Anyone who has followed this blog for a while knows that Blake has had speech issues pretty much his whole life. He has been receiving speech therapy since he was almost 2.5 year old. After having his tongue tied clipped, he gained a great deal of progress. In September of last year, he began speaking more and more. I'm blown away with his progress and the vocabulary that he has developed in 3.5 years. I always knew that he had a strong receptive vocabulary (understanding of what he hears), but now his expressive vocabulary (what he is able to say) blows me away too.
In early March, his private speech clinician performed new testing to see his progress and assess what is really causing his speech issues. In the testing it was determined that he has verbal and oral apraxia. We had a feeling that this maybe part of his issue before the testing was even started.
"Apraxia is a neurogenic impairment involving planning, executing and sequencing motor movements. Verbal apraxia affects the programming of the articulators and rapid sequences of muscle movements for speech sounds (often associated with hypotonia and sensory integration disorder). Oral apraxia involves nonspeech movements (e.g., blowing, puckering, licking food from the lips)." Dr. Marilyn Agin
Ok... now I know you are saying... so what does that mean? It means that he has issues doing things with his mouth especially when asked. There are movements that he can't do on his own and some that he can do involuntarily, but if you ask him to do it he struggles. For example, he struggles to lick his top lip, this is something that he can not do involuntarily or when asked. Another example is he can open and close his mouth on his own, but when asked there is a pause between the two motions because he has to think about it and can't just do it.
Part of the challenge with this is the fact that Blake is very smart (and not that isn't just a mother bragging... he is) and know what he can and can't do. He gets very frustrated when asked to do something that he knows he should be able to do and can't. But, gets even more frustrated when it is something he isn't sure he can do and you expect him to do it.
This was shining in full force yesterday. I found out that Blake hasn't been drinking anything at school because he wasn't confident in drinking out of a real cup. At home he uses a sippy cup, more for the fact that Colby dumps anything he gets his hands on than any other reason. But, knowing Blake he didn't want to try to drink out of the cup at school in fear of spilling it. So yesterday for dinner we worked on him drinking out of the cup. He could do it with one hand so it is not an issue of being steady or bring the cup to his mouth. It was hard to sit there and watch him struggle with how to put his lips on the cup. To watch him take the tiniest sips of juice to be sure he got it all in his mouth. He was so proud of himself when he did it on his own. But, the challenge with apraxia is that even if he did it last night doesn't mean he will do it right today or tomorrow or the next day. Children with apraxia struggle with consistency they struggle with getting the same motion and/or sound done the right way over and over.
This is hard to wrap my brain around. I know he is smart, I know he can do these skills, but his body doesn't always communicate correctly. I worry about how this will effect him in school. This is a child who is beginning to sound out words on his own, but at the same time he can't always correctly articulate the sounds when asked. I know that he knows all the letter sounds and does a good job getting close to the correct sound, but struggles with consistency. I just fear that he will get frustrated with it all and then not want to put in the effort because it won't always be rewarded.
We will get there. He has made HUGE strides in all areas... I'm so proud of him.