Any speech language pathologist out there? Phonological disorder or possibility of Apraxia?

Question

I have a 32 mo. old who is receiving speech therapy since Aug.2007. We cannot figure out exactly what is wrong with him. The speech therapist thinks he has a severe phonological disorder, but she still can't get a definitive pattern on him other than he uses the sound h for other consonants, ex."har" for "car" and leaves off ending sounds ex.. "daw" for "dog".He can sometimes say sounds in isolation, but he loses it once he tries to say a word. He substitutes with the h sound. We can't understand what he says most of the time, and the things we do understand, it's because we are around him all the time. Right now we also work on putting his lips together to make the p sound. Sometimes he does, other times he doesn't. We have to constantly que him. He is actually trying to talk in sentences but not intelligible. Also, he can hear when you say a word wrong but he is not aware that he is saying it wrong. For instance, he says Homas instead of Thomas. If you say Homas he knows you're saying it wrong, but when he does it, he is not aware. He has ear tubes, had an updated hearing test, everything fine, so we got that out of the way. The therapist told me to read more on apraxia to see what I think since I'm with him all the time as oppose to her 4x monthly. I am so frustrated, so is he, and I am scared. I don't know how to help him. I know it's difficult to answer from this, but I just want other views or suggestions. Oh, for the treatment as of right now we are doing auditory bombardment. We'll sit him so he can color quietly, while a word list is read to him. Then we'll read a book and point to pictures that correlate to the word list, and then close the session with coloring and the word list again. Session runs 45 min.

Answer 1

Hi,

Firstly, please try not to worry - it seems like you are really fretting over this, as a mum myself I know I would be, but please let me at least try to reassure you that I have worked with a lot of children who seem to have the same problem as your child.

Let me start by saying that it is a good sign that your son can hear when you are saying words incorrectly, this is good that he can hear the difference, as some children do not even know when others are saying the word wrong, so please be reassured that this is at least a positive that your son can hear when you are saying words incorrectly.

Have you tried working with your son sat side by side both looking in to a mirror? If you sit side by side then your son can see how you are making movements with your lips tongue etc, and then in turn can see how he is making them. Try starting off by pulling silly faces at each other ie sticking your tongue out, puffing out your cheeks. Can he copy this? If so, move on to single sounds such as 'p' and 't'. Talk about what you are doing in order to make these sounds ie, oh look what I've done here to make the 'p' sound, I've put my lips together look and make a popping sound. Etc.

Dyspraxia / Apraxia is a condition that results in a reduced ability / inability to voluntarily control single or sequenced movements of the lips, tongue or soft palate.

I hope that this has helped a little. Again, please you're not on your own here, I have seen a few children who have the same difficulties as you're describing. If you live in England, please ask your Speech and Language Therapist about the Nuffield Dyspraxia Programme.

Kind regards x