Introduction and good website for sound repetition

August 15, 2008

Hi,

I guess it is time to introduce myself. I have been lurking for

about a month now I guess. My son Isaac has been diagnosed with

verbal apraxia. He is 2 3/4 years old. He goes to speech therapy

and depending upon his mood is either very cooperative or not at

all We pay out of pocket because our insurance declined to cover

us stating that " Speech therapy has not been shown to be an

effective treatment in apraxia " (!) I would love to know what they

do consider effective. Chanting over his head with glow sticks? He

was given the proper neuro diagnoses and everything for the

insurance submission, so I was gobsmaked. We are appealing the

ruling b/c it seems a no brainer that speech therapy has been proven

effective for many speech issues including apraxia, but anyway I

digress.

I have gotten so much good info off of this group (thanks especially

for the ProEFA tip, that has been amazing), and I wanted to share a

website our speech therapist uses with Isaac to help him with sounds

and such. It is www.starfall.com. It is free and is intended for

use by elementary school and special needs teachers. We use it at

home with him as well as part of his homework. He is an early

reader which helps and has known his alphabet forever (just doesn't

pronounce all the letters correctly), but maybe this will be useful

to someone else also working on repetion of sounds.

We do the " ABC " option. For this one you click on a letter in the

alphabet screen and the upper and lowercase letters appear for the

letter. Clicking on the upper or lowercase letters gives the proper

sound for that letter. When the child repeats the sound correctly

you (or the child) clicks a button that gives a reward. So for

example, saying the " k " sound gives him the reward of a picture of a

Kangaroo (which is also pronounced). It is good for vocabulary

building and reading too. And it is free. And grows with the

child. Anyway, I liked it and found it cool. The website is very

benign but depending on treatment you may want to discuss with your

therapist as to whether it would be useful for where your child is

at. (Hope that last part didn't sound preachy it wasn't my intent.)

Thanks again for such a great group.

Groves

August 17, 2008

Hi ,

Welcome and I just want to chime about of the insurance covering speech. The

fact is, if it is a medical diagnosis, like apraxia, which is by definition a

neurological disorder similar to an adult who was either struck by lightning or

a stroke, some sort of injury to the brain and can no longer motor plan their

speech and need to relearn motor planning.

In the case of children of course the reasons are not known, but the symptoms

are the same, lack of speech motor planning abilities and yes, of course the

treatment for both cases is speech therapy. However insurance companies try to

hide behind the no speech covered if it did not exist previously and was lost.

Of course this is an absurd demand to place on a child who obviously has not had

the chance to learn to speak yet, but the same neurological disorder can exist

as in an adult. Another thing they say is no speech covered for children. Not

so again, they may not cover lisps and minor articulation issues which are

considered developmental in nature and sometimes do re mediate even without

speech therapy. But unfortunately apraxia does NOT fall in this category and it

does NOT go away on its own. In fact it needs a very rigorous, frequent motor

planning intervention 1:1 to improve and there is plenty of research supporting

this.

Here's what we did: we got the SLP who evaluated her to write the ASHA

definition--cut and paste_ in the report defining apraxia as a neurological

disorder. We then got the doctor to write the letter of medical necessity,

again, including the same cut and paste definition and clearly stating that

speech therapy is needed to re mediate it. And we also attached the full ASHA

document in our request for speech therapy and it was covered no problem.

Just be sure the ICD -9 784.69 code is included along with the exact ASHA

definition in every letter from every professional as well as the treatment

recommendations, as specific as possible, motor planing techniques, PROMPT

usually etc.

Aetna for example plays another trick, it has apraxia listed under conditions it

does not cover because they are developmental--which of course is not true, So

unless the exact definition is in every letter, stating clearly that it is a

neurological disorder, they may go only to their exclusions list and see it

there and just refuse treatment based on their improper categorization.

I am sure other insurances play the same trick. You see when a child cannot

produce speech and speech sounds that is a loss of body function that needs to

be medically treated. it is NOT a developmental delay or an educational issue.

Most schools are not equiped to treat a motor planning speech disorder and offer

generic articulation speech and language therapy, often in group and this is

completly inappropriate for an apraxic child. So if you have secured this

diagnosis, while it's not an easy one to overcome, it is just a matter of being

persistent enough to get insurance to cover it, because if taken to higher

reviews they simply have to cover it, there is no way they can deny a loss of

body function to a child when they would not deny it to an adult presenting with

the same symptoms.

And children with apraxia, as adults with this diagnosis do make progress and

many overcome it to the point where only at times do they still show

difficulties in speech. Other less so but the difference appropriate therapy

makes is HUGE. So not only does it have to be speech therapy, but it needs to be

appropriate for the disorder : 1:1 frequent, 3-5 times a week with a skilled

motor planning expert (PROMPT is most effective for most).

This is what you MUST insist on. It is actually easier to deal with insurance in

terms of what they are required by law to cover when a doctor declares it a

medical necessity than to get the school district to provide something they are

just not capable of doing and can always claim they are doing but in fact are

not and the child can get inappropriate therapy, wrong type, wrong therapist,

group not 1:1 etc. So your best bet is making the insurance company realize you

are NOT going to go away and save themselves some effort and agree to cover

sooner. The school district battle is much much harder and you have less

control as it can look good on paper but in actuality fail to meet your child

needs and proving that before your child misses out ion the best time for

intervention can sometimes be tricky to do. Keep at it, you'll do fine. They

Have to reimburse, it is a loss of normal body function and they cannot

discriminate against a child because of

his age.

Also progress reports from the speech therapist can show that they are wrong

about their statement that apraxia does not improve. There is so much research

on this that it''s not even an issue, they just pulled that out of their - - -

to scare you off, but it clearly is NOT a valid statement and they know it.

Just keep at it...

All the best,

Elena--mom to Ziana--almost 4 now, severely apraxic but otherwise a happy

healthy child and making great progress now that appropriate speech therapy/diet

and supplements have all been implemented.

From: <hgroves@...>

Subject: [ ] Introduction and good website for sound

repetition

Date: Friday, August 15, 2008, 10:31 AM