Our road to an apraxia diagnosis

Speech has always been Payton's biggest delay. She is a rockstar when it comes to gross motor ... but speech, not so much. It breaks my heart.

Payton received speech therapy services through the county beginning at around 9 months of age. She continued with that until September 2008 when she was 2 years 7 months, at which point she aged out and began preschool through the county and privately.

In April 2009, we pulled her out of private preschool and replaced it with private speech therapy. Our concerns about her speech delay were growing ... as did the gap between her expressive and receptive speech. Since that time ... and since starting her on gingko biloba ... her speech has come far. But she is still struggling.

During her time in speech therapy, I have asked about apraxia ... only to have it swept under the rug. I have always kept it in the back of my mind ... along with the slight possibility that she may have a submucous cleft palate, as evidenced during her T&A awhile ago.

I guess when they say things happen for a reason ... it is true. I was heartbroken when our old speech therapist left, but in hindsight -- it was a blessing. She was young and had not picked up on the fact that Payton has apraxia.

And that is a problem.

After posting a video on my blog of Payton talking, I heard from a few blog readers that are SLPs -- they wanted to know if Payton had been evaluated for apraxia.



Had she been evaluated for apraxia? Uhhh ... no?

Here are the comments I received from one of the SLPs that has specializes in treating kids with apraxia ...

Her errors seem apraxic to me.

--the unusual sound substitutions like "dyedye" for "byebye" when she can say /b/ sounds for words like "baby" which is harder to say with 2 different vowels than bye-bye

--the way she simplifies syllables and doesn't always include both/all consonants/syllables in words (e.g. "Duh/Dora" at first then adding syllable after practicing, saying "Duhduh"/Dora -- apraxic characteristic to add /d/ like in front of word whereas most children might say "Doyuh" or "Dowuh" for Dora

--the oral groping and inconsistency with words like "Zoe", "chips", "shoes", and "blue"

--the addition of syllables at times like "mapurple/purple", "bobo/boat"

--inconsistent vowel productions -- although most were pretty close, there are still some that aren't precise

--overall difficulty imitating words

Ideas for you ...

--When working on a one-syllable word, like 'fish', hold out the /f/ sound ffffffffffff then 'ish' rather than saying the consonant sound more than once like fuhfuhfuh ish because she is hearing that as a lot of sounds to sequence together when there are really just 3 in f i sh. Does that make sense?

--When working on a two-syllable word, if she is getting the first syllable like 'ha' for 'happy', say 'pee' then go back to 'ha+ppy'. This technique has been shown to work with kids with apraxia over and over again. It's like working backwards. They get so stuck on the first syllable or anticipating the 2nd one that they can't produce both correctly. Another example would be a word like 'bunny' if she can say 'buh' work on 'knee' and point to your knee and say 'Say bunny' (she tries it). 'Say nee' (she tries it). 'Say Buh-nee.' (she tries it) 'Bunny.'

--Take words/sounds/syllables she says well and find other words with those sounds/syllables to practice and focus on saying these for practice. For example, 'bye-bye, baby, bubble, Bible --see the pattern? same consonant with different vowels? Then try words like "mama, mommy, money, maybe' with different vowels/consonants over time...

--As far as her leaving off sounds at the ends of words, the way i work on this is practicing the word as two syllables (e.g. mil+k) with a ton of emphasis on the k at the end. We sometimes even pat our lap or the table as we say the end sound. Will/can she imitate sounds by themselves, not the letters but the sounds they make if you say 'Say 'kuh''?

I would love to hear Payton imitate you saying consonant-vowel combinations below to see if she differs with different vowels...

may
my
mo
moo
me
maaaa
mah
muh
mih
meh

pay
pie
po
poo
pee
paaaa
pah
puh
pih
peh

bay
bye
bow
boo
bee
baaaa
bah
buh
bih
beh

kay
kye
ko
koo
key
kaaaa
kah
kuh
kih
keh

day
dye
doe
doo
ee
daaaa
dah
duh
dih
deh

So then I sent the SLP this video of Payton saying the sounds she suggested ...



And she said, "I've only watched 1/3 and I'm convinced. APRAXIA APRAXIA APRAXIA."

Awesome.

To be honest ... I just cried. I felt like I failed Payton. I was angry that her speech therapist hadn't addressed the issue when I asked. And I felt like I failed her some more.

As soon as I was done crying, I went into fight mode. I googled and googled some more. I found that the best way to tackle apraxia is through use of PROMPT therapy. Our new speech therapist is not trained in PROMPT, however we are having her continue therapy with Payton to approach it from all angles, so to speak.

I found a local therapy center that specializes in PROMPT. They performed an observation/evaluation of Payton and confirmed that she has apraxia after doing an apraxia specific test. We are currently waiting to get start dates at this therapy center and we also will be having an extensive evaluation done at the clinic founded by Libby Kumin ... I'm really excited for that!

And ... just to be sure that she does not have a submucous cleft, we have an appointment at a craniofacial clinic. She will be evaulated by several specialists, all in the same appointment ... I'm excited for that too!

So yeah ... I had my meltdown concerning the apraxia diagnosis ... and I moved into fight mode. I have noticed Payton's speech moving along, so I feel confident we will get there.

Love her. We can do this.