PROMPT not really working - other speech therapy? Please help.

[Guest guest]

Hi,

I've had my 25mth old going to therapy with a PROMPT trained (advanced)

therapist for about two months now. There has been no improvement.

With the exception of a couple of word approximations that began shortly after

he began fish oils, he is non verbal, and can make only a few consonant or vowel

sounds.

He has seen several different specialists, and it appears that verbal dyspraxia

is in fact the only problem he has.

I was starting to wonder if perhaps PROMPT is not going to be of any real

benefit to him, and if I should look into a therapist that uses more traditional

type therapies - Nuffield is the most widely used here in Australia.

His current therapist of course believes that the only way to help a child with

motor planning speech problems is through PROMPT. Due to financial costs (no

insurance for speech here), he is only able to be seeing her twice a week for

45min sessions.

Am I expecting too much too soon? Is there something that I should be doing with

him at home to help him (his therapist is slowly teaching me PROMPT cues).

Also, his therapist advised me against encouraging him to say a word as two

seperate sounds eg u - p for the word up, telling me that it will set him up

with bad speech patterns that would be hard to break. The thing is though, I did

encourage him to say the word up like this (u - p), and over time the sounds

became closer together, and he almost says it correctly now. Should I continue

to do this, against her advice.

Please give me any advice you may have. I'm starting to really worry about the

possibility of my little boy never learning to talk.

[Guest guest]

Hi Tania,

If speech apraxia--motor planning is his problem-I'd stick it out with the

PROMPT. We weren't getting much out of it at first either---We started with it

around 3 y---and were doing it 2 --- 45 min sessions a week back then--Not

enough I hate to say--but she also was not ready for more at that time. She did

not even allow cuing at first---had difficulty making eye contact with the

therapist--basically just avoided looking at her and was only interested in her

play--not in a totally oblivious to anything else kind of way--but speech

sounds, words , verbal interaction just didn't have the effect they would on a

normal kid who is almost programmed to look up and respond--kids are wired to

communicate and learn speech---but not her. -She was really difficult to engage

and to get to follow adult directed activities. Everything had to be her

way--or no way--and she did let us know what she wanted and didn't want--no

mistake about that--pulling, grunting

and heaving or turning away from the activity and crawling under the table were

her best defenses. Until she was over 2 y she hadn't even been able to say

" No " --so once the word " No " came in we at least knew when she did not want

soemthing and didn't have to deal with the throwing on the floor of everything

and herself included. Boy, those days were hard, and everyone either looked in

pity thinking she was a severely disturbed child or thought we were such bad

parents to let her behave that way. --Either way, the guilt for us as parents

was overwhelming--becuase no matter what we did--we just never got it right and

tantrums were so common. When the activity was engaging--she would be a little

better--but this put great limits on the therapist and she was refusing to

follow their lead--pulled away when touched--we were at our wit's end --3 local

apraxia " experts' declared they could not work with her and sent us on our way.

I later learned some of them were NOT apraxia experts at all--even though they

claimed to be---and another was looking for an easier child--she was an expert

but had such a long waiting list so she could pick and choose--and didn't want a

child who tantrumed and disturbed others potentially--so we were told to " look

for a more child-directed practice " --But that's just the reality of having a

difficult to treat child-which many apraxic kids are--apraxia is a pretty severe

neurological disorder--and should be treated as such. I takes a patient and

well skilled SLP--who really loves working with kids--to get past a child like

mine. Non-compliance was her middle name--sot he therapists had to " trick " her

into trying to say sounds, words--remember --speech for an apraxic child is

probably the hardest thing in the world.

Yes I was desperate right about then--thought she would NEVER speak--it sure

looked that way and the tantrums were awful.

But luckily we began investigating her autoimmune skin problems and stumbled

across a biomed doctor who suggested diet/supplements --testing. That was the

turning point for us--We started to have hope--but not right away--it came

gradually as we realized more and more things were right as the doctor predicted

and as other parents with apraxic kids had experienced--these kids have

metabolic problems that impede brain function and it is sad that mainstream

medicien does not in any way deal with this so parents have to venture out and

exhaust their own financial resources for treatments and just to even a find a

medical professional willing to listen and trained to treat these developmental

disorders which in just about every case have metabolic/autoimmune

components--even when the child has a well known genetic disorder associated

with the speech developmental delays--the mechanisms of the disorder is still

the same--faulty metabolic processing---and

there's LOTS that can be done. This is the good news in all this. There's a lot

of hope--but not if you wait decades for mainstream medicien to catch up with

the neuroscience and microbiology research.

The diet helped some but not enough--not at first--it could be I was not doing

it right--to be completely GFCF takes a lot of practice and you have to be well

educated about your child's reactions and where hidden sources might be. We

also learned there were typical things associated with gluten intolerance--other

deficiencies that were present in her case--even though the allergy tests all

came back negative--much to the surprise of the allergist who finally admitted

that the tests must not be there yet--since this was obviously a child who was

malabsorbing a lot of things--and whose behavior and focus and speech greatly

improved won the GFCF-soy F and corn F diet---so he ran additional tests and

again--nothing was conclusive--but her IGg was on the low side and he said that

was unexpected as well--which made him recommend a metabolic specialist. We'

were already addressing her metabolic issues with the DAN so we didn't' pursue

that further---but it

was clear we were on the right track--even if the mainstream allergy tests had

not revealed anything--that was reassuring--they had revealed enough to tell us

something was indeed not right--even if they couldn't tell us what it was

exactly. Thsi si not a clear cut-here's the template kind of thing--every child

is slightly different depending on what the interactions between genes and

environmental exposures are. The genes get activated/triggered and that creates

metabolic unbalances that are very specific sometimes--some general things

apply--but specific tweaking is always the best way to optimize functioning--o

parents have to learn and be very observant--keep very good notes. At least in

the beginning--while you're trying to identify the best path--best

diet/supplements/avoidance of inflammatory substances --foods included.

Our daughter had fatty acid deficiency--in spite of supplementation, skin

autoimmune disorder, sensory problems, and speech apraxia with other soft signs

like toe walking, had carnitine deficiency but border line--was more deficient

in iron, vitamin D and B12--almost always seen in gluten intolerant

people--myself included--- so all of these need to be interpreted as a

cluster--they add up to a clinical profile where metabolic processing is clearly

an issue, and as we learned later she was also very prone to opportunistic

infections given her weakened immune system--thsi means

viruses/bacteria/parasites--we had them all--and these further complicate

matters and MUST be addressed if the diet/supplements are to really produce any

effects--so these must be tested for and addressed if they are a problem--and

again, Western medicine falls short in terms of their usual testing and

treatments-yeast in particular is very hard to get read of, their guidelines

would have never required testing for parasites for my daughter since she was

not underweight and did not have overt digestive symptoms--none in fact in her

case--yet she had two nasty microscopic parasites that can further damage

intestinal lining and create a vicious cycle of poor health and malabsorptions

and even organ damage in advanced stages. Gluten intolerant people are much more

prone to get and retain such parasites--and not all--in fact very a few have

overt symptoms that would prompt the doctor to test for them. They normally

just test for the usual suspects and only when they are suspected based on

clinical symptoms. For gluten intolerant people--it shoudl be a regular check

=-up procedure like checking for calcium, D, iron and B12 levels + others.

But that aside the MB12 shots were the most amazing for us--from that moment

on--around 3.5 or so everything turned around--behaviorally, speech wise--she

began babbling and complying, showing an interest in building a verbal

communication system--she learned signs too--but was babbling and attempting

more and more words, getting more and more right and within a few months went

from barely a handful of words said more or less consistently to a few

hundred---plus more signs, plus better behavior, plus more compliance--her

little brain was starting to crank the wheels in there--the MB12 had definitely

started somethign for her--something her brain was not capable of doing before.

B12 deficiency impedes methylation process--and without that there is

cognitive/memory loss, speech problems, sensory issues etc etc. All of these

improved for us gradually with the diet/supplements--we kept tweaking the

protocol--and saw great results when we added carnitine

and E to her fish oils--tests revealed she had not been absorbing them prior to

the carnitine--which helps with fatty acid absorption at cellular level--sot

here's a lot to learn and do for our apraxic kids. Never lose hope and know that

therapy--while critical for apraxic kids--is soemtimes NOT enough--especially in

the beginning. It just can't get their brain interested and focused--you need to

optimize neurological functioning before the therapy can take effect--and it

will.

There are other motor planning techniques--but from what I've experienced and

heard--PROMPT is the best one for apraxic kids. At any rate--regular artic

techniques do not produce resutls--and you can work on sounds too separately--in

fact you ahve to before the child can say words and sentences--you work on

individual sounds and it gradually builds.

So yes, I would say give it more time--and especially wait until you start some

biomed based on the test results you'll get back--and see if that helps some.

Again, for us the PROMPT alone would not have done it--I know that now--and it

is still the most efficient way to get her to say new multisyllabic words--to

say them in sentences, and different contexts--we have 3 therapists she sees

becuase it was the only way to fit in 4-5 sessions a week--and 2 of those

sessions are PROMPT---the other therapists are also very good and use good motor

planning techniques--but the PROMPT one gets her to say the hardest words--the

longest sentences--her brain is somehow rewired to respond to those facial

cues--and I can see a difference when she sees that therapist and they work on

the same words--the progress is greater. This is why we go so far away for

it--takes us 2.5 h on average --each way--but all worth it.

So just know that optimizing neurological functioning will improve the response,

and also 2 45 min sessions may not be enough in the beginning to see really

great results. The beginning is the hardest becuase the child is so discouraged.

As they can say more they gain confidence and it becomes more rewarding for them

to even try --it really must be so hard for them. be sure you teach signing as

that will releave the frustrations and it's fun--my daughter had almost 400

signs at some point before she was verbal and gradually stopped using

them--though I like to practice some basic ones once in a while and at least

the alphabet--helps with literacy skills now in kindergarten I think. Good luck

and don't lose faith. I know you want to finally see it happening but it

will--you're doing the right things, he's still very young and once his little

brain is ready it will get easier--you're doing everything you can to get him

there...

And yes, you can practice sounds--really--at this stage --if you can get him to

say sounds--that is awesome----I have a problem with therapists who make it like

they are the only ones who should be doing speech with the child--it's NOT

enough--they should teach the parent --give homework--so you can practice with

him. I know the inventor of PROMPT discourages parents from practicing with

parents--unless they pay for the parent seminar--but realistically --these kids

need so much practice--80-100 repetitions --more or less consistent before a

word can be internalized --more or less---there's just no way the therapists can

do it all even in the 4 sessions a week we had--and we also have different

therapists each with their own cuing technique--and I was afraid that might

confuse her even more--plus the signing on top of it--but you know what-----it

didn't-----their brains are like sponges once you get their interest and take

them to the next step they are

capable of--gradually. So ask the therapist how you can work with him at home

more--observe the sessions--take notes--especially since you cannot pay for more

PROMPT sessions out of pocket--she should work with you to better help him at

home--you have to form a team --so you will need to be his best therapist as

well---his advocate for special services--if he can get any there--and do ask

around --often times here in the US parents do not know what their child

qualifies for and hear about it only too late--oh and also you'll have to be his

best health care provider--administer dietary interventions if deemed necessary,

supplements, observe, take notes, etc etc...--moms wear many hats and this is

true especially for special needs kids. Hang in there--it will happen--you're

doing the right things and the therapy will work given enough time and

optimizing neurological functioning.

All the best,

Elena

[Guest guest]

We found the PROMPT method worked for us, and every SLP we've seen (5 of them,

not including those who just did evals) over the past 3 1/2 yrs has advised the

same. Liam really needed that type of cuing. That said, I think two months is

way too soon to be expecting much progress. Sometimes progress comes very

slowly, like just mastering a certain mouth movement, even if the actual sounds

haven't been achieved yet - and sometimes you get surges. And I think most of

us who have been doing this for a while would agree that daily work at home -

worked in all throughout your day in any way you can work it in - is crucial for

success. Make sure you're working on the same things your SLP is working on,

and ask for homework!

Some ideas for you try try at home - work on waking up his mouth by using tangy,

chewy, crunchy foods - anything that makes his mouth " work, " just to warm him up

before home practices. Consider using a set of Kaufman cards at home - they

include word approximations on the back so you can work your way up from the

very basic to the actual word. We love them! Also, make playtime work for you

by providing whistles, harmonicas, bubble blowing, blowing a cottonball across a

table with a straw - just anything like that which will get him using his mouth.

Make a game out of getting him to try to imitate your tongue movements. Play

CDs of simple children's songs in the background while he plays - after a while,

Liam started singing along, almost without thinking about it. It wasn't

perfect, but he was at least practicing! The progress will come!

For Liam, it took a while before he learned how to work for a certain mouth

movement or sound, if that makes sense. Once he realized that there was a

possibility of communicating verbally and that he could achieve that with hard

work, he was much more motivated to do so. We went through a couple of years

with so little progress that we all started learning sign language more

intensely because we thought it would be his only language. He didn't even say

" mommy " until he was 4! Now, at 5 1/2, he's using complex sentences! We can't

understand everything he says because there are still a few consonant sounds he

cannot make, and he leaves out a lot of prepositions, but we truly never thought

we'd even be here. Hang in there!

And if you haven't considered Nutriiveda yet, please do so! It has been a

miracle for us!

Dianne

https://garrettjones.myzrii.com/

>

> Hi,

>

> I've had my 25mth old going to therapy with a PROMPT trained (advanced)

therapist for about two months now. There has been no improvement.

>

> With the exception of a couple of word approximations that began shortly after

he began fish oils, he is non verbal, and can make only a few consonant or vowel

sounds.

>

> He has seen several different specialists, and it appears that verbal

dyspraxia is in fact the only problem he has.

>

> I was starting to wonder if perhaps PROMPT is not going to be of any real

benefit to him, and if I should look into a therapist that uses more traditional

type therapies - Nuffield is the most widely used here in Australia.

> His current therapist of course believes that the only way to help a child

with motor planning speech problems is through PROMPT. Due to financial costs

(no insurance for speech here), he is only able to be seeing her twice a week

for 45min sessions.

>

> Am I expecting too much too soon? Is there something that I should be doing

with him at home to help him (his therapist is slowly teaching me PROMPT cues).

>

> Also, his therapist advised me against encouraging him to say a word as two

seperate sounds eg u - p for the word up, telling me that it will set him up

with bad speech patterns that would be hard to break. The thing is though, I did

encourage him to say the word up like this (u - p), and over time the sounds

became closer together, and he almost says it correctly now. Should I continue

to do this, against her advice.

>

> Please give me any advice you may have. I'm starting to really worry about the

possibility of my little boy never learning to talk.

>

[Guest guest]

Hi, I can't really help you with some of your questions, but hope that you see

success soon. Keep with it. Have the therapist give you homework and do it

everyday, and if this therapist doesn't seem to be making progress, you could

switch therapists or maybe reduce this therapist to once a week and have the

other therapist work once a week as well. Personally, we have seen better

progress with a therapist who is teaching me the same cues that she uses so our

son is getting therapy at home every day. Also, some therapists just seem more

result oriented. But it is hard to know what actually makes an impact. We saw

very slow progress until was 3.5 years old, and suddenly much more

significant progress after we switched therapists. He went from CV words to now

three words together. The new therapist doesn't know PROMPT, but she does have

an extensive oral motor background. She concurs however that traditional

articulation approach does not work well with apraxia. I don't know what

Nuffield is. We also had significant progress separating out some words such as

" k-up " k--an " so that he could focus on the /k/ sound before making the rest of

the word.

Sincerely,

Barbara

>

> Hi,

>

> I've had my 25mth old going to therapy with a PROMPT trained (advanced)

therapist for about two months now. There has been no improvement.

>

> With the exception of a couple of word approximations that began shortly after

he began fish oils, he is non verbal, and can make only a few consonant or vowel

sounds.

>

> He has seen several different specialists, and it appears that verbal

dyspraxia is in fact the only problem he has.

>

> I was starting to wonder if perhaps PROMPT is not going to be of any real

benefit to him, and if I should look into a therapist that uses more traditional

type therapies - Nuffield is the most widely used here in Australia.

> His current therapist of course believes that the only way to help a child

with motor planning speech problems is through PROMPT. Due to financial costs

(no insurance for speech here), he is only able to be seeing her twice a week

for 45min sessions.

>

> Am I expecting too much too soon? Is there something that I should be doing

with him at home to help him (his therapist is slowly teaching me PROMPT cues).

>

> Also, his therapist advised me against encouraging him to say a word as two

seperate sounds eg u - p for the word up, telling me that it will set him up

with bad speech patterns that would be hard to break. The thing is though, I did

encourage him to say the word up like this (u - p), and over time the sounds

became closer together, and he almost says it correctly now. Should I continue

to do this, against her advice.

>

> Please give me any advice you may have. I'm starting to really worry about the

possibility of my little boy never learning to talk.

>

[Guest guest]

What type of homework did your therapist provide?

On 4/14/10, Dave <Firedog665@...> wrote:

>

>

>

> Hi, I can't really help you with some of your questions, but hope that you

> see success soon. Keep with it. Have the therapist give you homework and

> do it everyday, and if this therapist doesn't seem to be making progress,

> you could switch therapists or maybe reduce this therapist to once a week

> and have the other therapist work once a week as well. Personally, we have

> seen better progress with a therapist who is teaching me the same cues that

> she uses so our son is getting therapy at home every day. Also, some

> therapists just seem more result oriented. But it is hard to know what

> actually makes an impact. We saw very slow progress until was 3.5

> years old, and suddenly much more significant progress after we switched

> therapists. He went from CV words to now three words together. The new

> therapist doesn't know PROMPT, but she does have an extensive oral motor

> background. She concurs however that traditional articulation approach does

> not work well with apraxia. I don't know what Nuffield is. We also had

> significant progress separating out some words such as " k-up " k--an " so that

> he could focus on the /k/ sound before making the rest of the word.

>

> Sincerely,

> Barbara

>

>

>>

>> Hi,

>>

>> I've had my 25mth old going to therapy with a PROMPT trained (advanced)

>> therapist for about two months now. There has been no improvement.

>>

>> With the exception of a couple of word approximations that began shortly

>> after he began fish oils, he is non verbal, and can make only a few

>> consonant or vowel sounds.

>>

>> He has seen several different specialists, and it appears that verbal

>> dyspraxia is in fact the only problem he has.

>>

>> I was starting to wonder if perhaps PROMPT is not going to be of any real

>> benefit to him, and if I should look into a therapist that uses more

>> traditional type therapies - Nuffield is the most widely used here in

>> Australia.

>> His current therapist of course believes that the only way to help a child

>> with motor planning speech problems is through PROMPT. Due to financial

>> costs (no insurance for speech here), he is only able to be seeing her

>> twice a week for 45min sessions.

>>

>> Am I expecting too much too soon? Is there something that I should be

>> doing with him at home to help him (his therapist is slowly teaching me

>> PROMPT cues).

>>

>> Also, his therapist advised me against encouraging him to say a word as

>> two seperate sounds eg u - p for the word up, telling me that it will set

>> him up with bad speech patterns that would be hard to break. The thing is

>> though, I did encourage him to say the word up like this (u - p), and over

>> time the sounds became closer together, and he almost says it correctly

>> now. Should I continue to do this, against her advice.

>>

>> Please give me any advice you may have. I'm starting to really worry about

>> the possibility of my little boy never learning to talk.

>>

>

>

>

--

S. Kahn, M.S. CCC-SLP

melanieskahn@...

[Guest guest]

It has varied over time. She started with us just having him say the /k/ and

/g/ sounds over and over (like 10 times in a row). At first I had to hold down

the tip of his tongue and a little prompt upwards under his throat. Later,

after he mastered that, we worked on simple words with the k and g sounds, such

as gate, cat, car, cow, go, cup, etc. Later we did homework with two words at a

time using the k and g sounds. Later we started with the /y/ sound, just

learning the sound by itself. We started with a dental floss holder, which when

held correctly prevented his /y/ sound turning into a /l/ by having him use the

tongue further back. Then we started with /y/ words, such as yeah, yummy,

yucky, yellow; then to start the /f/ sound she just had us put a little bit of

chocolate pudding on his lower lip and then him clean if off with his top teeth,

and then the next week, adding air to make the /f/ sound. Basically, we are

repeating the same type of assignments that she covers in therapy.

When he was younger with a different therapist, we were also given homework, but

it never seemed to make a difference, and he never seemed to improve. I think

that there is a real big improvement if you have the child say the sound

correctly for 10 times in a row, multiple times. Just saying a word once or

twice doesn't seem to work as well.

On another note, I saw a well known speaker in apraxia recently, and she was

against using single sounds (although it has worked for us), in favor of using

short words with easy sounds. She was concerned about creating unnatural spaces

and gaps in the child's speech which may persist after the child is actually

able to make the sounds correctly. So if you do start separating the words, try

to stop when it is no longer necessary. I notice that our son still separates

the k sound from the rest of the word, when perhaps it is not necessary for him

at this point in time.

Good luck, please feel free to contact me at any time if I can explain further.

Sincerely,

Barbara

firedog665@...

> >>

> >> Hi,

> >>

> >> I've had my 25mth old going to therapy with a PROMPT trained (advanced)

> >> therapist for about two months now. There has been no improvement.

> >>

> >> With the exception of a couple of word approximations that began shortly

> >> after he began fish oils, he is non verbal, and can make only a few

> >> consonant or vowel sounds.

> >>

> >> He has seen several different specialists, and it appears that verbal

> >> dyspraxia is in fact the only problem he has.

> >>

> >> I was starting to wonder if perhaps PROMPT is not going to be of any real

> >> benefit to him, and if I should look into a therapist that uses more

> >> traditional type therapies - Nuffield is the most widely used here in

> >> Australia.

> >> His current therapist of course believes that the only way to help a child

> >> with motor planning speech problems is through PROMPT. Due to financial

> >> costs (no insurance for speech here), he is only able to be seeing her

> >> twice a week for 45min sessions.

> >>

> >> Am I expecting too much too soon? Is there something that I should be

> >> doing with him at home to help him (his therapist is slowly teaching me

> >> PROMPT cues).

> >>

> >> Also, his therapist advised me against encouraging him to say a word as

> >> two seperate sounds eg u - p for the word up, telling me that it will set

> >> him up with bad speech patterns that would be hard to break. The thing is

> >> though, I did encourage him to say the word up like this (u - p), and over

> >> time the sounds became closer together, and he almost says it correctly

> >> now. Should I continue to do this, against her advice.

> >>

> >> Please give me any advice you may have. I'm starting to really worry about

> >> the possibility of my little boy never learning to talk.

> >>

> >

> >

> >

>

>

> --

> S. Kahn, M.S. CCC-SLP

> melanieskahn@...

>