ITS is very expensive and doesn't take insurance. Hard to get ahold of. Skip them. We used National Speech. You can also try the clinic at U of MD if you are private paying. We were happy with them too. If child is talking that much its probably not apraxia.

Anonymous wrote:OP here, many thanks. Any good recommendations for therapists who deal with CAS or at least offer a range of different therapies in the Silver Spring/ MoCo area? I feel like I have read good things about ITS on these boards.

Try the Speech Space. Tons of experience with motor planning issues. Our son has apraxia and Megan Littlepage had been incredible with him. We’ve got a long road ahead of us, but Megan has made us feel hopeful. They also come to your house which has made the logistical nightmare of two working parents and speech therapy (that we’d like to attend) 2-3x a week, possible.

Anonymous wrote:OP here, many thanks. Any good recommendations for therapists who deal with CAS or at least offer a range of different therapies in the Silver Spring/ MoCo area? I feel like I have read good things about ITS on these boards.

Try ITS. Also Center for Communication and Learning or SpeechKids (they will come to your child).

OP- You do want to deal with any speech issue with your son at all possible in the early years because it can have a lifelong impact. I have the nicest nephew who was a preemie of about 3 weeks early with no diagnosis of any deficits at birth. However, he has had a stuttering issue in speech since a child. They did the best therapy intervention, but at a certain point he just decided to stop. He also had some mild LDs but with a lot of support from his parents he did well in a boys parochial high school and went onto graduate from a smaller college away, but close enough to get some support as needed at times. The speech deficits definitely have had a social impact on him and now in the work world, he definitely is behind peers in terms of the kinds of job he could hold and where he is working in seeking a management training spot. What struck me in your post is that beside the stuttering which can occur, it does appear to take him a slight amount of time to phrase what he wants to say which I realize in part is due to strategies to control the stuttering, but I would also say in framing what he wants to say,too.

Since our youngest daughter has a disability and continuing articulation issues in speech, I am more attune to what you are raising. With our daughter, when she is focused she can frame what she wants to say, too quickly, and come out with a stream of information that at times we can't decipher. With her, you have to sort of accept a certain level of unintelligibility. However, I can also see in single words that if the pronounciation is not caught clearly at first the initial incorrect pattern can linger as in a word such as "avocado." I think it is important to get a very detailed speech evaluation done based on recommendations from those whose children have similar needs of your son. You want to look at all the aspects of correct letter sound production as this will have an impact in reading, articulation and stuttering. A good SLP ca help you prioritize what goals would be worked on first. I also second private therapy as school based is most often small group now and in private you have the consistency AND you can be told what skills in the home to reenforce,too. We did private twice a week, year-round in the early years and then dropped to once a week. In our daughter's case, appropriate speech was key to demonstrating what she knew and to helping her do well in a job setting, too.

OP here, many thanks. Any good recommendations for therapists who deal with CAS or at least offer a range of different therapies in the Silver Spring/ MoCo area? I feel like I have read good things about ITS on these boards.

CAS is extremely rare and and an overused diagnosis, but that doesn't mean motor planning issues don't exist. Frequent practice is required to create new motor patterns. I'd ask for something simple you can work on each day for five minutes at home. I would supplement with private b/c more service now means less service later and it is good to have multiple minds and approaches to find what works. Also, private time will be one on one, which generally isn't possible when provided by the county. In this instance, frequency is more important that the length of an individual session. Vowel errors a bit of a red flag, but don't necessarily point to apraxia. Children with true apraxia are highly unintelligible and often end up using AAC. The vowel errors would lead me to an ENT to evaluate hearing and middle ear function.

I would add private. We found the county services were insufficient for all 3 of our kids. I would also think about finding someone who works with children with apraxia (CAS) even though your son wasn’t diagnosed with it. It sounds like he is displaying some of the features (vowel distortions and inconsistent errors). One of my kids has resolved apraxia but a second one has phonological disorder. My son with phonological disorder was stalled in traditional therapy but made tremendous progress when he switched to his brothers SLP that treats CAS.

By the way, I often see PROMPT mentioned as the only therapy for apraxia. This isn’t true anymore. It’s a great proven approach but there are others. My son’s SLP (who specialized in CAS) used a combination approach that worked exceptionally well.

My kid is doing PROMPT therapy for articulation issues. I think it is good. I posted a few posts below about does it matter WHY he has speech issues.

I am at a bit of a cross-roads in terms of therapy for DS, a 4 yr-old, who has been receiving MoCo speech therapy, 1x a week for speech issues that mainly concern articulation. He was late speaker, with only a couple words at 2 yrs. He went on to progress well in terms of vocab and speech acquisition (and is at least average in those areas), but his articulation was always greatly delayed and he was frequently unintelligible, even to us, until about 3 yrs. I probably should have looked into private therapy earlier, but he has been progressing quickly and there are no cognitive concerns--beyond the wacky articulation. Even today he does not only have atypical consonant substitutions, but also vowel distortions in words he finds difficult to pronounce.

So would you supplement with private? And if so, what type of therapy? Sometimes there almost seems an apraxia-like quality to his issues and I wonder about PROMPT or some more specialized therapy. Obviously his issues are not so severe, but he often seems to be searching for a sound, to the point that he has a bit of a "stutter" before any complicated sentence. And he also had low-tone issues as a baby, though they resolved quickly and we only did physical therapy for a couple months.

Hoping someone may have some insight dealing with similar issues. Thanks!