Apraxia diagnosis disagreement and best course of action

[Anonymous]

hi everyone. My DS is 3 In 2 months. A month before two we had county eval with infants and toddlers and he was diagnosed with expressive language disorder and all other testing in normal range. We started in home therapy with county an hour a week. Four months in and Progress was really slow so county suggested supplementing with private which we did. Six month in to county and 3 month into private DS stRated back at daycare full time after being home with bilingual nanny for a year. County therapist says she thinks he has apraxia and is one of her harder cases and recommends 2.5 hour language class twice a week at 3 and to transition to IEP. I ask private therapist she agrees moderate apraxia that was severe But after a language boom in October he moved to moderate. I research and question the diagnosis as do some pediatrician family Members and friends.

I find out about Mary Camarata and she comes and does eval after his biggest boom in jan where he can almost parrot anything now. She says 100 percent not apraxia, goes to his daycare and says he is thriving and highLy intelligent from her testing etc. He has phonological disorder, keep him in his great private daycare where he is thriving, keep doing private once a week and work with him at home. Close county case no IEP it will be too much stress and schedule disruption and not worth it. Let him be a kid and he will catch up In about two years and just need fine tuning when entering kinder. Can't tell you how how wonderful this all went.

His county and private say she is seeing DS after great progress which is why she says no apraxia and just artic is left. County therapist still thinks at least get IEP since he currenTry qualifies and do the 45 minute class at local school. DH wants to follow Mary and close the case. Thoughts? Any similar experiences? I need to decide this week whether to Proceed with IEP process or not but I already said no to hour bus ride each way for 2.5 hour language class. Thanks for any advice or thoughts!

[Anonymous]

Follow Mary, follow Mary, follow Mary (and your DH).

[Anonymous]

Boy, that's tough. Obviously, I can't opine on whether your DS has apraxia or not. Mine DS has apraxia and a severe language/communication disorder. Language acquisition was painfully slow and he never had what 'normally' would be called a language explosion but, for him, it was noticeable.

I can tell you that no matter your DS's challenge, if you're in FCPS, the county special ed preschool is wonderful - even if it's an hour away. DS loved the bus. I also wouldn't rule out an IEP. The bar for getting one seems to be lower before a kid enters kindergarten. If you think it would be a hassle now, it's much worse once a kid enters K. Having been through it both ways, I'd say it's better to have it and not fully use it than want it and have to wait to get it.

[Anonymous]

Anonymous wrote:

Follow Mary, follow Mary, follow Mary (and your DH).

I have only talked to Mary, but we saw her husband. I think Apraxia is very over diagnosed and one of those catch alls. I would increase the private and stay at the private day care, if possible. Bump up private to twice a week. You could also look at U of MD LEAP or the U of MD clinic which is much more affordable if you do not have insurance coverage.

They are not big fans of public programs as most are not geared to speech delayed kids. He recommend we keep our child at our private program till he catches up.

You can also try it, see if it helps and if not pull out.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Follow Mary, follow Mary, follow Mary (and your DH).

I have only talked to Mary, but we saw her husband. I think Apraxia is very over diagnosed and one of those catch alls. I would increase the private and stay at the private day care, if possible. Bump up private to twice a week. You could also look at U of MD LEAP or the U of MD clinic which is much more affordable if you do not have insurance coverage.

They are not big fans of public programs as most are not geared to speech delayed kids. He recommend we keep our child at our private program till he catches up.

You can also try it, see if it helps and if not pull out.

There are specific, public programs for kids with speech delays, and obviously a "speech class" would be geared for a child with speech delays.

OP, early intervention routinely labels speech delays as "apraxia." At this point, it's not very relevant. If your kid is continuing to make progress and is happy in the current preschool/day care, keep the private speech as it is. Only increase it if it's necessary.

You can always re-visit the issue of an IEP at any point down the road if necessary.

[Anonymous]

I would take the middle road. The public school's obligation is to offer a program that they think meets your child's needs completely. It sounds as though your child benefits from preschool, so their suggestion of preschool makes sense. They can only suggest their own programs, but if you've found another program that you like and he's thriving then I'd keep him there.

But I don't see the harm of having him keep his IEP, and receive speech therapy from the county. If he was getting speech therapy during his "language explosion" then I'd be open to the possibility that it contributed to his growth, and I'd keep it up. Worst (best?) case scenario, is he continues to progress wonderfully, and you'll never know whether the speech therapy contributed to the progress or was a waste of time. On the other hand, if he still has delays at the beginning of Kindergarten, then having a good working relationship with the county will be crucial for that transition.

Given all that, I'd probably split the difference, I'd reject the apraxia diagnosis at this time, and the language class, but keep him seeing the county speech therapist once a week, and continue with an IEP under a speech language impairment label.

[Anonymous]

Curious if your child ever had "groping" with speech. My child does have dyspraxia as well as dysarthria (he's 8 now). However, it is so complex to diagnose and the many slpeech paths we had always stated the "groping" was the distinguishing feature. Also, I have been told by many that it should never be diagnosed until right around 3.

If your child has articulation issues still , you are going to want to keep an Iep in place through early elementary. Easier to keep it now

[Anonymous]

It will be much easier to transition to services in Kindergarten (and he will likely still need services) if he has an IEP in place with the county. You are nuts not to go through the process just because it is "inconvenient".

[Anonymous]

Keep the IEP! At worst your son gets 45 minutes extra speech help and had that safety net there of qualifying for services in case his progress slows.

[Anonymous]

OP here, Thanks for the advice so far I will talk with DH more and convey the experience and opinions here. Let me be clear though if we did not do the IEP it is in no way related to "inconvenience." That is absurd. It would be based on following Mary's opinion that at newly turned 3 an excellent private daycare working with him, a private therapist working with him and his parent working with him is enough to meet his needs in a way that is specifically tailored to him and allows him to have a nice and structured routine and sti be a kid. The thought was a class once a week via the county where once the kids are settled they have 20 minutes in a group setting would not provide him enough speech benefit for the effort. I definitely don't think it would hurt in anyway but I also want him to have fun and be the awesome kid that he is and not overburden him if that makes sense. Thanks for all the advice I appreciate it

[Anonymous]

If there is not a huge benefit, I'd increase private and keep up what you are doing. 20 minutes of group therapy doesn't seem worth it to me.

[Anonymous]

I wouldn't close the case. I would accept the IEP for the 45 minutes of itinerant speech and then decide later on if you want your child to attend or not. That way it is still open. Once you close an IEP it is a pain to get it back. Or, you can also go extended C with infants and toddlers and have the SLP check in with you so keep a tab on DS's progress.

[Anonymous]

Ditto on keeping the IEP open. It is harder to get an IEP in K, so if he needs additional support he may not get it. If you plan to stay in private school through elementary, then this won't matter.

[Anonymous]

Another vote for keeping the IEP open. Like PPs said, it can be hard to get back once it's gone. My child (who has apraxia) also had huge speech explosions and progressed swiftly from severe apraxia to mild. But the demands on speech and language don't plateau as kids age, and my child continues to need speech therapy to (barely) keep up with the more complex social interactions that come in K. Whatever your child's diagnosis, it can't hurt to keep the option open and to get a little extra therapy at the same time.

[Anonymous]

I'm all for listening to Mary. I've been involved in forums for late talkers since my child was about 18 months old (she's 12 now), and have met many people who've seen Mary over the years. For the folks who are still around, Mary's predictions have been right on.