Need advice on how best to proceed on suspected apraxia in my 21-22 mo old son
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Anonymous
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My son has a very limited and inconsistent vocabulary. He has said mama, dada, up, mamao (papaya in portuguese), and george (for Curious george). He babbles the rest of the time, or grunts, points, etc. His receptive language is really good in both English and Portuguese. We live in Brazil right now due to my husband's job, but our homebase is DC.
After a speech eval at about 20 mos, we started him in ST (so we're about 6 weeks in). He attend 2x/wk for 30 min. They have recently told us that they suspect apraxia. Because we do live abroad, our options are somewhat limited in terms of English-speaking SLPs (we speak English at home, but we have a nanny who speaks only Portuguese with him). We will be in the States in October and plan to try to schedule an EI evaluation as well as a private evaluation with a ST that is certified in PROMPT therapy because I'd like to get the opinion of someone who works quite a bit with apraxic children. I know we have have to take one step at a time, but I'm just trying to think ahead. Say the U.S.-based SLP agrees that he might be apraxic, I'd appreciate your thoughts on what we should do. The SLP that he's been working with seems to have a good connection with our son, and they believe that he's already made some progress. I don't know--it's too soon for me to say. But they do not really agree with the PROMPT approach. They think it's too aggressive for a young toddler. They rely on a multisensory approach with touch cues. But I've read that PROMPT techniques can be really effective for apraxic children. I want to make sure that we make the most of this year between ages 2-3 because I know it's a critical time. We would consider moving back to DC earlier than next summer, when we're scheduled to return, if it would mean better treatment for him. I'm wondering whether we should continue to see how he progresses here given that he seems to have a good connection (so far) with his SLP or consider finding an SLP in DC that uses some PROMPT. I also haven't fully developed the confidence in the SLP practice here, but some of that may be because I just generally have this idea that we would be in better hands in the States. The downside is that I will definitely have to work (prob full-time) when we return, whereas here I'm able to stay at home with him (and sometimes work part-time from home, hence the nanny). I feel this is also important--for me to be with him in these early years and could be just as helpful? I'm reeling from all of this quite a bit so I apologize for the long post. If you made it this far, thank you! |
Anonymous
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I would not get hung up on approaches. PROMPT is a good approach but it's one approach. Exposing him to speech therapy is the important thing.
I also would not get hung up on diagnosis and whether the US based evaluation agrees. That's a senseless goal. Both therapists could be excellent and head in different directions and have a different sense of your child. Concentrate on doing as much as you can for him and working with his therapist(s) on home exercises. Given that you are in a foreign country, join Facebook groups for late talkers, for apraxia, for kids with speech problems, and so forth. Fantastic ideas and modelling for you about homework you can do with him. |
Anonymous
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OP - you should go on Facebook and ask to join the Apraxia Kids group (run by CASANA). There are even members from Brazil and several well respected SLPs who can give you advice.
Prompt is not the only therapy that works for kids with this diagnosis - most important is that you find an SLP who k owns how to treat a motor speech disorder. CASANA offers training and webinars for SLPs who want to learn how to treat kids with apraxia. |
Anonymous
| I would find an professional with an expertise in bilingual language acquisition. My friend's kid was nearly put in special ed, simply due to an assessment that determined she was behind in her English acquisition. Bilingual language acquisition is not linear. |
Anonymous
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Gabrielle Nicolette would be a good SLP to try and see while in DC.
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Anonymous
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Wow. OP here. Thank you so much for the quick responses and thoughts. Being out here in a different country can feel so isolating, esp during difficult times. Thank you for that.
I'll try not to get too focused on the approach. I think it's hard because this practice is sort of the only game in town when it comes to English speech therapy so I have a lot of what ifs going through my head. Also I don't feel like we're getting a lot of direction on what we should be doing at home. And I haven't been able to observe how they're working with our son, so it all seems a bit abstract to me. They've told me he's behind in an expressive language and on target for receptive language but just in those terms. I really don't know at what level (age-wise) he's at in those two areas. It's all more informal. Nothing on paper. And I don't feel like they have dealt with a lot of apraxic children. I asked this question, and they talked about two kids. I'm assuming there's more but again everything is in generalities, and my confidence in them is just not there yet. I'll check out those groups. I appreciate it. |
Anonymous
PROMPT was proven not to be evidenced based, so skip it. |
Anonymous
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OP,
Apraxia is often a blanket term that early evaluation folks use for kids who are behind on speech. It may or may not mean anything. It doesn't matter if you do speech in Portuguese or English, just as long as it's a certified SLP who is good with kids. This is a great resources for parents with young kids who have speech delays: https://www.amazon.com/Takes-Two-Talk-Practical-Children/dp/0921145195/ref=sr_1_1?s=books&ie=UTF8&qid=1472500304&sr=1-1&keywords=it+takes+two+to+talk BTW, don't worry (just in case you were) about more than one language--it doesn't cause speech delays. Lastly, take him to an ENT and make sure his hearing is okay. |
Anonymous
That's not a speech delay issue; more of an ESL issue. |
Anonymous
| How long will you be here for? You need to be calling NOW for October appointments and even then it will be close. You may also not get any hard and fast answers; with just one visit to assess your child, it may be difficult to give you a full picture of what's going on. If he is getting therapy in Brazil, that's great! If you think he would do better here, it might be better to move home sooner rather than later. I can't advise much better than this unfortunately; it can take awhile to evaluate and tease out what causes these delays and how significant they are and I'm not sure a one time visit will accomplish that, or help you reformulate a plan in Brazil if they don't follow the same approach. |
Anonymous
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The CASANA website has a database of all SLPs who have been through their intensive 'bootcamp' program for apraxia. Link below.
Many are PROMPT trained but some of the best are not. Explain you're coming from out of the country most will try and fit uou in. http://www.apraxia-kids.org/about-casana/casana-recognized-clinicians/ |
Anonymous
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I'd try to see Jodi Kumar at GW University.
She is an expert. level 2 prompt trained and has also been through CASANA training. For older kids (age 6-9) she runs a summer intensive camp for kids and their families. Their treatment rooms have two-way mirrors so you can watch therapy and see what is being done. The flyer for the camp is below, and on it is her contact information. https://speechhearing.columbian.gwu.edu/sites/speechhearing.columbian.gwu.edu/files/downloads/CHAMP%202015%20Brochure.pdf |
Anonymous
| OP again. Thanks so much for this wealth of information and advice. Currently we are just planning on going to Texas for our October visit (that's where family resides), though I am wondering whether we should add a trip to DC to meet with some specialists there. It doesn't look like there are CASANA-trained SLPs in Austin, though I did find some that were PROMPT trained (so I'm assuming they have more specialization in apraxia). Thanks for the DC suggestions. They will be helpful to me in the future for sure, if not now. |
Anonymous
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You could try a Children's Hospital in Austin.
OP, if you're already doing ST and there aren't any glaring red flags (sorry for the hackneyed phrase), another evaluation probably won't be necessary at this point, e.g., things that fall under the "Act Early" category: http://www.cdc.gov/ncbddd/actearly/milestones/milestones-18mo.html |
Anonymous
Post on the Apraxia Kids Facebook page and tell them you're looking for experienced apraxia SLPs in Austin. Someone will have suggestions and may be able to provide feedback on the PROMPT-trained folks you've found.https://www.facebook.com/groups/apraxia.kids.group/ |