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If not ASD, tell me about communication/speech disorders or delays? (updated) - Page 2

post #21 of 45

yeah, i thought my son had a hearing problem and he was cleared.. But as an ealry childhood teacher, i began to recognizance the signs and symptoms (much to his father's protests). Yes,m y son has no speech at all at 5.5 years old. I am waiting for the day, he calls me 'mama'. He is an independent and determined child. If he wants fruit, he'll gets it himself. If he wants milk, he'll have the botles laid out neatly for u to make it. We tried sign language with him, it was not much help. He does recognizes family members even thouogh we live on 2 sides of the continents.he is on Rispersdal to cope with the tantrum. I try to get him as much as exercise as he can, but the downside, he gets hungry :-0  He is 18kg. God, please let it stay that way for i need to carry him through Sydney airport!

post #22 of 45
Thread Starter 

Had a fascinating visit from his new speech therapist today. All in all, it was a great visit. They played. She didn't record anything (not that I expected her to), although reading other people's talk about their EI visits and making them sit a certain way and do certain things... yeah, none of that. But his first speech therapist didn't either.

 

I thought they had a ball.

 

I didn't bombard her with questions at all, but after we scheduled their follow-up visit I just asked about the future and what the 3+ yr world might be...

 

Her response.. I think he's just too smart. His brain goes faster than his mouth can keep up.

 

Hmmm... yeah. No.

 

She said in context, I understood all of his words, and he has an extensive vocabulary. Well, Yeah! He does! Because you were looking at picture books talking colors, numbers, and animals. All of which those singular nouns, he had a year ago when he turned 2. Everyone, all strangers, can understand those words that he speaks. He does have an incredible vocabulary.

 

It's everything outside of just a noun, when he's rambling on... a gah kah ga ga kah kee gak, mommee.... that you have no idea.

 

According to her, following his IEP, he doesn't need any more therapy. We scheduled the next two because she has to, but once again, "he's just so much smarter than most of the kids I see. I doubt he'll move in to the 3+ group."

 

And for the first time in all of this, I actually sighed. Because I whole-heartedly disagree.

 

And maybe I'm just seeing the wrong things. Maybe... ire-tuh, mine, woo-woo....  is a sentence. Yeah, Firetruck, it's yours, it makes this sound... maybe that is a sentence.

 

I dunno. Maybe he does just have a lazy mouth; lazy consonants that will catch up with time.

I don't think he's "just too smart that his brain moves faster than his mouth"

 

On a side-note, I called his pediatrician and asked for a referral to a speech therapist outside of the school district, which THANK YOU to you encouraging me to actually look up OHP regulations, yes, OHP will cover (and will cover some speech therapy, especially if they're part of a hospital). So, a formal evaluation is potentially in the works.


Edited by JordanKX - 6/28/12 at 10:42am
post #23 of 45

Your #1 diagnostic tool is your instincts - if they are telling you she's wrong then she's wrong. Period.  End of story.  I'm glad to hear you are getting an independent evaluation.

post #24 of 45
Yikes. I'm sorry that evaluator said his language skills were fine.. I'm so glad you've got some other options. You have something going on in articulation I think. I doubt most spectrum kids are saying "I'm scared" to anyone at his age! I hope you find some help. Apraxia really needs expert in apraxia help and the earlier the better. I so hope someone who knows this area will take the insurance.

You don't have a university with a speech department near do you?
post #25 of 45

duh.gif the "they're just too smart"  "diagnosis". She should have evaluated him against a standard and needs to provide you with her written evaluation. I don't know which particular evals are typically done at that age but when my ds was 7yo the school used CLEF (evaluation of language fundamentals), Goldman-Fristoe2 (test of articulation), and TOPL-2 (test of pragmatic language), to evaluate him for ST.
 

post #26 of 45
Thread Starter 
Quote:
Originally Posted by sbgrace View Post

You don't have a university with a speech department near do you?

 

I honestly don't know. I ask PP's here because I'm in Southern Oregon and we have one University here that just became a "university" recently. I'll look in to it, but I'd imagine not. Again PP's will have things to say about Portland, 4hrs north which is not too far at all. And I'm only 5hrs from the Bay Area. So while I'm far away from everything... I'm centrally located to a lot of options.

 

Not insurance-covered options. But, options.

 

I want to see what the formal eval happens with the speech-therapist at the hospital. My ped didn't flinch at writing the referral (which I don't necessarily like... how many times can I say I don't like this ped)... but at least he writes referrals I want.

 

more to come.

And thanks on the push to look locally. I can pretty much guarantee not here. but...

post #27 of 45

I'm going to agree that it sounds like a very mild form of apraxia or a phonological disorder.  Very mild because he does have a lot of words and it doesn't sound like he makes inconsistent errors (says apple 3 different ways in the course of a day--versus just misprouncing apple wrong the same way each time).  Many speech therapists have never seen a true form of apraxia so it can be hard to really diagnosis, but many other things can cause a delay to look like apraxia.

Have you been to an ENT recently?  DS1 sounded like he was talking underwater and had enlarged tonsils/adnoids/fluid in the error--all can cause the talking underwater sound.  He had no ear infections, passed the hearing test at birth and later at 18 months (I think that's when it was)--but at his ENT consult for the enlarged tonsils and adnoids, it was found he had fluid in his ear that probably would drain periodically and that's why it was never caught.  Once he had adnoids/tonsils out and tubes put in--he was talking as clear as could be in 4 weeks.  He went from his regular therapist not being able to understand most words--to his new therapists asking us why he was still in therapy (surgery right after the old therapist stopped seeing in and 3 weeks break with surgery/recovery and then started seeing the new therapist).   It was crazy how quickly it made a difference.  Prior to his surgery there was discussion about giving him an apraxia diagnosis--but after the surgery it was determined that his symptoms just mimiced apraxia red flags (and later when DS2 was in therapy--we could definately tell the difference between DS1's delays and DS2's delays which were classic mild apraxia).

Apraxia-kids has a facebook group and it is a wealth of information and they can help you find a therapist in your area with apraxia experience.

post #28 of 45

ETA:  Most apraxia kids also understand so much more than they can verbalize.  DS2 at age 2.5 tested recepetively at 3 and expressively around 18 months.  His therapist consistently mentioned how intelligent he was and his current therapist tells me how she has to change how she works with him because he understands things that her other students don't (she uses pictures that have the words typed with them...she'll then show the kids two pictures, like cat and cap and say the word as she shows them.  She then asks the kids what word as the tapping T.  DS recognizes the letter T and knows it makes the tapping T sound, so he'll point to that without listening to the words.  So she's had to start covering up the words for his sessions).  I was talking to a friend one day and updating her on DS2's speech.  She asked if I was sure he was delayed as much as they said and I said definately.  She said she had no idea because she had no problems understanding what he wanted or said, but then she started really paying attention to his words and was shocked that she couldn't understand him verbally.  But, he had such a way of communicating non verbally--that people could gather what he was saying.   
 

post #29 of 45

I like the Apraxia Kids Website. You can find good information there but also remember that kids under the age of three are different from older kids when it comes to therapy. Older kids understand the whole concept of "changing my speech to match the teacher"... Younger kids need to target imitation skills in general in a fun, interactive way. Definitely target activities that take the pressure off of speaking at first. Some children learn that it is easier to play alone than to be unsuccessful in their communciation attempts. That is why I had said before that experience with toddlers is important. Unfortunately, people associate hospitals with quality speech therapy and that is not always the case.

 

As far as a diagnosis, here is a partial checklist that may help you with your toddler (toddlers with apraxia may exhibit all or just some of these): may be essentailly non-verbal, not a lot of vocal play (ie: jabbering during play...), history of saying a word clearly once but then may not say it again, receptive language skills higher than expressive, inconsistent production (especially when asked to say the same word several times in a row ("apple>bapple>bapbap>bapoh"), may have poor eye contact when you ask him to watch you say a word, speech is often effortful, speech quality may be distinctfully different, over-use of a neutral sound for many words ("uh")

 

Apraxia is a difficulty coordinating everything together that is necassary for speech (tongue, lips, jaw, breath support...) It is a problem with motor planning. Your brain may know but your mouth cannot make it happen!

Good luck in your search for therapy and I hope you find some answers!

 

PS: I have seen many apraxic toddlers who, if I had to guess at the time, I would have said would struggle for a long time with their speech BUT they mature neurologically and their speech starts to mature as well. So don't despair too much! He is lucky to have a mom who cares enough to persue a diagnosis in spite of some doubters!

post #30 of 45
Thread Starter 
Quote:
Originally Posted by aspeechthx View Postinconsistent production (especially when asked to say the same word several times in a row ("apple>bapple>bapbap>bapoh"),

 

This one sticks out at me.

 

Tonight we spent the evening with my best friend who had an apraxic son, and while she's heard me babble for months about potential stuff, we haven't spent good one-on-one time together. Tonight she was a best friend... but also... well, you know, feeling him out.

 

This is Exactly what my son does. Especially if you goad him too much. He'll say it 3/4 right the first time, but it gets different and less understandable the more you ask him.

Tonight she was picking out that he can say ESS and ESH, but only in the middle of a word. He'll say "nake" (snake)... what sound... ESSSShhhh... eventually the H will take over.

But you ask him again, and it's just "Aaaa" (for snake).

 

He will say Bapple. But then, exactly as you said... it'll become bapoh. The more you ask, the less he tries to articulate it. "apah" is what you're left with. He's either frustrated or lazy... you asked mom, I said it once, I'm done. (is the impression I get)

That's why most works become GahGee... eventually EVERY word turns in to Gahgee.

 

Granted, we kept him up late tonight. He was sleepy. And she was trying to push him (which I encouraged... one night of pushing him isn't going to kill him).

 

Most of the night was "i pay....giget....aetbahd.... mo... giget pay me".... (I play with Bridgette on the Skateboard; Bridgette, play with me more).

Honestly, an outsider would even understand that.

post #31 of 45
Thread Starter 

I do have one question about FORCE.

Not punishment/discipline... but even my girlfriend B said tonight... "maybe you should try to force him to say it correctly"...

 

ie... you will not get said item until you say it correctly.

 

I told her that everything I've read/heard says DO NOT do that until they're at least over 4yrs old.

 

Is that right?

 

She did head-twist and thinking about it... her son didn't utter until 3yo, so it wasn't until at least 4yo that she forced with him. And she recoiled and admitted that while that was part of their therapy, likely didn't start until he was 4+yo. (in her defense, her son is 13, so while she remembers... her time-line is off a lot).

 

But thought I'd ask. I've never been this way. My mother, a very active grandmother, IS this way. And I've actually kept him from her recently because she requires him to say words correctly (which he... well, he just won't.. he's just not there yet). And I think it frustrates him more than anything. And makes him not like his grandma so much. She thinks his speech delay is just laziness, and I'm just not seeing anything in my readings that this is appropriate at not quite 3yo. At 6yo, Maybe. But not this young.

 

Thoughts?

post #32 of 45

Eek, I feel pretty strongly that forcing kids with language disorders to say words in general is a terrible approach.

 

Working with our developmental ped and our speech therapist (with distance input from a world expert on children with language disorders), the general agreement is that we want our DS to feel like a competent communicator and that we should simply recast a word correctly after they say it.  Don't tell them they made a mistake, just repeat the word correctly then pause to give them a chance to say it correctly themselves, then move on whether they say it again or not.  
 

Everything I've read says that forcing correct pronunciation can have very negative consequences.  For example, a child might simply withdraw, or stop trying since they know they can't say it totally "right."  You want to encourage MORE attempts, not less.  That is how they will improve, by trying over and over again. 

post #33 of 45
I haven't read through all the responses so far, but it sounds like he has a lot of characteristics of apraxia. Sounds like he is having trouble with his motor planning, which explains his clumsiness as well.

Also I agree w pp- don't try to *force* him to say the sounds correctly! You might be able to help facilitate accurate production by adding a hand sign to go with a certain sound (bringing his hand up to his lips for the /p/ sound for example) or even touching his lips gently when practicing the bilabial sounds (p, b, m) but don't force it and try to make it a positive experience when you practice :-)

Good luck mama!
post #34 of 45
Quote:
Originally Posted by JordanKX View Post

I do have one question about FORCE.

Not punishment/discipline... but even my girlfriend B said tonight... "maybe you should try to force him to say it correctly"...

 

ie... you will not get said item until you say it correctly.

 

I told her that everything I've read/heard says DO NOT do that until they're at least over 4yrs old.

 

Is that right?

 

She did head-twist and thinking about it... her son didn't utter until 3yo, so it wasn't until at least 4yo that she forced with him. And she recoiled and admitted that while that was part of their therapy, likely didn't start until he was 4+yo. (in her defense, her son is 13, so while she remembers... her time-line is off a lot).

 

But thought I'd ask. I've never been this way. My mother, a very active grandmother, IS this way. And I've actually kept him from her recently because she requires him to say words correctly (which he... well, he just won't.. he's just not there yet). And I think it frustrates him more than anything. And makes him not like his grandma so much. She thinks his speech delay is just laziness, and I'm just not seeing anything in my readings that this is appropriate at not quite 3yo. At 6yo, Maybe. But not this young.

 

Thoughts?

 

If your son had a broken leg, would you force him to walk on it?  If he was blind, would you try to force him to see?  Both ridiculous questions - just as your friend's recommendation is ridiculous.  If your son has apraxia, dyspraxia or other speech disorder then you could no more force him to speak correctly than you could force him to sprout wings and fly.  More than likely it's neurological in nature.  Your son's mouth isn't receiving the proper signals to form the words just yet.  A good speech therapist will work on your son's oral tone (strengthening exercises) as well as the speech itself.  Now, don't get me wrong, I do correct my son but I don't force him to say it correctly - just to try.  So, at your son's age, if he said "duff" when referring to a duck I'd have him look at my mouth and watch me say duck and then I'd ask him to repeat it.  He would usually just say duff again but you could see he was trying to get the hard "K" sound.  Over time and a lot of speech therapy (he's been getting speech 4x a week during the school year for 3 years - he drops to once a week in the summer), his articulation has improved dramatically.

post #35 of 45

There have been published studies demonstrating that forcing/telling a child what to say is the least effective method to stimulate speech.  The single most effective method is "maternal imitation," when the primary caregiver playfully, lovingly imitates every utterance that the child makes.  You can look it up on PubMed - I think the title of one study was "When 'Simon Says' Doesn't Work."

 

I have one child with autism and one child who was a late talker - both needed lots of extra interaction to learn to converse, and neither responded positively to being told what to say. 

post #36 of 45

It's good that you sought an outside specialist for an evaluation.  I am in Oregon too and Ive found that EI/ ECSE tends to see need only when it is almost an emergency.  Their cut off scores I am guessing are pretty low.  I had to get them to screen my DS multiple times before they agreed there was a problem and even then it was because the last time around the SLP was more in tune with parents' concern and based on that gave us a referral.  I suspect that my DS might have Auditory processing disorder but I have to wait until he is elementary school age to know for sure.  Like others have said trust your instincts.

post #37 of 45
Thread Starter 
Quote:
Originally Posted by Azik's mom View Post

It's good that you sought an outside specialist for an evaluation.  I am in Oregon too and Ive found that EI/ ECSE tends to see need only when it is almost an emergency.  Their cut off scores I am guessing are pretty low.  I had to get them to screen my DS multiple times before they agreed there was a problem and even then it was because the last time around the SLP was more in tune with parents' concern and based on that gave us a referral.  I suspect that my DS might have Auditory processing disorder but I have to wait until he is elementary school age to know for sure.  Like others have said trust your instincts.


And this is my question, that you asked for Multiple Screenings, whether or not had to, you did.

I mean... what does that even mean?

EI's goal is not to diagnose, but to merely get them ready for school. I didn't know you could even dispute. But again, what would it matter? they will not diagnose... they will simply re-evaluate to see if they're eligible for services, right?

 

So if you're looking for more, you HAVE to go outside of EI right?

 

I can say that I'm not over EI yet, because I will give them faith on the "almost-3" evaluation and see what comes from that. Yes, I'll do what I can privately too. I'm not closing any doors, and I am not a believer in anything yet.

post #38 of 45

JordanKX~ I only work one day a week in the summer so sorry for the delay in getting back to you but I haven't checked the website!

 

I am DEFINITELY against the "force him to talk" idea! Here is a quote from my previous post: "Younger kids need to target imitation skills in general in a fun, interactive way. Definitely target activities that take the pressure off of speaking at first. Some children learn that it is easier to play alone than to be unsuccessful in their communciation attempts."

Working with 1-3 year olds is very different than 4-5 year olds.

 

Here are some prompts to use...and some to avoid:

      Tell them "watch my mouth" then, at first, reward them for ANY attempt ("you were trying" or "Good job, you were watching my mouth.") Even reward them for trying the same mouth shape, even if the word is not said correctly, "You opened your mouth really big like mine!"

      Use cues they can feel or hear such as clapping the syllables for "buh-bol" or stomp your feet while saying "boom boom..."

      You may need to simplify a word so they can be successful:  hoho/santa, buh buh/ bubble, appo/apple...

      Be aware that some errors are normal for toddlers (simplifying blends such as nake/snake is OK, also goggie for doggie, dump/jump... and many other errors are just to be expected.)

      Therapy should NOT be a power struggle or adversive. I use the rule of three: if I have tried three times to get him to say it and he hasn't, I move on and try to think of a better, easier prompt that would make him more successful next time. They have to experience success early or they will shut down, just like it sounds like your son has done with g-ma! Getting ANY toddler to imitate can be tricky business!

       After I have built a relationship with a child and they are willing to try to imitate me, it is important to get several repetitions of the targeted word. ie: if they say a word that you are targeting with them, hold up three fingers and encourage them to practice that word three times. Repetition helps train the brain for the correct movement (remember that Apraxia is a motor coordination issue)

 

These suggestions are easy to do and easy to make fun. So I tell parents of toddlers to put away the flashcards and drills and just act silly, be overdramatic and repeat familiar words in play. The more you engage your child in playful back and forth interactions, the more they will want to interact and learn from you!

 

Have fun, be accepting of any attempt and, most importantly, be patient; it takes awhile to see improvement with toddlers with Apraxia!

post #39 of 45
Thread Starter 
Quote:

Originally Posted by aspeechthx View Post
So I tell parents of toddlers to put away the flashcards and drills and just act silly, be overdramatic and repeat familiar words in play. The more you engage your child in playful back and forth interactions, the more they will want to interact and learn from you!

 

 

Have fun, be accepting of any attempt and, most importantly, be patient; it takes awhile to see improvement with toddlers with Apraxia!

 

I really appreciate all your words, insights, ideas!! Thank you thank you! Thank you for being up here and offering your insights to this board.

 

And this really stood out to me because I am very relaxed, (i hope) encouraging, and Yay all around. That's just my nature anyway, but also because I DO read (everything I can get my hands on) and that seems to be the general consensus.

 

The flash cards stood out because this is So my mother. Ugh. She just brought over yet another packet the other day. I mean, he'll do flash cards and puzzles and word books all day long. Thank goodness the kiddo likes things like that. But watching her with him was painful.... not chastizing, but so In His Face, say it again, listen to the ESS sound, just over and over again. I felt very uncomfortable this last time and I won't let her do it again. The last thing he needs is any negative feelings about his attempts - his happiness so far through this all is an amazingly wonderful aspect. He doesn't get Too Terribly frustrated... yet.

post #40 of 45

I"m not a professional, so take this for what it's worth, but to me, so far this sounds like dyspraxia of speech.  Especially this statement:  Main kicker was his clumsiness... that he falls All.The.Time.

 

For more info, try http://www.dyspraxiausa.org/resources/links

Since your son is already in EI, ask them what they think about that possibility...

 

These behaviors are not typical with autism:

 

He is very social

loves all types of activities

doesn't have fixations

doesn't tantrum

no sensitivity issues

fantasy play

 

(I am thinking with the new hand-movement, that he might be a good candidate for signing... something we've never tried before, well, not since the few things as an infant).

 

If he has any kind of speech delay, signing won't hurt a bit!  It'll help a lot to encourage more communication, actually.

 

 


 

 
 
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