Defining Apraxia & PROMPT© therapy

Childhood Apraxia of Speech (CAS) “is a neurological childhood (pediatric) speech sound disorder in which the precision and consistency of movements for speech are impaired." CAS may occur as a result of known neurological impairment, in association with complex neurobehavioral disorders of known or unknown origin, or as an idiopathic neurogenic speech sound disorder.

Childhood Apraxia of Speech (CAS) is a complex and variable motor based speech disorder which emerges in early childhood, marked by inconsistent and imprecise motor executions.

Although there are not any formal guidelines for diagnosing CAS, as it is a variable disorder and features change over time, there are three key features that SLP’s look for to identify such a disruption in a child’s motor planning:

• Inconsistent Speech Sound errors in repeated productions of syllables and words

• Disrupted and/or lengthened co-articulatory transitions between sounds and syllables, as well as impaired prosody (or rhythm of speech)

• Inconsistent errors in repetition of the same target. (This is the strongest indicator of CAS)

Children with CAS tend to also have impairments in non-speech motor movements. They also tend to present with vowel and sound ordering errors, while experiencing groping.

A diagnosis of CAS is reached via an assessment in observation of the child’s speech production skills, prosody, and expressive language and non-speech skills. Such an assessment may include:

• A sound discrimination task (have children listen to, and discriminate phonemes)

• Syllable repetition and alternating production task (such as asking the child to repeat: “pu-tuh-kuh” several times)

• Sound imitation task: Children with CAS have significant difficulty imitate sounds.Obtain a speech sample of utterances of greater length and complexity.

• Administer a standardized Articulation Test, such as the GFTA (Goldman Fristoe Test of Articulation) to evaluate all sounds in varying word positions. 

Chatterboxes’ SLP’s are trained in a specialized form of ‘hands on’ speech therapy, known as PROMPT© therapy. The PROMPT© System stands for ‘Prompts for Restructuring Oral Muscular Phonetic Targets’.

WHAT:          PROMPT© is a dynamic tactile method of treatment for motor speech disorders which is based on touch pressure, kinesthetic and proprioceptive cues.

WHY:            PROMPT© helps to reshape individual and connected articulatory phonemes and sequences (coarticulation).

WHO:            During this approach, the clinician helps to manually guide articulators to produce specific sounds or words that seem to be problematic.

HOW:            This is a hands-on approach. The SLP uses her hands to cue and stimulate articulatory movement, at the same time helping the child to limit unnecessary movements

The below series of photographs demonstrate the touch cues that may be applied during a typical PROMPT© therapy session by the Speech-Language Pathologist. Please note: such kinesthetic cues may be provided by the SLP to aid the child in eliciting a single sound, such as “ah.” In addition, combinations of tactile cues may be used to aid in elicitation of sound combination, single words, short phrases, and even sentences.  More information about PROMPT can be obtained via www.thepromptinstitute.com  

The PROMPT photograph demonstration is as follows:

Puree recipes

Many table foods can be pureed.  To puree, chop the food into small pieces and place in a blender or food processor.  Depending on the food, you may need to add some liquid.  Blend to a mashed potato/pudding like consistency with no lumps.  Food that is already cooked to a soft consistency blends more easily.  Avoid foods that have shells (peas, blueberries, corn, etc.) as these are difficult to properly blend.  

 

Below are six puree recipes.  Please note that these are only suggested proportions of ingredients.  Experiment with these recipes to determine the best proportions of ingredients. For instance, when pureeing rice, add the gravy a few tablespoons at a time, then puree and determine if more liquid is needed.  

Pureed Rice

1 cup cooked white rice

1/2 cup gravy

1 tablespoon butter

Pureed Macaroni and Cheese (from box macaroni and cheese)

1 cup cooked macaroni and cheese from box recipe (includes butter and cheese)

½ cup milk


Pureed Pasta and Tomato Sauce

1 cup cooked macaroni noodles

½ cup tomato sauce
1 tablespoon butter

Pureed Carrots

½ cup cooked carrots

¼ cup chicken broth
1 teaspoon butter


Pureed Broccoli and Cheese Sauce (from frozen package)

½ cup cooked broccoli and cheese sauce

¼  cup whole milk

Strawberry-Banana Smoothie

1/2 banana

4 strawberries
¼ cup whole milk
2 tablespoons vanilla yogurt

Ideas for Practicing Pronouns “He/She” in Daily Routines and Play

For some children, the personal pronouns "he" and "she" can be difficult to master. Here are some strategies and activities to try at home to help your child practice the pronouns.

Strategies:

• Model the language that you want your child to use.
• Teach your child, “When it’s a boy, we say HE. When it’s a girl we say SHE.”
• Place emphasis on the words “he” and “she” to draw your child’s attention to them.
• When practicing “he/she” with boy and girl dolls, animals, etc. first make sure that your child identifies which one is a boy and which one is a girl.

Activities to try at home:

1.)    Pretend to have a picnic with girl and boy dolls. Take turns passing out pretend food.  As you pass out each food, model appropriate use of pronouns “he/she” and have your child repeat. For example, say “He eats apple” or “She eats banana.”

2.)    While reading books, comment about the pictures of boys and girls. Model accurate use of pronouns, for instance, point to a picture of a girl and say, “She is smiling.” Have your child repeat your comments.  Also, ask your child about the pictures. For instance, ask, “What is he wearing?”  Have your child respond using the pronouns.

3.)    Set up boy and girl dolls and blow bubbles to them.  Have your child choose who to blow bubbles to.  Ask your child, “Who wants bubbles?” Your child responds either “He does” or “She does.” You can offer your child a choice between the two options.  For instance, ask your child, “She wants bubbles or he wants bubbles?”

4.)    Color pictures of boys and girls.  As you color each, make comments about what you are coloring using pronouns “he” and “she.” For instance, say “He has blue pants,” or “She has a red hat.”

Liquids, Purees, and Dissolvable Solids

Looking for ideas for which liquids, purees, and dissolvable solids to try with your child? Here are our recommendations:

Liquids

Milk

Chocolate milk
Strawberry milk
Soy milk

Pediasure - vanilla, strawberry, chocolate

Juice
Water
V8 tomato juice
Smoothie
Milkshake
Odwalla or Naked juice
Hot chocolate 

Dissolvable Solids

Cheese puffs
Pirate’s Booty
Graham crackers
Veggie Sticks
Ritz crackers
Ice Cream
Frozen yogurt
Sorbet
Popsicles


Purees

Mashed potatoes and gravy
Mashed sweet potatoes
Pureed macaroni and cheese
Pureed pasta and sauce
Cream of Wheat
Yogurt
Pudding - vanilla, chocolate
Pureed carrots
Pureed butternut squash
Pureed broccoli in cheese sauce
Pureed green beans
Pureed asparagus
Mashed avocado
Guacamole
Sour cream
Tomato soup
Butternut squash soup
Split pea soup
Strained cream of mushroom soup
Strained cream of broccoli soup
Applesauce
Mashed bananas
Strawberry-banana smoothie
Pureed peaches
Pureed cantaloupe 
Hummus
Refried beans
Pumpkin pie filling
Whipped cream
Any pureed baby food

Many table foods can be pureed. To puree, chop the food into small pieces and place in a blender or food processor.  Depending on the food, you may need to add some liquid (e.g., milk, juice, water, etc.). Blend to a mashed potato/pudding like consistency with no lumps.  Food that is already cooked to a soft consistency blends more easily. Avoid foods that have shells (peas, blueberries, corn, etc.) as these are difficult to properly blend.

Infant Sibling Project

What if we could diagnose autism or language delays before a child’s first birthday?

Although there is some knowledge available about the cause and treatment of these disorders, we still have much to learn. The Infant Sibling Project—a joint collaboration between Boston Children’s Hospital and Boston University—aims to identify very early risk markers for language impairment or autism spectrum disorders. Currently, children are not usually diagnosed until they are 18 months of age or older. Identifying high risk infants at this early stage would allow for early intervention to begin much sooner than is currently possible, greatly increasing the potential for such treatments to have a lasting, positive impact.  

To achieve these goals, the project depends on area families who are willing to volunteer. They are looking for infants (age 12 months or younger) who have an older sibling with either a language impairment or an ASD. Parents who are expecting a new baby are also welcome to enroll. Babies in this project will be monitored closely for signs of autism or language impairment; they will be seen a few times during their first two years and for a follow-up at age three. Scheduling is flexible and based on each family’s needs. Travel and parking expenses are fully covered, and there is free childcare for any siblings who may come along with you to study visits. Participating parents are compensated for their time, and children receive small thank you gifts at each visit.

For more information, please contact Vanessa Loukas at project.infantsibling@gmail.com or 617-455-7238.

5 to 6 Years Communication Milestones

By the age of 5-6, children should be able to do the following:

LISTENING:

• Follow 1-2, and 3 step simple directions in a sequence
• Listen to and understand age-appropriate stories read aloud
• Follow a simple conversation

SPEAKING:   

• Answer open-ended questions (e.g., "What did you have for lunch today?")
• Retell a story or talk about an event
• Show interest in and start conversations
• Be easily understood
• Answer more complex "yes/no" questions
• Tell and retell stories and events in a logical order
• Express ideas with a variety of complete sentences
• Use most parts of speech (grammar) correctly
• Ask and respond to "wh" questions (who, what, where, when, why)
• Stay on topic and take turns in conversation
•  Give directions
•  Start conversations 

READING: (by age 5)

• Know how a book works (e.g., read from left to right and top to bottom in English)
• Understand that spoken words are made up of sounds
• Identify words that rhyme (e.g., cat and hat)
• Compare and match words based on their sounds
• Understand that letters represent speech sounds and match sounds to letters
• Identify upper- and lowercase letters
• Recognize some words by sight
• "Read" a few picture books from memory
• Imitate reading by talking about pictures in a book


READING:  (by age 6)

• Create rhyming words

• Identify all sounds in short words
• Blend separate sounds to form words
• Match spoken words with print
• Identify letters, words, and sentences
• Sound out words when reading
•  Have a sight vocabulary of 100 common words
•  Read grade-level material fluently
•  Understand what is read

WRITING:  (by age 6)

• Express ideas through writing

• Print clearly
• Spell frequently used words correctly
• Begin each sentence with capital letters and use ending punctuation
• Write a variety of stories, journal entries, or letters/notes

4 to 5 Years Communication Milestones

By the age of 4-5, a child should exhibit the following language skills:
 

RECEPTIVE LANGUAGE:

•  Pays attention to a short story and answers simple questions about it.
•Hears and understands most of what is said at home and in school.

EXPRESSIVE LANGUAGE:

•Makes voice sounds clear like other children's.

•Uses sentences that give lots of details (e.g., "I like to read my books").
•Tells stories that stick to topic.
•  Communicates easily with other children and adults.
•Says most sounds correctly
•Uses the same grammar as the rest of the family.

WHAT CAN I DO TO ENCOURAGE EXPRESSIVE &  RECEPTIVE LANGUAGE DEVELOPMENT?
•Talk about spatial relationships (first, middle, and last; right and left) and opposites (up and down, big and little).
• Offer a description or clues and have the child identify what you are describing.
•Work on forming and explaining categories (fruits, furniture, shapes).
•Follow the child’s directions as she or he explains how to do something.
•Give full attention to the child when he or she is speaking, and acknowledge, praise, and encourage him or her afterward. Before you speak to the child, be sure to get his or her undivided attention. Pause after speaking, allowing him or her to respond to what you have said.
•      Build on the child' s vocabulary. Provide definitions for new words, and use them in context: "This vehicle is riding on the highway. It is a car. A bus is another kind of vehicle. So are a train and an airplane."
•     Encourage the child to ask for an explanation if he or she does not understand what a word means. 
•      Point out things that are the same or different. Play games incorporating these concepts that he or she will encounter later in the classroom in reading readiness.
•      Sort items into categories. Now try to sort them by pointing out more subtle differences between objects (e.g., rocks that are smooth vs. those that are rough, heavy vs. light, big vs. small). Again, have the child identify the object that does not belong in a given category, but now ask him or her to explain why the item does not belong.
•      Expand on social communication and narration skills (telling a story) by role-playing. Play house, doctor, and store using dialogue, props, and dress-up clothes. Do the same with a dollhouse and its props, acting out scenarios and making the dolls talk.
•      Read stories with easy-to-follow plots. Help the child predict what will happen next in the story. Act out the stories, and put on puppet shows of the stories. Have the child draw a picture of a scene from the story, or of a favorite part. You can do the same thing with videos and television shows, as these also have plots. Ask "wh" questions (who, what, when, where, or why) and monitor his or her response.
•      Expand on the child' s comprehension and expressive language skills by playing "I Spy"
•      Give the child two-step directions (e.g., "Get your coat from the closet and put it on")..
•      Play age-appropriate board games. (e.g., "Candyland" or "Chutes and Ladders").
•      Have the child help you plan and discuss daily activities.

2.5 to 3 Years Communication Milestones

By the age of 2.5, a child should be able to demonstrate the following communication milestones:

RECEPTIVE COMMUNICATION:

• Understands the use of objects; for example:

•  Show what you use to cook food or Show me what you watch.

•  Show me what you can ride or Show me what you wear on your feet

•  Understands part/whole relationships, for example:

•  The wheel on the bike
•  The tail of the cat

•  Understands descriptive concepts, such as “big” “wet” and  “little”
•  Follows 2 step related and unrelated commands, without cues:

•  Get the cup and give it to me
•  Take off your coat and hang it up.

EXPRESSIVE COMMUNICATION:

•  Uses Plurals, such as “horses” or “blocks” or “babies.”

•  Combines 3+ words in spontaneous speech.
•  Answers “What” and “Who” Questions
•  Uses Verb + ing.

• For example, “The girl is playing.”

•  Uses a variety of nouns, verbs, modifiers and pronouns in spontaneous utterances.
• Uses prepositions
•  Understands the concepts of one vs. all. For example,

•  Give me just one block.

•  Put all of the blocks in the box.

PLAY:

•  Performs longer sequences of play activities

•  Acts out familiar routines

•  Pretends to perform the caregiver/parent routines.