Speech Therapy

**Note, this post may bore you if you're looking for a cute story from our kiddos, but I chose to write it for those that wanted the information - and to get the information down for memory sake :) **

I've shared lots of fun stories about our kids growing up - but I've managed to completely omit one very important area of our lives. Not purposefully, I just never had an excuse to mention it. Probably because it's not something I can take a picture of... So I'm writing about it today...

Nathan has always been a very bright kid. Tall, strong, and handsome - but I'm not biased ;-)  However, he has been slow to talk. About 9 months ago, I learned that Easter Seals offers free early childhood services for kids that are delayed in just about any area - speech, large or small motor skills, nutrition, etc etc. So we set up an evaluation for Nathan. And he easily met the requirments to receive speech therapy in our home.

Twice a month, a speech & language pathologist (SLP) comes to our home to work with Nathan and I for an hour. And twice a month an early childhood specialist (ECS) comes to do the same, also for an hour. So we get to see one of them every week. And Nathan LOVES both ladies! They're wonderful!

The ladies have given me tons of practical ideas to help encourage Nathan's speech. They're wonderful encouragers and advisors. And Nathan often responds to them better than he does to me, since he sees me every day. Plus, they see progress in all areas of his life that I have a harder time seeing, also because I see him every day.

Nathan's come a long way in 9 months. He's learned to sign for simple things like: help, eat, thank you, please, cookie, banana, strawberry, etc. He's learned new sounds and words. He's learned better eye contact skills, more patience and to deal better with his frustration when he's unable to do something or bored with an activity. He also rarely throws temper tantrums now, at least over something he wants because he doesn't know how to ask for it. He now leaves the temper tantrums to his sister... who is all too skilled at them! Don't get me wrong... he still throws tantrums. Believe me, he can throw a good one!! But they're no where near as frequent and are rarely because he can't communicate.

Speech Therapy has been good for me, too. It's given me new ideas to play with and teach the kids. It's given me more understanding of Nathan's delays. And encouragement on his progression and other abilities.

In fact, our ECS has shared with me that, of all the kids she sees or has ever seen, Nathan has the best receptive language skills. AKA - he has the highest vocabulary when it comes to understanding and acting on words he hears. He just can't verbalize those words.

And, she said that Nathan also has the best problem solving skills she's ever seen in a child his age. She said she wouldn't be surprised if he ends up being an engineer or some profession that requires working with his hands and figuring things out. hehe... I don't think she knows that's what Nathan's daddy does for a living, too ;-)  She warned me that a little while, he might be taking apart toys and appliances to put back together. lol

She's also mentioned that Nathan is at, or above, his age characteristics in every area of his life, except speech. And he'll push through that - he'll figure it out. And soon, I'll be asking for him to talk less!

Our SLP has also mentioned a possible diagnosis of what Nathan has. Well, she didn't mention it. The ECS did when she was surprised that the SLP had yet to mention it. But after it was mentioned, the SLP shared with me that she never diagnoses at this early of an age - which is why she never mentioned the word herself. And she said that, though she won't diagnose, that, yes, it is possible that Nathan's problem is something called Apraxia. She encouraged me not to google it... but if I did - cause who wouldn't? - to remember that apraxia can be a symptom of MANY problems... like strokes, autism, tumors, etc, etc. None of those problems are Nathan's! IF he does have apraxia, it's an early childhood version that he will eventually work through.

Well, like anyone would do, I googled apraxia. Ok... I swagbucked it ;-)  (Why use Google when Swagbucks pays me?? hehe... I know, another shameless plug!)

I learned almost nothing from my internet search on aprazia. Because everything I read was almost word for word things the SLP has been telling me since summer! She has used all the same language to explain what she thinks is the cause of Nathan's delays.

I did learn, during my search, that if Nathan has apraxia, we're doing the best thing for him! And if he doesn't, we're still doing the best thing for him! So there's no need to worry or stress. God has it all under control. He made Nathan the way He did on purpose. He's got great and awesome plans for our little boy one day. And, whatever they entail, getting over this bump in the road is just one of the things that will help prepare Nathan for his future. And us, as his parents, too!

So you might be wondering... what is apraxia? I'm far from an expert. But I'll tell you what I understand. It's a problem with motor planning. The brain is unable to make sense of things - words (and sometimes fine motor movements). Things seem disorganized in the brain and the person has to figure out how to organize them in a way that makes sense before they can do it.

There's nothing wrong with the child's muscles or anatomy. The mouth, tongue, lips, jaw, etc... they all work fine. The problem lies in how the brain tells those muscles to move.

Children with apraxia often have some delays in other areas besides speech - but it's most prevalent in speech. For Nathan, he was almost 2 1/2 before he learned to jump. You could see it in his eyes, that he just didn't understand how to jump. Still today, his jumps resemble skips more than a jump. But he's progressing great.

Some of his sign language is also not correct. For isntance, the sign for "help" is to make a fist with your right hand. And lift it up with your left palm. Nathan can't do that. Instead, his altered sign for "help" looks more like the sign for "more." He opens his right palm and holds it vertically. Then he gathers all his fingers in his left hand and points them into his right palm. He does the same with banana... instead of holding a forefinger like it were a banana, and pretending to peel it with your other hand (vertically) , Nathan he turns his banana (finger) sideways and pulls at his finger, instead of acting like he's peeling it. But when he peels a real banana, he does the same - he tries to pull the peel up and out instead of down.

Potty training is another area I can see his confusion & disorganization. He wants to use the potty. And he enjoys trying. He's ready in so many of the ways that they say to look for... he's dry when he wakes. He knows when he's going. He wants his dirty diaper changed. But he just can't figure out how to get those muscles to work when he wants them to work. Like speech, it's just going to be a long process to help him learn.

That gives you some idea of his backwards thinking. It makes sense if its apraxia (a motor planning problem)... things are all disorganized in his head, so of course it'll sometimes come out disorganized. Especially in the finer motor skills.

Some sites I've visited have lists of possible symptoms or signs of apraxia. For the vast majority of them Nathan doesn't fit those lists. But those lists are kind of like signs/symptoms of pregnancy... completely different for every person. Which is one reason it's hard to diagnose... and why few SLPs diagnose before the age of three. There's just no "pee on a stick" test for apraxia.

One sign that is often true of kids with apraxia (and is true of Nathan) is that they often have a favorite sound. And they use that sound constantly, in place of other sounds. For Nathan, that is "da". EVERYTHING is "da" unless he knows how to say the word. For the longest time he called Jacob "dada or daddy" and I was "da". But just after Christmas he got "Momma" down pat ;-)  Still today, though, if you ask him what something is, I can jsut about promise you he'll call it "da."

Apraxia can effect alot of things in life. Speech, potty training, reading, writing, etc. And the only way around it is for kids to learn to overcome it, one thing at a time, - to figure out how to organize things in their mind so it makes sense to them. Once they figure that out, they are good to go. Speech therapy is proven to have the best results. And we're so grateful to have awesome ladies working with Nathan so often!

Alot of our speech therapy revolves around trying to get Nathan to do fun activities and talk at the same time - so that he is thinking about the activity and not about speech. So the words come out spontaneously and not something he has to plan to do. You and I don't have to plan to talk, we don't have to think about the word, figure out the sounds, think about how to make those sounds with out tongue and lips, and then say the sound. It's automatic for us. And one day it will be for Nathan, too. He has almost two dozen words down now. Far less than the average 2 1/2 year old. But I refuse to compare him. He's bright, he's healthy, and he's figuring out the body God gave him.

Overcoming apraxia is a very slow process. We don't expect overnight results. We've learned not to press him to talk. But to gently encourage it with lots of repetition, eye contact and using lots of the practical tips from the speech therapist. When Faith began talking, that seems to have helped spur Nathan to learn a little faster. They have about the same number of words they can each say - though some are different. But Nathan clearly has a more vast receptive vocabulary - as well he should, since he's had a 15 month head start on his sister. And in time, he'll catch up to where he should be for speech. He'll figure it all out - he's certainly smart enough!

Brighton (the group our SLP & ECS work through) will stop seeing Nathan when he turns three this summer. That will be sad. But it's the policy. Because the public school systems start offering programs for kids with delays when they turn three. So we've started the process of getting Nathan enrolled in school for the fall. Although they do offer half day and all day preschool for three year olds with special needs, Nathan will most likely only qualify for speech therapy 1-3 times a week. And that's what I prefer. He gets some great peer interaction from Tuesday mornings when I'm in MOPS or Bible Study. And Wednesday nights when he's in Awana (Puggles). And Sunday mornings while we're at church. He doesn't need to be in school all morning - or all day - when he's just three. Later in March he will get some of his testing done - they will test his hearing and muscles, etc. Then in April or May, he'll have an evaluation done.  Our SLP is sure he will qualify for speech therapy through the schools. And they're helping us with our insurance to see if he can also get private speech therapy.

One thing I found to be interesting, is that though there's not a lot of research on the long-term effects of apraxia (many kids seem to completely outgrow it in time), it is known that it's not uncommon for kids with apraxia to grow up to be adults with a little OCD. A good portion - not a mental patient portion ;-)  They like things organized - because things in their head aren't. I see this in Nathan already. He likes to line up all his trains. Or separate all the red blocks from the bucket.

I think we're raising a very smart, compassionate, organized, book-loving boy with an ability to problem solve and figure out how things work. It's so cool that a child's personality can be so clear this young - or younger. He's going to go on to do great things for God one day. I can't wait for the day he makes Christ his Savior and Lord. And I look forward to seeing how God chooses to use my little man for His glory. But while I wait, I will thoroughly enjoy the time I have with him now. And watching him overcome every little obstacle that gets thrown our way.

** UPDATE **
I wrote the above post the other day, but held off on posting it until today, since this morning the ECS and the OT (Occupational Therapist) were coming to visit with Nathan. The OT had yet to see Nathan. Early on there seemed to be no need for her. Nathan can do just about anything kids his age can do. But, after spending the last 8 months with Nathan, the ECS & SLP decided that there was enough concern (though minor) to invite the OT out. She was hesitant to come after hearing them tell her about Nathan while in the office. But the last time both the ECS & SLP were out to see Nathan, new information came up that peaked the OT's interest enough to prompt an evaulation. 

What was the new information??  I don't remember how it came up, but Nathan's hatred of all things dirty came up. As soon as I mentioned how Nathan doesn't like to get dirty, the SLP lit up. We'd always assumed it's just a personality quirk... like his Uncle Dave. Dirt, messes, and touching gooey stuff is just not his thing. But apparently, to some kids, dirt actually hurts. Their senses misread it as pain. The SLP told me to google things like "sensory processing disorder." 

I did... and came the the conclusion that it was just someone's attempt at coming up with a new "disorder" just for the sake of claiming so... cause they were claiming that kids that don't like certain tastes (like broccoli) or kids that don't like to go to sleep, or kids that love soft things, or kids that love water, etc etc, all could have a touch of this disorder. Um... personally, I say that's a load of you-know-what. Kids are all different, we all like different things. That doesn't mean we process senses wrong. So I was very skeptical about the idea that Nathan had this disorder.

But I still believed the SLP, that some kids process dirt as pain. I just wasn't convinced that was Nathan's problem - his hatred of dirt isn't that severe. And he's been slowly improving as we work with him. For instance, he no longer avoid's grass. I've caught him, a few times, drawing in dirt. He's more willing to lick food off his finger instead of insist we wipe it off. etc, etc.

All that to say, I've been looking forward to the OT coming to visit Nathan. And to hear what she has to say - especially in regards to his delay in learning to jump and his sideways sign language signs.

We had a get evaluation with her! Boy is she bright and FULL of awesome ideas! But all the ladies that come to visit Nathan are very knowledgable in their field. The OT picked up on tons of things about Nathan that I never imagined she would care about. What were her findings???

She is pretty sure Nathan does NOT have a motor planning problem (aka something like apraxia). She is pretty sure his problem is all with fine motor skills and muscle development. She did some funny things with Nathan's train table and Nathan immediately immitated her. The OT said that a child with a motor planning disorder would not be able to so quickly immitate that. They would get frustrated and throw a fit or ignore her. Nathan, though, all too quickly immitated and thought it was funny.

The OT said that Nathan isn't under-developed muscle-wise. But he's leaner than the average kid his age. LOL - who'd of thought!!!! Someone thinks our hunk of a toddler is lean!?!? 

Well, he's lean in muscle mass on his back - especially along the backs of his shoulders. She noticed how Nathan sits (with his legs bent underneath of him, feet against his bottom). She said that's poor posture for building back muscles, and we should encourage him to either sit like his sister does - squatting with bottom off the ground - or sit with his feet in front of him, or beside him, or indian style. That will help build those muscles faster. Also letting him walk like a wheelbarrow will help (us holding his feet, him walking on his hands). I see lots of wheelbarrow games in his future!!

The OT also said that his fine motor skills are somewhat delayed. She said that he's a borderline child to have as a client. She could pick him up, but she could also not. So she decided to visit us every other month to check up on him, and continue to talk with the ECS & SLP in the office to pass on more ideas. Because of the way this organization works, after an evaluation is done, if it is recommended that a specialist work with a child, they must make their first appointment within 28 days. So the OT will actually be back next week - and then every other month after that. She'll only see Nathan 2-3 times before we leave the program (when Nathan turns 3). And her visit next week will be at the same time as Nathan's SLP. I'm looking forward to that!

Because the SLP is confident that Nathan has a motor planning problem - even if it's minor. And the OT is confident that Nathan does NOT have a motor planning problem. I look forward to both women spending time together with Nathan and hearing their discussions.

Regardless of what Nathan's problem is, we're doing all the right things. Being patient. Giving him opportunities to work on new skills. Getting speech therapy. Not stressing him. Loving him for who his is. And, most importantly, trusting God.

The OT gave me some awesome ideas on ways to help Nathan build those fine motor skills better, too. For instance, she told me to break all our crayons. Jacob was annoyed when he heard that - till I explained why ;-)  Nathan doesn't hold a crayon like he should for his age. He still holds it in his fist. Smaller crayons will force him to use only 3 fingers and hold it with the tips of his finger. Then there were ideas she gave me for playing with him in the bathtub, with playdoh, with oatmeal, with stickers, with water battles, with clothespins, etc, etc, etc. She was FULL of great ideas.

So we'll try many of these new ideas. And we'll keep being patient with him. And giving him opportunities to learn. We'll keep loving on him. And teaching/modeling to him to trust God. And next week, we'll get to meet with the OT & the SLP at the same time. And probably learn something new and get even more insight into our precious little boy ;-)  I'll let you know how that meeting goes at the end of next week.

Wow, I really wrote a novel. If you're still with me, thanks for reading. And thanks for loving our son, too!!