10 October 2011

Overdue Apraxia Update

As you'll recall, Sheridan was diagnosed over a year ago with Apraxia of Speech, and I wrote a post about the criteria for Apraxia back then, as well. Since then, I've seen many helpful videos on youtube... parents who video their children periodically to see the progress (or not) a child is making. I've been thinking for some time that I need to do that, so this is my first of what will be a series of posts over time.

When I first posted Sheridan's diagnosis, many people sent me private questions about Apraxia or simply asked that I provide as much information as possible. So, for this post I'll include some information about what Sheridan's speech intervention looks like, show you some of the materials we're using, etc.

Some Basics to Lay the Foundation

Sheridan's SLP is allowing me to record and post portions of Sheridan's sessions. Although she uses a number of strategies with Sheridan (e.g., oral motor therapy, facilitating speech through play), the two things you'll see in the video below are Jane's use of PROMPT and Kaufman cards. Most speech sessions look like this:

1. Oral Motor (usually about 20 minutes)
2. Kaufmann cards using PROMPT
3. Play (during which Jane works to help Sheridan generalize the speech production beyond the cards, often using PROMPT when necessary)

Here's an online description of the Kaufman cards: The Kaufman K-SLP Treatment Kit 1 (basic level) employs a systematic treatment approach that controls the level of motor-speech difficulty by simplifying word pronunciation patterns.  Each card displays a series of “successive approximations” of the target word based on least physiological effort. This “word shell” approach is highly effective for quickly building motor-speech coordination and allows children to begin progressing immediately from a simple core vocabulary toward becoming effective vocal/verbal communicators.

The 5x7 cards are organized from the "easiest" words (from a motor planning, speech production perspective) and then build on those sounds to form progressively more advanced/difficult words (I'll show you what I mean in a second). Bonus: Nancy Kaufman is a woman after my own heart... look at those color-coded dividers. *swoon*

I was a little hesitant at first because all the cards use cartoon drawings. For example, the "daddy" does not, ah-hem, look like daddy. At. All.

So I was worried about whether or not these would make sense for Sheridan, and his ability to generalize from the specific drawing to real objects/people. I didn't need to worry. He totally gets it - calls that card "daddy" every time he sees it, calls Gary "daddy," and doesn't call random up-tight white guys "daddy." So we're good.

An example of an early card (from the CVCV group (by the way, C = consonant; V = vowel) would be dada, mama, moo moo.

The next level is VC (e.g., on, out, in, eat, ouch, arm). Here's an example:

Sheridan has difficulties with /r/ (as do many 3-year-old children), so he still approximates arm as "ahm."
The image on the left is the front of the card (what Jane shows Sheridan); the image on the right is the back of the card showing the progression of the speech sounds. So, at first, a child might approximate arm by saying "ah," but then progress to "ahm" and eventually to "arm." The top is always the goal word.

Next, CV includes words such as two, bay, tea, new, dough, tie. Here's a couple examples:

Sheridan does well with this card and says pie (though he does drag out the /i/ and /e/ at times).
Sheridan still struggles with /m/ versus /b/. Most often he says "be" or "m-be" here.
VCV cards include words/phrases such as: oh no, okay, oboe. Here's an example:

Notice that as words get more difficult, one might use a longer progression of approximations to get to the target word. Sheridan is doing really well with this particular word, and nearly always says "a-po"
CV1CV2 are words where the syllable is repeated, but the vowel changes (such as: puppy, mommy, baby). Here's a couple examples:

Sheridan currently says "tay-to," but sometimes needs prompting (meaning a physical PROMPT). Jane always notes which cards in a set Sheridan says spontaneously (on his own), and for which cards he needs a PROMPT. This helps us see with what sounds he might be struggling, and the progress he's making in a given set (e.g., today on set #3 he said 16 out of 17 cards - correctly - all by himself). 

One of Sheridan's favorite words... he immediately says "bubbos" when he sees this card.

Sheridan says "pee-po" - but occasionally needs prompting to get the "pee" on the front (he has a tendency to say the last syllable of a word; this is somewhat common in people with apraxia).
 The "hardest" set he's working on now is a set of 30 C1V1C2V2 "simple bisyllabics" (such as: muddy, honey, panda, marble... notice the consonant and vowel change in the second syllable). Here's one example:

Sheridan says "noo-do" with prompting (he doesn't know all the words in this set yet by sight). Notice that this word is a combination of the sounds he learned in earlier sets (new & dough).
There's 12 more sets after these... and just because Sheridan is on set 6, doesn't mean his speech is perfect on sets 1-5. He still practices the other sets and is working on improving his speech on those words.

And Now... The Video

This video was taken this past Spring when Sheridan was 2 years, 8 months old. At that point he had been receiving two hours of speech therapy every week (two 1-hour sessions each week) for about six months. (Now he receives three 1-hour sessions each week).

A few things to note about the video:
  1. Sheridan is working only on sets 1 (CVCV) and 2 (VC) at this point in time.
  2. You'll see Jane using PROMPT when she uses physical cues to help Sheridan remember/feel how to make specific sounds.
  3. You'll see Sheridan get really frustrated a couple times because some sounds were really hard for him (for example, /e/ as in eat). Many vowels were really difficult for him.
  4. But know this... Sheridan LOVES (seriously loves) these cards. So much so that we bought a set so he could practice whenever he wants (sometimes he asks every day, sometimes he asks once a week... we follow his lead).
  5. Notice that Sheridan often leans into Jane so he can be prompted. 
  6. He often prompts himself, as well.
  7. I provide the sound he's working on, and the target word so you can get a feel for how this works.
  8. It's worth watching to the very end so you can see that, despite his frustration at times, he truly loves Jane (and he's a little obsessed and extra excited for some of the cards... we often have to hide the up card).
Turn your volume up so you can hear Sheridan :)


  1. Ok- so some questions- is your SLP a prompt trained one or did she just try it based on your wanting to go with that system?

    Do the Kaufman cards and prompt go together or are they separate systems that you integrated. I've heard of prompt- but not the Kaufman cards.

    Abby LOVES flashcards so I'm wondering about something like this. We see Sara Rosenfeld Johnson every 6 mos or so and work with a local SLP who is not trained by her or in prompt. She mainly does play therapy- but comes to the program plan updates with Sara and helps us work our way through those plans. In may we started using her apraxia kit- it has tubes and blocks that help to prompt the sounds. We're still working on individual sounds. About a year ago she had about a dozen or so words she would say- that's dramatically reduced in the last year. To where we occasionally hear a random word, but it's so hard for her to atively repeat it on request. The apraxia tools have helped to get the m sound, but for p and b she does more of a kiss noise. She's gotten better at s and sh, a and if you ask her what certain animals say she'll make approximations. I know she's making some progress- but its what she struggles with the most. Sara says her main issue right now is that she doesn't have volitional airflow. That's improved since may- but it's still not there.
    Thanks so much for sharing!

  2. I so enjoyed watching the video. I've never seen anything like the Prompts she's using with Sheridan. I look forward to watching his progress with this system.

    He definitely likes that UP card, doesn't he! :)

  3. How interesting! Of course I was looking at the cards and trying to figure out how Maybelle pronounces those words. I'm going to forward this post to my best friend, who happens to be a speech therapist (although not Maybelle's speech therapist).