speech therapy Q

[Sweetum]

We've started DS on speech therapy based on his EI evaluation that he needs a little push. The therapist has been coming home for the last 4 weeks (one hour each week). DS has started to warm-up to her and is playing with her. She started him off with colors (red and blue) and is having him sort the colors using colored cups, and small bears. She's now extended them to a couple more colors. she sings songs (like "twinkle twinkle" etc) at the end of each session. Gives us play suggestions. This week she started him on bristle blocks saying that they can be good for his fine motor development too. While it all seems nice, we are wondering how these activities will help in speech development. She hasn't so far focused on one syllable or sound. I admit that I have no experience in this area, but I do wonder. I would love to hear from other parents who had this done for their child and how the therapist went about the therapy. I do understand that each child is treated in a unique fashion depending on his/her needs, but I think it will give me some perspective. thank you all very much.

-SunshineAndMe

[crl]

I think it would help if you told us what kind of delay they found. Was it expressive or receptive? Are there articulation issues or something else?

Catherine

[Sweetum]

Hmmm, I don't know! DS understands pretty much everything that's said/told to him. He knows when we expect him to repeat something but doesn't do it. He avoids the whole thing, and just moves on to something else. We don't think he has any hearing issues and our ped too is not concerned. He just doesn't repeat and rarely imitates (he's much better now). I wonder if you can tell based on this information.

ETA: I'll also look up his report and see if there's anything in there.

ETAA: I just checked his report - it's expressive (ties in with what I described above)

[brittone2]

only have a sec, but in EI it isn't uncommon to work on other areas of development. If a child has some delays but not enough to qualify for other services (so may qualify for speech but delays aren't enough to qualify for fine motor), therapists often work on other areas of development. This is one way we can also keep an eye on their overall development...which is helpful in that if they fall behind in another domain of development, we can flag a need for more screening/eval in the future.

[PunkyBoo]

I'm glad to see I'm not the only one with the same question! Boo also just recently started speech therapy. He has a delay in expressive speech and pragmatics. I also was wondering about why the therapist has the kids (he's in a group setting) do motor skills activities... the conclusion I came to is that they have to engage the kids (toddlers probably won't respond well to just being talked to and asked to repeat...) and the activities give them real-life practice at using words. For instance, instead of just saying "say 'cow'" they have the kids do an activity finding a stuffed cow in a box of dried beans (texture exposure) and then ask "What did you find?? Is that a cow? Cow? What does the cow say? Moo! says the cow." Plus perhaps they are weeding out other issues, maybe a link between texure issues and speech issues... etc.

[codex57]

Sounds normal. The therapist did all sorts of play with DS. She adjusts to him. If one play seems more fun then others, then she'd use it as a reward for him to try other things. Of course, she made him ask for it. It's all play based because when they're that young, as a PP said, you can't just sit there and make them do rote exercises.

He only had speech problems, but I think she kept track of his motor skills and other things as well.

DS made GREAT improvements. We never really questioned the playing cuz we figured she knew better than us, but she did explain to DW what she was trying to do with each play exercise (cuz DW sat in on the lessons, which they encourage parents to do cuz they want parents to do the same playing during the week).

What you described sounds very much in line with how DS did. They have a list of things a kid is supposed to know at that age level. Colors, etc. Start off with a couple so they get an idea, then expand to more. Colors, animals, kitchen objects, etc.

[crl]

My son also had expressive delays. His EI therapist spent a lot of time following him and playing and trying to elicit speech while playing, even just things like saying BOOM when they crashed trucks to try to get him to imitate her. I am guessing that it is a combination of play being what works best with toddlers and play being the most natural way to teach language. So they are not going for robotic repition but real life use of language. But I am no expert, that's just what I've gathered.

Our therapists always saved the last ten minutes of a session to write a note, giving me a carbon copy on the spot, and talk to me about what they did and give me ideas of activities. Maybe you coukd ask your therapist to explain what she is targeting or hoping to accomplish during her sessions?

Catherine

[Sweetum]

Yes, she does give us a note before she leaves noting his progress, his involvement in today's activity, his overall demeanor, and homework for parents.

Since I have no experience, I didn't know exactly what to expect. But since his fine motor skills were assesed to be very advanced it didn't make too much sense to us. Ped also had asked me once if she was focusing a particular sound. That made me think about it a bit.

I agree that play-based therapy would be most enjoyable to him, not to mention fruitful at his age.

The idea in asking the question here is to understand whether or not we are working with someone who knows what she is doing, and if it seemed out of the ordinary, I wanted to raise a redflag to our services coordinator.

Thank you all very much for your responses. Others, please feel free to chime in if there's anything you would like to add.

[zag95]

DD has been receiving EI services for expressive language, since just before age 2; she will be 3 the end of Jan.

DD was born with a bilateral cleft lip and palate which has been repaired. We are learning to use the correct sounds, etc. With both our EI therapist, as well as our private speech therapist, they do a lot of play and talking through.

Sometimes sessions are to build relationships; sometimes to focus on certain sounds; sometimes to focus on placement of tongue, lips, etc. We are currently focusing on Pressure sounds P, B, T, D, K and G. DD has come a long way on making these sounds, and for her, therapy has been training her mouth/lip/palate to function differently now that there is no longer a large hole!

Some things our therapist has done include:
Mirror work; blowing bubbles or feathers or other things; playing with objects, such as little people and saying a word, such as bear or baby. Repeating sounds, and having child mimic; having a worksheet or game where you hop or move along, once the child repeats the same sound/word; etc.

Typically our private therapist has games or activities that DD does with her; sometimes we work on a certain sound- such as B- we might see little trinkets in a box that all start with B, she pulls one out at a time, and says word, DD repeats word, etc. Private therapist is in her own office, so there are many resources that are used- such as puppet bird eating bugs- we've worked on "Eat", and "open up!) and then we put a plastic bug in the puppet's mouth, etc.

At this age, it is about establishing relationships and using songs, games, etc to make it "fun", while also getting them to do more verbal expression and going for the correct sounds. It is really interesting to watch people work with these little kiddos!

[crl]

Well, an expressive delay may not mean he has an articulation issue so if there is no articulation issue there wouldn't really be any reason to target a particular sound. Does your paperwork indicate whether he has any articulation issues? DS had an articulation issue so we did eventually focus on particular sounds, but not all kids with expressive delays have articulation issues. Sorry if this is disjointed, feeding the baby which posting!

Catherine

[sste]

Our DS had speech therapy starting at 16 months with an excellent speech therapist who I personally vetted extensively. While there was always playing *but* there was always communication and communicative "temptations." So, the therapist spent a session or two figuring out what DS could do, what sounds he could make, what his strengths were . . . and what toys were motivating to him (in his case vehicles). Then she started with signing and some of the simple sounds: "oo" I seem to recall was early on. So, he would play with a train puzzle and she would say oo-oo train and then she would make DS say something that approximated "oo" in order for her to give him the train piece. Or have him sign more.

From that she built week after week: harder sounds (I forget but she was able to explain to me all the sounds in order of acquisition from easiest to hardest); then putting together sounds, short words, longer words, multiple words, and finally short phrases. This all took place over about 10 months of 2 sessions per week.

I really think you should ask the therapist very open-endedly: You have met with DC a few times and I am wondering what you are working on with him right now in terms of expressive language? What is your plan for DC for the next few months?

The answers to this question will I think be very revealing.

[brittone2]

Just agreeing it will be play based and may not always look like they are doing "therapy." It is normal to work on other areas of age appropriate development. When working on things like fine or gross motor skills at the same time they may also be trying to elicit some speech, but it is also normal to touch upon the other areas of development even if DC is only being seen for speech services.

Most therapists I know have hit a roadblock with a few kids on occasion, where the child is going through stranger anxiety or is resistant to the typical play in sessions. Sometimes in those cases we make more progress if we back off a bit and work on building the repoire again. That may mean 1-2 sessions of more play and less "therapy". It isn't something that happens all that frequently but most therapists have gone through a time like that with a few clients. The case managers/service coordinators I worked with all understood this. That wasn't common but there were 1-2 kids that I worked with where we made more progress by just working on repoire and backing off of what we were doing a bit.

Most speech therapists don't get really concerned about articulation until children are older, so I agree that there may be a reason she's not concentrating on a particular sound.