Today my son lost something. It wasn’t a favorite toy or a tooth. It was much more important than that. He lost the diagnosis of Childhood Apraxia of Speech (CAS).
He is 3 1/2, and until today, has held a trio of diagnoses: Childhood Apraxia of Speech, Attention Deficit Hyperactivity Disorder (ADHD), and Autism Spectrum Disorder (ASD). His speech therapist gave him a re-evaluation today, and she proudly told me we’d done it. He can officially speak! His articulation and intelligibility are on par with typically developing children his same age.
Tears filled my eyes, and an overwhelming array of emotions filled my heart. We don’t hear typically developing often!
My Son’s Apraxia Backstory
He was diagnosed with CAS when he was only 2 1/2 years old. CAS is a neurological speech disorder. Children with CAS have a disconnect between what the brain wants to say AND the ability to create intelligible speech.
The research says it is complicated to diagnose children with CAS as young as my son was, but it can be done. He had so many of the symptoms: regression in speech, difficulty producing certain sounds, inconsistent speech errors, groping or struggling to “find” words, and problems imitating speech.
He also had other symptoms that often co-exist with CAS, such as fine motor skill deficits, feeding difficulties, and oral sensory issues. The signs were all there. The Speech-Language Pathologist gave him the diagnosis so proper therapy could begin. (Click here to read my blog Our Childhood Apraxia of Speech Journey for more information on the signs we saw and how he eventually became diagnosed.)
The Strategies and Tools We Used
Intensive Speech & Occupational Therapy
Initially, my son started intensive speech and occupational therapy, and his therapists taught us how to also help at home. We practiced things like blowing bubbles to help him learn to push air out of his mouth and sucking through a straw to pull air back in. We would stand in front of a mirror and make silly faces to show him different mouth and tongue positions. During meals, we would work on sounds such as “mmm” and lip-smacking.
Easy Does It Hand Signals for Apraxia
We taught him hand signals as visual cues to help him create sounds using Easy Does It Hand Signals for Apraxia. For example, for the “hu hu” sound (called the Doggie Signal), you teach the child to put their hand in front of the mouth and huff into while making a panting dog sound. The hand signals were helpful as we went through the prolonged process of teaching most sounds individually before we could progress to saying words.
Kaufman Speech to Language Protocol
We also used a program called the Kaufman Speech to Language Protocol where you start with tiered word approximations until the child can say the whole word. For example, saying bubble starts with “buh,” then over time, you move them to say “buh-o” and so on until eventually saying the word.
The Kaufman Protocol also includes speech evaluations that identify sounds the child can correctly produce, enabling the Speech-Language Pathologist to know where the gaps are.
For me, just understanding that word approximations were part of the process of learning to speak was helpful. Then I began to learn to move him up the level to the next approximation.
Teach Me to Talk with SLP Laura Mize
We also played a ton of games where we’d use engaging toys such as a farmhouse and farm animals and repeat sounds over and over and over, such as cow says “moo.” I’d be overly animated, so he’d want to try and imitate.
I learned how play is one of the best tools in teaching toddlers to speak from Speech-Language Pathologist, Laura Mize of Teach Me To Talk. I followed her podcast and YouTube. Each morning as I got ready for the day, I’d listen to Laura and learn new, creative, and engaging ways to use play to work with my son. Initially, I worked on teaching him to maintain joint attention. Then we moved to pointing and using gestures. Next came learning to make sounds and imitating. And eventually to producing words and phrases.
Laura was a tremendous and positive resource. I felt she was there cheering us on every step of the way.
We also used a tool called Word FLiPS that helps teach functional vocabulary to children with limited speech. The words are divided into four articulatory categories so you can target exactly where your child struggles.
He’d sit in the high chair, and I’d go over word after word with him. You can purchase it as a spiral booklet or as an app. I bought the app and put it on the iPad, and it was great because it tracked data so I could monitor his progress.
Rachel Coleman’s Baby Signing Time
We also started teaching sign language and used Rachel Coleman’s Baby Signing Time. We found that he wouldn’t even attempt a word if he didn’t already have a sign for it. His brain needed a kinesthetic jump.
Also, learning sign language while teaching him to speak helped bridge the communication gap and reduced frustration on his part and ours. For the first 2 to 2 1/2 years of his life, sign language was a major form of communication. (Check out my blog Using Sign Language to Help Move Your Child Along the Language Continuum here.)
Another beneficial resource for us during this time was the non-profit organization apraxia-kids.org. I called and talked to them numerous times. They sent me literature, offered input on what to look for in a therapist, and their website is packed full of resources. We also attended the Walk for Apraxia and felt even more support from this wonderful organization. They gave us support, but more than anything, they gave us hope.
During this time, my son also received the additional diagnoses of ADHD and ASD. This added even more challenging layers to his communication struggles. Because of the ADHD, he was so hyperactive and impulsive, which meant it was difficult to get the most out of therapy. Because of the ASD, he had a receptive language delay, meaning he didn’t understand language the way a neurotypical child did.
Hurdle, after hurdle, was being tossed our way. Nonetheless, we all kept up the hard work. We kept pushing forward.
Mand Training through ABA
After he received the diagnosis of ASD, my son started a full-time Applied Behavior Analysis program. Part of his ABA therapy is what is called “Mand Training.” Most children with ASD have communication issues. Mand Training doesn’t specifically target the ability to speak, but rather the attempt at using language to request. For example, before Mand Training, my son would grab my hand and bring me to show what he wanted. If he wanted milk, he’d bring me to the fridge.
Using Mand Training meant he’d have to use language to request. Once we’d get to the refrigerator, I’d wait for him to say milk. If he didn’t, I’d prompt him. Eventually, we moved to 3-word mands. If he’d say and/or sign simply “milk,” I’d tell him to say, “I want milk.” Even if it were unintelligible, he’d get the reward for the attempt.
The speech therapy was helping him gain the ability to speak, while the Mand Training was giving him a reason to learn.
There was no one miracle tool, therapy technique, iPad app, or program that got us to where we are today. It was the dedication of a team of therapists, his parents, the support of the non-profit organization, and, most importantly, my son’s hard work.
My son overcame CAS at an age when most children are just receiving the diagnosis.
The main points here:
- Push for a diagnosis
- Get your child early intervention
- Don’t put all your faith in a one program approach
I truly believe that early intervention and our multifaceted approach is what helped him overcome CAS.
Now our good news doesn’t mean the hard work is over, far from it. My son CAN speak, but he still has lagging communication and conversational skills. We are working on those in ABA therapy and at home.
However, seeing what he has already overcome gives me the hope that he can and will conquer any obstacle that comes his way. He will, as I often say, burst through the ceiling of his disabilities, into the universe of his abilities.
I’m not telling you it’s going to be easy – I’m telling you it’s going to be worth it. – Art Williams