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Is Bad Speech Therapy Better Than No Speech Therapy?

Hmmm….. this is a question I’ve been pondering all day long. Let me walk you through my entire thought process before you weigh in on this issue.

This morning I was in a huge hurry to get ready to go see one darling little girl for speech therapy and then pursue my other passion, being a mom, for the rest of the day.  I usually check the website and my e-mail every morning for comments from readers and respond to any that I can adequately answer before dashing out the door to see my first client.

Today started no differently. I checked the comments section to see if I’d received any questions overnight.  The comments section was extra-full today (14 spam messages from porn sites!) and then a comment from a parent who is facing the challenge of getting her SLP to appropriately treat her 25 month old son who was previously diagnosed with apraxia.  (If you’re intrigued, see the comment from Luz.)

I was so irritated with this SLP in question when I read the comment that I knew I wouldn’t be able to generate a thoughtful, responsible reply, so I posted the comment and then left for work.  I literally could not quit thinking about this situation. It bugged me so much on my drive in that I had to force myself to switch gears and start to mentally prepare for my first and only client today.

After a great hour, I returned home to start my second-shift job as mom. Before I went to chaperone the back-to-school swim party for my daughter’s middle school cheerleading team, I asked my husband if he’d take a quick ride with me to McDonalds to grab lunch. While we were sitting in the loooong drive -thru line, I asked him if he’d read the comment already.

Now for those of you who don’t regularly read this blog, this really is a two-person show.  While I do all of the clinical stuff, my husband is the “techie” one who routinely figures out what I want to do and can’t, and more importantly, fixes all the things I mess up on here! He actually “runs” the site and reads most comments and e-mails before I do, so I knew he’d probably already seen the post.

As he drove me to McDonalds so I could grab our daughter some lunch (very picky and very sensitive tummy – but that’s a whole ‘nother post!), he listened to my rant about the comment I received this morning.  Again, if you’re a regular reader, you know is an everyday occurrence for me. I can get pretty worked up about children who aren’t receiving optimal therapy.

While I paused to take a breath, he posed this great question to me, “Is bad speech therapy better than no speech therapy?”

Hmmmmmm. After a very brief pause, I jumped in and said, “Yes. Bad speech therapy is better than no speech therapy.” I supported my initial argument with justifications such as, “At least the child is focusing on learning language during the visit when they might not otherwise be.” I continued with, “At least the parents are getting advice about how to target improving language at home.”

As I was yelling across him to order the only chicken sandwich our daughter will eat, I glanced at the look on my husband’s face. Why was he smirking?

Then it began to dawn on me too. I started to hedge on my previously “correct” answer. I questioned aloud what he had to be thinking.

But, what if the advice that parents get is the WRONG advice? What if the SLP is using the WRONG approach?What if the parents end up feeling more helpless and confused than ever before? Would this really be better than nothing?”

Hmmmmm……Then I arrived at my next conclusion. Bad speech therapy is not better than no speech therapy.

Actually, it could be (gulp) worse. When parents are counting on sound advice from the person they view as a “professional” and that person does not deliver, for whatever reason, be it lack of experience, or education, or in some cases, plain ole’ common sense, it may actually cause harm to the family and child.

Not harm in the way that the child is physically injured, but harm in the sense that his parents believe that they are doing “the best” job they can by seeing that he gets “the best” treatment possible. If parents don’t know any better and keep doing the same unproductive things week after week, session after session, precious months could fly by without a hint of measurable progress or even a glimmer of hope. In my opinion, contributing to lost time during this critical window of development is harm.

Then my husband asked another question. “What if the SLP herself doesn’t realize that she’s not helping a child?”

That opened up a whole new line of questions for me.

“What if she doesn’t question why her clients don’t make progress? What if she thinks it’s normal for kids to run away from her and cry? What if she gets fired and doesn’t even think it’s her fault? What if her area is so short of speech therapists that she never gets fired because nobody knows any better? What if she truly doesn’t know she’s bad?”

Hmmmmmm…… I don’t even know how to address this issue other than to tell parents, you’ve got to do what’s best for your child. If you think therapy is not going well, if you feel a pit in the bottom of your stomach during yet another horrible session, if you think there’s a problem, there is.

That’s where you parents come in. That’s where therapy supervisors come in. That’s where team members in multidisciplinary models come in. You have to have a voice. You have to speak up. You have to say to that unsuccessful therapist – there’s got to be a better way!

The answer may be helping an inexperienced therapist begin the process of self-analysis. Ask her, “Do the children on your caseload make progress?” “What expert’s material do you read?” “What would that expert recommend for my child?”  “What could we do differently to make this better?”  “Is there any other approach we can try?”

If your SLP can’t answer these questions, I hate to say it, but you and your child are in big trouble. The answer in this case is to find someone else to help you work with your child.

As I’ve said often on this site, most children with language delays and disorders need high quality speech therapy to make progress. Sometimes maturation kicks in and kids get better on their own or with a little help from mom and dad, but for children who have a diagnosis as a “reason” for their delay at 2 or 3, you’re going to need a professional, and a good one at that.

Many children who are just thought to be “developmentally delayed” must also have speech therapy in order to make enough progress with language to catch up to their peers. Good therapy can make a HUGE difference.

But what if there’s no “good” therapy? What if you just aren’t sure? Keep reading, keep watching, keep asking questions, and keep trusting your gut.

Sometimes bad speech therapy may be better than no speech therapy, but then again, doesn’t your child deserve better?

Posted in ,

Laura

38 Comments

  1. Kate on August 2, 2008 at 10:55 pm

    I couldn’t help myself as this question was also very interesting to me. As a Developmental Interventionist, I see this in practice on a regular basis!!! Case in point, I once saw a little fellow for therapy. He had been receiving weekly speech therapy for six months prior to the point where I got the referral.

    I guess you could say that I am a very “language based” developmental therapist/interventionist. The vast majority of the children who recieve early intervention services present with some form of a language delay as speech and language skills are typically the last things to “come around”. I have known and worked with Laura Mize for nearly ten years now and have learned a great deal from her. We routinely share experiences, valuable resources, and sometimes clients!

    Well needless to say, the speech therapist who had been seeing the child mentioned above, was NOT Laura Mize!!! For six months she had been reading him books. Unlike many of the children we work with, this child loved books. He quietly sat and listened to every word she sad, very quietly!! After six months of therapy, he had 4-5 words that he used on a very infrequent basis. At the rate of $75.00 an hour, those were very expensive words and I’m not sure the SLP had anything to do with them!!!

    So I go in as the Developmental therapist (AKA “closet speech therapist”). I introduced signs, child directed animated play activities, modeling with lots of repetition, positive praise, oh yea, and skittles! He loved skittles; he approximated 15 words that first day! I gave it MY BEST APPROXIMATION OF THE LAURA MIZE, TEACH ME TO TALK APPROACH, at the time. Mom was eager, concerned, and motivated to do all that she could to help her son. She committed to doing what I told her she should do.

    Long story short, well not so long, three months later I discharged this darling little boy as his speech and language skills were age appropriate! Meanwhile, the SLP continued to read to him on a weekly basis! My point here is that I see on a regular basis just how ineffective some speech therapists can be, sadly, many speech therapists.

    So many of the therapists that I deal with seem to think that speech therapy should be hard, closely resembling “work”. I’ve had more than one speech therapist tell a parent that even though a child is talking more with me because I am able to “play” with them, their age inappropriate approach is what “speech therapy” is supposed to be! Go figure…I guess this has turned into my evening rant…in closing, let me confirm what Laura has already stated…TRUST YOUR INSTINCTS AND YOUR CHILD’S INSTINCTS!

    If you find yourself beginning to dread your child’s speech therapy sessions or it is obvious to you that your child is miserable and making little or no progress-do your homework and find out who is good. Trust me when I tell you that all speech therapists are not created equally! Implement the strategies discussed and demonstrated in Laura’s Teach Me To Talk-DVD yourself and replace your current speech therapist with someone who trully knows her stuff!!!

  2. Kathy on August 3, 2008 at 3:07 pm

    I am struggling with this scenario currently, as I am sure many parents are. I knew my daughter had a problem shortly before her 2nd birthday and five months later I still don’t have a therapist I feel great about. The first SLP we saw through our insurance probably caused more anxiety in me than I have ever encountered. After a one hour consultation, in which she spent zero amount of time interacting with my daughter she announced that my daughter had autistic traits. The two traits she referenced were things I mentioned during the questionaire and were not even observed by her. One was lining of toys and the other was the loss of ONE phrase my daughter was no longer using. The therapist actually made this remark in an open setting where other parents could hear and I was livid at her lack of professionlism. I knew that lining toys in itself did not equal autism (something she no longer does by the way)but she spooked me nonetheless. A week later I received a copy of the evaluation and was horrified to see that they had merged another patient’s information onto my daughter’s chart and what was submitted to both my insurance and pediatrician was inaccurate. Obviously, I was not going to take my daughter back there but that meant going on an extremely long waiting list for the next available SLP. Three months later we got in and while the initial eval went much better, I have doubts about the actual therapy. I have not been impressed by her lackadaisical approach and I was informed that our insurance will only cover 10 sessions. So, I continue to go for fear that something magical happens.

    The Regional Center evaluated my daughter and determined that she was age appropriate in her gross motor skills and actually ahead in her social, self help, and cognitive skills but both her expressive language and fine motor skills were delayed. We have been cutting through red tape for 3 months now and the only positive thing so far is the developmental teacher who comes to our home once a week. She works specifically on speech and I feel she has made great strides in that area but, unfortunately, when we start the actual speech sessions we will lose her. I have struggled with making the choice between her and a new SLP because I hate to disrupt a good thing. However, the new facility we are to attend offers 3 weekly sessions, 2 hours each (1 hour O/T, 1 hour S/T)and I feel I should give it a try, although it seems extensive.

    Anyway, great article and it is such a terrible choice for parents to make when there is NO alternatives to bad therapy. I keep hearing over & over that speech services are over extended.

  3. Laura on August 3, 2008 at 6:04 pm

    Oh Kathy! It’s soo bad that you’ve had such a horrible experience with speech, but I am glad your developmental teacher has been helpful. It also sounds like you have a good plan going forward for the new facility, but I understand your fear of giving up a good thing for what could be worse. I wonder if you live in the USA? Speech therapists are in short supply internationally as well, and judging from the e-mails I get, finding a good one overseas is even more challenging than here in America.

    I hope that you’ve gotten good information for things you can do with her at home, and I love how persistent you are being with pursuing a good match for her for services. I don’t understand why you have to give up your developmental teacher one-on-one at home if you go to a center, but it must have to do with your area program requirements. If the sessions are individual, it sounds great, but if it’s group, I’d make sure other parents are happy with the program before giving up your home sessions. One of the best professional experiences I ever had the pleasure of doing was running a play group for language-delayed kids, but all programs are not created equally! Make sure she’ll get LOTS of language focus, even if it is within a group. Just a thought…. hope it doesn’t scare you more!

    Nonetheless, I wish you all the best as you continue to pursue services for your little girl! Please let me know if there’s anything else I can help you with! Laura

  4. Kathy on August 4, 2008 at 11:50 am

    Laura,

    The facility we are waiting to get into is considered a “full service” facility and the Regional Center said that we couldn’t go there and have a developmental teacher because it would be considered “double dipping”. We live in Southern California and for some reason, speech therapy is in very high demand.

    I do have a question. In your opinion, does it matter who is working with my daughter (developmental teacher versus SLP?)Logically, it makes sense that I should be taking her to a licensed professional who specializes in speech but it is so hard to cut our teacher loose when she is making progress & comes to our home. Also, you are right to assume the new facility is group therapy although I think we can opt for private sessions. They really recommended the group environment so I was going to see how it goes. The one thing I am tentative about is I will have to view the sessions from a monitor in the waiting room with the other parents. Do you have any thoughts regarding this?

    We are currently seeing a SLP through insurance and after reading some of your articles I am really questioning her methods. Her only advice for us at home was to provide a “language enriched enviroment” meaning narrate everything I am doing all day long. It totally makes sense what you stated about that not making a difference. How frustrating!! I have copied a bunch of your suggestions and both my husband & I are studying them.

    Thanks.

  5. Laura on August 4, 2008 at 8:13 pm

    Kathy – I understand your predicament. It’s hard to know if you should give you a good thing when you’re not sure of what could happen next. One thing I would recommend is a visit to the group facility before your daughter begins. Watch the session on the monitor and see if the children are engaged. Are they talking? Are they getting individual attention? What do the other parents have to say about the program? I think you’ll get lots of good information this way.

    My friend Kate is often in this same situation. (Look for the post about our new show “Teach Me To Talk with Laura and Kate” on the home page.) Although she’s not an SLP, she uses the same approach I advocate, so consequently, she frequently gets better results with language with the kids she sees than the SLP on the team. Parents tell her this often. A degree in speech pathology doesn’t necessarily mean you know what you’re doing. Kate and I addressed this issue on our first show, so you may want to listen to that.

    That being said, the SLP at the facility may be wonderful. You won’t know until you try. I wonder if you decide to switch providers if you can change back if it’s a mistake. Could your developmental teacher work with her “on the side” and you pay her out of pocket until you know that the new place is a good fit? Just a thought….

    You may also want to check out the DVD so you can SEE how to work with toddlers using age-appropriate techniques since you have some doubts about your private SLP. Some SLPs have not been trained with how to work with toddlers. I wasn’t either, but I learned it trial by fire, by attending courses with experts in toddler assessment and evaluation, and by reading everything I could get my hands on and making sure it matched what I knew about 1 and 2 year olds from being a mom. Ask her what experts she reads and see if the names are the same ones I recommend, or better yet, check out their stuff yourself to see if it “gels” with what you know about your child. YOU are the expert on her!

    Thanks so much for your questions! I have enjoyed hearing from you. Let me know if there’s anything else I can do for you! Laura

  6. Helen on August 5, 2008 at 10:00 am

    Hi Laura,
    Last night I really questioned whether or not we should really start looking for new EI SLP. A while back I posted on another board about how my dd is 2.5 now and that she’s been in therapy for about a year and a half and how she’s getting really frustrated during all of her therapies (ST, PT, OT & DI)…You gave me some really great advice and I’m thrilled to say most of the therapists have really changed up their approach w/success…with the exception of her SLP in EI — Now, I have to work on the day the EI SLP normally comes, but the SLP and I speak often and use a communication book. Last night, dd had a make up and so I was able to watch the session–the SLP just went on and on about dd’s behavior and how she “only gets a good 15 minutes” out of my kid. This isn’t the first time this therapist has complained like this and frankly I’m tired of it…Now I know that the SLP only works for EI one day a week and works the rest of the week at a hospital. So I flat-out said to her “do you work w/a lot of 2 year olds?” (she’s 29 and has no children of her own either) well that set the tone for the rest of the session – I know I offended her – I try to stay objective and not go into momma-bear mode and I know my daughter is by no means perfectly behaved all the time, but I explained to her that I don’t get that kind of feedback from any of her other therapist at all b/c they’ve let the sessions become slightly more child directed… the SLP called after the session last night to be sure that “we are OK and on the same page” which says to me that the SLP seems to want to work w/dd. But I am just so anxious over this and I really don’t know what to do…the SLP is PROMPT trained and it seems as though very few SLPs (especially in EI) have this training (signs of dd being apraxic are becoming more apparent by the day)…Right now we are working w/a private SLP until a PROMPT certified SLP becomes available…Maybe they just are not connecting…I’m sorry I’m rambling…but I am so confused as to what do…DD really needs help. We need a PROMPT certified SLP, but it seems that this woman is almost unable modify her approach. Is it b/c she does most of her work in a clinical setting and not w/EI (aren’t most kids are a little more reserved when they are out than when they are home)? I am having so much anxiety over this… have any suggestions as to how I can make this work? Thank you so much!

  7. Holly on August 5, 2008 at 10:53 am

    Hi Helen,
    I just thought I would drop my ‘mom’ opinion from my own experiences. I think from what I saw from my own son, now 4 but 2.5 when he started with EI SLP’s (he’s apraxic), that 15 minutes of ‘good’ therapy isn’t bad for that age, especially when they are at home. That’s their ‘comfort’ zone and they tend to ‘act’ up if you will more at home, then when therapy’s some where else. . They do have a short attention span and if he/she’s only doing prompt, perhaps your child is just ‘bored’ with it, causing them to lose interest. From my own mom experience, if you have a bad feeling about the therapist and/or they are not willing to listen to you and your ideas for therapy, then you’re probably best to find another one that you’re comfortable with. Perhaps the other therapist your child sees doesn’t have the same problem because they aren’t as ‘boring’ if you will with your child’s therapy. If they’re not ‘connecting’ with your child, your child will not be getting the most out of their sessions. I know it’s hard, fusterating and so darn confusing sometimes what to do as a mom and when to back off, been there, done that and I’m still doing that. Just remember usually us moms intuition’s are right and any good therapist will listen to them since we know our children best. So if she’s not willing to change her strategies to make things work with your child, then I would say it’s time to move on. 🙂 Keep smiling and don’t give up.

  8. Laura on August 5, 2008 at 4:21 pm

    Helen – I agree with Holly. The SLP, no matter what method she’s using, MUST connect with your child.

    PROMPT is a very successful method for children with apraxia, but I don’t use it at all because I think the focus for most kids under 3, even those with apraxia, should be language, language, language. Now that’s not to say that I don’t use some tactile cues and other verbal prompts and sound cues with toddlers, but in my opinion, if sounds are the primary focus of the session for kids under 3, you’re going to lose a kid for most of the session, most days, and it’s just not worth it to me. Unless the PROMPT person or ANY therapist for that matter, can make it more kid-friendly so that she WANTS to participate, find someone else who can.

    I know I’m probably going to step on toes by saying this, and I hope I don’t get bombarded with hate-mail from other pediatric SLPs, but it’s from years of successful personal experience that I say this. I think PROMPT has its place, and it truly is the only method that works for some apraxic children, but if your daughter can’t stand the therapy or therapist, what good is it doing anyway? It should not be the only method a pediatric SLP uses either. The bag of tricks should be bigger than one approach!

    Again – just my opinion,from a language-language-language perspective, but I’m stickin’ to it! And again – please no hate mail!!! Laura

  9. Yvonne on August 6, 2008 at 11:53 pm

    Laura,

    I completely agree with you about PROMPT. I’ve only been PROMPT trained for about a year. I work with EI, and I was really gung-ho to start using it after my training. I quickly found that my little kiddos were just not very keen on it. I’m sure part of it is my inexperince with it, but I’ve come to my own personal conclusion with it. (I’m glad to see I’m not alone!)

    With my kiddos that I suspect apraxia, I tell the parents that I am PROMPT trained, and I do some of the “gestures,” but I do not do it in its “truest” form. I look at it more as getting the kiddo used to someone touching their face, supporting their head, etc. If the kid doesn’t want me to do it, I back off. That way, when they are a little older, and ready for “true PROMPT” therapy, it may be a little easier transition. I consider it more “tactile cueing,” but with the hand gestures for PROMPT. I hope that makes sense.

    I always use it during play therapy though, and never just on its own. I’m sure there are therapists out there with much better PROMPT skills and experience than I have, that can make it work, but I agree with you…. Language, Language, language.

  10. Helen on August 8, 2008 at 7:43 am

    Laura,
    Thank you again for your wonderful advice…my daughter actually connects well w/one of her DI’s (a retired Special Ed. teacher) and that DI has offered to do a co-treat w/that SLP in the hopes that the SLP will pick up on her method. So we’ll see what happens for next week…in the meantime I picked up your video in the hopes that I can become a more effective teacher too. Looks great from the preview and I can’t wait to get it! Thank you so much!
    Helen

  11. Allison on August 8, 2008 at 5:26 pm

    I dunno….I’ve got to respectfully disagree with you ladies on the PROMPT thing. As I’ve told Laura before, my son had an EI therapist starting at 18 months old. She did play based, language bombardment therapy. It got him nowhere. At 2, we got an apraxia diagnosis, and in the first 10 minutes of therapy with a PROMPT trained (she had 2/3 courses) therapist, using PROMPT tactile cueing, he was saying the “p” in “up,” something the EI therapist had been trying to, but unable to, do for 4 months. From there on out with the PROMPT therapist, he improved by leaps and bounds. This SLP is highly successful in treating young apraxic children. So it can be done well. I just don’t see how language bombardment is going to help a child with apraxia who physically can’t get their lips and tongue in the right position without hands on prompting. Particularly since children with apraxia have a near impossible time mimicing facial movements by mere observation.

    Allison

  12. Laura on August 8, 2008 at 5:53 pm

    Allison – I appreciate your input, and you’ve shared that story about your son with us before. I am glad that PROMPT was so successful for him, and it sounds like you had a talented SLP who was able to implement this with him without a negative response. I just have to wonder, if your son had not been so receptive from the beginning, if you would feel the same way. I was addressing a comment from a mother who did not feel that her daughter responded to this approach. I think EVERY decision we make about our own children and in our professional lives is based on our own personal experiences. For you and for Alex, PROMPT certainly was the way to go. But for other children and other mothers, maybe not. Laura

  13. Allison on August 9, 2008 at 6:07 pm

    I completely agree that PROMPT might not be for all children. I only posted because the posts were just being made to sound like it’s not right for most younger children. And I know quite a few younger children who have responded very well to PROMPT. My son is not an isolated success story with it. So I wouldn’t want people with children who have apraxia to not give PROMPT a shot because of what they’ve read here. That’s all.

    Allison

  14. Laura on August 10, 2008 at 7:24 am

    Allison – I am so disappointed that you seem to misinterpret my intentions about PROMPT every time we talk about it. Again, your experience has been very different from my experience. I’ve been an SLP for 15 years and have treated thousands of children, so I have the benefit of looking at this from a much broader perspective for LOTS of children with a range of issues vs. your perspective as a mom of an apraxic child.

    Many children have, can, do, and will benefit from this very hands-on approach, and I would not discourage a parent from trying it ever, just like I wouldn’t discourage parents of an autistic child from trying ABA or biomedical interventions, both approaches that I don’t use. If it’s out there and a parent feels it might be beneficial, give it a whirl.

    However, and I will say it again, many children are resistant to any hands-on approach (be it from their PT with NDT or OT who is using physical manipulation to achieve fine motor goals).

    When I responded to this very specific comment from this particular mom, it doesn’t sound like PROMPT is even the problem. It sounds like she has a pediatric SLP who doesn’t know how to engage a two-year-old. My point it that her therapist should be using more than one approach, particularly when it’s not effective for her clients.

    Your point is well-taken, and we need to move on. Laura

  15. Alicia on December 30, 2008 at 11:58 am

    Dear Laura, I just found your website and am very excited about it. I knew around my son’s first Bday that something was wrong. We were able to start therapy around 15 months. It’s such a long story, but he is now 2 and 1/2. He has OT, PT, and Speech. He was formally diagnosed with oral and verbal Apraxia a few months ago. He fits the profile perfectly. We’re on our 3rd SLP. I still don’t have a good feeling about it! I am ready to keep him home and try myself. I don’t think we’re getting BAD or harmful therapy. But, I don’t think it’s helpful either. I’m looking back thinking that I tryed so hard to intervene early and get him the best we could, but know I’m realizing that he’s almost 3 and he is NON-VERBAL. My therapist says this is normal. That it is slow going with a child with Apraxia. She really hasen’t worked much with Apraxic children. When she first started with him she had high hopes and was very confident. She was basically using a typical speech therapy approach.She shrugged off the signs I’ve taught him and the picture book I made him. Now she is doing Easy Does It for Apraxia with him and her own picture communication. I observe therapy often and my son is very cooperative. She always braggs on him for being such a hard worker. He is very social and attempts an approximation almost every time it is requested. Your article really captured my attention. There really are not a lot of options for therapists for me and he is doing very well with the other therapists. I just don’t know what to do at this point. I feel like he should be saying some words. Is this slowness normal? What do you think of the program she just started using? I want to give her this website, but don’t want her to see my post. I would love to have your advice!

  16. Laura on December 30, 2008 at 7:43 pm

    Alicia -First of all, welcome to the site! I hope that you find the info you need.

    Sometimes progress with apraxia is very
    s-l-o-w. It is sometimes very difficult to make progress even with a therapist experienced treating children with apraxia, so I’d definitely want one who had experience over one that did not! That being said, every SLP has to gain experience with somebody’s kid, so if she has a good rapport with him AND is reading and searching for new info, then you’re probably okay. BUT if you think you should get someone else, then pursue it.

    AND I would never recommend that a parent exclusively try to treat a child with apraxia on their own at home with no professional help to guide you with what to work on next and demonstrate how to use the techniques. That being said, it is most beneficial when the strategies are actually working, so keep asking her to tweak her approach until she finds something that seems to click for him.

    Even if she doesn’t sign or like your pictures, you should continue to do that at home. He needs a way to communicate while he’s learning how to talk. You did the right thing by starting these alternative methods, and you should keep them up at home, whether she supports your decision or not. When you’re signing to him, be sure you keep saying the words and prompting him to do this too. Kids with apraxia often start to vocalize with their signs, and then you can shape those sounds into word approximations.

    I own the Easy Does it Set for Apraxia and use the concepts, but not the actual program, for the children I see with apraxia. I love the ideas for using the vowel sounds alone, but I do these in play with toys, not the worksheets. This is a well-recognized approach, and I hope he begins to make progress soon, for his sake and yours!

    Hope I’ve answered your questions! Keep reading for more ideas! I’m working on a DVD specifically for parents for kids with apraxia, but the first DVD Teach Me To Talk is also filled with the basics for working on expressive language for non-verbal kids, and is highly appropriate for children with apraxia.

    Again – welcome to the site! I’ll change your name on your original comment and this question if you want me to so that your SLP won’t know it’s you, or delete it altogether if you’d like to refer her to the site. I’ve done this for other moms so they can remain incognito and then you can talk with her about what you both read. Let me know if you’d like for me to do this! Laura

  17. Alicia on December 30, 2008 at 10:19 pm

    Laura, Thanks for getting back to me so quickly and for your advice! Your advice makes me feel better about my SLP. I know she cares for him and his progress. They mesh very well too. I have two other young children and am getting burnt out on 3/day a week therapy that seems to not be helping. I feel like the SLP and I may be having a power struggle also. She really seemed disdainful at my communication book. It was a velcro system of boardmaker pictures. I really think she just wants to be in charge of it. She said she didn’t want me to use her book with my son until she got him going on it. I haven’t seen it yet. We’ve been on break for the holidays. I’ll keep sticking my nose in. I know she means well. I just wanted to see if you thought she might be totally off with the lack of verbal progress.

    I have been on your site on and off all day! I’m going to try some fish oil! And, maybe I should get my own copy of the EDFA manual. I may get your DVD, as well. I wish my therapists could see my son in our home. Often they comment on things he is doing new. But, they aren’t new it’s just that he is opening up to them more as he gets more comfortable. I feel like they forget that as mom I know him SO well. Can you tell I’m a proud mom?

    I’m using a fake name, but I would appreciate it if you would delete these two posts of mine just in case she found them and suspected. I want to tell her about this site. I’m so glad I stumbled onto it. I was only familiar with Apraxiakids. So, you recommend The Late Talker. I guess you would recommend it for me? What about a good kids signing book? My child uses his several signs very well, I should expand our signs. I had a SLP rec’d Sign Exact English, but my SLP advised against that method. What do you think?

    Thanks so much!

  18. Laura on January 1, 2009 at 8:42 pm

    Alicia – I am going to delete these posts after a few days when I’m sure you’ve had a chance to read them!

    The Late Talker is a good starter book for parents. Read all of the articles in the apraxia category for other resources I recommend.

    I use a mix of ASL and Baby Signs for the signs I use with clients. It really doesn’t matter what you use since most of the time, signing is not a permanent means to communicate to kids with speech and language delays.

    I hate the whole power struggle issue for you with your SLP! You’re both on the same team! Hopefully the two of you will begin to click soon!

    I would definitely talk to her about the “new” stuff issue though. I try to remember to ask moms “Is this new?” rather than to assume, and this DOES make a difference to me so that I know if things are beginning to click and a child is acquiring new skills OR if I’m just getting to see his “typical” speech after several sessions.

    Happy New Year! Laura

  19. Alicia on January 2, 2009 at 10:33 am

    Thanks, Laura!

    I will get on the ball with more signs. Thanks for the freeing view on that! I was just realizing that myself yesterday when I was talking about signs to a friend. It IS just temporary for my son!

    I love your site, thanks for the help!

    Happy New Year to you also!

  20. Michelle on February 11, 2009 at 6:49 pm

    My daughter is 3 1/2 with Down Syndrome and Apraxia. We started out with a bad therapist and my daughter made very little progress. The therapist would withhold things from my daughter until she cried. We also are in a bad school district that believes that the number one priority is saving money. In June of last year she was at a verbal level of 0-3 months. We had an apraxia evaluation in September and she can’t be diagnosed because she is saying so little and she can’t immitate. On an evaluation last month she can say 5 words which is appalling and I think it is because of bad therapy that wasn’t treating Apraxia. We are now seeing an outside therapist who is wonderful and my daughter is finally making progress. The therapist is an expert in Apraxia and the techniques are working. Our insurance will not cover any therapy because she has Down Syndrome and that can’t be fixed. Her speech delay is a huge concern for us and I liked your article about good/bad therapy.

  21. Joy on October 22, 2009 at 5:35 pm

    My son just turned 29 months, and is enrolled in speech therapy for the past six months. I’ve also been working with him at home using techniques from your DVD’s Teach Me To Talk and Teach Me To Listen and Obey. We noticed that around his 26th – 28th month, he started to imitate more words. However, he is not able to do this when he’s with his speech therapist. I think it’s because her style of therapy is somewhat different from yours. I’ve been using your techniques with him at home, and it worked for my son. My son’s speech therapist does not encourage my son to talk that much. I’ll give you an example – They do puzzles together which my son enjoys. His therapist will give my son each piece of the puzzle and say the name of the animal and sound of the animal and have my son put the piece in the puzzle. She just models, and expects the toddler to imitate. I do the same at home, but I try your style where I put all pieces of animal puzzle on the floor and ask him, “Where’s the bird?” Bird says tweet, tweet! Then he will look for the bird and put it in the puzzle. I also make him try to say the word “bird” of which he will make an attempt to imitate. His therapist doesn’t do this with him. We even showed her that my son can now imitate words, because with her my son doesn’t do it. After his speech session, they usually provide crackers for kids, I made my son say “eat” and “cracker”. She also taught my son body parts, but with her, she would only guide my son’s hand and very quickly say “eyes, nose, mouth, fingers, etc.” So, one day I showed him by asking my son “Where’s your eyes, nose, mouth, etc.?”, and the therapist witnessed that my son can point to the body parts and say those words.

    I’m not saying all her efforts were futile. My son continues to learn a lot from her except that she doesn’t give my son much chance to say anything. When he points at books, if I say where’s the horse, dog, etc. He will say the sounds of the horse, and dog, etc., at times he would attempt to say the words like cat, elephant, etc. With food, we make him say it before giving it to him such as apple, cracker, chips, etc. I guess my standards became pretty high when I saw your video, and used it successfully with my son. I even lent her the video, and told her how much it helped me. I hope she did not feel offended.

    I’m thinking if we should look for another speech pathologist, but I am also hesitant because my son is used to him already, and also what if the next one is no better? She’s also very easy to talk to when it comes to scheduling sessions, and very encouraging. Maybe her approach is just different. Your feedback is appreciated.

  22. Laura on October 22, 2009 at 9:35 pm

    Oh Joy…. On one hand I am just thrilled at the progress your son has made with YOU working with him at home!! What a testimonial this is to other moms who are afraid they can’t have success with their own children!! I am so proud of you for taking the reins and helping your son learn to talk!!! HOORAY for you!!!!

    On the other hand…. I wish that you were seeing more direct success in your therapy sessions – especially since you’ve been able to show your SLP what strategies have worked for your little boy at home. I am not going to say anything negative about your SLP since you have pointed out several wonderful qualities….. but….it would just be nice if you felt like she was really helping him! I certainly realize that personality plays a big part in what approaches SLPs use, that there is more than one way to accomplish a goal, and different approaches work for different children… but….. I’m also wishing for you that you had someone who was easy to schedule with, who your son likes, AND who helps him learn to talk!! I hear from those SLPs all of the time, so I know they’re out there!!!!

    You won’t know if your next SLP is better or worse until you make that decision to move on, and that’s just something you’ll have to decide for yourself after you continue to weigh the pros and cons like you’re doing now.

    But let’s not lose sight of the best news of all here- YOU have made a HUGE difference in helping your son learn to communicate, and I applaud you for that!!! That’s why I do this job!! Thanks for sharing and making my day!! Laura

  23. Patty on October 30, 2009 at 11:45 am

    Hi Laura! I was referred to your site by Allison (Jake’s mom!). I believe that we have a bad SLP. I’m sure she is good for others, but she and my son just never connected. His OT was fantastic (he graduated OT last week!), and they were very well bonded and attached to each other. After reading all this information on your site, I suspect that my son may have apraxia. He had motor delays that appeared to be due to a motor planning issue, and now we are deeply entrenched in dealing with the expressive speech delay. His spontaneous speech, such as it is, is age-appropriate, but difficult to understand (even for me, sometimes). He has most of his sounds down (except for some of the more complex ones), which he developed just through babbling, which is very encouraging. At almost 3, he can tell me when he wants something, usually by saying “Ah wan (fill in the blank),” and has always been awesome about telling us when something hurts – he’ll say whatever the body part is, and follow that with “owie!”

    Anyways, I don’t feel that our SLP has done much for him. She usually spends most of our sessions asking me what he has done been doing, and we only see her every other week. That is all that we were approved for – pretty surprising considering that a year ago, he was non-verbal. Since he only has 2-3 more sessions, I’m not too concerned about it, because he’ll be moving on to speech and preschool through our school district, but it’s frustrating to realize after all this time, that we could have been working with someone who might have been more helpful.

    I’m glad you wrote this article – hopefully it will help others realize that they are in bad situations before it’s too late to change SLPs, like it is for us! I can only hope that our next SLP will be more helpful.

  24. Jana on May 22, 2010 at 7:00 pm

    Hi Laura,

    I put Jakob in speech therapy with a private SLP. He has been going twice a week for 30 minutes at a time. And while he has developed more words, they all have the same characteristic….they are open syllables. Where does this lie on the road to Apraxia?

    He does have some “eee” words now, so that’s good.

    We are getting dropped from our Early Intervention services, because our insurance won’t let them double bill for the same services. That is really disappointing to me. Since Jakob is not in any daycare of anykind, I was really using that as another chance at adult interaction other than me. Also, at our last session with our ECI SLP, Jakob actually sat with her and did exactly what she asked him to do, instead of leading her on an obstacle course around out house. I am really bummed, and can’t help but have those lingering feelings that she gave off by suggesting I discharge him from services on her first visit. I can feel a joy in her message that she doesn’t have to come anymore. (In our area, the ECI SLP’s are covering like 8 counties or something ridiculous.)

    Anyway, I am just curious about how the complexity of the words Jakob is learning is increasing……

    ~Jana Green

  25. Laura on May 23, 2010 at 10:41 pm

    Jana – Celebrate your successes with Jakob and try not to worry about the articulation piece just yet. His language needs to catch up first, then you can target articulation. When you focus too much on the specifics of sound production at 2, sometimes kids become so frustrated that they plateau or shut down, and you don’t want that. Just keep encouraging his expressive language with new vocabulary and longer utterances, and the intelligibility piece will fall into place later. I’m glad he’s doing so well with his new person. Focus on that and try not to live with regret or second guessing – What if? What if? It’s not productive. I know you know all of this already – just giving you the same advice I give myself 🙂 Laura

  26. Ed on November 6, 2010 at 6:32 pm

    Hi Laura,

    I’ll likely get slammed for this but in regard to your original question I believe the answer is yes.

    I have our 40 month old daughter on what I call “Nick Jr Therapy”, yes television, and it has made a marked improvement in her vocabulary and intelligibility over the last 4 months.

    At 36 months she was talking plenty but no one, including us, could understand much. It was a vicious circle where she would initiate conversations but then receive inappropriate feedback which would end any meaningful dialog, thus leading to less conversation.

    My theory was that quantity would eventually lead to quality. So every night I plug her in front of Nick Jr and watch the pre-school programming with her.

    The visual context allows me to interpret what she’s saying then repeat it back to her in proper form so she knows she’s been understood. I then prompt her with simple questions in order to maintain the dialog. I repeat back everything she says (once) then continue the conversation. I never try to correct her, only to generate more speech.

    This can go on for hours because she loves the programming, loves to talk about it and doesn’t feel pressured. In fact she now gets upset with me if I skip an evening.

    The broad content also allows me to continually introduce new words and concepts. Whenever she doesn’t respond to a question I simply tell her the answer. After a few days the new words will magically appear in her conversation.

    I believe that her intelligibility has doubled during this course and now even strangers are beginning to understand her. Once she has reached the point that she can dialog with others the process should become self sustaining.

    In any case she has her first evaluation with a real SLP in a few weeks and I expect an Apraxic type diagnosis to come out of it. Her larger problem is consistency and this has not improved as quickly as the other factors nor am I qualified to deal with it.

    In general though it appears that simply increasing the quantity of (accurate) dialog will eventually increase the quality of dialog. Something that anyone can do.

  27. Laura on November 10, 2010 at 7:32 pm

    Ed – The important thing is that you are regularly spending time with your daughter, responding to what she likes (vs. trying to introduce her to something new), and are targeting her speech in a very naturalistic way. I’m not a huge fan of TV for kids, but you’ve found a way to make it an enriched language experience that the two of you share together. Who can argue with that?? I applaud your effort, and while it may not be a traditional way to target improved speech and language, you certainly cannot argue with the successes you’ve achieved. Keep up the good work! Laura

  28. Ed on November 11, 2010 at 8:39 pm

    Thanks Laura,

    I knew it wasn’t a traditional approach but it seems to work. Eventually I will introduce reading in the hope that one reinforces the other but she is not ready yet.

    I am hard pressed to understand how even the pros deal with consistency issues since they’re systemic errors rather than particular ones.

    By consistency I mean random error, where speech may be intelligible or not depending on sequence. My daughter must not only know a word or phrase but also be familiar with particular sequences of use in order to achieve intelligibility.

    In my limited experience I have found that consistency only improves with familiarity. And listening is not adaquate, she must speak in order to improve. This naturally leads back to (expressive) quantity.

    Having thought it through I would propose that expressive quantity, followed by accurate intreptation and appropriate feedback, leads to familiarity, consistency and finally intelligibity.

    Any other thoughts are appreciated…

  29. Laura on November 14, 2010 at 5:11 pm

    Ed – I am using this question on today’s podcast – Sunday 11/14 at 6 pm eastern time. Hope our comments help! Laura

  30. Laura on November 14, 2010 at 5:14 pm

    On today’s podcast (Sunday, November 14) we’ll be answering recent questions from Sarah who is concerned her son might have apraxia, Alisha who is worried about having her son formally diagnosed, and Ed who is using a non-traditional method of targeting his daughter’s speech delays. Join Kate and me at 6 pm eastern time as we hash out answers for these great parents! You can listen live from here on the website. Laura

  31. Ed on November 17, 2010 at 2:45 pm

    Hi Laura,

    Thank you for the kind words during your podcast, I just listened to it.

    I have some observations that I would like to relate. I’m convinced that our daughter has increased intelligibility by decreasing complexity. This was not something that I taught her but was instead a natural outcome of the dialog and feedback process.

    Through feedback she learned what worked and what didn’t work and her adaptation was to simplify her speech sequences to the shortest possible form while still preserving the meaning.

    For example she now restricts herself to simple 3 ~ 5 word sentences. She also decreases complexity by omission. She consistently omits grammatical connectors and also omits syllables in more difficult words.

    On another note she had her SLP evaluation this morning. The SLP ran several standardized tests, recorded speech samples, used pictures, toys, and prompting to elicit as much speech as possible and took lots of notes.

    The SLP did not want to make a diagnosis. She felt that our daughters short speech sequences made matters difficult. But in summary she felt the case was borderline. She wants several days to review her findings before writing a complete report.

    The only definitive answers came from the standardized tests. I don’t recall the names but the age appropriate scores ranged between 85 and 115. On the single word isolation test she scored 97 and on the articulation test she scored 86, just above the low end.

    I made sure to remind the SLP that had she been tested a few months ago she would probably have scored much lower. Now the matter goes before a commitee to determine if she qualifies for benefits. You know how that goes…

    In any case I intend to continue working with her. I think it’s time to modify the strategy and challenge her with more complex sentence forms. I won’t be able to do this with Nick Jr. because the rapid pace will not give her enough time to consider complex responses so I will need to find another tool.

    Ed

  32. Lisa on March 21, 2011 at 2:47 pm

    I am absolutely at the end of my rope…I have searched and searched for an answer and have taken my daughter to speech/language therapy, doctors and such. No one has mentioned to me the Apraxia at all…she didn’t even qualify for speech services, only language. She was 3 in November. She developed normally and hit all milestones with no problem…babbled early and more and more when she hit 1 year old. Lots of inflection in her voice and said Dada before she was one. Then, as time went on, nothing new, no new words, just Dada. Always a great problem solver and very curious. She can currently do a 52 piece puzzle by herself and more with help. Knows her colors, shapes and some numbers by pointing. She will agree or disagree to questions and understands conversations. No problem with hearing or tongue tied…that was already checked out. Sometimes out of the blue will say a word so clearly then not say it again….Calls me Bah Bah…We have done the stand off where I will not give her a drink unless she says drink,milk,juice. She is very advanced with fine motor skills and gross motor skills are fine. She is not making any progress with speech therapy. I don’t know what to do now….everyone says to wait it out and she will make progress…We have been waiting so long.

  33. Laura on March 21, 2011 at 9:49 pm

    Hi Lisa. Thanks for your comment. How frustrated you must feel at this point!! Have you had her seen by more than one SLP? Sometimes a therapist isn’t a good match for a particular child, or she may need a new approach to make progress, so see someone else if she’s been with the same person for a while.

    Many SLPs are reluctant to mention apraxia as a reason for a child’s speech issues until the child turns 3, but your daughter is 3 1/2, so she is not to young to get this officially diagnosed if this is what’s going on with her.
    Of course since I can’t SEE her, I can’t say for sure that this is the issue, but from what you’re describing, it’s certainly a possibility. I hope that you feel comfortable talking about this with her current SLP. If it’s not apraxia, then hopefully the SLP can tell you why she feels it’s not an appropriate diagnosis for her.

    Regardless, I’ll still recommend that you take a look at my Apraxia DVD for ideas for how to work with her at home. I’ve had many moms tell me that using these strategies at home is what helped their children begin to make progress.

    Let me also tell you what a great job you’re doing in persistently looking for help for her. She’s lucky to have YOU for a mom!

    Good luck with her, and let me know how it goes!! Laura

  34. Ed on March 25, 2011 at 2:44 pm

    Just a follow-up.

    She will be 4 in a few months. I spent several months using a new tool, simply dolls, she was willing to take more risks speaking on behalf of a doll than for herself.

    This lead to expanded speech and she is now well on her way, able to dialog with strangers and no longer afraid to communicate.

    She still suffers from mild apaxic issues, struggles with speech expression and such, but is now on the right track.

    I have discontinued my further therapy since she is progressing well on her own.

    Thank you all for your help and advice!

    Ed

  35. Carrie on March 28, 2011 at 1:22 pm

    Hey Laura,

    I have a question about my almost 3 1/2 year old daughter. She started speech therapy at 18 months through our state’s early intervention program and has transitioned into early pre-k at the local elementary school which she attends 1 full day and two 1/2 days every week. She has been evaluated recently for OT and did not qualify for those services and the IEP team believes that her main issue is her speech.

    I am concerned that she may be apraxic but I am not sure who would diagnose that. I have talked with her current SLP about my concern and but I do not get any definite answers. Part of that could be because my daughter does not seem to have a great rapport with her like she did her former therapist (different styles – play therapy v. more structured therapy where she sits at a table and works with materials) and her current therapist believes that my daughter only has a vocabulary of 20 different words (which is not true and I advised her of same – I estimate between 75-100 different words she can say – knows more). She has been seeing her current SLP for five months. Sometimes I think that the SLP is still trying to figure my daughter out and that, plus not hearing much language from her, limits her diagnostic ability.

    From my observation, my daughter seems hesitant to try to say new words. Sometimes I hear her over the baby-monitor in her room practicing word sounds by herself and I really believe that her issue is with seqencing sounds. She has some short sentences – 3 words tops – and tries to convey her thoughts as best she can. For example, she was playing a harmonica and brought it over to me, held it out, and said “Your turn try”. Mostly, however, it is one or two words or a string of sounds that I cannot decipher. With more complex words, she either does not try at all or comes up with a one syllable name for it (fant for elephant). Some of her sounds are also strange in word combinations. She says the word more, but the ‘or’ sound in the middle sounds like oar – sort of dragging out the ‘o’ sound. She is also interested in music, but has a hard time singing anything – some songs she can follow and will say some words from time to time (she will sing “all fall down” in ring around the rosie).

    Long story short – she has made progress, enjoys the school setting very much, and is a great kid. I am just unsure if the therapy she is receiving is helping her meet her full potential and to that end maybe a diagnosis would help focus the therapy delivery method. Could she have some form of apraxia? And if so, what would you recommend both from an at-home standpoint and with the school setting?

    Thank you so much for your time and all the wonderful information you have provided on this site.

  36. Laura on March 29, 2011 at 8:45 pm

    Carrie – I’d definitely get a second opinion about her. I would also have concerns about apraxia based on how you’ve described her. If you have insurance or can afford to pay privately, see an SLP outside the school setting and then call an IEP meeting and take that report to school to help validate your concerns. I would also talk with the preschool personnel about her and see if they are seeing/hearing the other words that she says at home. They may be able to give you information about her overall language at school.

    If there’s another SLP available for her to see at school, I’d also request that someone else take a look at her, but many times, this isn’t possible. To find out about that possibility, you’ll have to call the Special Ed or Preschool Office so that you’re speaking with the SLPs supervisor. This can create hurt feelings though, so be sure you’re being as diplomatic as possible. That being said, you have to look out for your daughter with your first and primary concern being her wellbeing. If she’s not getting the best services available for her, then you’re certainly not doing her any favors by letting the rest of the school year go by without saying anything.

    Hope these ideas help! You may also want to check out my Apraxia DVD so you can use those ideas to work with her at home. You sound like a great mom, and sometimes just knowing how to tweak what you do with her will make the difference and be what she needs to get the ball rolling with her speech-language skills. Good luck to you both!! Laura

  37. Linda on April 22, 2016 at 4:33 pm

    Hi Laura. I’m really struggling with this particular topic. I’ve had a speech therapist from day one that I suspect thinks my son is autistic. I recently had an eval including several therapists and a developmental pediatrician at a very reputable Childrens hospital done. They all agree he is not anywhere on the spectrum. Their exact words are that he is just “quirky” with the way his speech is developing. He has some echolalia and scripted speech. They also advised me that the therapy I’m receiving may not be the best fit. My speech therapist routinely brings in toys she tries to force him to play with and much of the sessions are commands or instructions on what she wants him to do. He seems to be bored and I think tunes her out which she interprets as him not understanding. It is truly painful to watch. Is there a specific approach to a child with atypical language development without an autism diagnosis? Should I just contact my caseworker to possibly change therapists for a fresh approach? Thanks for any advice.

  38. Adianez on June 18, 2016 at 4:37 pm

    Hi,
    I know you’re super busy so I will try to keep my question/comment short.
    Our 21 month old has been receiving speech therapy for about 4 months, and although the first few sessions were smooth, and he seemed to have taken to her, now he refuses to go with her and cries the entire session. Is this typical?
    I already had a chat with the SLP about the possibility that there just wasn’t chemistry between them. She seemed to get defensive. She’s bent on sitting him in a chair the entire time, when all he does is struggle to get out.
    We also have a therapist who comes home who he reeeeeally likes, and I know it’s an unfair comparison because of the settings, but he interacts with her and really enjoy their time together.
    Something tells me to change, but I’m just not sure if his behavior is a typical one.
    Love your resources, your book is wonderful! Thanks!!!

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