Re: My child shutting down during individual therapy

[Guest guest]

How old is your child? What are all his diagnosis? Have you ever had a sipt

and praxis evaluation which is done only by an OT who is licensed as well

as sipt and praxis certified. Many of his issues sound familiar to my son's

such as oral defensivess, propioceptive problems, etc. While a speech

therapist might be qualified to do some oral motor therapy, she cannot deal

with sensory problems like an ot can. Schools and therapists in the

educational setting put children in group settings when they should be getting

it

one on one bcs it saves them money. Kinda like a k-mart blue light special.

If you take your child to a behavioral/developmental pediatrician who

writes a MEDICAL script as well as a report indicating the your child needs his

services one on one, the school will have to provide them that way. Their

staff is not more qualified than a developmental pediatrician. Also

remember the IEP is the driving force of what the child receives in school, if

it

is not CLEARLY outlined in the iep, then it wont happen and the school

cannot be held accountable. Make sure that the your child's IEP when it comes

time states not just direct, but DIRECT 1:1.

In a message dated 6/17/2009 9:08:32 A.M. Central Daylight Time,

sweetysource@... writes:

At my sons IEP meeting , I was told that my son is shutting down as far as

working with his speech pathologist in school so she decided to teach him

in a group setting instead. I am worried that this is the wrong choice

because I know he needs the one on one therapy. I am also not sure if we are

going about his therapy right. He is doing oral motor therapy. I know that

PROMPT seems to be the choice but is this in addition to oral motor therapy ?

I really have a hard time sifting through what is the best because everyone

has different stories of what they are doing for their child. Is there

anything that I should make sure he is getting? I feel like he needs OT also

but I am not sure how to prove what he needs and doesnt as they are the

professionals.At my sons IEP meeting , I was told that my son is shutting down

as far as working with his speech pathologist in school so she decided to

teach him in a group setting instead. I am worried that this is the wrong

choice because I know he needs the one on one therapy. I am also not sure if

we are going about his therapy right. He is doing oral motor therapy. I know

that PROMPT seems t

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[Guest guest]

If you feel like something is not the right choice for your child you are

probably right.?? You know your child best and you are his biggest advocate.???

I had a similar experience with 2 different types of therapies I was trying

where I felt that my son wasn't responding well and making progress.??? I also

felt like he didn't connect well with the therapist.???? I changed to a

different therapist who comes to my home in January and I can't tell you how

different this experience has been.?? He engages with her, and is she really

engages with him to by doing things he likes while he learns.? Having speech

therapy doesn't need to be a torture session.?? She plays wiht him while they do

exercises.??? If he likes to jump, she?jumps too.???She has mostly been focused

on pairing gestures with sounds using some visual aids.??? I'm dont' believe

this is officially the PROMPT method but I will say it is working very well for

him.??? I also just found a wonderful therapist that is going to work on the

oral motor and the muscles and for my son with hyptonia/dysarthia this is

important too.??? I think you need to pair both.?? The fish oil has also helped.

And, it's just my opinion but for everything I have read I am told ABSOLUTELY

not, an apraxic child needs one on one attention to thrive and overcome this.???

Some group is ok but they need small sessions of one on one routinely.

I can't speak highly enough about the book " The Late Talker " ?? It is co-written

by a parent of an apraxic child and I found her advice on all of this to be

invaluable.???? If you read it you may find some of your questions below

answered.

Also, I don't know where you are located but maybe you can put that out there

and find a fellow parent that can make some recommendations of people to see.???

It might be worth going to an expert in your area for apraxia (or even traveling

a little to do it) to have them give you their opinion so you have something to

take back to the schools.?? I took our son in this past monday to the expert in

town and I was overwhelmed by how much great information she was able to give me

about his oral motor issues and approaches to take in therapy with her as well

as things I could take home and discuss with the therapist that we have through

early steps.??? Also, I have noticed (after seeing 3 therapists in action with

my son) that the approach to doing oral motor is just as important as the

therapy.?? My son would get so angry about anyone touching his mouth, but the

person we saw this week has a method of 3 seconds of the oral motor paired with

3 seconds of something fun and by the end of a session he wasn't even crying

anymore.??? Other therapists just pushed and pushed it until he knew what was

coming and would just scream his head off.

Good luck!

[ ] My child " shutting down " during individual

therapy

At my sons IEP meeting , I was told that my son is shutting down as far as

working with his speech pathologist in school so she decided to teach him in a

group setting instead. I am worried that this is the wrong choice because I know

he needs the one on one therapy. I am also not sure if we are going about his

therapy right. He is doing oral motor therapy. I know that PROMPT seems to be

the choice but is this in addition to oral motor therapy ? I really have a hard

time sifting through what is the best because everyone has different stories of

what they are doing for their child. Is there anything that I should make sure

he is getting? I feel like he needs OT also but I am not sure how to prove what

he needs and doesnt as they are the professionals.I think thats part of the

reason he shuts down . He also has little attention span and will want to be

hanging upside down or running back and forth ....I feel like there are so many

things he needs work with and if we balanced it all out , it could help with his

language. I feel a little frantic because he is getting older and I dont want to

miss this valuable time. Thanks!

[Guest guest]

Well one can also look at your child shutting down during individual therapy as

your child now has an incompetent therapist. So now your child may be in

therapy with an incompetent therapist with inappropriate group placement! Do

you have a private SLP and neuroMD to help you advocate?

No matter what the school says, or this SLP says -your child is entitled to a

FAPE in the LRE. There is a ton of research to back up the importance of one on

one therapy for apraxia -and nothing but this one SLP to back up doing something

inappropriate to your child.

Here's two links just to start

http://www.cherab.org/information/speechlanguage/therapymatrix.html

http://www.cherab.org/information/speechlanguage/therapyintensity.html

This is not to say that in addition to individual therapy a child with apraxia

can't benefit from some small group therapy as well -but in almost all cases

group therapy alone is inappropriate. <-(period)

Here's some archives about one on one therapy!

Just in case you have not seen the one on one info at Speechville

and/or CHERAB:

One on One Therapy

A Review of Apraxia Remediation

The Cherab Foundation gratefully acknowledges permission to print

the following, cited by Hecker, a parent advocate for her

apraxic son, .

" The type of treatment appeared to influence whether patients

improved. More patients improved and improvement was greater in

Group A, individual stimulus-response treatment, than in Group B,

group treatment. These result imply the way to treat AOS (Apraxia Of

Speech) is to treat is aggressively by direct manipulation and not

by general group discussion. This is consistent with what has been

recommended (Rosenbek, 1978).

The type of treatment appeared to influence whether improvement

occurred or not. Four of the five patients who did not improve

received group treatment with no direct manipulation of their motor

speech deficit. " Apraxia of Speech: Physiology, Acoustics,

Linguistics, Management. Rosenbek et al. 1984

" The frequency of professional speech assistance is critical in the

habilitation of children with developmental apraxia of speech. This

disability call for all-out attention and deserve serious

instruction to the limits of the child's attention and motivation.

When normal children begin their formal education, they do not go to

school two or three times a week for just a half-hour at a time,

even in kindergarten. Thus, I do no expect to provide special

education for children with developmental apraxia of speech on a

cursory basis, for it may be the most important part of the entire

education. " Current Therapy of Communication Disorders, Dysarthria

and Apraxia. H. Perkins 1984

" They use the term developmental apraxia to describe a disorder that

is not confined to the phonologic and motoric aspects of speech

production, but includes difficulty in selection and sequencing of

syntactic and lexical units during utterance productions. Most

clinicians agree that planning the appropriate treatment approach

and methods is crucial to the efficacy of intervention. A variety of

factors can facilitate treatment of DAS. DAS is often characterized

as being resistant to traditional methods of treatment. Group

therapy decreases the potential of responses per session for each

child and therefore, the motor practice needed by children with

apraxia and dysarthria. " Treatment of Motor Speech Disorders in

Children by Edythe Strand in " Seminars of Speech and Language " Vol.

16, No. 2. May 1995

" Early stages of treatment need to be carried out on a one-to-one

basis for it is only in this way that the patient can learn to

develop his own particular strengths and adopt compensatory measures

for weaknesses. " Disorders of Articulation, Aspects of Dysarthria

and Verbal Apraxia. Margaret 1984 " These children do not seem

to make good progress with the usual approaches to clinical

treatment of articulation problems. Carefully structures programs

that combine muscle movement, speech sound production, and sometimes

even work on grammar seem to get better results. " " Developmental

Verbal Dyspraxia " on Healthtouch Online, ASHA website

" Children must be seen one-on-one, at least in the early stages of

treatment. " Kaufman, author of the Kaufman Speech Praxis Test

and expert on Apraxia, on The Kaufman Children's Center for Speech

and Language Disorders website .

" However, many of the theories, principles, and hierarchies

described for adult apraxics are potentially helpful to the

clinician designing motor-programming remedial program for an

individual child. (We stress the word individual since the program

development for children with DAS must meet the individual, and

often unique, needs of each child.) " " Intensive services are needed

for the child with DAS. Children with DAS are reported to make slow

progress in the remediation of their speech problems. They seem to

require a great deal of professional service, typically done on an

individual basis. Therefore, clinicians working with DAS must

accommodate this need and schedule as much intervention time with

the child as the child and/or his/her schedule can allow. The

definition " intensive " varies from clinician to clinician and from

work setting to work setting. Rosenbek (1985), when discussing

therapy with adult apraxics, defines the word as meaning that the

patient and the clinician should have daily sessions: Macaluso

Haynes (1978), Haynes (1985), and Blakeley (1983) also advocate

daily remediation sessions. " Also, " our experience has been that the

overall outcome has been best for those children with DAS who were

identified as possibly exhibiting DAS and received services as very

young children. " Developmental Apraxia of Speech, Theory and

Clinical Practice. Penelope Hall et al. 1994

" We recommend therapy as intensively and as often as possible. Five

short sessions (e.g., 30 minutes) a week is better than two 90

minute sessions. Regression will occur if the therapy is

discontinued for a long-time (e.g. over the summer). Most of the

therapy (2-3/week) must be provided individually. If group therapy

is provided, it will not help unless the other children in the group

have the same diagnoses and are at the same level phonologically. "

Velleman, authority and published author on Apraxia, on her

website (velleman.html). " Our clinic has had tremendous success with

the half-hour format, we find these session to be very intense,

packed with therapy, and have little

down time. The earlier and more intensive the intervention, the more

successful the therapy. Group therapy can be effective for

articulation disorders and some phonological processing disorder,

but children with Apraxia really need intensive individual therapy. "

Lucker-Lazerson, MA, CCC-SLP, and Clinic Coordinator for the

ish Rite Clinic for Childhood Language Disorders San Diego, on

the Apraxia Kids website.

" A few major principles in particular have direct relevance to the

treatment of motor speech disorders. The most obvious, yet

surprisingly often disregarded, is that of repetitive practice.

Pairing of auditory and visual stimuli is included in most

approaches, and intensive, frequent, and systematic practice toward

habituation of a particular movement pattern is suggested instead of

teaching isolated phonemes. It is important to

consider the treatment needs of each child and attempt to find

creative solutions that

> allow frequent individual treatment for children that will most

benefit. "

Childhood Motor Speech Disorders Edythe Strand

" Given the controlled conditions stipulated in the studies..., it is

clear that speech dyspraxia can respond to therapy. All approaches

involved an intensive pattern of therapy. Even if not seen daily by

a therapist, patients carried out daily practice. " Acquired Speech

Dyspraxia, Disorders of Communication: The Science of Intervention.

Margaret M. Leahy 1989

" Consistent and frequent therapy sessions are recommended. The

intensity and duration of each session will depend on the child. At

least three sessions per week are recommended for the child to make

consistent progress. " Easy Does it for Apraxia-Preschool, Materials

Book. Robin Strode and Chamberlain

" In stark contrast, the children with apraxia of speech whose parent

stated that three quarters of their child's speech could be

understood following treatment, required 151 individual sessions

(ranging from 144-168). In other words, the children with apraxia of

speech required 81% more individual treatment sessions than the

children with severe phonological disorders in order to achieve a

similar function outcome. " Functional treatment outcomes for young

children with motor-speech disorders by in Clinical

Management of Motor Speech Disorders A.J. Caruso and E.A. Strand

1999.

(In addition to the information on this page, a great page on 1:1

therapy is at Apraxia-Kids)

1:1 Therapy Question Sent To Children's Apraxia Network:

Advice From our nonprofit's SLS/MA/ EDUCATIONAL CONSULTANT, Cheryl

- SLS/MA (Hi Cheryl you quiet little cutie you!

http://www.cherab.org/about/cheryl.html )

It is interesting to note that when a child is receiving Early

Intervention services in the home, therapy is 1:1. It is also

interesting to note that children as young as 6 months of age have

received 1:1 services. Every apraxic child is different, with a

diagnosis of severe apraxia, the child would benefit from 1:1

therapy. What data is the school SLP (Speech Language Pathologist)

presenting indicating that the age of 5 is too young for 1:1

services?

Remember when a request for services is not given as requested, the

denying party must give a written rationale as to why. The IEP

(Individualized Education Program) is an individualized Education

Program. How will the SLP (Speech & Language Pathologist) address

the severe oral motor needs of the child within the group setting?

What are the short and long term goals and objectives that are

specific to the nature of this child's severe apraxia? Does the SLP

plan to devote x amount of minutes providing 1:1 therapy to your

child within the group setting? Your child's disability of apraxia

affects his involvement and progress in the general curriculum and

access to nonacademic and extra curricular activities due to the

fact that he is not able to communicate appropriately to school

personnel when needed and communicate effectively through speech

and/or writing to class- mates and teachers. The severity of his

disability warrants 1:1 speech therapy intervention. Your child's

disability of apraxia of speech affects his ability to engage in age

relevant behaviors that typical students of the same age would be

expected to be performing or would have achieved {IDEA-Code of

Federal Regulations (C.F.R.): 34 C.F R.300.347 (a)(1)(i) Statue 20

United State Code (U.S.C.) 1414 (d)(1)(A)(i)(1).

I am requesting that the parent draft a letter to the Dr. of the

Child Study Team including the information listed above. Indicate

that you are not in agreement with the type /amount/duration of the

speech therapy services that will be provided to your child. State

that you are seeking 1:1 therapy services for your child because...

Send the letter certified receipt return requested. Send a copy to

the SLP, the District Superintendent of Schools, and Board of

Education President. Severe Apraxia requires the parent to advocate

for 1:1 services in the area of speech therapy.

http://www.cherab.org/information/speechlanguage/therapyintensity.html

Here's some more from Speechville including one quote from apraxia

kids the website that originally built and hosted for over 7

years.

http://www.speechville.com/diagnosis-destinations/apraxia/speech-therapy-frequen\

\

cy.html

It's also worked for people to bring in The Late Talker book which

of course has in it the severity intervention matrix. (we also were

granted permission to put this up on the CHERAB and Speechville

websites) And as Kathy from this group always says -you can let

them know you know the authors and that we are interested in what

the outcome for our next book.

" Literature Review: Frequency and Intensity of Therapy for Children

With Apraxia of Speech. Click here to print a " text only "

http://www.speechville.com/printer-friendly/frequent-speech-

therapy.html copy of this page for personal use when advocating for

appropriate services from your child's school or appealing an

insurance denial. "

http://www.speechville.com/printer-friendly/frequent-speech-therapy.html

Recommendations of Frequency and Intensity of Speech Therapy for

Apraxia

" For use when advocating for increased frequency of therapy sessions

from insurance or school "

http://www.speechville.com/diagnosis-destinations/apraxia/one-on-one-therapy.htm\

\

l

Apraxia: Researchers' Websites and Citations

Researchers with an interest in developmental apraxia:

http://www.speechville.com/diagnosis-destinations/apraxia/research.html

The Late Talker Book

Chapter 6: Getting the help you need (pgs, 70 to 89)

http://www.speechville.com/late.talker.html

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