As I mentioned earlier Isabella qualified for Early Intervention services in early May under the category of Speech/Language. In late May a Speech Language Pathologist (SLP) conducted a more comprehensive Speech/Language assessment. This assessment gave us more information as it showed us that our 13 month little girl only had the mastery of skills of a typically developing 9 month child for speech and language. This was important information as it gave us a place to start working. The SLP also gave what turned out to be an incredibly valuable resource in the form of a website and podcast. It is hosted by an early childhood SLP who works specifically with late talking toddlers.
http://teachmetotalk.com/
It was here that I learned there were in fact ELEVEN skills a toddler needed to have before they could even begin to demonstrate the ability to communicate verbally with words-who knew?!?!
Some of them she had already mastered such as reacts to events in her environment, plays with a variety of toys appropriately, vocalizes, initiates interactions with others, responding to others and follows simple directions. So we were more than half way there!
Over the next few weeks I worked with her on the ones for which were emerging such as those related to attention span (the child has a typical toddler attention span for anything physical but try to get her to sit for more than a minute to do anything else? Forget it!) and imitation. During this time her receptive language skills seemed to really blossom. She could go and get just about anything I asked her to and when I told her it was time to eat, go outside, go the car, etc. she would go to the exact right spot. Her ability to understand what we were saying was becoming very evident which was super exciting and made me hopeful that our "late talker" would begin talking soon. A.J. calls me Mama (though I always try to redirect him to attempt to say Beth), so I would love to hear my own kiddo call me Mama too:).
Imitation was interesting because it began with purposeful imitation with objects and then body movements. The first we had done some, but as soon as we began to be more deliberate with it things really took off and the same was true about body movements. She could now wave and clap consistently. She could also spin, do some yoga pose J.T. does to stretch his back, and dance to music. The next level of imitation involves imitating sound effect like sounds (beep, whee!, animal noises, etc.). This is where we hit a roadblock. This roadblock was more telling than we realized.
During Isabella's speech assessment in May we signed up for Speech once a month. This involves an SLP coming to the house once a month for an hour primarily to check progress and provide me with new strategies. Our first session was on Thursday and in it we got more information than we bargained for.
Recently I was watching Bubble Guppies with Isabella and there was a horse saying neigh. I said neigh and asked if Isabella could say neigh. She was sitting on my lap so I couldn't see her face, but I could feel her body stiffen as she strained to try to imitate the sound. After much effort the only thing to come out was some type of guttural sound I couldn't replicate to save my life. She didn't seem upset or frustrated but it was the first time I wondered if it wasn't that she wasn't ready to imitate sounds, but rather maybe she COULDN'T physically imitate sounds. So my first question for the SLP was whether or not there was any type of issue that involves an inability to reproduce sounds. The answer is yes and after working with Isabella for a little bit it became clear to the SLP that it may be what we are dealing with. It is called Childhood Apraxia of Speech.
Apraxia is not usually diagnosed until a child is closer to three, but one of the tell tale signs is apparently what is called "groping". This is the clinical term for what I was hearing Isabella do when she was trying to imitate a sound. For the first time I saw her face when she was trying to imitate a sound the SLP was making. It made me want to cry. Isabella's eyes were fixed on the SLP's mouth, her jaw was jutted out the way it does when she is concentrating really hard, and you could tell she REALLY wanted to make the sound but no sound would come out. It didn't seem to upset her, but to see her physically unable to do something she really wanted to do hurt my heart:(.
Like most disorders there is a continuum. The fact that Isabella can make sounds (and boy can she make a LOT of them!) is very promising as severely Apraxic children often make few if any sounds at all at this age. There is also a physical component that will be assessed by an Occupational Therapist at the beginning of August. So as we continue to collect more information our current goals are to continue to encourage sounds, ramp up our use and teaching of sign language, and encourage imitation of the use of open vowel sounds as word approximations (for example uh for up or oh for go). The fact that we know what we may be working with is very helpful, though it is taking some time to process that what we are working with may be less temporary than we thought.
At the end of the day however our little girl has been fearfully and wonderfully made to do great things and we have been blessed with the resources to help her achieve every last one of them even if the road we take is, as usual, the road less traveled.
