Up the speech

We have made the decision to do something that we have been talking about for a while. We are upping Jillian's speech from once a week to twice a week. She will now have two 45min sessions a week.

This move has been talked about several times and we decided that this was a good time. Jillian has now hit 8 of the 10 top indicators for Appraxia of Speech. This makes a lot of sense with Jillian's symptums. Here are some indicators of appraxia:

• have no direct impairment of speech muscles although children with DS typically have low muscle tone.

• often have difficulty with movements needed for feeding, eating, and swallowing.

• have difficulty with voluntary movements for imitating sounds or speech.
• Receptive-expressive language gap
• More frequent loss of previously produced words
• Groping for sounds
• Presence of oral motor incoordination
• “Inappropriate prosody, especially in the realization of lexical or phrasal stress”
  
  Children with CAS make a number of prosodic errors including (a) applying stress to the wrong syllable of a word (e.g., “pony” instead of “pony”)
• “Lengthened and disrupted coarticulatory transitions between sounds and syllables”
  
  
  Children with CAS may demonstrate prolonged pauses between phonemes,syllables, and words resulting from challenges making smooth articulatory transitions from phoneme-to-phoneme or syllable-to-syllable. The pauses and breaks between phonemes may give the child’s speech a staccato quality. When coarticulatory transitions are disrupted, the child also may exhibit articulatory productions that negatively impact speech intelligibility (e.g., frequent phoneme and syllable omissions, vowel errors, voicing errors, resonance differences, and difficulties producing increasingly complex phoneme sequences).
• “Inconsistent errors on consonants and vowels in repeated productions of syllables or words”
  
  This feature refers to token-to-token variability, or variations in the way a specific word is produced. For example, within the same session, a child may produce banana as “babana,” “bana,” and “nana.”   
  
  
  
  
  

  
  
  
  
  
  
  
  
  
  
  
  
  
  
  So What does this all mean for Jillian? 
  
  
  • Jillian understands a lot more then she can say. 
  • She have very limited spontaneous speech. Most of what Jillian says is something she is imitating. If you ask Jillian if she would like a doll she will try to say doll however she very rarely asks for something by labeling it. That includes people too. She vary rarely calls me mommy unless someone else has said mommy recently. This also creates the illusion that Jillian has a lot more words in her vocabulary then she really does. She will try to repeat almost anything you say however that does not mean that she can say them without you saying them first. Most words that Jillian can say consistently independently are words that are on her speech cards that we practice a lot.
  • Just because Jillian can say something once does not mean she can say it again the same way. You can ask her multiple times in the same night to say a word and it frequently will come out different every time. 
  • Jillian learns words and then seams to unlearn words. This was one of my biggest cues that something was going on. Jillian would learn a word and then we would not hear it again for months. She will say a word somewhat consistently independently and then it will disappear. Like the word "yea." She was saying it for a while when she wanted something. Now I have not heard it again in a while. We have to reteach her the word like she never knew it. 
  • Jillian will take long pauses in the middle of words that she does know. Sometimes there are several second pauses in the middle of a word. During that time she will frequently move her mouth like she is trying to say something however nothing is coming out. It is like she is trying to say something but nothing comes out.
  • Jillian's communication patterns are not consistent during a day. She will have short periods of time where she will babble a lot and we will have some words pop through, however she will also go hours at a time without talking at all, even imitating. 
  • She substitutes odd things. Many kids substitute words, like all furry animals will be a dog. Jillian's substitutions are not like that. Most commonly they will be any word that starts with a "b" sound will be baby or bubble. Words that start with "d" and "p" will sometimes be baby or bubble also. 
  •  Jillian is a month away from 2 and normal is: "By the time your child hits his second birthday he should have between 100-200+ words and should be starting to combine 2 words." Jillian has significantly less then 50 words that she can use independently. We are currently working on putting together a list of independent words however it is hard since she tries so hard to imitate whatever we say. The only two word combination Jillian has is "thank you" however to her that is really one word. They are always said together, and most of the time while signing. 
  • She struggles sometimes with words that she can say independently. Tonight she was trying to say "hi" to Brent and all she could say was "bay." 
  • Despite all of this she is still happy. She still tries to communicate. She uses sign language for somethings. This week we started to introduce PECCS pictures to her to try to help in her communication. To help her even more we are adding an additional day of speech.   
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