Tag Archives: speech therapy at home

Apraxia – Is there a Time to Drill and a Time to Not Drill?

Noah has been back riding the horses at Red Arena for a couple months now.  I’ve been blown away by his instructor,  Miss Emily.  She adores my little guy and although she is not a SLP, she has worked with him extensively on his speech and is getting great results.

A few weeks ago she told me about all these words he was saying and how he was putting phrases together on his own.

Seriously?

She said he had said words like throw, rock, water, snake.

Again, seriously?

I prompted him to say “water” right there in front of her, and Noah grunted as usual.

“No, no,” she said, “He really said it.”

“Okay, whatever you say,” I thought.  (I didn’t say it outloud, did I?)

So last week at Noah’s session, Miss Emily produced a video.  Proof.  The little boy on the video is not the little boy I know.  He was throwing rocks in the water and asking for more rocks, water, putting words together.  It was like she said.  He said “water,” he really did.

So I mentioned all this to Noah’s speech therapist and asked for his take on why Noah does so well in that environment, but I don’t get the same results.

“Well, Mrs. Dunn, you are Noah’s mother, Noah’s homeschool teacher, and his speech therapist.  It’s probably too much.  Take the speech therapy drilling out of his routine, and just work with him on his school work.  Work on prompting speech from his lexicon during real-life opportunities, but leave the speech therapy to me.”

Seriously?

Okay.  So I horribly misquoted the speech therapist, I’m sure, but that’s the gist  I got.

Seriously?

Stop drilling?  The kid has got apraxia, he’s barely verbal, and he’s 7 years old.  You can’t stop drilling a kid with apraxia.  Everybody knows that.

So I fumed for a few days.  Noah is darn tooting lucky to have a Mom who is willing to drill with him every day.  Stop drilling?

But you know, as I thought about it, I think the speech therapist may have a point.  Maybe.  Or maybe I’m just tired and welcome a break.

But going on the notion that the speech therapist might have a point – Noah actually excels at drilling.  He can make most of the consonant and vowel sounds in isolation.  It’s words and phrases that he struggles with.  I think I tend to wear him out in our speech sessions, so then when I try to prompt speech in real-life activities, he responds to it like its another speech session and resists.  Perhaps it might be better for my wanna-be speech therapist persona to fade into the background and just stick with Momma.

You know, I think what really got me was the notion that somebody other than myself might hold the key to helping Noah find his voice.  I mean, we don’t farm out our kids education, academic or religious, we don’t pay other people to take care of our kids; we feel like we’re wholly responsible to give our children what they need.

So this idea of “leaving speech therapy to the experts” just doesn’t fit.

But I think he might be right.

But I also think, in looking back, that Noah needs different things at different times.  I think he needed traditional speech therapy when he got it at age 3-6.  And I think he needed PROMPT once he turned 6.  And I think he needed the drilling we did over the past year.  But I think, perhaps, the speech therapist was right.  Right now, he just needs his Mom.

So Mom is what he gets, even if Mom is going to still be capturing every teachable language moment she can, even if Mom is still going to be prompting for speech and teaching sign language, even if Mom is still going to be on the lookout for predictable books and opportunities for speech.

What do you think?  Am I caving, or does this make sense?  Where do you think the balance should be between what a speech therapist does in weekly sessions and what a mom should be doing at home?

When is a Bus Not Just a Bus?

You know how exciting it is when you hear your new talker say a new word from the back seat as you drive on your merry way?  That awesome moment when you ask yourself, “Did he really just say that?” and then, sure enough, he says it again.  And that new word that to anyone else is just a word becomes to you the pivoting point that the world is resting on?

Well that happened today.  Just driving down our old country road on the way to the recycling plant.  I heard “bus” in Noah’s unmistakable gruff voice.  No way.  There was a school bus heading our way, but no way could Noah have seen it before he said “bus.”  So then I glanced in the rearview mirror, and sure enough, we had already passed one bus.

I looked over at Leah and said, “Did he just say bus?”

Affirmative.

Well, I hooped and hollered and Noah growled and said and signed “Stop.”  (He hates it when I get all excited about his speech.)

More busses.  “Bus, bus,” I prompted.  More growling.  And then as the next two school busses passed, it was reported from the back seat that Noah was whispering “bus” (knowing Mama just couldn’t help but get excited if she heard it).

Next thing you know, all the kids, including Noah were playing a game of being the first person to say “bus” when another bus was spotted.

Talk (no pun intended) about being in  the right place at the right time!

Raising a courageous hero with Down syndrome rocks!

(Once kids with speech issues start playing games like this, keep the game going by looking for school busses on all your drives and shout out “bus” each time you see one – perhaps the kiddo will join right in, and you’ve just captured a few more word productions for free.)

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.

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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.

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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?