To ask if anyone can help me work out what might be causing my son's speech problem

[grizzabellia]

Hi, I posted a couple of months ago about my worry about my little boy who is now nearly 3 and not speaking properly. He is under nhs speech therapy but appointments so far have been sporadic and the first therapist left so there was a gap and we have only seen the new one once so far. I am finding it frustrating that so far no-one has been able to give any clear answers or a prognosis, although I guess they are still undertaking an assessment and it may be difficult at this stage as he is so young. The one we saw most recently thought he seemed to have a speech disorder rather than a delay, as there are a number of sounds he does not seem to use much, mainly consonants. I got the impression this was more severe and was really upset as I had actually gone to the appointment thinking his speech was improving!

Currently he has very little clear speech but he does vocalise a lot and a lot more than he used to, and in context I know what he is trying to say so the number of words he uses is increasing. He also now puts some words together such as 'look mummy' (more like 'ook' though) and 'blue car' ('oo' 'ar') and police car ('eece' 'arr'). His longest phrase is 'more milk please' ('ore ilk ease') and he will now put the end 'k' on milk which he wasn't doing before. He understands absolutely everything people say, including when I have mentioned to people I am worried about him, when recently he has gone very huffy and clingy so think I should stop doing so in his presence. Otherwise he seems bright enough. i was a bit worried about ASD as there is a tendency to geekiness and eccentricity in my partner's family but I don't think he would meet criteria for this - he loves pretend play and is very focused on what he is doing for long periods, so his attention is good. He is very expressive facially and can also modulate his tone to convey different emotions. He is reasonably sociable and will play with other children though also plays well on his own.

I have googled various things and read about verbal dyspraxia as a possibility though in one source I read this is actually very rare. His motor skills are good so he does not have dyspraxia in this area. He also had a lot of ear infections as a baby - we have had his hearing tested twice, once at about 10 months and at just over 2 and they said it was ok but the test did not seem very rigorous to me - they play sounds and when the child turns a scary tigger thing does a dance. My mother in law recently commented that when he does speak he doesn't seem to modulate the volume very well and wondered if he might have a problem hearing consonants. He does still seem to get quite a lot of wax in his ears. I also read one post somewhere about a child who had eventually had a problem with palate muscles diagnosed which required surgery so am wondering whether to ask for a referral back to ENT.

I would be really grateful if anyone could offer some advice/expertise as I just don't know what the future will bring, whether he will be able to talk by reception and the impact on his social abilities - it is really worrying me a lot! Thanks for anyone who has taken time to read this.

I would suggest another hearing test. See if you can get your GP to refer.

Also there are some games you can play to help with this difficulty with hearing all the sounds in words, if his hearing is not the problem. It is called 'I Hear with my little ear' - may be useful when he is a bit bigger.

Verbal dyspraxia is a nightmare to get dxed in the UK.

Sorry have to dash off, but there's nothing to stop you using the Nuffield card (if you can get them) or Kaufman cards yourself.

Google apraxia kids (american site but useful) and Nancy Kaufman. She does video assessments I think.

Will be back later or tomorrow - if you can't find the sites let me know and I'll link.

We needed a speech therapy apt for our son ,two year waiting list at the time. Shocking.
I don't know what to advise other than perhaps shout louder at the GP. The hearing needs investigation.
I hope it reassures you to hear that my son was still silent at four ,but is now a loud chatting eleven year old with an impressive vocab.
Is he at a nursery? Are professionals concerned?
As an aside, are there any chewing /feeding issues?

You have just described my DD.
She too has been diagnosed with a speech disorder. She had lots of single words, but quite a few of them were not understood by other people, and there was no chance of holding a conversation with her.
The main thing with DD was eye contact. The speech therapist thinks she missed a lot of understanding on how to pronounce words, as she was such a busy child doing her own thing (still is now, tbh) that she didn't look up and notice how people's mouths moved when they spoke...if that makes sense?
She has just turned 4 and can now hold a conversation. She asks and answers questions and practically every new word she learns is pronounced correctly. She is still quite behind her peers, but I at last feel like she is getting there.
Try and relax a bit, he is still only young, and has a lot of time to catch up before he goes to school. Feel free to pm me though, if you would like to chat more. They all get there in the end

It is definitely worth getting his hearing checked. Ds2 has speech problems , he performed poorly in a hearing test, had a lot of wax build up and had the syringed. he has been diagnosed with glue ear. Since the syringing ( loads came out) his speech has improved and his speech therapy seems to be having more of an impact.

I am not sure if this will help but might reassure. My youngest boy is 3.9 yrs and under NHS. We have had 3(!) appointments where they have either stopped 5 mins in or at the end of the session have expressed it needs someone 'more senior and more experienced' to see him. Like your son he has issues with certain letters and either misses them or substitutes (this is the main issue - he is substituting with unusual letters/sounds). I am hoping my next session in a couple of weeks will actually give me homework, assurance etc

He is my youngest of 4. He makes himself understood. He has not held back from talking although he did start late (he was physically advanced in terms of movement, fine motor skills etc so I didn't worry then thinking it would all catch up). What I am trying to say is that he is gradually improving on his own - yes big issues still there - but he is getting there. We have small breakthroughs - like your 'k' on milk and while (for example) he may not use it on similar words I know he can say it so he will (eventually) get there. My major concern is 's' as I am not sure his tongue is in the right place...

I am going to see how these sessions go and take it from there. Mine is due to start school in September and if I feel like he needs it, I will try and find private therapy to help (which will be a financial strain).

Ps as part of our initial consultations he has had a hearing test - although that was instigated by me asking my go for a referral - and it happened very quickly. No issues for him.

Dyspraxic children are often inconsistent in how they pronounce words and vowels are more likely to be incorrect than with a more general speech disorder or delay. From what you have said he does not sound like a typical child with verbal dyspraxia.
Speech delays and disorders sometimes just happen there is no reason.
However getting, another Hearing test is very important glue ear can mean hearing is okay one day and not the next. Even a slight nearing loss can effect speech a huge amount. Imagine trying to learn a second language over the phone. Look on the ndcs website they have lots of tips that can help even if hearing is not the issue (Keeping background noise to a minimum etc.)
Be reasured that if his comprehension is good and he has all the great skills you describe his speech is something that can resolve very easily and quickly but he probably will need therapy.
Socially kids tend to talk about the here and now, if he says to the kid at nursery 'ook a ar' while pointing to the car they'll probably get it.

One of mine had speech therapy as they weren't pronouncing the ends of words. K was particularly difficult, iirc.

In the speech therapy group, there was another child who didn't pronounce the beginnings of words.

We had specific homework to do, but the therapist also stressed the importance of 2 things.

Firstly, don't have the TV on as background noise, makes it hard to concentrate and harder to hear other sounds.

(Phone gone wonky.)

Secondly, play some tabletop games everyday, like cards or a board game. They can hear you more clearly and you can repeat what they say and model sounds for them.

Having been through speech therapy with DSL who had a phonological disorder, I would recommend a look at the Caroline Bowen website. She is an Australian SLT and has an amazing collection of resources online.

I agree with the advice about eye contact whenever speaking to him. I am guilty of not doing that enough with dC & 3 had speech delay.

Has anyone looked in his ears for glue ear?

Hi,

I think you should feel ok about it if - as you say - you are seeing progress - even if he's not at same level as his contemporaries yet, steady progress is the most important thing. My twins said not a single word at two; they never stop now at five ;-)

Obviously you still need to find out what it is, just trying to put in context with his personal trajectory

Your situation sounds very similar to my DS. He is 3.3 and has just been diagnosed with an expressive speech and language disorder with consonants. We too have struggled with therapy, basically I have pestered and we are now receiving approximately 6 sessions a term, some with a month long gap so I totally sympathise your concerns about a lack of consistency.

Personally I have now decided to take matters into my own hands and try my hardest to do plenty at home. We ask no open questions, never say 'say...', we do small sessions of focused play with single words said slowly, sometimes he tries to repeat, sometimes not. We sing an awful lot and he is now trying too. I found a brilliant website with images that are separated into consonant sounds with starting and ending. It is excellent. I have printed out and laminated and chosen a few, put into a box and DS chooses and I talk about the image with the sound. These sorts of activities are very similar to the therapist so we are trying our best and have seen a huge improvement. Try as many activities as you can, daily but without pressure. It is very hard but it is absolutely necessary.
Best of luck, link below

www.speech-language-therapy.com/index.php?option=com_content&view=article&id=37:consonants&catid=9:resources&Itemid=117

Oh and sign language too is really useful!

Thanks for the advice, tips and reassuring stories. It is interesting what has been commented about verbal dyspraxia affecting vowels and causing inconsistencies, that does not really describe his speech and I had not read that before. I really am hoping is not verbal dyspraxia as that sounds like a big deal! I also think I will get his ears checked again and maybe ask about syringing - though I would feel awful if all this time that had been a problem and I was reassured falsely by the hearing test! I have tried to do single sound modelling with him but he is very resistant as he knows what I am up to. I try to talk simply, comment on what he is doing and reinforce things he says by agreeing and repeating them back clearly. It is just very slow going and I am clinging to any sign of progress but hope I am not deluding myself!

Yes it is very slow going, so try to make it into a game so your DC is excited to play. A speech therapist told me recently that verbal dyspraxia is actually extremely rare and often wrongly diagnosed.

Inside leg, noone has mentioned not asking open questions - do you mean you give options instead? I don't ask him to say particular words but I will for example ask him about what animals he has on his farm. When you say focused play do you differentiate this from just playing with him? I tend to just follow his lead but use short phrases to comment o what he is doing eg 'man driving tractor' - he doesn't use verbs so trying to encourage these!

Think i responded on last thread of yours.

sorry you not had much progress.

I got worries about my little boy at 18 months.

hes now 2 year 8 months and really had to push for speech referal from hv .

he had his hearing test before xmas they couldent the headphone bit but they dd have a boat and when he heard the sound he was to put a person in the boat they concluded his hearings fie was some congestion but nothing interfere with speech and would test again 6 months but he understands everything and is light sleeper so never considered hearing be issue.

He has speech and language 1st appointment monday only took 8months.

he rarly says mama. he never says dadda.
he makes lots sounds, very sociable, smiley ,laughs out loud understands everything , he points to things.

Hes tall so looks older and his mobility/blance is fine he runs, scoots, climbs no problem.

Whats been most hurtful is comments all time.

washing machine repair man asked whats wrong with hmi is he autistic or something?

Then before xmas at pat saw baby 4 weeks older than him who was fluent speaker felt sad.

then he had fall ended up in a&e had to see nurse first he hates new people, new environments and is quite shy.

she asked me if he was on autistic scale and had go at me for delaying his mmr.

Every week im having to explain hes not being rude he just dont talk easier when see older kids but when see kids same age, younger i keep thinkings whats wrong.

we tried phonics toys.
songs
preschool was disaster they said he was mute and really worried hes behind hes not had preschool place since sept as we moved.

hv seems quite blase and rarly sees him, I did ask for 2year check but they dident do one.

Hes my 3rd and my youngest and constantly worried about him.

Hi, it doesn't sound like dyspraxia as that tends to cause issues with articulation. What you're describing is a phonological disorder, namely initial consonant deletion, so I would recommend reading up on this, but echo a pp with the modelling, lack of background noise and potentially look into hearing as this could affect it.

Gosh he sounds like my son to the t - our first speech therapy is end of Jan - he seems to refuse constenants also and has fabulous understanding.

Ps the same also with his playing - v much the same as you describe your ds

Yes apparently asking lots of question can put pressure on a child who won't be able to articulate an answer. My DS started to show physical signs of anxiety and this went away when we stopped asking. So I try to make statements. Yes give options too.

DS had no speech at 3, about 20 words, no two-words phrases, although he did understand everything. He just didn't want to speak. By 3.6 though, he was talking easily and now at 4 he is very articulate.

I second the proper hearing test - we had to insist to get the GP to refer us.

In my experience, no-one particularly worries about a 3 year old boy not speaking, although a girl would trigger more action.