A Mother’s Journey…. My Son’s Initial Signs and Symptoms of Apraxia
This is the second in Laurie Felty’s series of articles about her son Jack’s apraxia of speech. I hope you enjoy this one as much as the first! Laura
A Mother’s Journey ……
INITIAL SIGNS AND SYMPTOMS OF APRAXIA AND WHAT LED US TO EARLY INTERVENTION
By Laurie Felty, MS, CCC-SLP
As mentioned in my previous article, my son, Jack, is 3 years old and has apraxia of speech, a neurological speech disorder that affects a child’s ability to plan, program, execute, and sequence the precise movements that are necessary to produce intelligible speech.
Jack has been in speech therapy since he was 21 months old. What I’d like to share with you are the circumstances and initial signs and symptoms that he displayed that led us to seek early intervention.
My first son, Nick, is 8 years old and was a very social, very early talker. By the time he was 2 years old, he could carry on conversations with adults and sing dozens of songs from beginning to end. In fact, he often seemed to prefer interacting with adults rather than children his own age.
I’m bringing up our experiences with Nick because, when our second son, Jack, came along 5 years later, we just assumed he would follow along in Nick’s footsteps. I know that every child is different and I wasn’t expecting an exact replica of Nick, but I wasn’t expecting any developmental delays either.
I had a fairly uneventful pregnancy. I had gestational diabetes, but it was diet controlled (with Nick I had to be on insulin shots). Because of the diabetes, labor was induced on my due date. However, Jack decided that it wasn’t time to be born because my labor never progressed. Our doctor joked that we were getting the first peek at our son’s possibly defiant personality (by the way, he was not wrong!).
I went home and was brought back in 4 days later, and labor was induced a second time. When my water broke, it was brown-tinged which indicated the presence of meconium (a baby’s first bowel movement), so right when he was delivered he was whisked away and suctioned so as not to breathe in the meconium. After those very scary first few seconds, all was well.
Medically, as a baby, Jack had frequent ear infections and eventually had tubes placed in both ears at 10 months of age. He had also developed a flat spot on the left side of his head just behind his ear, despite the fact that we put him to sleep on his back and devoted plenty of time to “tummy play.” We tried to position him every which way to keep him from resting his head on that side, but he simply preferred that position. The pediatrician didn’t seem to think it was anything to be concerned about so we didn’t either.
When Jack was 15 months old, he developed a really bad cough in which he would cough so hard he would, at times, turn momentarily blue and/or vomit. He was diagnosed with pertussis, also known as “whooping cough.” After many, many weeks and a round of antibiotics, he finally improved.
The reason I’m giving so much history is that over the next few years, I would question each and every one of these events individually and as a whole as a possible explanation or contributing factor for why my son has apraxia.
Initially, Jack seemed to move right along developmentally. It wasn’t until about 5 or 6 months of age that I began to have some niggling suspicions that things just weren’t right. He wasn’t an early babbler and was very resistant to any introductions to spoon feedings. In fact, he was so resistant that we stopped and didn’t re-introduce them until he was a few months older. These behaviors could be attributed to his frequent ear infections, so I took kind of a wait and see approach while continuously trying to facilitate more vocal play and babbling. I may have forgotten to mention that besides being a Mom, I am also a Speech Therapist.
Jack’s developmental milestones weren’t exactly average, but they weren’t too far out of range for normal development. He sat alone about 9 months and started crawling at 12 months. Jack didn’t start walking until he was 16 months old. Other than being an inconvenience having to lug that big baby around everywhere, that alone didn’t necessarily cause me concern.
What did concern me was the fact that Jack wasn’t talking either. We had seen no improvement in his babbling or attempts at first words since the tubes had been placed in his ears which ruled out the frequent ear infections as a cause for his ever increasing delay.
By the time Jack was 1 year old, he was showing more and more signs of having apraxia of speech. As a Speech Therapist, what stood out the most to me was that Jack could not imitate oral movements, sounds, or words, but his receptive language (what he understood) was right on target. Jack used “bah” or “da” for most words. For example, “bah” meant bite, Bob (the Builder), block, bug, book, Barney and ball. “Baba” meant mama, grandma, brother, bye-bye, Big Bird, Batman, Spongebob, Blue’s Clues, etc. He also had very few vowel sounds that he could produce. Whenever Jack tried to say new words or imitate, he would produce a very peculiar sound. It was something like “tzh.” It seemed he used that sound to represent almost everything.
Because Jack was so unintelligible, we began using signs and gestures very early with him. He would use signs in conjunction with trying to say words. If Jack didn’t know the sign for something, he would try to gesture the best that he could or point or pull us by the hand to show us. Jack certainly had the desire to communicate. He even learned how to hum the “I love you, you love me” theme song whenever he wanted to watch Barney on TV or if he wanted his Barney stuffed animal.
I also noticed some “sensory” issues. Remember the resistance to spoon feedings? He was also very resistant to hand holding and tooth brushing. He hated the feeling of tags in his clothing and he had a very difficult time with food textures and with self-feeding. He loved the feeling of jumping straight up in the air or off the couch and landing hard on his bottom.
When I voiced my concerns to our family and suggested having Jack evaluated, I was told that I was too closely comparing Nick and Jack, and that Jack would come along in his own time. As an SLP, I knew this not to be true. I also knew that it would be too difficult to be both his mother and speech therapist. I routinely voiced my concern at Jack’s check-ups with his pediatrician. They were very supportive and because they knew I was an SLP, left the decision for making a referral to early intervention up to me. As it turned out, I did wait until Jack was 20 months old to have him evaluated because I knew he wouldn’t qualify for services until he got a little older and the gap between “normal” and “delayed” was more evident.
I have to admit that I was quite apprehensive about the whole process of early intervention (a state funded program that provides services from birth to age 3) and the quality of services that he would receive. Once I called and initiated services (a parent can make the referral), I realized I had nothing to worry about. Jack had a service coordinator who oversaw everything and was in regular contact with me. He had a speech therapist that came to our house weekly to work with him, and he had an occupational therapy evaluation. I honestly feel that Jack received the absolute best services possible.
I want to make clear that I am not advocating that parents wait to have their child evaluated if they feel that there is a possible delay. I am in a unique position because I am a practicing Speech-Language Pathologist. I was able to facilitate my son’s expressive speech in a way that many people cannot. In fact, when he was evaluated by his speech therapist through early intervention, she commented that Jack would probably have been non-verbal had he not had a mother who was a speech therapist and worked with him continuously.
When Jack turned 3 years old, he transitioned from early intervention to the school system for speech therapy with a few private practice therapists thrown in there in the middle. Although Jack continues to make progress, our experiences from that time on have not been as favorable, but I will save that for another article.