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SLP Mommy of Apraxia: July 2014

Tuesday, July 29, 2014

Minimal pair sort

I have a little guy in therapy right now who has a difficult time with /st/ blends.  He consistently drops the /s/ in this blend only.  To bring awareness to what he saying, SLP's many times employ what is referred to as "minimal pair" therapy.

Minimal pairs are two words that are similar except for one sound.  Many times, minimal pairs rhyme if the only sound changed occurs at the beginning of the word.

In this case, I created five minimal pairs found hereST MINIMAL PAIRS

I had him sort all initial /t/ words first.  He then traced his finger on the /s/ while making his "hissing sound" and then said the word.

For example: "ssssssssssssss....tool."  I then asked him what word he said, and we added the minimal pair "stool."

Having him physically sort the pictures and use his finger to trace the /s/ has a purpose.  Research is showing an increased connection between our hands and mouth.  (Think of when you're trying to find a word you might circle your fingers etc).

Having the child use their hands adds another pathway to the brain to aid in recall!

Finally, save this tray because the possibilities are endless and I will have more ideas in the future.

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Saturday, July 26, 2014

DIY "Park your speech!"

Do you have a kiddo who LOVES cars and needs a different activity besides flash cards to work on his speech sounds? Check out this super easy parking lot activity.

I bought a cheap black poster board from the dollar store, and mapped out a street and parking spaces using white and yellow crayons.

This boy was working on ST blends so we said "stop" each time he parked a car; however you could glue pictures or write target word or sounds into the spaces and have them say it each time they "parked" a car!

It's also great if the child is only at the single sound level. Just repeat the sound and pretend it's the sound of the engine!

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Friday, July 25, 2014

Language with a loom

OT and PTs can have fun and creative activities for children. They provide good tactile and/or sensory activities that can also be great for practicing speech and language at the same time. 

This loom idea from the Inspired Treehouse is a perfect example! For instructions on this easy to make loom check it out here! http://theinspiredtreehouse.com/fine-motor-activities-simple-outdoor-weaving-loom/

We started first by cutting strips of material...a good fine motor activity. When my kids are cutting I have them say something for each cut. You can just make the /k/ sound, say "cut" if you're working on initial /k/, final /t/, or on your CVC syllable shapes for apraxia therapy. For Ashlynn, we said "snip" since we are working in CCVC syllable shapes, including /s/ blends. 

You could also practice sentences that you could set to song like "Are you sleeping" but sing "Are you cutting, are you cutting, yes I am!" 

Melodic intonation therapy like this is easy and fun for parents to do at home!

Next, we set our sites on weaving. This activity is great for locational words such as: top, middle, bottom, under, over, up. Kids with language processing deficits frequently have difficultly with comprehension and following directions that include these concepts. 

Ashlynn kept wanting to start in the middle of the loom and I had to keep reminding her and showing her to start at the bottom. Then while we were weaving we chanted "in then out, in then out" to get practice with these concepts; however you could also practice saying just "in" or "out" or "up" if you're working on VC syllable shapes.

When you're done you can give silly directions like, "throw the ball OVER the loom" or "roll the ball "UNDER" the loom. 

We made this over a course of two days and now the kids have a little hideaway in the backyard!

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Thursday, July 24, 2014

Speech & Language with puzzles

Sorting is an important foundational skill that sets up the building blocks for logical thinking and organizing.  These skills are necessary for later educational development in math (i.e. order of operations, geometry), reading (identifying main idea and relevant details), and writing (developing a topic sentence and organzing relevant details).

Most parents have simple puzzles like this at home.  When my daughter was two, I held the pieces and gave her two choices.  She would have to make a sound or word approximation (because of the severe apraxia) to request and then I would give her a piece and she would find the appropriate place.

Now that she is 4, I laid out the pieces as you see below, and she sorted them using a sentence: "A cat is a pet."  "A tiger is a zoo animal."

To promote pre-literacy skills (exposure to print, print awareness), I wrote the name of the category on a sticky note and put it above the puzzle.

That's it!  Happy playing!

Skills addressed:
Expressive language
Early-literacy skills

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Wednesday, July 23, 2014

CV BINGO printable FREE!!

Speech therapy for apraxia requires a motor based treatment approach that works up through a hierarchy of syllable shapes with lots of repetition, repetition, repetition.  Unfortunately, repeating the same syllable shapes is limiting and many times boring. 
I decided to create some BINGO game sheets that can be used, starting with the CV syllable shape.  Look for more to come if you're interested!

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Monday, July 21, 2014

Why we need milestones, and why I can still be proud of my daughter.

I recently read a blog article about not buying into speech and language milestones.  The writer asserts:

"Because here's what I think of traditional milestones: f*ck them............My baby will do that when she's ready. This is not the Olympics, people."

She went onto explain that parents seem to make milestones into some sort of competition, and she doesn't want to buy into that.  I get her point probably even more poignantly that she does.  

My child was late with all of her milestones, and because she was late, I felt the sting and continue to feel the sting every time someone else's child on social media or in my life meets a milestone with which my daughter still struggles.   

This author was already sick of the comparisons, real or imagined, and just wanted to enjoy her baby.  Yeah I can relate, but lucky for her it seems, her child was just on their own timeline and would still go on to develop typically.  Some kids aren't so lucky, and those "milestones" become very important so that kids can get early intervention when they need it.

Oh she goes onto say, "Is your pediatrician happy at your baby's checkups? Good......remind yourself that no one's counting."

Unless of course your pediatrician IS concerned, or worse they're not and your child misses valuable early intervention.  

Oh, and no one's counting, unless of course you get to feel a punch to the gut when you are faced with low standard scores, percentile ranks, and descriptors like "definite dysfunction" or "severe apraxia of speech" or "below average," in black and white reports that have your child's name on the top.  Lucky for her, her pediatrician is happy and no one is counting.  

What about the other kids she wasn't considering who don't meet them?  

Yes, milestones make any parent crazy.  Yes, parents can get stuck on being overly proud of their offspring, but then again, they should be.  They're the parent!  I'm proud of Ashlynn for other qualities that maybe some other kids her age don't yet possess as adeptly including: 

And why shouldn't I be?  I'm her parent, and I'm supposed to be proud of what she is good at.  I don't look at other parents with disdain who have kids meeting or blowing the lid off the milestones.  Jealousy maybe, but not disdain.  I think, good for them.  They should be proud of their child,  and every child deserves and needs their parents to be proud of them for their unique God given talents.

So, I decided to write a printable for the parents who are forced to look at milestones.  Who have googled milestones and felt the pit in their stomach when they know their child isn't meeting them. I wrote this so that parents will not say "F*ck them" but will instead pull up their big girl panties, and get the help they need for their child, no matter how hard and painful it is.

Speech and Language Milestones: Birth to 3

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Wednesday, July 16, 2014

Speech and Language with Post it Notes

My daughter loves Post it Notes.  LOVES them.  She loves writing some small scribble on them and then proudly sticking them up around the house to put on display.

Today we drew pictures that included her target sounds to work on speech, but we also drew shapes to work on our pre-writing strokes for OT.

Based on the response from my facebook post, my kid's not alone in loving them!  Try it!  Easy and fun way to get speech practice in at home.

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Friday, July 11, 2014

"I love you mommy!"

These words are cherished by any parent.  These words are eagerly anticipated.  When you have a child with a speech delay, the eager anticipation eventually gives way to desperation, and maybe, (though hopefully not) apathy.

Ashlynn has been able to say "I love you" for awhile now.  Once she really got good at imitating, we had her imitate it every time we told her goodnight and tucked her into bed.  Now that she's older, she automatically says it after we say it in any situation, and we are happy.  We are very happy.

Today though, I heard these words spontaneously.  She said them in a moment of pure joy and blessed me with them.

First, a little back story.  I've been home for a month now on summer break with my kids. It's awesome and exhausting.

I am admittedly not an artistic person, and I really could live without the messes that art creates.  I'm a writer.  Writing is so clean.  A pen and paper is all you need to create beauty out of words, which then are easily put away until later.

Kids are not writers.  They do not yet appreciate the beauty within words, but they love a good mess.  A good mess and me are not on good terms.  However, kids and neatness are not on good terms either....so what is a mom to do?

Ashlynn begs to do messy things.  Play with play-doh and proceed to get it everywhere including in her hair, in her shoe, and ground into the carpet even though she's playing on the tile in the kitchen.

Let it go mama.

Play with water in the sink.  Except the water inevitably ends up in a huge puddle all over the (small) counter, the floor, her shirt, her pants, and possibly needing a change of underwear.

Let it go mama

Play with the dirt outside.  However, the dirt somehow happens to turn into mud that gets under her fingernails, in her shoes, on her shirt, and again ground into the carpet that is INSIDE my house even though she was playing outside.

Let it go mama.

And I really have been trying.  Messes make her happy.  The tactile input is helpful for her SPD (sensory processing disorder).  I've really, really been trying to just accept the mess.

Today I was at Target getting some odds and ends.  I'm not an impulse shopper.  I only buy necessities and if I do I usually have a coupon or it was on sale.  I saw the dollar bins and I decided to take a peek.  I'm also not a window shopper, so this is unusual as well, but you know, I've become more flexible this summer and I don't know what has gotten into me.

I ran across foam stickers and my memory instantly recalled paper after paper that came home in Ashlynn's backpack this year full of random papers that had some scribbles and foam stickers on them.  I would never buy foam stickers.  What a waste.  They serve no purpose.  You put them on paper and then throw the paper away.  What's the point?  Something in me though remembered all of those papers and thought Ashlynn really likes these things.  I stood there awhile debating.  They were only a dollar, but it seemed like such a waste!!  But I think, Ashlynn really likes creating with them and (and this is my internal argument that allowed me to buy them) they are good for bilateral hand coordination since you need both hands and fine motor control to get the paper off the back.

I bought them.  Good.  Ashlynn will practice fine motor skills.  I'm a good mama.

I brought them home and she was happy.  Not overly happy, but happy.  She was busily creating when she randomly walked over to me and tapped me on the leg.

"Mama, Mama, MAMA!!"

"What honey?"

"I love you!!"

I'm stunned.  What on Earth prompted this?  And that's when I looked a few feet beyond her to the messy table, backs of foam stickers littering my carpet, and paper after paper full of foam stickers.

I gave her the biggest hug.  I might have cried.

As it turns out, a good mess and me have gotten closer.

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Wednesday, July 9, 2014

Seeing the numbers in black and white are equivelant to a punch in the stomach

This is the score I knew would be low, but still feels like a punch to the stomach when I see it in black and white.  Why is it so hard to see it in black in white??  I knew it would be low.  I KNEW it would be low.  The OT is my co-worker and friend.  She asked me if she could go over the report with me before she gave it to me.  I brushed her off explaining I had heard her give numerous reports to other parents.  I understand her report.  No need to cushion the blow.

But the 4th percentile??  I've heard these scores at IEP meetings.  The 4th percentile means out of 100 kids, Ashlynn did better than 4.  Than 4!!  


I knew it would be low, but this hurts. My poor baby.

"She would benefit from occupational therapy services to address gross and fine motor skills, self-help skills, attention, transitioning, and sensory processing skills."

So basically, Ashlynn needs help in every area the field of occupational therapy addresses.  I don't know if that's accurate but that's what it feels like.

On the sensory scales she has "definite dysfunction" in Balance and Motion, Planning and Ideas, and in Total Sensory Systems.  

Double sigh.  "Definite Dysfunction" is fun to read.  Blah. 

I"m sure there's a plus side to all of this, and I'm sure I could find the silver lining like a I normally do and will; but for now, blah.  This sucks.  Apraxia sucks.  My daughter is too sweet to have something like this.  She doesn't deserve it and I hate it.

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Early literacy skills: Print awareness activity

The other night I was reading this book to Ashlynn.

If you're not familiar with the "David" books, they center around the main character David who is mischievous and frequently getting into trouble.  

These books are great for early print awareness!  As you can see, the print is larger and is written as though a child wrote it.  Ashlynn kept pointing out all the capital letters she recognized from her name.  Her favorite was /S/ and she would declare, "Look!  That's in my name!"  This is great for transfer of early letter recognition skills. 

The sentences are typically short, and contain no more than maybe 5 words per sentence.  On some pages, the words are separated onto separate bits of paper (see below).  

The reason this is great is because you can get your child pointing to each word.  This doesn't mean they need to be reading the word.  They just begin to get an understanding that those combination of symbols denote an orthographic representation of a word.  Ashlynn can't read, but she is starting to get the hang of pointing to each word while she reads (from memorizing the book).

As a bonus, the stories are relatable and entertaining to your child, allowing you work on oral language as well.

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Tuesday, July 8, 2014

You play dirt with me?

We took our annual Fourth of July camping trip to Glendo State Reservoir in Wyoming.   It's a family tradition, so I decided to document her progress each year.  Last year's experience can be found here: Glendo 2013
This was only a few short days after our near drowning incident at her pool during swimming lessons.

Glendo is a HUGE reservoir, and a lot of our time involves the beach.  I was worried about Ashlynn's safety, and also if she would be too scared to go in the water.  The first day she kept her distance from the shoreline; however, the second day she walked to the shoreline and was watching her dad who was floating in the water maybe 10 feet away. Sensing she wanted to come in, he held out his arms.  I didn't see him at first and my sister motioned to me that it looked like she was going to go in.  I went running to her, but stopped just short behind her.

I saw my husband with arms outstretched encouraging her to come to him, and then I saw her little shoulders rise up big as she took a deep breath, and she marched in the water.  She marched through the waves, keeping her balance, until she fell into his arms with a big smile upon her face.  He hoisted her up into a floaty with him to enjoy floating in the water under the warm sunshine.

I looked on in awe.  She's so brave.  Her character is quite astounding to me, and I'm her mother.  She faces challenges, fears, and obstacles head on.  She never gives up. She is determined and resilient.

She also of course, rode our jet ski.  I wrote last year that she asked, "Ashlylnn play boats with daddy?" and this year, she announced proudly after riding, "I ride the je-si huh!"

One of her favorite requests this year was, "you play dirt with me?"  imploring anyone who would listen to play in the sand with her.  No one had the heart to say no, so she made quite a few friends and suckered in quite a few family members!

When it was time for fireworks, Ashlynn has historically stayed in the car.  However, this year, she again put on a brave face and ended up enjoying the show!  At times she would say, "that was too close!!!" but she never went back in the truck.

I like documenting some of her milestones on the Fourth of July, Independence Day.  It's so fitting since each year she becomes more and more independent.

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Tuesday, July 1, 2014

I saw the light go out in her eyes

I saw the light go out in her eyes as she floated buoyant, but motionless under water. Her eyes staring out in front of her.

I wish this was the beginning to some fictional novel, but instead it's what happened today at swim lessons. This is on the heels of great success in swimming I just wrote about last week Good teachers change lives
If you know me, it's no secret I have an over active inhalation and freak out whenever I think my kids are getting hurt, but today this was no false alarm.

I'm shaking typing this. As a mom, sometimes you have to keep it together and find strength you didn't know you have to reassure your child even when you know you will fall apart.

I was sitting poolside about 20 feet away behind the red line so "lifeguards can do their job." Two life guards keep watch on the side, and as I've mentioned before, Ashlynn has had to be rescued twice.
Ashlynn is getting more comfortable in the water. She can stand in it, so she's been venturing out more with the other kids to do her head bobs and bubbles while the teacher does individual instruction.

I have to watch my little man too who is good but active wondering around a play structure they have there. I looked at the water and Ashlynn was underneath doing a head bob. I turned away to make sure Jace was in view. I looked back to the pool and Ashlynn was still under water. She was struggling silently and I saw her trying to reach the top of the water with her chin, but because she was freaking out she wasn't putting her feet down.

I ran over.

"Ashlynn!" I screamed.

Other parents stepped forward. The lifeguards were still talking.

I looked over at them while crouching poolside and screamed, "someone help my baby!!"

The lifeguards didn't move. I looked back at Ashlynn and, and, ugh.....I can't get this image out of my head.

She stopped struggling. She was in a sitting position under water staring into nothing. I jumped in and pulled her out. I patted her back and looked at her blue lips. It was probably only a few seconds, or maybe even one, but it seemed like an eternity and then she started coughing.   Then she cried and I have never been so relieved in my entire life.

I wanted to cry tears of anger, of relief, of joy, but she was so scared I had to dig deep. I didn't yell at the lifeguards (though the pool will be hearing from me), and I put on a smile and told her it was okay.  Even after this, the lifeguards casually looked over asking "what happened?"

Josh her instructor came over and was incredible. He put on his big smile and reassured her for close to five minutes. We both knew she had to get back in the pool, because if she didn't she might never go back in.  He and I coaxed her back.  I hear his voice and I don't know what he said but it was soothing to me so it must have been soothing to her.  He made her smile.

I happened to look back and it felt like a dream. Parents had their hands over their mouths. I see them in slow motion. They almost witnessed a tragedy.....and the tragedy was MY daughter. Another parent told me that's why she always sits on the side of the pool regardless of the red line. I hear her voice as muffled confusion. A grandmother told me she's had to save both of her grandkids last year. Her voice is just jumbled confusion.

All I can see is the light that left my daughter's eyes.

Ashlynn has had a Mormon blessing and a Catholic baptism, and I know she was saved today.

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Ashlynn summer speech therapy 3.9 years

Ashlynn received two grants to help with her speech and occupational therapy over the summer!  The United Health Care Foundation and the Lindsay Foundation made it possible!  I am so grateful.  Ashlynn will be back to getting intensive 1:1 speech and OT services.  

As far as speech goes, Ashlynn communicates her wants and needs.  She has basic conversational skills and really does try to tell us what happened in her day.  Sometimes when she's talking, I see my husband look at her with pride in his eye and I know what he's thinking.   Even though we don't always understand what she is saying, it is amazing to listen to her talk and try to tell us things.  She was silent for so long.  

I love her speech therapist.  She was actually my mentor and is now one of my good friends.  She's fun, but I also know she'll push her.  However, I also know she'll find the deficits and the continued deficits are hard to be faced with and make me sad.  I want to write it down though, because if I know anything about Ashlynn, I know she'll overcome it.

- She has significant word finding issues.  Sometimes, she needs so much wait time that eventually she even forgets what she wanted to say and moves onto something else.  
- Her attention continues to negatively impact her progress
- When something is hard, she changes the subject and tries to talk about something else
- Auditory processing skills such as auditory discrimination between minimal pairs (sleep, seep) appear to be impacted.  
- Grammar, including marking varying tenses and using s/v agreement along with pronoun usage are faulty
- Syntax is jumbled, particularly for question forms
- Still has a tendency to assimilate sounds she knows how to say (goggy/doggy), and continues to be inconsistent with her production of consonants in her repertoire (koys/toys). 
- Needs continued work with /l/ and /r/
- Continues to breakdown with novel multi-syllabic words
- Receptive language skills continue to need monitoring

That's a long list, but I have to remind myself it used to be longer.  She'll get there.  I know it.  There was a time I worried if she would ever make friends because she couldn't talk to them.  Here she is at the splash park talking to perfect strangers and making friends.  One step at a time.

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