29 September 2010

Happy 100th Birthday, Grandma!

Today is my grandmother's 100th birthday! Some might think it's sad she died just a few weeks shy of her century mark, but I say she gets credit for the full century! My grandma was born in 1910. 1910! Just think of all the "firsts" she experienced. 

Here's my favorite first of hers... the first time she met Sheridan.

Yes, he was passed out in the moby wrap... but who cares?! Such a cute little Buddy.

Here's the celebration of Grams' life that I wrote for her... I think she deserves a little blog time :)  

I love those hugs

12 September 2010

Eleven Criteria for Apraxia of Speech

Many people have reached out to me asking about the "signs" of apraxia I mentioned in my last post. My time is still being ruled by the two men of the house, so I thought that the least I could do is slap up the 11 criteria for apraxia until I have more time to post about Sheridan specifically...  

You all know I'm not a speech language pathologist (I don't even play one on TV), so keep reading with that in mind. Seek out a professional who knows apraxia if some of this raises an eyebrow for you.

Sheridan's SLP used the Differential Diagnosis for Childhood Apraxia of Speech assessment (adopted from Ruth Stoeckel, MA, CCC-SLP and David Hammer, MA, CCC-SLP, members of the Childhood Apraxia of Speech Association Professional Advisory Board - by the way, I found their Family Start Guide to be a useful overview). 

Here are the 11 criteria, in no particular order of importance... 
  1. limited phonemic repertoire (e.g., limited vowel and consonant sounds)
  2. frequent omission errors
  3. predominant use of simple syllable shapes (e.g., “buh buh”)
  4. reduced expressive language (speech) compared to receptive language (comprehension)
  5. high incidence of vowel errors
  6. increased errors on longer units of speech output
  7. difficulty imitating words or phrases correctly
  8. altered suprasegmental characteristics (A.K.A. prosody, or the patterns of stress and intonation in language)
  9. impaired volitional movements
  10. inconsistent speech errors (e.g., may be able to produce accurately a sound/word in one context but is unable to produce the same sound/word in a different context)
  11. reduced/irregular diadochokintic rates (a person's ability to make rapid speech movements using different parts of the mouth; ability to accurately produce a series of alternating sounds)
Other signs often go with the diagnosis (but aren't enough to actually distinguish those who have apraxia from those who don't). One example is a loss of previously spoken words (e.g., used to say "baby" consistently but no longer says the word).

The Childhood Apraxia of Speech Association noted that SLPs do not demonstrate consistency in which characteristics they place more weight on than others in a diagnosis (so are some of the 11 criteria more indicative of apraxia than others?).  It is not clear which or how many characteristics must be present for the diagnosis (I've seen a few sources say a child must clinically meet at least 8 of the criteria, but other sources say 7 or 9). Also, many of the cites I found indicated that children must have a decent repertoire of words before a diagnosis can be attempted (in other words, they have to have enough speech sounds and words in order to detect these errors).

I'll be posting more as we learn more... from what I have gleaned so far, oral motor and PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) are important and critical therapies, especially when used together. And other strategies can be helpful, as well. Most important is that apraxia requires intensive one-on-one speech therapy.

Anyway, we're still learning and we're grateful for any lessons learned you can share. We'll certainly be sharing what we learn :)

10 September 2010

Birthdays, Hospitalizations, and Apraxia of Speech, Oh My!

It's been a while since I posted an update primarily because, well, like the rest of you, life gets crazy. Our crazy the last few weeks looked a little something like this:

Sheridan celebrated his 2nd birthday and had an awesome party (that will get it's own post, thank you very much), but Gary was in the hospital and missed the party because... (drum roll please)

Gary's appendix burst and it wasn't removed until 24 hours after it burst. Cue rampant infection, sepsis, almost dying (surgeon said if he had come to the ER even 30 minutes later he would have died), Sheridan developing behavioral issues because he missed his daddy so much, me trying to keep Sheridan's life as normal as possible (even though he would wander through the house to our bedroom calling "Dada" and "Daddy" looking for Gary), me trying not to pull my hair out, craziness. (A quick shout out to my family, my sisters, and one - make that two and three - close blogging friends from around the country for helping me survive the near loss of my husband - much love to you.)

After two weeks in the hospital Gary came home on antibiotics (the infection wasn't gone but the doctors had no better plan).

One week later he went back in after spiking a fever because his infection grew (despite 3 weeks on antibiotics) and he had another procedure to try to clean out/drain the infection.

Now he's home again (with a nasty, foul, way-cool drainage tube) and we're hoping the infection goes away and stays away. But this time he's in more pain and Sheridan doesn't understand why Daddy won't pick him up. Poor little man.

And, as if this fabulous cake needed a big, heaping scoop of icing... Sheridan was diagnosed with Apraxia of Speech. Gary and I have suspected for some time, and we're not totally shocked by the diagnosis. I'm just sad. I feel for him. His receptive communication (what he understands/comprehends) is age appropriate, but his expressive communication (what he says, his actual speech) is really delayed. I will write a more detailed post about this, what criteria Sheridan exhibited - by the way, he exhibits 11 of the 11 criteria for an apraxia diagnosis - that boy scored 100%, just not on something we wished for :)

In the end, it'll all be just fine... Gary is on the mend and we are hopeful that this last surgical intervention took care of any remaining infection. And Sheridan is, as always, a very clever, silly, sweet, vocal little boy who just happens to call most things "buh buh" but can say "daddy" and "I did it" clear as day :)

I will leave you with this basic explanation of apraxia that was part of Sheridan's report:

Apraxia is a speech disorder that interferes with a child’s ability to correctly pronounce sounds, syllables, and words. It is the loss of ability to consistently position the articulators (face, lips, tongue, and jaw) for the production of speech sounds and for sequencing those sounds into syllables or words. It’s a planning/programming problem.

As a result, even though Sheridan knows what he wants to say, he cannot say it correctly at that particular time. Sometimes he cannot even begin. Either the wrong sound comes out, or many sounds are left out all together. At that time the motor plan is not accessible. These errors are not under Sheridan’s voluntary control so he often cannot correct them, even when trying his hardest. Frequently, a child will be able to produce a sound or word at one time and not be able to say it again when he wants to.