Tag Archives: speech therapy

Say That Again: Giving Your Child The Gift of Voice

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By Leslie Lindsay

Making a list and checking it twice?  Your child may have all of the cars and trucks, dolls, & love, but don’t forget to give one very important gift: the gift of speech. 

Your child was given to you as a wonderful and miraculous gift to tend to and raise, and impart life’s lessons to.  But your child also brings much to your life: laughter, love, joy, and…well, baffling questions and concerns.    (image source:http://www.sheknows.com/kids-activity-center/print/dear-santa-list)

When my daughter was given the diagnosis of childhood apraxia of speech (CAS), I had little idea what that really meant, or how I could help.  Aside from the fact that I would be schlepping my daughter to and from speech therapy, I was dumbfounded.  I shrugged, rolled up my (elf) sleeves and accepted the challenge; I would give my daughter the gift of voice—even if I didn’t know how. 

Of course, the pediatric speech-language pathologist (SLP) we worked with privately for the next few years, coupled with the special-education preschool Kate attended five days a week really helped her thrive, socially and academically.  I wasn’t carrying the brunt of apraxia alone, yet at times it felt that way.  It really does take a village to raise a child.  Along the way, I learned some valuable lessons, insights, and therapy ideas that may also help you along your apraxia journey.  Think of them as small glitter-wrapped packages under your tree; a toolset for apraxia. (image source: http://www.centsationalgirl.com/2011/11/in-the-spotlight-matthew-mead/)

glitter ribbon wrapped gifts matthew mead

          Here are a few things you need to keep in mind as your “golden rules” in working with your child with CAS:   

  • Have your child repeat, repeat, repeat! Movement repetitions build strong motor planning/programming/gestures. Can you say that again?
  • Provide lots of opportunities throughout the day to get your child to talk or vocalize—about anything.Your child will begin to see that communication is indeed a fun part of life.  What color is that dog?  Is the cup big or small? 
  • Be goofy and funny. If you are relaxed and your kiddo is relaxed, words will come easier.  Ask nonsensical questions to elicit a response, give silly options.
  • Make talking and speech practice more about your lifestyle and less about “sit and speak” time.  In this sense, you “work it in” to your routine.
  • Team up with your SLP. Have her give you ideas for homework and report back to her. Let her know what your child does well at home and see if it works as well in the clinic. Think of your SLP-parent-kid connection as a circle with no beginning and no end; make it appear as if you are driving a fancy automatic car—smooth and effortless, even if it’s really a jumpy 5-speed jeep.
  • The more talking feels like work, the less willing your kid will be to do it.
  • Imitation is huge, too. “Can you say what I say?” Try it. If imitation is too hard, try doing it in unison. Remember all of the chanting our grandparents did in school for memorization? Even singing the ABC song is a form of imitation in the form of chanting memorization. 
  • You are mom or dad first. You do not need to become your child’s speech-language pathologist. Kids are smart. They will know what you’re up to and won’t participate if you act too much like their SLP. 
  • Your goal is to complement your SLP’s efforts in your own home. Talk to your SLP about a reasonable amount of home practice. This will also depend on the age of your child. As one apraxia parent named Mike shared, “An SLP is like a personal trainer at the gym. You go, your trainer works with you for an hour and teaches you things to do on your own, but it’s up to you to do the rest.” 

Once you have a good sense of these basics, it’s time to start incorporating moments in your daily routine which will help your child see that communication is indeed important and valuable.  No worries, you don’t have to do anything fancy or special.  Most of these ideas are free, or low-cost. Chances are, you already have a lot of toys, materials, and props at home that will spark your creativity.  Remember, just about any toy or object can be used as a “therapy” tool. 

The “gifts:” 

  • Have a family game night. Traditional favorites will do the trick.The speech payoffs here: turn-taking, counting, requesting, being a good sport, and other communication opportunities.   
  • Visit your public library. Let your child find some books of interest and then read them to her. Speech payoff: child-directed learning, introduction to new vocabulary, 1:1 time with you in which you are modeling pronunciation and articulation. You might even hear some sounds or word approximations from your child! 
  • Experience and connect with nature. Speech payoff: identify and describe what you see, hear, and smell. Think holistically—this is more than just a walk in the park.  (image source: http://www.roundmidnightmusic.co.uk/page5.htm)

  • Exercise by biking or sledding, walking, or swinging. Speech payoff: vocalizations and words are often heard with movement.  Exercise also increases self-confidence, which these kiddos need more than anything. Children with CAS often crave movement. 
  • Do some art. Speech payoff: Besides the 1:1 time all kids need, it also unleashes creative potential and gives you something to talk about: “What color should we make the tree?” Practice saying “tree” or “green” while you’re at it.  tree pine(image source: http://zoe1297.wordpress.com/2009/07/20/not-pointing-fingers/tree-pine/)
  • Listen to music. Speech payoff: Kids need physical movement, and what better way to get them to move than with some rockin’ tunes? Encourage singing; even if they can’tget the lyrics out, they can hum along. Plus, music has a positive effect on mood—even yours!  
  • Bake cookies or cupcakes. Speech payoff: identify ingredients as you toss them into the bowl, have your child repeat the words (flour, sugar, butter, etc.) if she is able, talk about shapes as you roll out sugar cookies. Share your cookies with friends and neighbors and let your child do some of the talking—if possible—when the two of you deliver the goodies. It can be as simple as saying, “cookie” or “bake”–even an approximation will do.   (image source: http://www.life123.com/parenting/young-children/cooking-with-kids/teaching-the-joy-of-baking-to-kids.shtml)

And when it’s all said and done (yes, pun intended), you can sit back and be proud, not just of your child—but of your efforts as a parent as well.  Who knew you had it in you?!  Thanks for giving your child the gift of a lifetime; the gift of speech. 

Bio: Leslie Lindsay is a former child/adolescent psychiatric R.N. at the Mayo Clinic.  Her daughter, Kate is in 2nd grade and recovering from CAS.  Kate's Tooth! 004

Say That Again?!: How SLPs Can Help Parents Cope with CAS

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By Leslie Lindsay

(image source: http://flhealthykids.wordpress.com/2010/07/)

If you have been reading SPEAKING OF APRAXIA (Woodbine House, 2012) then you know each chapter concludes with a summary called, “Say That Again?!”  In spirit of the book, this series on Apraxia Monday will be the “Say That Again” series.   Ready? 

Future SLPs:  Our Children with CAS Need your TLC

By Leslie Lindsay, R.N. B.S.N.

You won’t soon forget her.  The red hair and blue eyes the size of saucers will linger in your memory.  So, too will the fact that she is as fire-y and energetic as that copper hair that cascades down her back, framing her freckled face with possibility. 

And when you hear her speak, you may have an inkling that she once suffered from moderate to severe childhood apraxia of speech (CAS), or you may be none the wiser. Although Kate is a bright, creative, and eager soon-to-be 2nd grader, she has overcome a road block most of us never have to deal with: a struggle to communicate expressively. 

And why do I share this? 

Since you are about to embark into an exciting profession of working with children and their families, I’d like you to have an inside view of what it’s like to raise a child with CAS.

  • We are hurting.  We feel a sense of loss in our child’s lack of verbal communication.  We are grieving.  We didn’t want this to happen.  Heck, most of us don’t even know what CAS is! 
  • We are frustrated.  We don’t know what we are doing wrong (some of us blame ourselves on our child’s inability to speak).  It’s hard to live a life where we only hear our child(ren) point and grunt to get their needs met. 
  • We feel all alone. It’s not every day you run into someone else who is also struggling with CAS.  It often feels like it is “us” against “the world.”  If you know of anyone else who is open to connecting for play dates or support groups, hook us up!
  • We have a lot of other concerns.  It may be that we have to take off work early—or stop working altogether to make sure our child gets to speech therapy.  Money may be tight.  Our insurance may be giving us a hard time.  The demands of raising a family, running a household, and dealing with apraxia may have taken a toll on our relationships. 
  • We have a full, busy life.  Apraxia and speech therapy is a part of our life, but we are many things to many people.  Please respect our time. 
  • Deep down, we just want to have a “normal” kid.  When we overhear a precocious 3-year old chatting with his mommy or daddy at the local park or coffee shop, our heart breaks.  “Why can’t that be my kid?!”
  • We worry.  Will this ever get better?  Will my child be able to talk—when?  What do I need to do? 
  • We want to help.  Let us into your speech-pathology world.  You don’t have to give away all of the secrets to the trade, but let us be your partner. 

As a professional SLP, here’s what you can do to help smooth our path: Graduate student working with a child(image source: http://splh.ku.edu/ipcd/)

  • Give us homework, tips, ideas, and more information on childhood apraxia.  Some folks may request this, others might not know what they need or want.  Feel us out.  If you come across something in your professional life you think will help, but all means, pass it on. 
  • Treat us with respect and compassion.  We know a lot about our children and we want to help them. 
  • But don’t tiptoe around our feelings. Go ahead, lay it on me.  Tell me that CAS is serious and complex and can take years to remediate.  Tell me, too that you will do all you can to help my child learn to speak verbally and that we are in this together.  I need that right now. 
  • Ask us about our home life.  We may have some inside tips to help you with our child in therapy.  For example, she really does get scared of bubbles; please do not blow them with her.  She can’t go anywhere without her favorite stuffed puppy.  Let her bring him to therapy and perhaps incorporate him into your activities. 

You see, as a former R.N. who worked with children day and night in an inpatient child psychiatry program at the Mayo Clinic, I know that children and their families matter.  We are not simply a diagnosis who needs treatment.  We are real people, with real feelings and real lives. 

It is because of my daughter Kate that I wrote the first book designed for parents on this complex neurologically-based motor speech disorder.  SPEAKING OF APRAXIA: A PARENT’S GUIDE TO CHILDHOOD APRAXIA OF SPEECH(Woodbine House, 2012) is as much as labor of love as it is a resource to help others along their apraxia journey.

The book is comprised of over 300 pages of tips, ideas, research, and more on various topics related—not just to CAS—but other speech disorders from suspecting a problem to getting treatment (what that treatment consists of), school challenges, what you can do at home, family coping, child coping, networking, advocating, and co-morbid conditions.  Sprinkled throughout are quotes from parents speaking out about apraxia—what helped, what mattered, and what challenged them. 

Speaking of Apraxia is a must-have for every practicing pediatric SLP.  Read what others are saying:

” I was so excited to open up my Advancefor SLPs magazine today and see your book advertised! Your ‘baby’ is out there. I wish you lots and lots of success with it!”–R.W.

An SLP in Missouri shares this: “I already have a couple of families in mind that I am excited to tell about Speaking of Apraxia. What a great resource!”

“I could feel your blood, sweat and tears as I flipped through the pages (wiping my eyes).Outstanding!  I just shook my head in amazement…I am in awe and I am still kind of speechless…really! This book will be just one of your legacies…well done!!”

–T.K.P., CCC-SLP in Minnesota

And remember, our kids need your special touch.  For without the “magic” of dedicated SLPs, our children with apraxia wouldn’t be able to make the gains they do.  Thank you. 

[this article was written for, and first appeared on The Future SLPs Blog, ,http://www.futureslps.com/1/post/2012/08/future-slps-our-children-with-cas-need-your-tlc.html)

 Bio:  Leslie Lindsay is former child/adolescent psych R.N. at the Mayo Clinic-Rochester. She is the mother of two school-aged daughters and a basset hound, named Sally. Lindsay and her family reside in the Chicago suburbs where she writes full-time. She is the author of “Speaking of Apraxia: A Parents’ Guide to Childhood Apraxia of Speech” (Woodbine House, March 2012). Read more on her blog, “Practical Parenting…with a Twist” where she writes about apraxia, parenting, education, and more 5 days a week, www.leslie4kids.wordpress.com


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Apraxia Monday: Assessment and Diagnosis, an excerpt from Chapter 4

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By Leslie Lindsay

Here’s chapter 4 from Speaking of Apraxia: A Parent’s Guide to Childhood Apraxia of Speech.  Here, you’ll get a glimpse of what it’s like to go to the very first (initial assessment) appointment with your child, what the SLP is doing and why…read on to learn more.

At the Appointment :

You’re there. You might be excited, nervous, indifferent, or in complete denial. Depending on the type of SLP you have—and how she or he prefers to work—you’ll likely see a combination approach to formal and informal testing at your first appointment. If your SLP is completely informal, you may be skeptical of his or her approach. “How can playing with Play-Doh and blowing bubbles really help?” you may wonder.

Your SLP should have enough toys to hold your child’s attention for a good hour or so. You’ll want to feel like you just walked into a toy superstore. But on another note, it should be organized and well-maintained, and not too overwhelming. A good SLP will know this and perhaps only bring out a few items at a time.

Besides developing trust and rapport and assessing your child’s behavior, your therapist is busy evaluating. Remember how your child’s job is to play? Well, your SLP’s “play” is her work. Here are some components of a typical speech-language evaluation:

  • Behavioral Observations: How your child engages in play, whether or not the play style is developmentally appropriate/similar to other kids this age, alertness/attentiveness/excitability. Be sure to point out to your therapist if the behavior is an accurate representation of your child’s abilities.
  • Pragmatics: Your therapist is evaluating how your child uses language to communicate with others in his environment. Examples of pragmatics include: responding to other’s vocalizations, point to/show/give objects, making eye contact, responding to greetings, and controlling behavior.
  • Gesture: How does your child uses gesture to express thought and intent without spoken language? Examples of gestures include taking on/off articles of clothing when asked, “dancing” to music, pushing a stroller/shopping cart.
  • Play: Time for fun! Really this piece of the evaluation determines your child’s development of representational thought. This is really a fancy way of saying, “your child’s ability to think in analogies; to understand symbols and infer meaning.” Can he show how to play with a toy in different ways? Hand a toy to an adult for assistance? Group objects together? Use two toys together? Put toys away when asked? This is also an opportunity to see your child’s temperament and personality; important for planning future speech sessions.
  • Language Comprehension (Receptive Language):  Determines how well your child attends to, processes, understands, retains, and integrates spoken language with and without linguistic cues. This      may be tested by asking your child to pick just one object from a group, follow two-step commands, identify body parts/clothing items on himself, and perhaps follow novel commands.
  • Language Expression (Expressive Language):  Examines how easily your child can put words together to express himself verbally to others. If your child is able to sign certain concepts such as      “more” or “thank you”—it’s still considered “expressive language,” though not verbal. Your therapist is looking to see if your child can shake his head yes/no, name an object, say several meaningful words, consistently identify 5-7 familiar objects when asked, or use single words correctly and frequently. (See Chapter 2 for more information about receptive and expressive language.)
  • Speech and Articulation: What speech sounds are in your child’s repertoire, and how accurately and meaningfully does he      produce them? Does “down” sound like “done?” If so, he is unable to      differentiate her speech. Does your child have one word that represents several different concepts? (Kate’s word was “nanni.” It meant “Grandma,” “pacifier,” and “blanket.”) Does your child appear to be looking for the right word,  but come up empty-handed (groping)? Does he grunt, squeal, and scream to      get his needs met?
  • Motor-Speech Examination (MSE): An essential tool for speech pathologists faced with diagnosing CAS is the MSE. The child is asked to imitate utterances of increasing length and complexity. Your SLP is looking to see if your child can make the same sounds in different contexts. When the SLP makes modifications to the MSE by slowing down the rate or by giving the child cues (by touch or gesture), she can begin to determine severity, and even get clues for determining the prognosis.
  • Oral Motor Skills: Do your child’s tongue, lips, jaw, and facial muscles work together to formulate words? Are facial and oral features symmetrical? Can he smile, frown, and press his lips together? Your SLP might use a flavored tongue depressor and gloves (mention if your child has a latex allergy) to examine his mouth. This can be tricky—some kids hate the idea of having someone’s gloved hand in their mouth and some kids are painfully reminded of the dentist or doctor. Your SLP should ask you and your child if this is acceptable. Some therapists will allow your child to play with the instruments used for this examination.
  • Feeding: Your child may be asked to eat something like a cracker or cookie and take a drink of water (or  juice). This will assess whether your child has any difficulty drinking, swallowing, chewing, or aspirating (drawing in air and liquid at the same time—choking). Your SLP will also ask if you have observed any eating difficulties at home. Pay close attention to the texture of foods that your child eats well and those he doesn’t (does he hate applesauce, but eat yogurt in earnest?). Mention them to the SLP, as well as any food allergies or insensitivities your child may have.

Leslie Lindsay is a child/adolescent psych R.N. turned author.  Speaking of Apraxia: A Parent’s Guide to Childhood Apraxia of Speech is the first-ever book written for parents exclusively on this complex, neurogically based motor speech disorder.  Published by Woodbine House, Inc (March 2012), a publisher providing high-quality special needs parenting resources since 1985, www.woodbinehouse.com.  Speaking of Apraxia is also being offered through www.Amazon.com

Apraxia Monday: Chapter 3 Excerpt

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By Leslie Lindsay

If you have been following along recently, you know that Speaking of Apraxia: A Parent’s Guide to Childhood Apraxia of Speech will be released later this month.  It’s been a long–but overall good–journey in which I have been reading, writing, and revising to get this book into the hands of parents of children with CAS.  As a “count-down-to-release-day,” I am offering some excerpts of the book.  This one is on chapter 3:  Finding Help When You Suspect CAS. 

Here goes:

“As first-time parents, we didn’t want to appear “delinquent,” so when Kate was 15 months old, exactly, we headed to the doctor (the same one who delivered her) for her scheduled well-child check-up. I say “we,” because both doting parents were off work for the occasion. We came armed with our wiggly daughter; along with thoughts, questions, and toddler antics to relate to our doctor.

Kate was meeting all of her developmental milestones right on target. Except one: talking. She had only one word, “Hi.” I was excited that she had such a friendly and outgoing first word and proud that it was the one I had predicted she’d say first.

It seemed I had a natural extrovert (how did that happen with two self-proclaimed introvert parents?!). She was smiling and saying “hi” to strangers in the grocery store, on the playground, at the library.  After Dr. Baumgartner whirled into the exam room, plopped down and smiled at us, she asked a series of questions . . . was Kate doing this, doing that? Yes, yes, and yes, we nodded and smiled proudly. “Is she saying ‘mama’ and ‘dada’ and a few other words?” Nope. We held our breath, awaiting her response.

Sure, I was slightly concerned. After all, I had friends from childbirth class whose toddlers were jabbering up a storm. As a first-timer, however, I didn’t want to jump the gun. Kate was only 15 months old after all. She still wore diapers, took a pacifier when distressed, and was rocked to sleep. In many ways she was still a baby, and babies don’t talk, do they? Plus, I knew kids—through my years as baby-sitter and as a child psych nurse.

We told our doctor that all Kate was saying was “hi,” and that she started saying that around 13 months. Wasn’t that good enough? Our caring doctor probed a little further and eventually referred us to a local speech-language pathologist (SLP). “You can do it now, if you want to be aggressive, or wait until she is 18 months, if you want to take a conservative approach.”

I took the conservative approach. I finally made the call at 18 months. Kate still wasn’t saying “momma” and I wanted to hear my little girl call my name, instead of grunting when she needed me.

Enter the speech-language pathologist (SLP).  He or she is the key player in your child’s progress with speech and a sounding board for you.  He or she is also a professional with a master’s degree (some may have a PhD) with a background in communication disorders. SLPSs complete a practicum—usually a year in length—following their graduate program. SLPs are required to be licensed in the state in which they practice and must complete continuing education criteria to maintain their licensure. They are also accredited by the American-Speech-Language-Hearing Association (ASHA). They perform evaluations, deliver a diagnosis, carry out therapy, and recommend “homework” for you. They are also there to field questions and concerns and give you resources for additional information.

By the way, SLPs are the only professionals qualified to treat CAS. And while this is a subjective piece of information, you may also hear that an SLP’s diagnosis of CAS is more respected than that of another professional.”

Thanks for reading!  Like what you saw?  Want some more?  Head over to www.woodbinehouse.com for a $5 introductory savings off the book.  Speaking of Apraxia is also being offered by Amazon.  Pre-order now, book will be delivered to you hot-off-the-press in late March.

Apraxia Monday: How sibs can help with apraxia

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By Leslie Lindsay

I have two kids.  Both of them have red hair.  Both of them have blue eyes.  Both of them of girls.  But that is where the similarites come to an end.  You see, one of them is very, very precocious (read: talkative) and the other, well…not so much.  You know my comparison has nothing to do with love.  It has to do with Childhood Apraxia of Speech (CAS).

My oldest daughter has CAS.  Her younger sister does not.  When we first learned of the apraxia diagnosis, I was very focused on helping my older daughter get the help she needed.  I shuffled her to and from therapy, I got her into a great language-based preschool program.  I worried about and read about apraxia.  I cried.  I laughed.  I saw glimmers of hope.

Now, at six years old, my daughter with CAS is doing a world better.  But, being the oldest, she’s a little sensitive about her speech skills not being quite “up to par” as her chatty little sister.  What’s a parent to do?!

A few weeks ago, I interviewed Angela Baublitz, mother of a daughter with CAS and author of “I Want to be Your Friend,” (a book intended for children about CAS available through Apraxia-KIDS, www.apraxia-kids.org).  She mentioned several tips for siblings in regards to CAS.  Keep in mind, though that Angela’s son is older and it’s her daughter who has CAS.  It may be easier for older non-CAS sibs to take on the roles Angela mentions:

“[My son] protects his sister a lot.  Should someone start to make fun of my daughter for the way she talks, he is right there defending her.”  She also gives these tips to parents:

  • Keep open communication  with the Non-CAS child so they can understand what the CAS child is going   through. 
  • Also make sure the Non-CAS child has free time by themselves to  play with other children and alone time with parents.
  • Make sure the Non-CAS child is sharing how he feels with you. 
  • Try to go on with life with a positive  attitude, treat both children the same
  • Socialize with other families–do not isolate your family from this speech problem
  • Have fun in life

I’d love to hear from you all–how have you balanced the CAS diagnosis with the other demands and children of your family?!  Email me today, leslie_lindsay@hotmail.com or post a comment in today’s blog.