatment of the disorder. In fact, she had met many a therapist who admitted they didn’t feel comfortable treating stuttering.
    She and other stuttering experts have definitely done a great job of educating newer therapists, because most therapists I meet who are around my age or younger feel very comfortable treating stuttering.

    In my opinion, apraxia is the new stuttering. In my speech department for my school district, no one is trained in PROMPT that I know of, and when people have a child who they suspect have apraxia, they borrow the set of Kaufman cards or the Easy Does it For Apraxia book out from the department.  I have faxed multiple clinicians the information I had on apraxia from the professional development I attended when Ruth Stoeckel was here because they didn’t have any information on apraxia at all!!  My field needs to address this! I don’t know where my road will take me, but I want to make sure we have SLPs graduating with a clear understanding of motor speech disorders and treatment.