November 5, 2013

Let's Talk Tuesday - Q&A With An SLP & Mommy of Apraxia

'Let's Talk Tuesday' is a bi-weekly post series with ideas on how you can help your child of any ability, but especially those with Apraxia, Autism, speech disorders or late talkers. These are meant to be simple ways to encourage speech. I am not a speech therapist, but I am a mom of an Apraxic child, I am just sharing these ideas in hopes that they will help someone else. 

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Today I am so excited to welcome Laura from SLP Mommy of Apraxia!  In case you didn't realize by her blog's name, she's a certified SLP & a mom of a daughter with Apraxia... a unique combination!  We decided that it would be fun to do a little Q&A session for this week's Let's Talk Tuesday.


Me:  Tell us a little bit about yourself, your background as an SLP & your family.

Laura:  Thanks for having me! I’m excited to be able to talk about my professional and personal experiences with Childhood Apraxia of Speech (CAS). My name is Laura Smith, and I’ve been an SLP since 2005. I am a Denver native, born and raised, and received my BA from the Metropolitan State University in Denver, and my MA at the University of Northern Colorado. I currently work for a large school district in the metro area, and a private practice, Lowry Speech therapy where I specialize in working with children who have CAS.
I have always been interested in Apraxia since my second year of being an SLP. A little boy who was nonverbal appeared on my caseload. One day, he pulled out an alphabet BINGO, and proceeded to say all the sounds individually. He couldn’t blend any sounds though. A light bulb went on, and my search into treating CAS began. 

In 2009, I had my daughter. She never babbled, and at one year she only said “hi.” I worked with her every night doing traditional early intervention therapy, but she still gained sounds and words at an excruciatingly slow pace. I finally took her in before her third Birthday, and she was diagnosed with CAS and other motor delays, which I now realize is termed global Apraxia.

Me:  Did you change as an SLP when you found out your daughter had Apraxia? 

Laura:  I changed so much as an SLP when I found out my daughter had Apraxia. For one, I experienced firsthand all the feelings of guilt: that I somehow didn’t take enough prenatal vitamins, I should have refused the petocin, should have breastfed longer, didn’t talk to her enough even though I did therapy with her everyday etc. Even though I know it was nothing I did, a mother can’t help but go through all of those emotions and worries.

I know now that a mother knows her child better than ANY professional in the world. A mother knows when something is not right, even when they don’t know what it is, and I try to be very aware of that now when I’m talking with parents.

I also am now on a mission to become an expert in Apraxia and to try and spread much needed awareness to even other SLP’s in the field.

Me:  What is the difference between an SLP & a speech therapist?

Laura:  An SLP stands for Speech/Language Pathologist. It’s the term used by our professional organization. Many of us say we are speech therapists because the term is more understood by the public. However, do make sure your SLP has their C’s, or Clinical Certificate of Competence (CCC). Some people say they are a speech therapist because they haven’t received the certification through the American Speech and Hearing Association (ASHA), and therefore can’t say they are an SLP.

Me:  At what point should someone contact a speech therapist or SLP for their child?

Laura:  In my opinion, don’t wait! Early intervention is free! Even if you have some suspicion, it doesn’t hurt to take them in and get them evaluated by a professional. Warning signs include: little to no babbling, limited repertoire of consonant or vowel sounds, difficulty combining sounds, words that were once produced aren’t produced again, and not combing words by age 2. This is a very limited list, so as a mom to a mom, TRUST your gut. Moms know their child better than anyone.

Me:  What can we do as parents to make the most of our child's speech therapy appointments?

Laura:  Go in with them and follow through with the homework! I know SLP’s who don’t like parents in the session, but a good SLP won’t mind. You can learn so much from sitting in there with your child that you can then carry over to all other aspects of their lives. In this way, homework won’t necessarily have to be a worksheet and cards because you will know how to sneak (transfer) their learned skills into your everyday routines.

Me:  What are your top 5 suggestions for how parents can encourage speech development at home?

Laura:  Great question! Parents are their kids’ best and first teacher!  

1.  One idea I love is just to read with your child every night. Books are a great and fun tool to promote speech and language development. For Apraxia, repetitive books are even better. These include books like: Brown Bear, Brown Bear, Five Little Monkeys, and Pete the Cat. The repetition decreases the cognitive load and allows for a level of predictability. Your child can fill in a word or phrase depending on their level of ability. For example, in Brown Bear, you might have your child fill in: “I see a white dog looking at ____.”  

2.  For the young child, nursery rhymes and songs are also great. The more exposure they have to the song, you can do the same thing. You can sing it and then pause, allowing them to fill in a word. My daughter’s favorite song was Baby Bumblebee. I would pause after bumble and wait for her to say, “bee.” Bee is also an easy CV (consonant-vowel) syllable shape that kids with Apraxia will learn first.

3.  David Hammer, an Apraxia expert out of Pittsburgh advocates the following, “For children who have the cognitive capacity to understand picture stimuli, I find that an essential component to early therapy is the development of a “core vocabulary” book. This involves the inclusion of photographic pictures into a “Grandma’s Brag Book” (small photo album). The photos should consist of meaningful people, toys, and objects in the child’s life as well as words that contain initially targeted sound sequences. This book often serves as a child’s first success at expansion of functional communication interactions with significant others.” I have also found this in my personal experience to have been effective with every child with CAS whom I have treated. They absolutely love it, and by including words they can already say, it builds their confidence.

4.  Pair sounds with movement. When you’re on the swing for example say, “whee!” Don’t get discouraged if your child doesn’t repeat with you. In the early stages, they won’t, but trust that it IS going in receptively.  

5.  Finally, always be in contact with the SLP so you are aware of how to “up the ante.” Apraxia is tough and has to be treated aggressively. If a child can say, “I want milk” and you let them say “milk” they will not learn to use the sentence because it’s easier to say “milk” and they get what they want. If they know how to say “bye,” don’t let them get away with a wave. Make them say “bye” every time. If they know how to say “bye momma” don’t let them just get away with saying “bye.” Apraxia is all about repetition and getting it into the motor plan. The more practice they have throughout their day, the faster you will see progress.

Me:  What is your favorite part about your job as an SLP?

Laura:  I love the kids, and I love seeing them transform. I have so many great experiences, but one I’ll share is with a Kindergarten boy with undiagnosed Apraxia of Speech who showed up on my caseload essentially nonverbal. After I finally realized he had CAS, and after a full semester of drilling his core vocabulary words and drilling those vowels and basic syllable shapes, his dad came in to listen to all of his hard work. I didn’t realize it was the first time his dad had ever heard him say “dada” and he broke down in tears. This was before my daughter was born, and it was one of the most powerful experiences of my life. So many more have directed me on the path toward treating CAS, but that was definitely the catapult.  

Me:  What tips do you have for us on how to peacefully get what our child needs in IEP meetings? / Do you have any tips for parents regarding IEP meetings?

Laura:  Ideally, every SLP in the schools would know that Apraxia needs to be treated with more frequency and intensity than other disorders. In addition, they would know that they need to use a motor based approach to therapy, as the traditional approaches won’t be effective, or as effective. Finally, they would be given the time from their district to be able to service these kids the way they need.

Unfortunately, the schools many times don’t have the resources to see you child with the frequency they actually need, which is why there are so many stories of parents having to “fight” to get appropriate services. Unfortunately, CAS has only been recognized by ASHA as being a separate disorder in 2007. Unless the SLP has attended conferences for Apraxia, they will be doing what they have always done, and may not be aware of the new research. In addition, I have some fellow colleagues who graduated as recently as 2008, and had their professors tell them Apraxia isn’t a true disorder!! In my experience though, most SLP’s want to help the children and would be open to you bringing in the following articles:

ASHA - Childhood Apraxia
Apraxia-Kids - Speech Therapy for Children with Apraxia

Hopefully, this can start a friendly dialogue. Unfortunately, the schools many times don’t have the resources to see you child with the frequency they actually need, which is why there are so many stories of parents having to “fight “ to get appropriate services.

Thank you so much for having me! I am so passionate about CAS, and I welcome any opportunity to spread awareness, give parents therapy ideas, review iPad apps, etc. Please feel free to have anyone check out my blog SLP Mommy of Apraxia where I do all of the above and also give updates on my 4 year old daughter’s journey with CAS.

Laura is a certified SLP who is passionate about working with children with Childhood Apraxia of Speech (CAS), following her own daughter’s diagnosis several years ago. Laura publishes a blog to help support other families with children living with CAS: Visit her at SLP Mommy of Apraxia.

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