Small Steps

In October, we had our list visit with the Kaiser OT we had been seeing all summer.  She had been working with Nate and assessing him but did not find anything that would qualify him for OT services.  He has many inconsistencies (or what I like to call--conundrums).  For example, when he goes up stairs, he does not usually alternate legs, unless we stop and remind him.  He is also inconsistent with his handedness, still using which ever hand is closest or available at the time.  His teacher is concerned about his pencil grip, which could be something he should be seen by on OT for, but I'm sure at 3 1/2 years old, they are not as concerned with pencil grip right now since in public school, most kids don't encounter writing until preschool or kindergarten age at 4-5.  He is being seen by the OT at his preschool a couple of times a month, so that will do for now.

Nate's school had their parent-teacher conferences this past week and the whole team was there.  His teacher, the schools' SLP and OT, the part-time school psychologist, and the school's principal.  It was good to see everyone together as a team as it can be challenging to coordinate all the different services.

He has been working on approximations for several words including more, up, and out.  The SLP at his school has been using ASL as a cue for him to use those words.  It's as if, even though he can now approximate several words, they are not automatic for him to use.  He will use them if he is signaled to do so.  His signing has increased, which is a good thing, as all 3 of his SLPs have been using ASL with him.  Just today, as he was looking at the snowy covered mountains, he was signing for snow and brought me his mittens.  Guess we need to take a trip to the snow soon!  

I put together a short video of some of the words he's been practicing.  We work on these almost every night (in addition to in-context repetitions throughout the day).  Some words he can say more easily, others you can clearly see are hard for him.  Because of CAS he doesn't know where to make the appropriate placements in his mouth or how to move his lips.

Through many of the blogs or Facebook apraxia sites I read pretty regularly, I came across this article written by an early childhood consultant about her experience with her son's apraxia.  I always find some comfort in reading about someone else's experiences as it confirms what I already know, like this part:

          "The difference between a speech delay and a speech disorder is that in a delay,

            the child follows a typical path of speech development but at a slower pace.  For 

            the child with CAS there is a significant gap between their receptive language

            abilities and their expressive language abilities.  In other words, the child's ability

            to understand language (receptive ability) is broadly within normal limits, but his

            or her expressive speech is seriously deficient, absent, or severely unclear." 
So Apraxia is not a delay, due to the huge discrepancies between comprehension and expression, it's a disorder.  Although I often feel that he will never learn how to talk (how I yearn to have a conversation with him that doesn't rely on hand gestures or a complete reliance on context) I am cautiously optomistic that he will learn how to speak.  "The outlook is promising however and most Apraxic children overcome this speech disorder if they receive the appropriate, intensive speech therapy early on."  I have to remind myself to take one day at a time, one small step after the other.  

I am very excited that Childhood Apraxia of Speech of North America (CASANA) is having their annual conference in San Diego this coming summer.  At this conference they have presentations on current research and it will be a great way to connect with other people.  I'm looking forward to it.