Tag Archives: PROMPT therapy

Free Printables!!! Evoking Speech – Two-Word Phrases

Noah’s receptive language is great; Noah’s ability to make sounds is good, Noah’s use of speech in daily life – not so good.

In my experience with Noah, his confidence in his speech is key to him using his speech in daily life.  Because of Noah’s apraxia symptoms  it takes lots of PROMPT-ing and lots of drill to program in the words we expect him to recall and use later on.  Drilling has negative connotations in speech therapy sometimes because of its lack of emphasis on language and context, but for kids like Noah who have motor planning issues, drilling is appropriate.

We’ve been working on two-word phrases with Noah for the past three years, and we’re just now seeing him put two words together on his own in contexts other than “more      (juice)     “ or  ”   (ball)    please” verbally.  Before now, we would have to model one word at a time and he would repeat one word at a time.

It’s exciting to be moving on from that, and I’ve made three pages of two-word phrase flashcards to share.  The first word in each is blue – Noah’s favorite color to speak.  The second words are words that Noah has learned to speak.  The first three pages of the file are those flashcards.  To use them the way I did, cut them in pairs; in other words, blue/boot should be one card, blue/truck should be another card.  The last five pages of the file have two picture cards on each page.  Cut each of those picture cards out individually.

Two-Word Phrases Blue 02-03-13

Depending on where your child is cognitively and with his speech, you may want to only work on the two-picture cards for a while and just use them as flash cards and visual prompts.  This is where I started with Noah.  I would show him a two-picture card and point to blue and say “blue.”  He would repeat.  Next, I would point and say the name of the second picture.  He would repeat.  Then I would say “Your turn.”  I would point to blue on the card without speaking and he would say “blue.”  Then I would point to the second picture on the card and he would say the word.


Doing this just about broke my heart, but I want to share what apraxia tends to look like in case you are unfamiliar with it but are seeing these symptoms in your child.  It doesn’t necessarily mean your child has apraxia, but this would point to a motor-planning disorder

This was my experience with Noah:  Understand, on any given day at any given time, if I point to something blue and ask Noah what color it is (and he is in the mood to cooperate), he says a beautiful “blue.”  I mean, he gets his “L” in there and everything.

With these two-picture cards, I would point to blue and say blue and he would have no problem saying “blue.”  Then I would point to the second word and say it and he would say it reasonably well.  When I went back to the beginning of the card and only pointed to blue without speaking it, what came out of his mouth surprised both him and me.  It wasn’t anything close to blue.  In processing that he was going to have to string two words together, the motor planning for the first word, which he knew inside and out, completely fell apart.  It is so great to see him putting effort into speaking these days, but it is also heartbreaking, because at times like these, he gets very frustrated with himself.  Wouldn’t you?  He knows exactly what to say in his mind, and he opens his mouth and something completely different comes out.  It reminds me of what it is like in a dream when I try to speak and have to put great effort into it, yet I still can’t get it out of my mouth.  His daily existence.  Every.  Single.  Day.  Sigh.

So, we press on, slowly but surely.  After several attempts which involve me remodeling the words, he can usually say the two-word phrase.  I suggest, depending on your child’s ease in verbalizing these two-word combinations, to drill them once or twice a day, starting with just modeling one word at a time and having your child repeat it back to you.  The more times your child pronounces them individually, the easier it will be later when they want to put the two words together and the quicker they will be able to overcome the motor-planning issues that may come into play.

Stepping Up:  Taking this one level further involves using the larger one-picture cards you cut out.  For this activity, place all the two-picture cards face up in front of your child.  Then take one of the larger picture cards, hold it up, and ask your child, “What’s this?”  Help your child pick the two-picture card that describes the picture, and then give your child whatever help he needs to read the words outloud.  You may find this a good time to work on word recognition with your child, showing him how the words on the two-picture card correspond to the words on the one-picture card.


When introducing a next-step concept like two-word phrases, it’s important to back off of other cognitive demands like new vocabulary or words; that’s why we’re using Noah’s current vocabulary instead of words in a more predictable fashion.

Now it’s your turn.  What’s been most effective in teaching your kids two-word phrases?

Apraxia or Not Apraxia – the VMPAC, Down Syndrome and Apraxia

Our courageous hero underwent the VMPAC (Verbal Motor Production Assessment for Children), which was a formal assessment for apraxia.  He did the entire test in one sitting, and he came out of it smiling.  Amazing stuff!  So, the test got scored, and if Noah didn’t carry the diagnosis of Down syndrome, he would definitely have the diagnosis of apraxia.

But since apraxia is technically (depends who you talk to) a condition only present in the absence of other neurological conditions, Noah doesn’t carry the diagnosis of apraxia.   In fact, because the has Down syndrome, he never really should have been given the test to begin with.  The reason it was administered was because I’ve been pestering his speech therapist to formally assess him for apraxia for a year now.  So, I think it’s safe to say Noah has all the verbal features of apraxia, but he probably will never be diagnosed with it.

The bright side?  Well, the speech therapist Noah has been working with is an expert in PROMPT therapy, and that is the method he has used for the past year.  I searched him out when I became convinced that Noah had apraxia, and I think his use of PROMPT is the exact thing that Noah needs.  So diagnosis or not, his treatment is consistent with that of apraxia.

I don’t know why this issue of diagnosis versus no diagnosis is so important to me.  I guess in a way it’s the first time Noah has been excluded from anything based on his Down syndrome.  Not all kids with Down syndrome have apraxia.  Kids with apraxia do not tend to progress without very specific apraxia therapy.  There are thousands of kids out there who have Down syndrome and are not progressing in speech therapy, and it is being blamed on their Down syndrome.  In talking with countless parents of these children who have not progressed with conventional speech therapy, I am convinced that the majority have apraxia-type symptoms.  They are not being considered or treated for apraxia.  I was fortunate that Noah’s first speech therapist was willing to use Kaufmann cards with Noah, which are part of the Kaufmann Apraxia Protocol.  She too was uncomfortable diagnosing Noah with apraxia, but she was willing to use apraxia materials with him.

This is my opportunity to plead with you speech therapists out there and parents too.

If you have children with Down syndrome who are not progressing with traditional speech therapy, DO NOT WRITE IT OFF TO DOWN SYNDROME.  These super-kids with Down syndrome who are speaking so clearly – I’m betting they do not have apraxia symptoms.  Apraxia is TREATABLE!!!!  If you suspect your child has apraxia, ask for a formal assessment, if for nothing else to get an objective black-and-white record of all his features consistent with apraxia.  And then it may be best to avoid the apraxia/Down syndrome argument, but insist on apraxia-based treatment to address the motor planning and sequencing issues that treat apraxia symptoms.

Speech and language pathologists – I know it’s political, and I know it’s a hot topic, but please, please, please, look at the evidence.  We need to look at apraxia differently, and we need to get objective diagnoses of apraxia even in the context of dual diagnoses.  Children with Down syndrome with apraxia or apraxia-type symptoms NEED apraxia protocols.  We lose such precious time when you dismiss the possibility of apraxia and insist on traditional speech therapy methods.  Look at these kids with an open mind, and if you are seeing apraxia, PLEASE speak up!  Our kids with Down syndrome need SLPs who will advocate to diagnose and treat them no matter what their co-existing diagnoses are.  May I humbly suggest that it is time to redefine the term “apraxia” in order to secure the treatment these kiddos so desperately need?

Noah’s Courage – Words and More Words

Anybody hungry for a What’s Noah Doing Now update?

Well, for starters, apparently he’s been more cooperative in his PROMPT speech therapy lately.  I can’t tell for sure, because I’ve been sitting out

Sitting out?  Yes, you heard me right.

I know, I know, totally unlike me, right?

Long story.

But I can tell you this:  Noah has added several new words to his vocabulary in the last few weeks.  Most importantly, he has made HUGE progress in being able to access on command all those wonderful sounds he can make.  Before we started PROMPT therapy, I knew Noah could actually form almost all the phonemes, but he just couldn’t do it when he wanted to.  In other words, when we would drill using our Lingraphica Phonemes (free) app https://itunes.apple.com/us/app/smalltalk-phonemes/id384170714?mt=8, Noah could say those sounds.  But later if I gave him a banana and said “say buh,” he often would concentrate, purse his lips and say “puh” or “tuh” or “muh” or even “puh-tuh” and very quickly get frustrated because the sound he had in his head was not the sound that was coming out of his mouth.  When I would repeat “buh,” he would go to a new sound, but it still wouldn’t be “buh.”  If I said “buh, buh, buh, buh,” he often then could say “buh.”  But then go back to banana and have him try to say “buh,” and he would often be unable to.

Very apraxia-ish, eh?

Currently, Noah usually is able to repeat any phoneme I give him on the first or second try, and if he does wind up going down a list of sounds, eventually he is arriving at the right one.  HUGE progress!

Some words that have popped out of my little guy’s mouth lately with prompting (not always pronounced exactly right, but syllables in the right place and main sounds made) – turtle, teeth, cake, bunny, money, candy, boom, and boot.

I’ve also been doing some auditory bombardment with Noah.  I actually don’t have much faith in auditory bombardment in Noah’s case since a huge piece of his issue is oral motor dysfunction, but I have to say I’ve seen him progress greatly over the past few weeks.  I have a sheet of 16 PECs with words like bag, boat, bone, bug, bat, etc.  At first, I just read the words off without even having  him look at the paper.  After a few days of that, I sat him in my lap and used hand-over-hand assistance to have him point to the words as I read them.  Next I said each word and waited for him to say them after me.  As soon as he started resisting, I reverted back to letting him point while I said the words.  Now I say the word and point to it, and he automatically says the word back to me.  So, let’s hear it for auditory bombardment!  (Technically, auditory bombardment uses repetitions of the same words in one session – I did the slacker version – just one but sometimes two runs per session.)  So he can now say about 12 of those 16 words as well.

The big question here is will Noah integrate these new words into daily usage.  “Carryover” is a huge issue in speech therapy, especially in kids with Down syndrome.  It’s great that they can pronounce words on cue, but if those words never make it into their working vocabulary, all that hard work really isn’t doing them any good.  I can report that Noah is using some of these new words.  He is using nana (for banana), teeth, iPad, candy and bear at times without any prompting.  He’s also got some good approximations for “Caelie, Trinity, Abby and Leah.”  I’m probably forgetting a bunch here, but it’s safe to say Noah is still not a very talkative fellow.

My favorite thing that Noah is doing?  He’s been going up to his siblings and tickling them and making a new sound along the lines of “tickle, tickle, tickle.”

Oh, and get this – he’s had about enough of me putting my hands on his face to reinforce the PROMPT tactile cueing he’s getting in therapy.  I make him SOOOO mad.  I think for now I better let Marcus work his PROMPT magic on Tuesdays and I’ll do some hands-off coaching during the other days of the week.