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ch0ban  
#1 Posted : Tuesday, October 15, 2013 6:37:12 AM(UTC)
ch0ban

Rank: Newbie

Joined: 10/15/2013(UTC)
Posts: 3
Bosnia and Herzegovina
Location: tuzla

Dear all,

I sincerely hope I didn't break any rules by starting a new topic, but you guys here are my last resort. I live in Bosnia and speech delay therapists are like diamonds, or even worse.... can't find almost any that get the job done.
My problem is this. I have a 3 year old son, born at full 34 weeks, who was ok at birth, all the neurological tests and all was ok, but had to undergo 2-3 excercises/week because he was not able to hold a toy at 3 months, leaned his head towards one side of the body, (not torticolis), didnt know how to raise himself using his hands while lying on the stomach. The excercises lasted until 8th month of age, untill he began crawling. All the "expert" speech delay therapists here told us it wasnt necessary for him to undergo any excercises untill age 3, but now his "active" vocabulary is zero, meaning he can NAME at least 200 things and activities, but if you ask him anything he either doesnt understand or babbles something... he doesnt even use yes or no or call me or his mother, doesnt even say "give" when asking...and besides he is very jealous, and after my wife gave birth to a baby girl a year ago he just seemed to decline in every way.
Guys, I am SERIOUSYLY afraid that leaving everything at the risk of the abilities of my local speech therapists that have a couple of years of practice will lead me nowhere.... is there ANYwhere any tried out set of excercises that I could do on daily basis to get me anywhere... or are there any paid speech therapists to whom I could pay and explain my situation and ask for their advice?
One think I must add that is odd to all doctors here is that he knows the entire alphabet and numbers, and learned it before he turned 3, almost can read but cant sspeak :S
Thank you in advance

Azur
Bosnia
Sponsor
Mary Lou SLP  
#2 Posted : Tuesday, October 15, 2013 3:31:00 PM(UTC)
Mary Lou SLP

Rank: Advanced Member

Joined: 1/21/2008(UTC)
Posts: 903
Location: Colorado

Was thanked: 3 time(s) in 3 post(s)
Hello Azur,

It is great that you started a new thread with your post. I wish more readers (parents and others) would post and respond to others who post on this great forum.

In terms of whether you could connect with a speech-language pathologist outside of your country, with telepractice emerging, you may be able to set up such a relationship. To learn of any US SLPs who provide telepractice, I suggest you contact the American Speech-Language-Hearing Association (www.asha.org) as a consumer and ask if there are any contacts the organization can provide you. You may succeed with similar organizations in other countries. I hope to set up my own telepractice within the next year, at least to consult with and coach parents.

I appreciated your many details in your description of your son's abilities and difficulties. Would you please elaborate on when your son says those 200 words (the context or situation) and how clearly he says them? Does he try to communicate with you in any way (pull you to things he wants, point, etc.)?

Does your son try to engage you and your wife? Does he make eye contact with you often? Has his hearing been tested by a clinical audiologist (with pure tones in a sound-proof booth)? Have you already or can you have your son evaluated by a developmental pediatrician, clinical psychologist, or other professional who can assess your son's cognitive abilities with non-verbal stimuli (tasks that don't involve understanding or speaking)? Have you thought about autism and ruled it out? Is your son frustrated by his difficulties with communication (or not)? Did the physical therapists you worked with or your son's physician indicate why your son had early physical weakness?

I support your sense of urgency to learn as much as you can as soon as you can since your son is 3 years old.

I hope you will respond. I will certainly try to provide some additional guidance through this forum of things you might want to consider or pursue. I hope others will join in, too.

Best wishes to you and your wife and children,

Mary Lou
Mary Lou B. Johnson, M.S.,CCC-SLP

http://www.HelpYourChildSpeak.com
ch0ban  
#3 Posted : Wednesday, October 16, 2013 1:56:36 AM(UTC)
ch0ban

Rank: Newbie

Joined: 10/15/2013(UTC)
Posts: 3
Bosnia and Herzegovina
Location: tuzla

Dear Mary,

Thank God for people like you who understand the fact that 10 minutes of your time spent for me, giving me advice from your personal knowledge and experience on this matter will in a true sense of the word CHANGE my sons life and the future course of his development, and no matter how far away from me you are right now, be sure that my blessings will come after you ;) for I am more than grateful for your answer.

Anyway, you asked a couple of questions and I will try and answer all of them. Pardon my bad English, haven't used it in a while :)

Originally Posted by: Mary Lou SLP Go to Quoted Post


I appreciated your many details in your description of your son's abilities and difficulties. Would you please elaborate on when your son says those 200 words (the context or situation) and how clearly he says them? Does he try to communicate with you in any way (pull you to things he wants, point, etc.)?




The 200 words I meant goes like this: those 200 objects or actions that are portrayed in pictures or videos he can "name". He doesn't clearly say all of them. For example, the word airplane in bosnian is pronounced like "a-veeown" ... and he says like "a-yona"... and this young speech therapist tested him for sounds of the alphabet. Bosnian alphabet contains 30 letters and she told me he has problems pronouncing 13 of them correctly. There are a couple of letters he doesn't use at all. The letter L he doesnt use using his tounge to touch the upper lip or teeth, doesnt pronounce the letter "V" at all.... I am typing this but am really pessimistic about whether the mere pronouncing of these letters is as important as the other problems he is havng, hence my contacting you on the forum :)

You asked about his way of communicating with us... I think the main problem started with a woman who was babysitting him at the age of 2, and later I found out he watched english-speaking cartoons all day, and the speech therapist told me that other-language cartoons and tv material is "futile" for him. You see, almost a year ago we went to see a therapist to evaluate him, and we didn't know that we were walking in to a autism facility, where the doctor told us "Ok, he is not autistic". Was nice to know but we were kinda afraid when we found out we were testing him for that. Anyway, he started using "mama" "baba" (our name for dad) since he was 9 months old, but everything changed when he first started at kindergarden at I dont remember how old, maybe a year and a half, where one day when I picked him up I couldn't even recognize him!? It is hard to believe but he cried from 7:30, slept for half an hour at 1pm, continued to cry until 4pm when I came. The kindergarden workers didn't seem to bother to call us. His face was.... changed...I don't know the right word for it...made from crying.... anyway, the next big "milestone" was the birth of our baby girl, at his age of 2. This prelude (english speaking cartoons, kindergarden, sister) is because now when he finally started POINTING to what he wants... he just BABBLES some words where you can't understand any of them... he keeps on talking while pointing, talking fast, but nothing is reckognizable.

You asked about his eye contact often. This speech therapist told me that his look in the eyes is kinda "strange"... meaning that he seems stubborn, you sometimes call him once through a whisper and he will look you right in the eyes, and sometimes you have to be persistent in calling his name and telling him to look at you and only after 4-5 times of calling him he will look you in the eyes. I just erased what I previously typed about him not having hearing problems because you said about testing his hearing "with pure tones in a sound-proof booth"... his hearing was ok when he was a couple of months old, but we havent tested him recently, not this way anyway, will do it promptly and let you know about the results.

You asked about "evaluated by a developmental pediatrician, clinical psychologist, or other professional who can assess your son's cognitive abilities with non-verbal stimuli (tasks that don't involve understanding or speaking"... I told you before, hard to believe that in the middle of Europe, we have a whole bunch of GREAT heart surgeons and other doctors where people from all of Europe come to us to have surgeries and medical treatment at the tenth of the other countries price, but while having that we don't have a real speech therapist or a child psychologist, or a developmental pediatrician who stand by what they say.... the best one I found is a guy who is NOT a doctor, but is a defectologist, and has worked as a speech therapist in our hospital for 5 or so years... he looked like he knew what he was doing and for an hour or so with my son he told me that his "non-verbal communication is ok, but his language abilities are not developed as they should be"....

You asked about autism, and I already typed that a specialist in autism ruled it out.

He is VERY frustrated by his difficulties with communication.... it is so sad that I can see in his eyes when he runs towards me, tries to tell me something, IF I don't understand what he says, you can see in his eyes that he is dissappointed and just turns around and goes to play with something. I also have to add that he is tweaking/pinching both us and his kindergarden friends in the last 6 months or so. I strongly believe that is has to do with the birth of his sister and his inability to communicate properly.

The physical therapist we worked with didn't tell us WHY he had his weakness, they told us it had to do with his premature birth, and the excercises really helped.

That is all for now, if I remember something else, will continue typing :)

Thanks again for responding,

Best wishes and God bless you

Azur
Mary Lou SLP  
#4 Posted : Thursday, October 17, 2013 4:37:38 PM(UTC)
Mary Lou SLP

Rank: Advanced Member

Joined: 1/21/2008(UTC)
Posts: 903
Location: Colorado

Was thanked: 3 time(s) in 3 post(s)
Hello Azur,

I am glad you responded with some additional details. I always hope that one parent's questions and observations and the responses I provide may help other parents.

I will respond to your comments with some more questions to get closer to the basic issues and also try to provide you with some information and ideas to try.

First--how many months ago did your son turn 3 years? I want to know if he is a "young 3" or an "old 3".

About the 200 words your son can name--does he say the name of a picture on his own (from his own recall) or is it an imitation of what or someone else has just said? In other words, are these words in his "expressive vocabulary" or is he just copying you? In terms of your further description of your son's word productions, please know there are 2 distinctly different processes occurring--language (the actual word labels for people and things) and articulation (the way he can pronounce the words). It sounds like your SLP has identified that he needs help with 13 of the consonant sounds. That also means that he is producing 17 sounds of your language correctly! Does your son leave off sounds at the beginning or at the end of words, or does he replace (substitute) a sound for another? Ask your SLP to give you more information about your son's articulation ability and whether she thinks it is his greatest area of difficulty or whether she thinks he also has difficulty with language.

Does your son combine any words to form two or three-word utterances like (in English) I want more, more milk, go out, help me, I hold it, and so on?

When you talked about your son's unhappy day of crying his first day at kindergarten (daycare?) did you mean to convey that his face looked different to you because he had been crying so much, or did you think he had been injured at the school? Did you feel he regressed around that time, saying less than he did previously? Did he continue to go there, and, if so, did he get more comfortable there?

I agree that TV time should be very limited.

Does your son talk you to things he wants? Does he come to you with items he wants to show you or that he needs help with? Do you feel he is trying to communicate with you a lot? When he points and says a lot of things that don't make sense to you, do you think he is just jabbering, or do you get a sense that he is saying real words but that you just can't figure out his articulation pattern?

Keep talking with your SLP about your son's eye gaze, attention, focus, etc., since she can observe him directly.

That's good that you are going to get a current hearing test from a clinical audiologist.

That's interesting and amazing that your country has lots of specialists in some medical areas but that you don't feel the developmental specialists are there. Keep looking for alternatives. Did the "defectologist" give you a report that might convey what tests he used to assess your son's non-verbal abilities? If it is accurate that your son's non-verbal cognitive abilities are age appropriate but that it is "just" his speech-language skills that need help, that is very good for you to know. I say "just" because I know that your son's communication difficulties seem huge to you right now. Strong non-verbal skills bode well for a good prognosis (outcome) with treatment and practice. Ask your SLP if she has a feeling for how well she thinks your son will do.

It's good that you ruled out autism. A parent should do that if there is any possibility that autism is the reason for the communication difficulties.

You can't change the fact that your son has a younger sister. I imagine you try to spend as much one-on-one time with him as you can.

Here are my suggestions for you today. I can provide more later.

1. Be sure to keep interactions as positive as possible. Do your best to try to figure out what your son is trying to communicate. Encourage him to show you what he means if you don't know. You "take the blame" for not understanding him. Tell him that you can see he really wants to tell you something but you are sorry that your "ears" don't understand right now. As he gets older, if he is still so unclear, ask him to "use different words" to try to tell you.

2. Listen to yourself and others talking with him. Is everyone asking him a lot of questions? If so, I strongly suggest that questioning be minimized and that people make matter-of-fact comments about what he is doing, what they are doing, etc. I provide a tremendous amount of information about how to make statements in my eBook. It is important to know where you are starting in terms of the quantity of question-asking. It is very common for parents and others to ask young children who are not talking well A LOT of questions. I explain why the questions are not helpful.

3. Consider making a list of 10-20 single words that would make life easier for your son and for everyone else if he could say those words more clearly. These are words that would be useful or functional for him to say. If you want to do this, make the list, and then show his current pronunciation, just as you did with the airplane (avion) word. I will then tell you how to set up a practice book that you and he could practice daily together. Of course, I wouldn't want to interfere with your SLPs plan, so, if you decide you want to try this method, I would want you to share my information about it with your SLP before starting to make it or use it.

I hope you will write again.

Sincerely,

Mary Lou
Mary Lou B. Johnson, M.S.,CCC-SLP

http://www.HelpYourChildSpeak.com
Jennifer  
#5 Posted : Sunday, October 20, 2013 5:16:07 PM(UTC)
Jennifer

Rank: Administration

Joined: 1/25/2001(UTC)
Posts: 64

Thanks: 1 times
I think Marylou is providing excellent advice. I just wanted to add some additional simple strategies to consider:
Interact with him on his physical level- that means get down and try to be face to face, so that he can see your mouth move and your facial expressions. Use gestures and facial expressions when interacting with him.

Provide a rich language environment for him by continuing to model language for him through out the day. Talk about things you are doing, that you see, have done or will do during the day (as Mary Lou suggests, this is "commenting" rather than questioning).

Make sure you have his attention and he is attending visually to what you are talking about.

Limit background noises that might be distracting, such as the tv or radio.

Try to keep interactions going back and forth, whether it is just play with a toy, sound play, or word imitation. It should go something like this:
He pushes a toy car... you push it back to him. He pushes back again, and you back to him again...
OR He vocalizes a sound or word, and you imitate ( English example sorry) ie. he says "oo" when playing with toy car, you respond with "vr oo m " and push car. WAIT for him to imitate or repeat. He pushes car, says "oom", you push back saying "vroom, car". He says "ka", you reply "car".... You will be turn taking! This will be teaching him the act of communication (back and forth between people with intent), and modeling appropriate words for him. Remember to keep language at his level.
ch0ban  
#6 Posted : Monday, April 7, 2014 4:18:08 PM(UTC)
ch0ban

Rank: Newbie

Joined: 10/15/2013(UTC)
Posts: 3
Bosnia and Herzegovina
Location: tuzla

Hello there! :) sorry mary and jenifer for not answering your posts, even though I am the one that needs this communication most. As in all of us, so many things happened to me in the past 5 months that it looks like 5 years. My little daughter had so many bronchitis problems that once the ambulance had to drive her to the hospital. Besides that, my wife is still recovering from a tick bite in her knee. The doctors thought it was Lyme disease / boreliosis... for what I see it is almost common in the US.
Anyway... this forum helps me make a time frame for when my son started going to the speech therapist. I have to admit a lot has changed in 5 months. So the routine is like this, 3 times / week he goes to 1 hour speech therapist practices, 1h week child psychologist, and 1h / week he works with a defectologist.
The child psychologist works with his "behaviour" as I can see from what I see, and the young woman that works with him is really reliable and whatever problem we had in his behaviour she helped us and it worked.
The "defectologist" works with his motor skills, as they say he is the least skilled in fine motor skills, as well as he is kind of lazy when speaking of normal "self-chors" (tying shoes, undressing, etc.)
The speach therapist works mostly on his problems with pronounciating letters. He sits in front of a mirror with headphones on, attached to some high tech gizmo they got as a donation from one of the local companies, I can see the exact model and tell you if it is of any importance.
Anyway, I have to say that the speech therapist is a woman that really and truly has come to love my son as if he was her own and she puts the most effort possible to help him. These 5 months have been a tremendous progress but he is still way behind his age friends, so I wanted to tell you about his present status, if I may call it that way.
Mary, you asked about his non verbal cognitive abilities. I have to tell you that each and every doctor I have taken him to has said that they have never seen such an interesting case as in my kid. The SLP first started with the pronouciating problems, then figured out that it is more imperative to make him speak more, because as I have told you then, his active speaking skills were almost equal to zero. She then started showing him cards and asking him to tell her what he can see. Only a couple of weeks after starting those excercises, she once told me she showed him a card and he told her "brother and sister are bathing in the water"... mind this... A FULL SENTENCE!!!...it was a shock :) a pleasant one :D his visual skills are above normal,he is a great detail-lover, will notice something that takes you a dozen of seconds to figure out where he saw what he is saying.... as it is very difficult for me to describe something I know little about, I am just about to type all the different situations and "speech abilities" he has now, that he didnt have 5 months ago, so I hope you could send me sub-questions
5 months ago he knew only how to name objects. Now he makes short sentences like "give omar toy"
one of the problems my slp warns me is that he is constantly speaking about himself in the third person
if you ask him either where he wants to go, or what he wants to have or whatever, he now points and only says "that" to all the situations I presented
One of the things my SLP warns me also that he is way behind on is his orientation in space, meaning what is above, what is besides, what is straight, left, right etc
My biggest concern was and still is that there is still a whole bunch of stuff that he answers as if he learn by hard what the answer is. For example my mother asks him where do you live, he says the city, what street, he says the street, what number and then he says the number, but when I ask him how old is he, he says "one". The problem is that he used to say "three" a whole bunch of times, but when I told him that his sister is one and not him, he got confused. This situation is what describes him most. As I can see, he seems to be (I hope I wont sound funny now) having something like "too much pride". Its almost like he is afraid to make a mistake and like he is having pain with each situation of me not understanding what he wants to say, and after such situations he backs down.
He has a smile on his face 100% of the day, but contrary to that now we have a whooooole different problem, and Mary and Jeninifer I will be refreshing this forum post in the next days every hour waiting for your advice on the mater :) because we are trying everything, with little success. The problem at hand is now his hyperactivity. There is one kid in the kindergarted, and ONLY ONE KID, that he is pinching in the cheeks each and every day. that is only the beginning of the problem. As I have seen, in these 5 months he used numerous different "tools" to attract attention. For a month he used to pee himself, just out of nowhere. After that he started repeating certain words over and over again. Now it's screaming. He screams from the bottom of his throat. We got an advice from one of the doctors just to ignore all that. We did it and it worked. But the problem is that he is now constantly running, constantly agressive towards his sister and she is most of the times entirely red in her face out of all his pinching and pushing around. The saddest thing is that she got used to it. But when speaking of his hyperactivity, I honestly doubt you have seen a lot of children that have this kind and this much energy as he does. He is now 3 and a half years old, has 23kilos, strong as a bull:) and imagine him going now to a gym class for kids (something our SLP advised us to start him going because she said all his motor skills are as important to his speach as everything, considering he is too lazy), most of the kids cant stand the entire practice, and this guy continues to run all day long, and gets to sleep at 23h. The kindergarden teachers told me that in the past couple of days he is just "too active". First I worried that we give him the wrong kinds of foods, but if you start googling, it's a bottomless pit, so I beg you if you can tell me your advice out of your personal experience WHAT is the line of aproach to this problem, where to start, do I really have to find activities that go for so long just to tyre him. One of the gym trainers told my wife that my son is the best at the end of the training when he gets a little more tired than in the beginning so he listens to the trainers orders more.
One other very important thing I have to tell is his lack of attention. He does make eye contact IF you tell him "listen here, look into my eyes and listen what I am saying" but other than that its zero attention. But once I was very astonished when I got into a classroom where he was working on putting some punched little rings/balls through a small thread with this defectologist. It was so quiet and he was so concentrated that he didnt even mind I got there to pick him up. That kind of tells me there MUST be a way to calm him down and work with him, it's just that I MYSELF dont have the right "tools".
Well, that's about it for now, 23:13 here, got to hit the road at 5am so I bid you good night or good day :)
Thank you all in advance for answering to my posts. I have a friend that has a child who was 10 times more hyperactive than my kid, all the doctors refused to even try and help him. His father was persistent to try and find help, got his blood analyses and everything else, scanned them and sent it to some US doctors who then told him that his son has some rare kind of allergies or whatever to milk and other related products, and has some bacteria in the brain that only affects the part that involves speech. Started taking medications, diet, and thank God the kid is now ready for school. So, I am grateful for the opportunity to be sitting in my kitchen and writing my problems and having help from you people from the opposite part of the planet :) Thank you once again, God bless you all
Mary Lou SLP  
#7 Posted : Friday, April 18, 2014 5:20:18 PM(UTC)
Mary Lou SLP

Rank: Advanced Member

Joined: 1/21/2008(UTC)
Posts: 903
Location: Colorado

Was thanked: 3 time(s) in 3 post(s)
Hello Azur,

I regret my delay in responding. I hope my thoughts will be helpful

It sounds like your son is overly active and now is hurting a child at school and his sister at home (pinching, etc.) He is receiving therapies from 3 different providers each week and he gets activity in a gym.

Were you able to try the suggestions I made before? (reduce the number of questions you and other people ask him, increase the number of informative statements, make a practice book of basic words he needs to learn to say more correctly)

Of course, I cannot provide any specific insights about your son, since I have not observed him directly. But, from your notes, I offer these general suggestions to you and to other parents whose children show some similar behaviors:

1. Work on getting him into bed sooner than 23h (11 pm US). He could very well be sleep-deprived, which affects his behavior during the day. At this point, he has established a habit of having difficulty settling down at night. I suggest you work with one of your providers on a calming period of preparation for going to bed (for example a warm bath without rambunctious play, a quiet story time, no "screen time"--no TV, no iPad, no computer, etc. for several hours before bedtime, no running around or rough/active play, quiet time with you or his mother with one or two books, massage or whatever is calming. Set up a reward chart for going to bed when you say it is time. Move the time back 1 hour each week (22h 1 week, then 21 h the next week, etc. until you get to 19 h (7:00 pm). He gets a sticker the next morning for going to bed when you say and also for not getting out of bed all night. Pre-select the rewards so he knows what he is working toward.

2. Address his hurting other children. Be direct that it is not okay at all. You can talk about keeping a "personal bubble" (reach your arms forward and clasp your hands together to make a circle--have him do the same and show him that your 2 bubbles may not touch) This applies to standing in line, sitting next to someone, going over to someone. There need to be clear and immediate consequences for touching another child directly with the intent to hurt them. (Time out, loss of a privilege, a mark off on a chart.) Regarding the last suggestion, I like children to receive a lot of positive reinforcement. I talk about "expected" and "unexpected" behaviors. I make sure to notice every little positive thing a child does and mention it out loud while making a tally mark on a chart. I give only 1 warning about an unexpected behavior, so I am sure he knows what is not appropriate. If it happens again, there is a mark off on the chart, with verbal feedback. Set up the chart so he is likely to succeed the first time. I hope you have someone there who can help you set this up. I am struggling to convey all of the small details here in writing.

3. Keep working on his language skills--what he understands and what he can express. Give him choices, especially if he has difficulty expressing what he wants. Hearing the choices will give him language models.

4. Everyone needs to keep observing his abilities and difficulties closely. Over time, it should become clear whether your son has primarily a specific language impairment or whether there is some other cognitive issue that is affecting his behavior.

5. Keep thinking about whether reactions to food could play a role. If so, you will need to eliminate all foods that are known to cause problems for some people and then gradually add each one back for a few days to check for reactions. Again, I recommend local guidance from a professional to do this effectively.

Best wishes to you and your son!

Sincerely,

Mary Lou

Mary Lou B. Johnson, M.S.,CCC-SLP

http://www.HelpYourChildSpeak.com
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