Conference

Tomorrow we leave for the CASANA conference!  Four days in sunny San Diego.  I'm looking forward to the sessions and meeting other families and speech pathologists.  I'm going to try and write a post or two while we're there.  So excited!

Three!

Last week Nate put together his very first three word sentence!  No prompting-verbal or signs.  It was amazing.  He had been playing with some of his older brother's polished rocks and knew there were more in his bedroom.  He came to me and said "want more rock".  It made my day!  I calculated that he's had about 100 hours of therapy since September, plus all the repetitions we work on at home every day.  It's paying off.

Late Blooming or Language Problem?

I came across an interesting article published by the American Speech-Language-Hearing Association (ASHA) the other day, titled Late Blooming or Language Problem?  It has some useful information about the differences between language problems and possibly just late blooming kids (although I've ready that its fairly rare for late blooming talkers to be without some kind of learning disability entirely--see the book The Late Talker).

The article reassures parents that if you think something is wrong with the way your child is speaking or their lack of speech, get it checked out.  We know our children best.  The wait and see approach to communication is not a good approach.  Language skills are developing so quickly that missed milestones could mean something, that if left untreated or without therapy, could be even more detrimental in the end.

The article describes certain factors that late-talking children who are 18-30 months old, with normal intelligence, may have continuing language problems.  These include:

• gesturing-the number of gestures by "late-talkers" with low expressive language may indicate later language abilities, as it seems those with more gestures were more likely to catch up to peers (this may be a great support for using gesturing and ASL in therapy)
• age of diagnosis-the older the child is when diagnosed, the less positive the outcome...so important as a parent to trust your instincts and get an evaluation and therapy as soon as possible.  I wish Nate had received more intensive speech therapy when he was younger, but all too often I came upon resistance by therapists and doctors to treat his speech delay
• progress in language development-even if a child is delayed in speech, if they are trying to use speech in new ways at least every month, without demonstrating this there may be more language issues than just being a late talker

Some of the research available contrasts other research, as there is still much work to do be done in this area.  

Childhood Apraxia of Speech has general signs according to ASHA--

      

     For young children:

• No cooing or babbling as an infant
• Only a few consonants or vowel sounds
• Problems combining sounds
• May have problems eating

     Older children:

• Inconsistent sound errors
• Understands language much better than they can speak
• Difficulty imitating speech, but imitating is easier than spontaneously speaking
• May grope when attempting to produce sounds to coordinate lips and jaw for speaking
• Is hard to understand, especially for unfamiliar listeners
• Difficulty with fine motor movement/coordination

These are just of some of the characteristics of a child with CAS and those that I listed are the ones that Nate exhibited or continues to exhibit.  I'm glad that I trusted my instincts with Nate, and although I had to keep pushing and researching on my own, he's now getting the therapy that he needs and his expressive language skills are growing every day.

Spontaneity

Nate continues to have more and more spontaneous speech.  Some of the words we hear more frequently now (although unintelligible to some):

bowl      car      baby      park      here      where      ball      boat      water     more      want    wash     bike bug       look     walk      me        out        go    up       work     yes        no     ma    book    bird     horse

Even his name Nate as Nt!

Slow but steady...

Today one of Nate's SLPs wrote in his binder (which follows him everywhere), that he is making notable progress.  This is very exciting!  He is spontaneously using more word approximations and signs.  Just tonight at dinner, he noticed I took his fork and he said "ork"!  Lots of new approximations and word attempts.

I have an updated video demonstrating some of the words that he is able to do very clearly and others he still has trouble with.

We've been practicing showing numbers with his fingers and he's getting pretty good at it now.  It had been difficult for him due to some slight global apraxia issues.  He literally use to have to use one hand to hold down the fingers on his other hand in order to demonstrate the right number.

In my last post I spoke about the Kaufman cards and how these cards are used in the treatment of apraxia.  It got me looking around on-line and although expensive, I was able to find a set for sale on ebay at a reduced price.  We have been practicing them at home and Nate is excited to be using something he sees in therapy.

In July, he Childhood Apraxia of Speech Association of North America is having their annual conference in San Diego.  It looks like there's going to be some great presentations, ranging from:  A Map for Caregivers Unraveling the Mystery of Treatment, Using Symbolic Gestures to Facilitate Speech Motor Planning and Literacy Development, and AAC and Apraxia: Perspectives from a Parent, a Teacher and an SLP.  (AAC stands for Augmentative and Alternative Communication, which can be anything from pictures in books to facilitate communication or even high-tech iPads or computer devices specifically used for communication.)  I need to get registered and decide which presentations to attend!  I'm looking forward to getting the latest information on CAS research as well as connecting with other parents of apraxic kids.

A Session

Although on spring break this week, Nate still has several of his speech sessions to attend. This morning we went to the session at the Truesdail Center. He missed a few sessions last week because of being sick, so he was a little apprehensive when his therapist appeared.  Today was a really good session.  I read the daily notes from his SLPs but it was nice to see him in action as I don't always get to see this. He's working so hard and cooperating, most of the time--he is only 4 after all!

The Truesdail center consists of a long hallway and off the hallway are multiple small rooms that are used for the sessions, each with observing windows where parents or other students can sit and watch. Because he was being shy today, I decided to sit in the room during the session and participate. This SLP in training has begun using a short schedule with Nate, briefly going over the activities they would be completed and allowing him to check them off as they work through them. The menu for today's hour was fishing, squiggly worms, beach ball and then free choice. The fishing game was all set up when we got in the room.  Using a fishing pole with a magnet attached to the end, Nate picks up small foam fishes, about the size of a playing card with a picture of a focus word attached to the underside. So Nate "fishes" for a word and then practices saying it several times. We all took turns with this game and worked on different words with the /b/ sound: burger, boy, ball, bottle. The /b/ sound is difficult for him as he generally makes more of a /p/ sound.

Next was the game squiggly worms. For this game, we played a game that has an apple shape with a bunch of worms and when you turn it on they move up and down inside the apple and you have to try and grab one to match to your card. In order for Nate to get a turn grabbing a worm, he had to practice saying some sounds from a program called Kaufman speech practice cards.  This is a program that Nancy Kaufman, a SLP in Michigan, has created for use with Apraxics and uses at her well known clinic.  They break down words from the most complex (the actual word) into more simple forms.  For example apple (which Nate can say) becomes a-po....a-puh....ah-puh....ah-o.  From complex sounds to least complex in order to work on a target word based on the least physiological effort.  This way, Apraxic kids can start working on communication at their own level as Apraxia requires multiple (multiple!) repetition of a word before connections are made and it becomes automatic.  So Nate practiced words as we all had fun picking squiggly worms from an apple.

When that activity was done, he reviewed his checklist with the SLP and checked off what was completed.  The last task, before free choice was using the beach ball.  The goal here was to have Nate say a word or sound as he hit the beach ball.  We started with "up" as that it a word that is very automatic for him now and we hit the ball around for several minutes.  He loves balls and being physical, so he had a great time doing this.  The next sound was /b/.  It was interesting to watch him as having to coordinate his body and say something.  That is extremely difficult for him to do all at the same time.  It  was nearly impossible for him, but that didn't keep him from trying.  His little mouth would move and twitch trying to get it to do what he wanted it to.  Most of the time he'd say the sound and then we'd toss the ball to him to hit.  We did that with /b/ sound and then the word "ball".  After a successful check off on his list, he chose to play with some cars and had a good time knocking over his SLPs dinosaur as she chased him around the room.  She has a lot of energy which really keeps him engaged.

Since we're on vacation this week, I want to work on posting some new video clips of his progress, so hopefully soon.  He's making baby steps and tries to imitate so much more now that I know things are slowly coming together.

Celebration!

Nate celebrated his 4th birthday a couple of weeks ago with friends and family.  He had a great time!  I remember that just two years ago, blowing out candles was a difficult thing and this year, he had no problems!

The weekend after his birthday we went and had some fun in the snow.  Nate really enjoys the snow and has been wanting to go all winter long.  He did some sledding and had a great time.  Here's a quick video of him sledding on his own for the first time.  He had so much fun that he didn't want to stop!

This past Friday we had a follow-up appointment with one of the developmental pediatricians we had seen nearly 1 1/2 years ago.  I think we spent nearly an hour with her.  She had him perform some different tasks and went through all the different questions about development, speech and coordination.  She felt that since the his speech issues are motor coordination, that speech should be covered by Kaiser.  She put in for an evaluation for speech (again) and to meet with a geneticist--to rule out any other genetic disorders Nate hasn't already been screened for.  Unfortunately at this point I think we're just at the wait and see stage.  With six sessions of speech a week, he is making small improvements with more spontaneous word attempts and signing, but with the severity of his apraxia it's going to take a lot of time and practice on his part.  Just the other day, he was wanting ice out of the dispenser and he said "ief" on his own.  Since approximations are what we want, it was very exciting to hear him say that, especially since he wasn't repeating after us!

I often like to read whatever I can find on-line about CAS and just today I found this news report on children with CAS.  It was on a local station in Pittsburg.  I really like watching videos and hearing about other kids with CAS.  It helps me feel better about the things we are doing for Nate.  It's been a while, so I will have to post some more updated video on Nate soon.