One of the first questions that parents of a child newly diagnosed with apraxia ask, is, what can I do at home? The fact that you are asking that question and reading this article are great signs that your child will make big strides toward recovery. In my opinion, the single biggest factor in the improvement of speech for your child is your commitment and involvement.
Since you have found the Apraxia-Kids website, and are continuing to read this article, I will assume that you are more than committed, and are willing to get involved in the treatment of your child.Congratulations!Your child is very lucky to have you, as you are one of the special parents that truly want to get involved.
Communication Is the Start
Now lets get into the good stuff. What can you do at home? Well, the first thing you have to do is to help your child communicate. It is especially frustrating for a child that has good comprehension skills and understands what you are saying, but can not communicate their desires. Just imagine, if today you had no voice.What would you do? You would not let yourself be cut off from the rest of the world; you would alter your method of communication.
As an adult, you might start writing messages on paper, type them on a computer, point, sign, gesture anything to get your message across. Now think about your child. Your child doesn’t have the same skills to express himself as you have as an adult. Your child probably does, however, have one very import thing in common with you a desire to communicate. So, you will have to help him. Although this doesn’t directly help your child to speak, it will certainly go a long way towards lowering his frustration level (and yours), and help him to understand the power of communication.
The question is, how? Well, this can be done in a variety of ways. One of the simplest ways to help your child communicate is to create picture boards. The concept is simple. The child uses a board containing a number of pictures that he can point to in order to get his message across. A number of picture boards can be created with different themes. For instance, you can have a board that contains breakfast foods like: toast, juice, milk, cereal, pop-tarts. You can create a board with toys and games your child might ask for, a board for places you child likes to go, a board with facial expressions representing emotions. Anything that you might want to hear from your child is a candidate for a picture board.
These boards can be easily created.You can simply get a piece of paper or cardboard and cut pictures out of magazines that represent the things you want on the picture board. If you can’t find pictures you want in a magazine, then take a picture of the items, get them developed and use those.Or, if you want to get a little more high-tech, you can use a digital camera to take the pictures, assemble the pictures you want on the computer and print out the completed picture board.That is what I did and I involved my son in the process. He helped me pick out items to photograph and put on the picture board. We hung up a number of them on the refrigerator, the wall of our family room and other places.
A high-tech version of the picture board is an augmentative communication device. These devices are portable picture boards, that when touched actually speak. If a child touches the picture of milk, then it says milk. I don’t personally know of many people that have used these. For one, they are very expensive. In addition, many children can improve their speech without them. However, for some children augmentative communication devices are great tools for learning expressive language skills (gaining experience at how words go together in our language) AND it gives them a way to communicate with those around them. If you are considering electronic communication devices it is advisable to find a speech language pathologist who has some expertise in AAC so that you purchase the best tool for your child.
Another tool that is commonly used at home is sign language. To this day I have mixed feeling about the use of sign language.I did use limited sign language with my son, and it was beneficial. However, when beginning the process of first learning some sign and then teaching it to my son, it was both scary and kind of fun. It was scary because, just like many other parents, I kept thinking that once he learned sign he wouldnt bother speaking. On the other hand it was fun because it was a new challenge for me, and it was something that our family was learning to do together. Many experienced therapists use sign language in therapy for children with apraxia (if even for a short while) but not as a replacement for practice on their speech production skills.
Sign language did help my son by allowing us to better understand basic ideas and words he was trying to express. Later on in his development, he utilized various signs to help remind him how to make certain sounds. And studies done by people much smarter than me have shown that sign language skills do not discourage the use of the spoken word. In fact, in many cases, just the opposite occurs. Children with apraxia often times need queues to help them speak. These signs not only help them communicate, but can help them learn and hone their speech skills.
One personal comment about teaching sign language. I feel that there is a delicate balance between teaching sign language and working with your child in other ways. I am firmly convinced that sign language can be beneficial to the recovery of your child. However, teaching sign takes time. I found that with my particular child, if I worked with him in other ways, I was getting him to produce real sounds.And then real words. However, working with him on both sign language and sounds was more than he could handle.There was a point in time when I decided that my time with him should be spent on working on things that are directly impacting his speech and I dropped the sign language. Of course every child is different, and yours may be better at handling various communication methods at the same time. Experiment, and be patient. And also you hopefully are getting the advice of a good SLP who is your guide in this process.
Now that youve got him communicating, you’ve got to encourage speech.The funny thing about raising a child with apraxia is that he didn’t wake up one day unable to speak. He or she never spoke or did not speak much and therefore you and your family adapted to the situation. You created a perfect home for a child with no or limited speech. The problem is that you want your child to learn to speak, and yet he is in your home environment that has become a place where he doesn’t really need to speak! I found myself desperate to respond to my childs attempts at communication. This meant responding to grunts, screams, rants, raves, kicks, hits, claps, pointing and on and on and on. Unfortunately, what this did is encourage my son to continue this practice. And it became habit. If this sounds like you, then youve got to break the habit. Not your childs habit – yours!
No parent should take my statements to mean that we have CAUSED our children to not speak. Nor am I suggesting the tortuous practice of demanding speech from a child who is truly not capable. But we also have to understand the reality that there comes a point in time – when you have gotten helpful therapy in place – that your home environment and your expectations have to change. Hopefully, a good SLP is holding your hand in this process of changing expectations.
Working with your child doesnt necessarily mean playing therapist. It doesn’t mean that you should commit x number of hours every day for homemade speech therapy. Helping your child with speech at home is more like a way of life. You’ll need to change your thinking and change your way of life. If you can do this, then you’ll be well on your way.
There are several things you can do to change your habits and encourage speech. Your child’s therapist needs to help you understand what your child is truly capable of saying and doing and what things he isn’t capable of yet. Then one of the first things you can do is stop responding to grunts!! Does this mean ignoring your child? Absolutely not! Let me give you an example. If you child points to the refrigerator and grunts, and you know she wants more juice and you know she can use say /mah/ and /jew/ you can say something like, “oh, you want more juice?” When your child verifies that you are correct, then you might say, “then tell me more juice.” Then you model one word at a time. You say, “more” and then wait for an attempt by your child. Then you say, “juice.” Again, wait for an attempt at the word. Or perhaps your child is currently only capable of producing the word attempt simultaneously with you. Fine! As long as they understand you expect a speech attempt. Then give lots of praise!T he idea is to illicit speech, not frustrate the child.
A friend of mine’s son had very severe apraxia and she found, through the guidance of her son’s therapist, that while he couldn’t produce many sounds or words initially, he could say ooh for no and ess for yes. And so in the example above, she would ask him, “Do you want juice?” and not accept a grunt or a head nod alone as a response. She would ask him to use his voice to say NO or YES in the closest approximation he was capable of. That is where her particular child had to start because that is what he was capable of doing. No matter, her son quickly learned that she was no longer going to be satisfied with a grunt or a pointing finger. He needed to now use his voice to communicate what he could, even if not perfectly.
So it is important that you use your therapist’s guidance, your knowledge of your child, and your best judgment when it comes to accepting an attempt of a word. As the child becomes more advanced, you can hold out for a more accurate attempt. At first you may accept virtually anything.
This may sound cruel. It may sound painful, but it works. Please, please, please, do not do this to the point of frustration for your child. Use your best judgment. Yes, there is a fine line between encouragement and frustration. However, this is a very powerful tool. If you can make this a habit, you can see remarkable results. Why? Because your child will learn that a shift has occurred and will quickly realize that in order to get what he or she wants, a speech attempt will be required. In order to expedite a response to their request, they will begin to attempt speech without your encouragement. When this happens, it will be a true break through.
A Letter Day
Another fun thing to do when working with your child is have a letter day. If you are working on the /b/ sound in therapy, then why not have a /b/ day. You can have your child point out and say as many things as they can that begin with the /b/ sound. You may be surprised at how many things they and you can find. This is a fun way to practice speech with your child without them even knowing it.
Kids love to route through magazines, and cut out pictures. One of the activities that you can do at home is create a special speech notebook. You can find pictures that contain sounds your child has in their current sound inventory. Then you paste them into a notebook with your child so that you can work on saying those words. You can add to the notebook as your child’s speech improves and new sound combinations are emerging. Make sure that the pictures you are selecting are consistent with your childs ability. You may want to get your SLP and your child to help you decide on words. But this is a wonderful way for you to work with your child on a daily basis.
Repetitive Childrens Books
Books with repetitive words and phrases are also a fun way to work on speech with your child. The Apraxia-Kids website Resource section has listings of children’s book titles that fit this bill. Children love these sorts of books anyway, but you can use them for speech practice. If you understand your child’s current capabilities you can select books that use words that start with certain sounds or that include various phrases. For example, take the book Chicka-Chicka Boom Boom. Perhaps your child cannot yet use the /ch/ sound or even attempt a Chicka. Instead, maybe as they become familiar with the book they can fill in the blank when you read boom boom.Or, perhaps they are only capable of saying boo boo, oom-oom or even oooh-ooh. Whatever the child is capable of you take it and you praise it!
There are lots of ways to encourage speech. It’s important to remember that you should encourage speech always. Normal games can help speech when you have them say move five before they move five spaces. Ask your child questions that elicit speech. Always think of ways to give your child an excuse to talk. Remember the picture boards? Well, they too can be used to encourage speech. You can even use them to play a form of bingo. Make a stack of cards that have the same pictures as your boards. As you pick cards, have your child identify the picture, and cover their picture board with a chip. Of course they have to say the word first. There are many things you can do. Be creative.
I’ll never forget the time my sons therapist scolded me after a therapy session. After therapy, I was putting my sons coat on. He grunted because he wanted me to zip his coat, and I did exactly what he wanted. I zipped up his coat. Well, the therapist (God bless her) reminded me that after all the time, energy and money being spent on therapy, why would I respond to a grunt. Well, after that I didn’t. I encouraged speech, and boy did that help.
Hone Their Skills
Now that youve got them speaking, you’ve got to get them speaking well. After all, the goal is clear and articulate speech, not just speech. Observing what your child does in speech therapy and consulting with their therapist is advisable. You need to fully understand just what your child is capable of doing, day-by-day and week-by-week. By understanding your child’s true capabilities, you won’t inadvertently put him in frustrating situations by asking him to do things they truly cannot do.
Remember the example above about your child wanting more juice? Well, initially for I want more juice, you may only be able to get your child to produce, Ahhh waaa mah ewe, one word at a time. Why? Because your child is not consistently capable of certain sounds yet or using those sounds at the ends or beginnings of words. And so you accept and praise their best attempt. But sooner or later, as they build some more skills, you have to start prodding and encouraging better and better articulation of the words. As an example, if you know your child can say juice clearly (you’ve heard them do it before and they do it with help from their therapist), then don’t let them get away with ewe. Again, you don’t prod to the point of total frustration. But if you know your child can clearly articulate the word, then don’t accept anything less.
It is this constant nudging and attention to speech that will get your child to improve faster than any other single thing you can do. Master this technique yourself, and your child is well on their way to mastering speech for themselves. Speech therapists can be very valuable allies and partners in helping you along this process.
Teach Your Child, Teach Your Therapist
There is a widespread misconception about the relationship between parent and therapist. Many parents feel that apraxia of speech is something that can be easily fixed by simply taking your child to therapy twice a week. I assure you, it cannot. On the other hand, many therapists feel that they are the only ones in a position to get the child to improve speech. This too is false. The best scenario for your child is to take a partnership approach with your therapist.
Therapists and their expertise is needed so that the parents clearly know what their child can do; what their child cannot do; what the starting point for therapy is; what the end point is; and what strategies and methods will get the child from start to finish. Therapists can be great teachers, guides and cheerleaders for families. Often, therapists need to gently wake up the parent to habits and practices that they perpetuate which are not helping the child. But surely, therapists and parents have to have high expectations for success.
My son has gone through several years of therapy and now has wonderful communication skills as well as pretty clear speech. We are now working on his r, sh, and th sounds. I’m confident well nail these this year. I’ll never forget the first Christmas my son could actually communicate. Not speak well, but at least verbally communicate. It was definitely my most memorable Christmas. Many of the things mentioned above I used with my son Trent. Does this mean this is a recipe for recovery? Of course not. All children are different. But I can say that in my experience in working with Trent, it made a huge difference. Not only in his life, but in our family’s as well.It feels great to get involved. And, when you are involved you don’t feel helpless because you’re not!
Every night before I go to bed, I stop in to give my children a kiss goodnight.On special nights, when I lean down and tell Trent goodnight, still in his sleep hell whisper back, night night Daddy. Even now, it brings a tear to my eye. By reading this, you’ve taken another step in the recovery of your child. Good luck, and God Bless.
[Tim Burns is on the board of CASANA and the father of a child diagnosed with apraxia. Tim was also the co-founder and a vice president of TechRx, the leading national pharmacy software developer.]