Does anyone have a child with a speech delay that has not been helped by speech therapy?

[LadyMargolotta]

My four year old ds is still very difficult to understand. In fact much of the time his speech is unintelligible. He misses out most consonants and the end of words. I can only understand what he says if I know the context eg. getting him to point to what he wants.

He has been recieving speech therapy twice a week for the last eight months. The SALT has just told me that he has made very little progress, and that any progress he does make, is soon forgotton. She wants to refer him to a developmental specialist. It was hard enough getting a referral to SALT in the first place - because where we live in Belgium, age three is considered too young for SALT. Also we are a bilingual family and this has been blamed for his language delay, but this is a red herring. It has nothing to do with having two languages.

His development in other areas seems normal as far as I can tell. He seems bright enough, communicative in other ways, and very motivated to learn. He just isn't making progress with speech.

Does anyone have any similar experience?

I assume youve had his hearing tested?

Yes, his hearing has been tested by an ENT specialist and is normal.

His understanding of both languages seems normal.

Bump

me.

ds is understandable to me but most other people find it hard to understand.

his hearing is fine but he has a slight tongue tie which might be to blame(????)
he has trouble with the L sound, the TH sound and makes deliberate glottal stops

i have to say some words a syllable at a time or he will make his own pronounciation up.

Salt wasn't much help so i am hoping it will improve as he grows.

Have you heard about phonological speech disorders?

They are when the child tries to make the speech sounds in the wrong part of their mouth.

I dont know that much about them but I know a LO who has recently been diagnosed with it and it needs a different approach to the therapy.

Maybe you could google??

Good luck

Thank you. I will google phonological speech disorders. Unfortunately he seems to be missing most consonant sounds and some vowel sounds. He often tries to say a word and will miss out all the consonants. He also misses off the ending of words. Even the consonant sounds that he can say he will use inconsistantly.

He has been seen by a paed and tongue tie and palate problems have been ruled out but I might take him to a different ENT clinic and have everything checked again.

I found this site it has a chart that shows the ages when sounds are usually achieved. I found it quite reassuring.

LadyM: I assume that you sit in on his SLT sessions. What format do they take? What games or exercises are they doing? What does your DS do?

Does any of this sound familiar?

www.asha.org/public/speech/disorders/childhoodapraxia.htm#signs

Is he still attending speech therapy?

lijkk- no I don't sit in on the sessions. The speech therapist goes to his school. That's normal in Belgium. Even in the holidays, I am not encouraged to sit in on the sessions.

I read his report each time and there are fun pictures and stickers in his book. He seems to enjoy the sessions and he likes the speech therapist.

My ds seesm very motivated in most things that he does, and he is co-operative with the speech therapist as well.

Despite the frustration of not being understood, ds is a very happy little boy. In fact he is happy all the time more or less. I get the impression that he thinks he is saying the words correctly, even if it is undecipharable to me. We are all bi-lingual so it is not a problem of not understanding the language. I am used to understanding a mixture of the two languages because my girls mix them all and swap from one to the other all the time.

I have looked at the apraxia of speech, and he does tick nearly all those boxes, but he ticks nearly all the boxes for most speech impairments that I have been reading about on the 'net.

I don't think it's particularly straightforward to give him a diagnosis, or else he would have been given a diagnosis already - he has already seen a paed and other doctors.

Thank you everyone.

Hello, my youngest ds has very similar problems to yours. He is 4 & started school this sept, he won't be 5 till summer. He has received salt for approx 18mths (1:1 & group) with no improvement. Da replaces most sounds in his words. They think it is verbal dyspraxia & he has been referred to the Nuffield in London which specialises in speech disorders, is there anywhere similar where you live? I asked his salt to refer him as the GP didn't have a clue.

I would recommend using visual cues (pecs) & sign language. They all assist in teaching a child to speak & won't delay it further according to research. They also help if he gets frustrated when trying to get himself understood. My ds is very calm but I can imagine he will become more frustrated as he gets older & can't participate fully in the curriculum. We are applying for a statement; salt, ed psych & Paed all agree he needs 1:1 help in lessons at school, would something like this be possible in Belgium?

Hope that was helpful. It's terrible not knowing what's causing the delay but when you find out what is wrong at least you'll know to ask for the right kind of help...

Thanks momma2lilboys.

TBH it was a beaurocratic nightmare to get the speech therapy started in the first place - it took months of me pestering the doctors/teachers for the right referrals. I was fobbed off with his age/bilingualism as excuses for his late speech, before the doctors etc had even seen ds. As soon as he was assesed properly, all the professionals agreed that he needed urgent speech therapy.

Added to that, the insurance company have refused to reimburse us the cost. We have to pay the full amount - about 50 euros/week.

We are waiting for a referral to a developmental clinic, but it will be a six month wait due to the waiting lists .

In Belgium I have never come across a child with 1:1 help in a standard school. Teaching assistants don't exist. A child with any problems is either held back a year or sent to a school for SE eg. dyslexia. There is very little integration of children with SN. The system simply isn't set up that way.

LadyM, I am a speech therapist which is why I asked about the diagnosis - sorry I can't help myself! I'm sure it is very frustrating trying to get to the bottom of it. Has your speech therapist given you any diagnosis at all? The paed and other doctors would obviously not be able to give you a diagnosis for a communication disorder so the speech therapist would be the only one to provide that.

I agree with momma2lilboys that the Nuffield programme is great and other supplementary ways of communicating, as mentioned, are excellent tips. Although, without a diagnosis as momma2lilboys says it may not be the right type of help.

I'm pleased to hear he is enjoying his speech therapy and hope some kind of breakthrough can be made for him.

Best of luck.

themammy73 - I have a more in depth appointment with the SALT on tuesday.

The Belgian culture is different to the UK in that they don't sugar coat anything - the SALT was very blunt in telling me that he hasn't progressed and any progression he does make is quickly forgotton.

I'm not sure if she will give me a diagnosis on tuesday. I will tentatively mention speech apraxia to her and see what she says.

I will also take him back to the ENT clinic and ask for more investigations of his blocked nose/post nasal drip and mouth breathing, becaues I wonder if that effects his speech (although I could be completely wrong as I haven't got a clue!)

I assume SALT will continue. I will suggest three sessions a week instead of two, to see if that helps.

I will ask about sign language.

Thank you.

Yes, definitely get the ENT checked again as this can impact upon speech development and I must stress the apraxia is only a suggestion as without seeing and more importantly, hearing him I wouldn't want to suggest one way or the other but it's something to think about. I hope she can give you some answers and reassurance.

It's good he is having even two sessions a week and if you can get more, that is great. I am not based in the UK either and I have worked in a school system with children with quite complex phonological and language disorders and we would see them either individually or in groups about twice a week. Individual therapy outside of the school setting tends to be more limited in a community clinic so the level of input your son is receiving can only help.

I wish you and your son all the best.

Thank you themammy73

Can he hear the different sounds very clearly? Can he easily tell the difference between Gate & Date or Key and Tea? Or is SLT just working on expressive speech?

How much homework do you have? As parent the SLT should be giving you loads of homework to help his speech along (5 minutes/day). So you should see for yourself what his current targets are, and what approach the SLT is taking to get to them. Unless your child is reluctant, perhaps.

If you tell me that you are clueless about his targets & what the SLT is actually doing to reach them, and you haven't been told any strategies at home to help him along, I dare say I may turn apoplectic on your behalf. Get private SLT instead (I would). You so uninvolved makes me feel rather unsurprised that your child is making so little progress, too. Of course you can't do homework if you don't see for yourself how the SLT does the exercises, how they need to be done.

On the NHS, even at school age, you'd have paperwork describing the targets & types of exercises to achieve them. On top of daily SLT homework together. And you'd be encouraged to sit in on his sessions.

I've been pulled off of doing homework with DS because he got a mental hangup about it, but I still know roughly what's going on with his school SLT.

Apologies for hijacking your thread but just wanted to ask themammy73 a question if I could?

DS2 is just 2 (last week!) and has no speech at all really. I totally appreciate it's still really early but he has had a tough road so far (He was born at 32 weeks and has got heart issues as well). He had his tonsils/adenoids taken out at beginning of september-the ENT team were trying to sort out another issue connected to his heart and they seemed to think he had glue ear as had repeated ear infections so thought taking them out might help. He hasn't had a hearing test so far apart from the ones in NICU as ENT said to assume it was glue ear and to see how his speech develops...but it hasn't lol!

He can definitely hear better than he could before he had them out. He will watch a bit of tv now and will listen to stories etc whereas before he never seemed to settle. He understands everything I say to him and can follow quite complex instructions but is getting so so frustrated at not being able to communicate with us which results in him spending most of the day screaming and me crying! I literally spend hours every day talking to him and trying to get him to say words and getting him to copy me but nothing at all.

I have an 7 year old who also had quite delayed speech...he had his tonsils/adenoids out at nearly 3 by same surgeon and within a few weeks he had caught up with most other children. He wasn't at all bothered though about it whereas my little one is.

Is there anything else I can do to help him and is there anything about what I have written that would worry you? HV's don't want to know and have said they won't refer to ST here until over 3 and there is then a 6-8 month waiting list...I can't cope with this for another 18 months.

Thank you lijkkk. Your post has been very helpful. I have made a list of questions for the SALT based on your post.

in the UK speech apraxia is refered to (or similar to) Developmental Verbal Dyspraxia, which is explained quite well in this document: www.dyspraxiafoundation.org.uk/downloads/Developmental_Verbal_Dyspraxia.pdf

One of the characteristics is that traditional methods of speech therapy don't work well on children with Dyspraxia. The method developed by the Nuffield targets specifically children with dyspraxia, and it also benefits children with other disorders. Basically, it is a method to isolate vowel sounds (and consonate sounds as all well I think) and encourage the child to repeat each sounds correctly, over and over again, until the correct sound is pronounced automatically. Then they move on to CV (Consonate-vowel) words and practice over and over, and then CVC words.

It's a method that is not practiced by all speech therapists, but it is the only method proven to work with children with Developmental Verbal Dyspraxia.

There is also oral dyspraxia but I don't know much about it, and I don't know the difference between verbal and oral dyspraxia. Apparently there's a difference. Be prepared for hard work at home if your DS is diagnosed with Developmental Verbal Dyspraxia.

When I wrote 'method developed by the Nuffield targets specifically children with dyspraxia' I meant 'Verbal Dyspraxia'.

iheartttc - in most of the UK (I think) you can actually self-refer to SLT, at least for initial advice/to get on their radar. It could be worth googling your local service's contact details rather than waiting for your HV to agree to refer you.

It sounds like speech apraxia to me. My ds has it. If he does have it they can do things to help him.

ihearttc - sorry to hear you are having a frustrating time of it. Are ENT going to follow up on the hearing test? It might be good to get that done. Many services might not engage in much direct therapy at 2 years of age but see if your HV might put in a referral for you in a few months and then hopefully when he is around 3 he will be seen shortly after.
In terms of your son, there is a good book by Hanen - It Takes Two to Talk which will give you tips and advice on how to encourage speech development but it is quite pricey. This is a lovely website which you might find useful and has lots of information. www.talkingpoint.org.uk/Parent/My%20Child%20Is/2-3-years/How-to-support-your-child.aspx
Hope the referral won't be too far away for you and his frustration eases soon. I have a 2-year old as well and appreciate it's quite a frustrating time anyway!!! Best of luck.

LadyMargoletta, (and ihearttc too) try reading the lovely book BabyTalk by Sally Ward. It seems to be available everywhere in the world, so you might get it at your library, and your speech therapist may have a copy. If not, then a bookshop or Amazon . It describes a programme you can follow yourself at home, it takes half an hour a day.