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Thank you for the suggestions
Since we do not know if it is an issue with low muscle tone or if it is an issue with the way her brain processes the sounds, we have been focusing more on drills that work on specific sounds with cues. We use games and fun activities to help her get through the drills. The SLP will put a flash card next to her mouth and DD will repeat the word or sound. If she gets it even remotely correct, she gets to move her piece of the game. She is only working on the 'forward' sounds right now (like b and p). We have also started working with more signs to help her communicate with everyone. I am sure there are better ways to explain what she does in ST but, I cant think of them right now She has made great strides this year, but I am always looking for moreways to help her. Oh, and she has had her hearing checked, and everything is fine.
This sounds very similar to my daughter.
I just did a speech eval last week. I'll get results soon. She was unclear to anyone outside of the family until about 4 1/2. I don't know that she completely fits apraxia, but maybe oral apraxia. At this point, I think we just need something different. She is understandable now, but she is still not clear for someone her age.
How is her oral motor? Can she lick her lips all the way around? if you put whip cream on her top lip, can she lick it off? If you put a lollipop to the corner of her mouth, can she lick it. If you put licorice on the inside side of her mouth, can she chew it, or does she turn her head?
My daughter has some oral issues going on as well, and these are some of the items we see, so in her case it isn't straight articulation.
She was intially diagnosed with severe phonological delay, but I think there is more to the store. She shows apraxic tendencies.
I know some SLPs use non-speech oral motor exercises, but I would strongly suggest you research these if they are being used with your child. Some people support them and say they have seen changes, but the research right now shows they do NOT help speech.
This is very dependent. I wouldn't recommend using them by themselves, and that is it for therapy. I think for some kids, though, using these can be helpful as one part of an overall speech program.
As an example, while my daughter has an issue with articulation, she also has an oral motor issue. She couldn't even lick her lips full circle until she was about 7. At a minimum, oral motor exercises have at least have helped her oral motor skills.
Honestly, I don't know how much it helps, but I don't know if much of anything else an SLP has done has helped either. At a minimum, I have seen some progress on her oral motor. Of course, if she is apraxic, it may explain some of the issue.
As an SLP, I wholeheartedly agree with what Aridel is saying. Non-speech oral motor drill will not benefit speech. The research shows this over and over. But there are plenty of people making big bucks (Sara Rosenfeld Johnson being one) that promote all kinds of horn hierarchies, bubble blowing, button pulling, etc. It is simply not evidence based at all, and I'm surprised its been allowed to continue in our field. Other non-evidence based practices have been essentially done away with for the same reason. For some reason, this bugger has held on. My suspicion is that lots of clinics are doing it because its perceived as "medical" and they get reimbursed easily from insurance. Articulation is harder to bill for.
In response to the OP, does your daughter have varied sound production for the same target. For example, kids with artic disorders might say "tat" for "cat" but they will say "tat" every time. A kid with apraxia has a problem with motor planning, so they might say "tat" "tot" "tap" etc. They grope and their productions vary. Another tell tale sound is vowel errors. Vowel errors are often seen in apraxia, but rare otherwise. You will also see a noticeable breakdown as words lengthen and there is more coordination demand. Simply adding a syllable or a phrase instead of a word can make a person with apraxia's speech fall to pieces.
From what I'm hearing from your OP, it just sounds like articulation. Some phonological processes (such as final consonant deletion) as well. But all that means is that your child's articulation errors follow a pattern and your SLP is working well with her by using her "rules" to teach the correct way. Like teaching her the "forward" sounds.
Traditional artic therapy teaches each phoneme separately, but phonological processing research shows they come in quicker if you teach the rule system. So instead of teaching K, then G. You would talk about "back sounds" and possibly achieve both together.
It sounds like your SLP is doing everything right to me. Unless you see your daughter groping, making vowel errors, and having wildly different productions (or her artic getting substantially worse as the length increases and requires more coordination), then I would not think of apraxia.
For what its worth, I have been an SLP for 8 years, and only seen one child with true apraxia. It is very rare, but is becoming a buzz word lately. Like dyslexia and auditory processing, it seems to be a diagnosis that more and more people are getting.
OP, by any chance does she have a high arch palate, or a split uvula - this can be signs of a sub-mucus cleft palate. Open you get hyponasal speech, but not always. The sounds that she is having problems with are the same ones as my DD, she is 4, has/had a submucus cleft, repaired at not quite 3 years old. The mucles where all in the wrong places, the corrected some and her speech improved alot - but the stuff your DD is missing Megan still struggles with because the muscles have to be taught how to move. It is a slow prosesse, but at 4 she still working on it. Does she start school this year, if so be sure that you try and get some additional in class support for her so that she dosn't get frustrated