We have now completed our fourth session of PROMPT therapy and Johnny is now able to really close his mouth on the final consonant of a word. Before he could say the vowels and miss the first letter of a word or he would not finish saying a word completely because he didn’t completely close his mouth. By being able to close his mouth Johnny could now say the words “on”, “up” and “help” very clearly now. He was also speaking louder with more confidence to the SLP.
The SLP gives us homework sheets for Johnny to colour and cut out that we can use to practice the target sounds and words a little bit each and everyday. I try and turn other activities that we are doing as learning opportunities by using the target words in different contexts to practice speaking. The only homework word Johnny having trouble with saying clearly is “Mom.” Johnny calls me Mommy but for articulation purposes the SLP is trying to get him to say “Mom” and really close his mouth for the last “m.” This is hard for him. He is sometimes saying “uppa” which means he’s opening his mouth again at the end instead of keeping it closed. The SLP says that we can help model the correct way and gently remind him to keep his mouth strong.
Way back in January when another SLP identified Johnny as having a motor speech delay of Apraxia of Speech she had us begin to work on getting his vowels to sound a lot clearer. Why? Since he was trying to say more and more words and string them together but wasn’t sounding clear most of the time and vowels are in all words that she felt it would start to improve other people’s understanding of what he was trying to say. Now we are working on more consonants and one that is really hard is “T.” If he says the word “top” it sounds more like “op.” That was okay way back in January but now its time to move forward. The plan is to re-train his mind but trick the tongue into nearly going in to the position for “T” by substituting the letter “D” instead in the word. ie “top” we say “dop.” We did this a bunch of times and then had Johnny try to say “top” and I heard him pronounce the letter “T” for the first time ever!
During this session there is only a few quick tears when I remind Johnny that vinyl blinds are not toys and what does Grandma say about her blinds. Experience is teaching me that this wasn’t about the blinds. When Johnny gets anxious and he is elevated in terms of his sensory integration he does some impulsive things even though he knows its wrong or that he shouldn’t do it. The blinds were a sign that he was beginning to have trouble with anxiety and sensory integration and having someones hands on his mouth, lips and face was probably the culprit.
What was beautiful was watching Johnny reach out and grab the SLP’s hand and place it on his mouth when he was having trouble saying a word. It was like he was trying to say “hey lady I need help here because this is hard”. She was overjoyed that he was requesting the PROMPT and also putting his hand on her mouth feeling out exactly how his lips and mouth should move.
There was also another moment when they were looking at a book together and she let him try and describe what was happening in the book with simple words and practice speech. At one point he kept pointing and saying “help” and it wasn’t about the person in the book or trying to say one of the target words we were working on. He was actually asking for help before he got frustrated because he wanted to say something. I had coached him before we came explaining that if things got too hard or he didn’t like a game to just tell the SLP “I need help” or “I don’t like it” instead of pushing stuff off the table or ripping paper. I reminded him that the SLP is there to help make it easier for him to talk.
Some of the things we learned at this session:
1) Johnny is really looking intently at the SLP’s mouth and watching it move
2) He is now speaking consistently louder and with confidence
3) He is trying to make a more mature sound in a word prononucation that was much farther advanced then what was typipal for a child with Apraxia at this stage. He is probably spending a lot of time watching other children’s mouths and adults speak in order to understand and know how to say different words.
4) The SLP said he’s trying to say the “alk’ in the word Block that she would not be expecting
5) Johnny is moving forward faster and stronger then the therapist was expecting and she is very happy and proud of him
6) We learn a word in speech and language in differently contexts….the meaning of the word, what it looks like, how it sounds when it is said, how the word is used.
When Johnny says some of the words or attempts to say them he is showing that he already knows exactly how it should sound and is trying very hard on his own to replicate the word correctly.
The best moment came at the end when Johnny gave his SLP a big hug. “You are such fun to work with” she told him. I would hazard a guess that even though “its hard” he is enjoying his time with her too.