Speech Therapy - What to Expect? Really Need Input!

[belle&sebastiansmom]

What should I expect from speech therapy?

My son just turned 2. His speech evaluations place him at a 9 month old level in expressive speech. Basically he babbles some consonant and vowel sounds, no real words for anything or anyone. Developmentally and behaviorally he tested on level.

He has worked with a speech therapist for almost 3 months now. One hour per week (it is through a state run program). He has made no progress.

Every week the therapist does the EXACT same thing. Brings out a doll, "say baby. ba-ba-ba-baby." Brings out a toy train, "say choo choo." Brings out a bowl and spoon, "say mmmmm."

I've spoken to her supervisor about my concerns, that my son is not learning, that the therapist never changes her tactics based on my son's behavior for the day, that she doesn't seem to have a connection (or even a clue) with my child or how to handle a young kid, she gets as frustrated as my son does. The supervisor came and evaluated my son, and really didn't do too much more than his therapist (who, for what it's worth, is not licensed, but just graduated and is working on her C's.) All she said was if I have any more concerns, call her. The therapist also is unable to answer my questions. My son's pediatrician brought up apraxia. I asked the therapist several times about this, she said she'd get back to me, never has.

So is this all that speech therapy entails? She's not doing anything with my son that I don't do and haven't done for the past two years, every day, all day long.

Before I make my concerns known to request (demand) another therapist, I need to know if this is typical. This is a state program, we were on a waiting list for over two months (not enough therapists) just to get this girl.

What should a speech therapist do for a toddler with no words?

 

[everylastbreath]

I have no experience with speech therapy for toddlers, but just wanted to tell you something that might help you feel better - my son didn't really speak until he was 3, just grunted basically, boys are just naturally slow in speech I have found and it was confirmed with my GS who is now 4 and was exactly the same way. At 2 years old, I think most girls are speaking really well, boys on the other hand are like little primative people, grunts, sounds, etc. I don't know if I would be seriously concerned about it until he turns 3, things change overnight with little ones. Is this your first / only child?

 

[Lisa loves Pooh]

Sounds like he may have apraxia and the speech therapy may be useless if they don't treat him for that.

My son was eval'd by the therapist on his first visit (since she hadn't met him yet) and she tried basic thigns for 3 months and we had ZERO progress.

Then we got 2 days a week/30 minutes each and she began using the treatments for apraxia (Kauffman cards--breaking down words to a most basic level to encourage ANY kind of copying) and we got progress.

He just got approved for 3 days, but I am too sick to do that right now.

1 year later--he can speak, though us understanding him is difficult.

He has a ways to go, but it will turn around. But I would have them consider Speech Apraxia.

My son started with vowel cards--and his speech therapist also uses facial cues by touching certain aspects of his face for mouth position or feeling to give him an idea of what to do.

IMHO--and in my therapists opinion--1 hour in 1 session is way too long and is probabyl the root of the frustrations along with perhaps an incorrect approach.


For example--we haen't done baby yet (we focus on SINGLE syllable words)--but if we had baby as a word...it would be broken down to baaaa---beeeee and if that didn't work then it would be aaaaa----eeeeeee.

My son would say EEEEE and he would get praise for copying a portin of the word. after several weeks of consistency with that,then they'd try to get him to addd the aaaaaaaaa----usually takes longer though for him to connect two sounds together though without promption.

The Kauffman approach is fabulous!

In the mean time--we supplemented with signing and used Baby signing times and that helped with some of our gaps while waiting for his speech to work on catching up to his language capabiilities.

Again--if it is apraxia--the speech therapist is spinning her wheels. Traditional speech therapy will not work for an apraxic child. The work is focused on getting the mouth to approximate sounds.

My son has been in for 1 year--and we are working on words an consanants--but all words are still single syllable.

For train he does a whistle type sound and says ooo-oooo.

In practice--it started off with aaaaa--nnnnnn the "t"--aaaaaaiiinnnn. He cannot really do consonant blends yet. "Ch" is too difficult for the therapist to be using with him.

 

[freckles and boo]

I have to disagree with any "wait and see" advice. My daughter wasn't talking at two, either. All the in-laws said "Oh, her father was a late talker. She will be fine." In my heart I knew that wasn't the case but I wanted to believe it so we waited. We later discovered that she is autistic. She did begin to speak near her third birthday with crisp diction but none of her speech was meaningful until after her fourth birthday. Her speech finally became language after we dealt with her sensory problems. I am not suggesting your son is autistic, OP, but I am saying that you are right to be concerned. Ask your pediatrician for a referral and see if you can get therapy that way. I regret the time we waited.

 

[mtemm]

both of my boys received EI services at the age of 2 for expressive speech delays. they had no other issues and were both speaking fine over the course of the year. they had different therapists and both did far more than it sounds like yourse is doing. each brought an array of toys and the kids had so much fun. both were speech pathologists and really seemed to know what they were doing, from what I could tell. definitely addressed any concerns I had.

I had a friend who had a very different experience with her son. he started services by age 2 as well, but she said his therapist didn't seem to do much with him, and did not address any concerns she had. he was 4 before he was diagnosed with autism. she wishes she had pushed harder and earlier for better services/better therapists.

 

[mjkacmom]

My ds received ST starting at 20 months. Everyone kept telling me it's because he's the youngest of 5, he's a boy, he's a twin... He also drooled a lot, and it turned out he had weak mouth muscles. After 3 months of ST, he went from zero words to tons of words! My nephew was diagnosed with apraxia before he turned 3. My sister had a horrible ST, who her ds didn't like. She had the team come out to observe, they made a change, and he's doing much better.

 

[Val]

My DD12 has significant hearing loss, and has been in speech therapy since she was 2! At first the speech therapist (private- we paid out of pocket, but she was a friend of mine from the university) came to our house 2x/week. She did lots of activity based work- ate a meal, colored, etc.....it often seemed as if she was "just playing" with DD, but if you watched closely, she was prying speech out of DD. Once DD got into school, she also had speech therapy there 2x week. In school they seemed to focus on voice and pronunciations. At home, the therapy continued but began to focus on language issues- grammar, fluency, and once DD began reading- a huge emphasis on phonics and reading skills.

Fast forward to today. DD has pull-out speech 1x/week at school and 1x/week at home. Most of the work is correcting "s" and "r" sounds, working on voice volume, and then reading/language skills. Even given the massive number of hours of speech therapy, DD has no phonemic awareness- spelling and pronouncing words are hard when you can't hear them very well. Her IEP addresses some of the language issues.

That being said, my daughter is oral (her primary language is verbal, not sign), she reads at a 12th grade level although she is only in the 6th grade, and she is a straight A student. She has trouble understanding oral instructions, can't spell her way out of a box, and when her hearing aids are out or she is excited/tired, she can be really, really difficult to understand. BLESS all speech therapists......my DD is an active, typically moody 12 year old who doesn't look or sound too different because of the massive efforts of her speech therapists!!!!!! Have to add that the audiologists and her teacher of the deaf are absolute angels, too.

IF you are NOT seeing progress- scream, kick, complain. Find a different therapist....we had a few in school that didn't work as well as others. One problem with having a child with developmental/academic issues is that you must fight like crazy and remain vigilant.....don't let your guard down and listen to your gut instinct. Your little one can't fight for himself- he needs you to do that.

Good luck! God Bless, and remember- things WILL get better!

 

[minkydog]

I'm assuming that your child has been evaluated by an audiologist? Because that comes first.

I agree with you that speech therapy needs to be started. I am not in the wait & see crowd. If your ped is concerned and you are concerned, then there probably is something to be concerned about. The speech therapy you are describing doesn't sound like any speech my son ever had. Christian is non-verbal and mentally handicapped. He has been in speech therapy since he was 9 months old. Of course, his situation is differnt than your child's but his ST has been very good. For one thing, none of his sessions went more than 30 min, and a lot of them were only 15 due to his short attention span.

A lot of Christian's speech therapy has appeared as play therapy. For him, getting him to pay attention was Job 1. They have worked on words, signs, and pictures with various degrees of success. It sounds like you're not very satisfied with this therapist, and frankly you raise several red flags. The fact that she blew you off when you asked about apraxia tells me that she's not very familiar with it. The fact that she doesn't change up her treatment a little is worrisome. They usually do work a similar program most of the time, but when it's obviously not connecting you have to try something else. That's just common sense.

To tell you the truth, the best ST Christian ever had was hippotherapy--therapeutic horseback riding. Something about being on that horse woke up his senses and he made more progress during that time than any other. We went once a week for 1/2 hour. sometimes he couldn't make it the whole 1/2 hour and our therapist charged accordingly. You have to look to find these programs, but they're out there. Our ST took Medicaid, too, so we ended up having only nominal out of pocket expence.

I hope you can find a Speech therapist who can help your child more. The 0-5 years are such an important window. You're doing the right thing to seek treament now.

 

[tazdev3225]

I agree with the previous posters who said do not wait and see. My DGS did not talk at 18 months, just da-ee for daddy. I argued with his pediatrician who said wait. At 2 she said wait. At 2 1/2 after he lost his insurance she said maybe there's a problem. DUH! He was evaluated and has a hearing loss, talks on the level of about 18 month, he's 3 1/2, and now goes to a special needs preschool for speech therapy and dealing with the behavioral issues because of his frustration with non-communication. We are now fighting the state for the medicaid he is entitled to for further testing and possibly hearing aids. OP if the hearing has not been tested do it immediately and give the therapy some time. Once a week is not going show a significant improvement yet.

 

[Lisa loves Pooh]

About the audiologist--I know lots of people suggest that.

The issue is that her son's receptive language is fine.


My son's is as well. He understands completely what you are telling him. (he's learned colors and letters before he can say them for example.)

While an audiologist will help rule out a hearing loss, often--a child who goes through an early steps process that tests everything, would have had issues on receptive language/following directions at an age appropriate level.

I would still expect the present speech therapist to immediately change the course of therapy under the assumption of apraxia versus waiting for a hearing test that likely not show a problem given the rest of his eval results.

 

[hearingaidmom]

About the audiologist--I know lots of people suggest that.

The issue is that her son's receptive language is fine.


My son's is as well. He understands completely what you are telling him. (he's learned colors and letters before he can say them for example.)

While an audiologist will help rule out a hearing loss, often--a child who goes through an early steps process that tests everything, would have had issues on receptive language/following directions at an age appropriate level.

I would still expect the present speech therapist to immediately change the course of therapy under the assumption of apraxia versus waiting for a hearing test that likely not show a problem given the rest of his eval results.

I have to respectfully disagree with your thoughts on receptive language and hearing loss. My DS tested above age level for receptive language but behind for expressive speech. The hearing evaluation was done as an afterthought. We were shocked to discover he is hearing impaired. Kids have a way of compensating.

My DS has spent years in speech therapy. I think the OP needs to pursue a different therapist.

 

[mookie]

I don't have much time to post today, but I do have a lot of experience with Apraxia...my son was diagnosed with severe Apraxia at almost 3 years old. And audiologist is only part of the equation. There are many ways to treat Apraxia, but the most succesful one is the Kaufmann practice. It is also reccommended that patients receive short bursts of therapy several times/week.

Another option to try is a dev. pediatrician vs a reg. ped. They can help with special circumstances. Most Apraxic kids are referred to a nuerologist, as it is a proven neuro disorder.

This website is very helpful if you are interested. Good luck!

www.apraxia-kids.org

 

[mookie]

ps - also wanted to add, if you are unhappy woth your therapist...CHANGE IT. Don't waste time. you need to do what's in the best interest of your child.

 

[Desnik]

Do not take the "wait and see approach"! You are your sons only advocate and you must fight to get the right people to help him!

OK, sorry, just had to get that out!

My son was a preemie, had sever reflux, labeled failure to thrive and almost died at 6 months old. At around 20 months he had no words at all. He wasn't walking yet either. He had adversions to textures as well. He was evaluated because at first they thought it was autism. But he excelled in comprehension, and fine motor skills. His texture adversions stemmed from his reflux and adversions to textured foods. He also didn't like to be touched or have cream or powder put on him. Anyway, he had a year and a half of occupational therapy and he was cured of those things. But, he was evaluated, given tests, we took him to a feeding and swallowing center and he was seen by so many specialists because of the speech issue. He was diagnosed with apraxia of speech. Which basically means he knows what he wants to say but can't form the words. It is common for kids with severe reflux and texture issues to have apraxia. What really helped get rid of his frustrations with trying to communicate with us was sign language. His therapist would come 2 times a week for about 30-40 minuets. She right away taught him the basics for him in sign language like eat, sleep, food, drink, etc... She also took polaroid pictures of the things he would ask for, like a picture of me, my DH, my DD, his juice cup, his bed, etc... She put those on the fridge and when he couldn't say what he wanted we would take him to the fridge and have him point at it and I would then say the word. Can I tell you that she had him saying his first world, "banana" at the first session!! She would come in and play with him with his toys, read to him, craft with him and she was loud, upbeat, fun and through play taught him how to talk. She would sound out every word. We would use flash cards too. She included me in everything too and I would do the same things with him throughout the day. He had speech until he was 4 years old. It really is amazing to see how far he has come. But early intervention is the key! So, if you are not happy with the therapist and her methods, get a new one. It is your right and your sons to have a experienced, knowledgeable person working with him.

As far as the hearing test, not for nothing but any good pediatrician would perform that test first when dealing with a child who has no words at the age of 2. We were lucky that our pediatrician gave us a "heads up" early on that we will probably be dealing with issues with him and kept an eye on him and tested him right away. She was the one who told us about early intervention cause I never even heard of it or new those services were available.

Good luck! I know it can be a very difficult road but it is well worth it.

 

[cats mom]

I'm surprised that they scheduled a 2 year old for an hour long session. Yikes!
I think that's one of the first things I'd address.

As with anything; some therapists are great, some not so much. It sounds like there's not much of a connection between the therapist, your son, and you. But you all really need to be working as a team if you want to see progress.

Is requesting a different therapist an option?

 

[belle&sebastiansmom]

OP Here:

Thank you so much for your responses and stories about your own children.

Yes, my son has had a full audiological workup. Hearing loss was a huge concern. I can take a pot lid and drop it on the tile floor behind him and he won't even flinch. I can dangle metal bracelets behind his head and he doesn't notice. He had quite a few specialized hearing tests done he was put to "sleep" for. His hearing came out in the normal range. So that's not a problem, but it still doesn't seem normal his non-reaction to loud noises.

Also, we've tried signing with him from newborn. I even took a baby signing class with him. He won't do any signs. The family has incorporated several signs in our everyday life with him, but it hasn't helped.

I think I needed a kick in the pants, and after reading your responses I got that. I called the supervisor and requested a new therapist. The new therapist will begin on Monday!

 

[Desnik]

OP Here:

Thank you so much for your responses and stories about your own children.

Yes, my son has had a full audiological workup. Hearing loss was a huge concern. I can take a pot lid and drop it on the tile floor behind him and he won't even flinch. I can dangle metal bracelets behind his head and he doesn't notice. He had quite a few specialized hearing tests done he was put to "sleep" for. His hearing came out in the normal range. So that's not a problem, but it still doesn't seem normal his non-reaction to loud noises.

Also, we've tried signing with him from newborn. I even took a baby signing class with him. He won't do any signs. The family has incorporated several signs in our everyday life with him, but it hasn't helped.

I think I needed a kick in the pants, and after reading your responses I got that. I called the supervisor and requested a new therapist. The new therapist will begin on Monday!

Good for you!! That is great news! Let us know how it goes.