Both Marcus (Noah’s speech therapist) and I have noticed Noah being a lot more verbal lately. It’s exciting, and yet I hold my breath because I know that this could just be another phase that will fade away rather than prove to be a new pattern in his speech progress. He’s been willing to mimic back attempts at almost any word I prompt him with (as long as he is in the “mood”).
The other night he did something, though, that I consider quite a breakthrough. He was lying in bed as I was tucking him in, and he said an unintelligible word with a lot of energy. When I didn’t understand and started rattling off a list of words that I thought he might be trying to say, he said no to all of them. But whatever it was he wanted, he really, really wanted. He even grabbed his mouth to try to force the shape of his lips to help him say the word. I still couldn’t decipher it, and Noah gave a frustrated sigh that I could tell was an inward disappointment that he couldn’t say the word. He tried SOOOOO hard!!!! Finally, even though I’m always so relieved to get everyone one in bed, I let him out of bed to show me what it was he wanted. He wanted the phone so he could say goodnight to his Daddy who is at our new house tonight trying to get it ready for move in. I dialed for him and he had quite a conversation (mostly made up of “Daddy” and “yeah.”)
So, of course, it’s great that he initiated speaking with both his father and me, but what was really different was the pressure he was putting on himself to say the word “phone” and the energy he put into it.
Noah has proven he can do most anything he really, really wants to do. And as hard as he works at speech, I’m never sure just how much he wants to talk because he finds so many other ways to communicate, and speech takes such a HUGE effort on his part. So many times he tries to say a word and then gives up after one or two attempts, usually frustrated with me because I’m trying to make him do something he really doesn’t care to do once he realizes how difficult it is. The other night he wanted to do it more than he wanted to give up.
I really want to help Noah’s attempts at speech be succesful. i think if we can channel his attempts in such a way that they end up feeling successful to him, this kind of effort and persistence on his part will continue; but if they end in his perceived failure, he will stop trying. Oy. So difficult because my courageous hero gets very frustrated with me when I say “Good job” too enthusiastically. I hate to say it, but I think he really doesn’t like feeling like his efforts are a result of being manipulated by his mother.
(No pun intended.)
Noah had another session with Marcus today. Noah is trying soooo hard to do the things Marcus wants him to do. I have to remind myself that Marcus doesn’t know how far Noah has come, nor can he really tell how difficult all this is for Noah. Part of what Marcus works on with Noah is getting his mouth positioned in exactly the right position for each sound. Then Marcus fine tunes the sound so that Noah’s sound productions sound 100% normal. It’s been amazing to hear some of the sounds and words that come out of Noah’s mouth without any impairment whatsoever. Noah has to work very hard with Marcus to get them out, but they are definitely in there.
I have a couple questions floating around in my mind. One is how much of this will carry over into Noah’s speech outside of therapy. If he can make a good word approximation for, let’s say, go, won’t he choose to make that word approximation that is obviously easier for him than going to the trouble to shape his lips correctly in order to form the word?
I think the answer to this will only come with time. I feel like my hands are tied behind my back because I can’t really replicate the kind of therapy Marcus is doing with Noah at home. I don’t have the know-how. Marcus says in time he will show me things that I can do at home with Noah, but for now the articulation therapy stuff all has to come from Marcus. He says we have a lot of work to do. Every individual sound that Noah is making he makes a compensatory ending sound to that is of equal force. We have to get rid of those compensatory sounds because they affect his intelligibility. He needs to move his jaw less and his lips more. I suppose the bigger feature, the jaw, is easier for him to control than his lips.
I am thrilled that Noah is getting this therapy now, even though it looks like he is going to have to unlearn some of the speech patterns he picked up over the last couple years.
Marcus did say something today at the end of the session that nearly took my breath away. He said something along the lines of if he did diagnose apraxia even when there were other underlying neurological issues, he saw a lot of evidence that would support that diagnosis in Noah. (Can you tell I’m trying really hard not to exaggerate anything?) He is seeing a lot of sequencing issues that are typical of apraxia now that he’s had a couple sessions to get to know Noah. I noticed today that he used some hierarchy approximations that reminded me very much of the Kaufmann apraxia cards Noah has done so well with. It was bittersweet to have my suspicions confirmed, and it just confirmed to me that Marcus is the right person to treat Noah, because he is identifying what I have been seeing for so long. PROMPT therapy is a very effective treatment for apraxia as well as other speech disorders, so at this point the diagnosis is not important – Noah is getting appropriate treatment either way.