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- Christina
- Burnham
- No
- Teletherapy in Texas
Austin
Texas
78701
United States - CloudSpeech
Austin
Texas
78701
United States
When I receive a consultation request from a parent that says ‘my child isn’t talking’, the first thing I always explain is that there are many reasons why a child may be experiencing a speech and/or language delay. The brain is a complex structure, where development may take a detour in one or several specific areas. This is why differential diagnosis is so important. It is not appropriate to simply label the child as having a ‘language delay’; we must investigate and determine the nature of the problem, so that appropriate treatment can be recommended.
Parents should be aware that speech therapy approaches to address a language disorder are very different from approaches for a severe speech sound disorder, like apraxia. I always tell parents early on, that even if we are only ‘suspecting’ apraxia, we want to monitor closely and provide the right kind of therapy from the beginning, so that we don’t waste the child’s time and lose out on the critical developmental period.
I like to think of childhood apraxia of speech (CAS) as an extra special speech disorder that requires an extra special touch. Not all speech-language pathologists have developed the ear for tuning into CAS early on. I feel that early diagnosis is very important, because it dictates the path for treatment. Using differential diagnosis, I take a careful look at everything the child IS doing, and compare it to what they are struggling with. There are many red flags that can be found if you understand what you are looking for.
Let’s look at an example here. Child-A is 2.5years old, appears to be understanding most of what is said to him, is following directions, and has good joint-attention and clear communication intent. They are trying to communicate, and seem to know what they want to say, but they rarely say words that anyone can actually understand. But then they have about 10-15 words that they say clearly and consistently with no problems. Parents wonder, why can he say ‘apple’ clearly, but when he tries to say his name (Paul), which has similar sounds, we can’t understand him?
Many times the child speaks in long strings of ‘gibberish’ (the official speech term in jargon) that sounds like real speech, but you can’t understand any of it. And when family members try to get him to repeat words sitting face to face with exaggerated models, he produces a different combination of sounds each time (Say Paul: ‘aba’. Say Paul: ‘ala’. Say Paul: ‘papa’).
Child-B is also 2.5y old, not talking much, and using only a few words to communicate. They have trouble following directions, don’t seem to understand what is said to them, don’t follow along with story reading time very well, and are easily frustrated. This child also says about 10-15 words clearly, but when you ask them to repeat words, they can imitate words pretty well. When you point to something and say the word without them seeing your face, even on a noisy city street, they immediately repeat what you say clearly (Look a bus! ‘bus’).
We would say that Child-A is suspected of a speech sound disorder and Child-B is suspected of a language disorder. We would approach therapy differently for these two children. If Child-A does indeed have a motor planning disorder, and therapy does not provide approaches in line with motor planning research, then they may
lose valuable time where they could begin to make progress.
This is why I believe that differential diagnosis is so important, and why I spend the time to take a close look at every individual client that comes in for an evaluation, so I can recommend the right treatment approaches and maximize their opportunity for progress.
I discovered apraxia-kids during my early searches for better information about apraxia. I wanted to be able to share good resources with families I was working with at that time. Apraxia-Kids.org came up in my search, and I was so happy to find the plethora of free resources available! I quickly ordered the free materials for SLPs in Spanish and English, and shared them with the families of children with CAS on my caseload at that time. Since then, Apraxia-Kids is the first step I usually recommend to parents when I meet a child suspected of having apraxia. The fact that they offer resources and information in Spanish is a great asset for me as a bilingual therapist. I currently live in Costa Rica, where I am developing my vision for holistic retreat camps for kids with apraxia. I plan to utilize nature, horses, surfing, and alternative energy healing techniques to give apraxia warriors and their families a life-changing experience that will accelerate their growth process, in more areas than just speech. I was inspired to do this by a boy I met while traveling in Costa Rica. He was 6 years-old at the time, and couldn’t even say his name. His family didn’t know what was going on with him. He could understand everything, was very smart, active, athletic, and yet, he couldn’t even say yes or no clearly. After I interacted with him, I immediately suspected childhood apraxia of speech (CAS). I performed an evaluation while I was there that first visit, and felt even more confident based on my differential diagnosis. Since then, I have been providing weekly 30 minute sessions via WhatsApp for him in Spanish. It’s been one year now, and I’m so happy to report that he is really starting to make significant progress!
This year my goal is to advance my skills with apraxia. I am attending the national conference in Texas this summer 2023, and will be applying to the advanced training bootcamp that Apraxia-Kids offers later this year. This fall 2023, I am participating in the Apraxia-Kids Walk in my family’s hometown of Austin, Texas, and will be highlighting my little apraxia-star friend in Costa Rica to encourage donations for this wonderful cause.
Personally, as a speech-language pathologist, I find apraxia to be a fascinating disorder, and one that requires specialized skills to treat. My goal is to not only advance my own skills as a therapist, but to help educate and train other therapists through my retreat programs, so that we can grow the options of support and awareness for this very special speech sound disorder.
As a speech-language pathologist that specializes in younger children (2-7y is my sweet spot), parent coaching is such an important part of the therapy process. I help parents to understand that if they can learn to carry-over therapy techniques to the home setting, then their child can continue to practice on a daily basis, not just when they visit me. My goal is always to educate and empower parents, so they not only feel included in the therapeutic process, but they feel that they are helping their child grow and ultimately succeed.
AAC (augmentative and alternative communication) is often thought of as high tech computer devices, but it can be anything that helps bridge the client to better communication. For example, creating simple identification cards for a child to carry and introduce himself to others that not only gives his name, but also explains his condition. For example, this could really help a child when they are away from parents at school with a substitute teacher.
I have made many simple recommendations for incorporating low-no tech AAC approaches in the home environment. For example, the child I work with in Costa Rica has his own phone device that we use for therapy. We have full conversations using only emojis to convey our messages. I often recommend that parents create visual choice boards around the house (cut out pictures of the child’s preferred foods and tape to the kitchen refrigerator), so that the child with apraxia can begin to make independent choices and learn the power of language. I have also supported families with the use of more advanced programs like ProLoquo2go on a phone or iPad, to give the child with apraxia more extensive access to language. I also model ASL (American Sign Language) signs whenever possible, in order to teach the child an efficient alternative to using speech. This has even been effective with some of the youngest children I have worked with (2.5y).
People often say that if you give the child an alternative to speaking, then he will never speak. This is absolutely not true. Language always takes the path of least resistance. Believe me, if the child can say it, he will! But until he can, we want to be sure he has options to express himself to the best of his ability.
This is why AAC can be such a beautiful bridge to actual words.