We had a speech eval at Duke this week, for another opinion regarding apraxia. Or just for another opinion in general on what could be going on with Sweets. We were there for about 2.5 hours and while Sweets was shy at first (understandably), I think that she got comfortable and performed well for the eval.
First off, this SLP does NOT think that Sweets has apraxia. She said that there are too many things that don't fit. She said that maybe as she gets older she may show more signs of apraxia, but right now she doesn't. She also said that Sweets is doing so many good things that she feels really good about her progress, and she thinks that we have a good chance that Sweets will just "catch up" by the time she's 5, with therapy and hard work, of course. So that is very encouraging!
She did a test called REEL-3, which is a different test than what we had last week. On this test, there is a series of yes/no questions. The first number is based on when she gets 5 "Yes" answers in a row, and the second is based on when she gets 5 "No" answers in a row. For some reason, and oddly, Sweets actually scored lower on receptive language than on expressive language on this test. Neither the SLP nor I felt that this accurately describes Sweets, but that's just the way the test came out this time. She said that once she is 2.5, they could do a different test on her that might be more accurate. It seems like everyone uses a different test and it's just whatever test they like - not very "standard" at all.
Receptive Language: Raw Score 45 | Age Equivalent 16 months | Ability Score 78 |
%ile Rank 7%
Expressive Language:Raw Score 48 | Age Equivalent 20 months | Ability Score 85 |
%ile Rank 16%
Language Ability Score = 78
80-89 Below Average
<70 Very Poor
I told the SLP about the recommendations from the EI eval, regarding using the picture boards and focusing on 20 words. She said that she didn't want to say that she disagreed with the other SLP, but that it's definitely not what she would have recommended. (Sounds like she disagrees to me...) She said that she does use picture boards for kids who can't/don't sign, but that since Sweets can sign that she wouldn't have recommended a picture board for her. She also said that she would continue to work on all vocabulary with Sweets. She said continue to sign and say the word together, and encourage her to try to do both as well, instead of just signing. She does this sometimes, but often she just signs. Our usual pattern is that she signs, I ask "Do you want XXX?", she signs again while approximating XXX. So we are to try to get her to do the approximation up front and prompt her with less. So instead of saying the whole word, I can try to shape my lips, or look at her expectantly, to give her the idea that I want her to say it. Gradually over time, of course.
She did demonstrate this technique with Sweets, and Sweets responded to it pretty well. She even got Sweets to say "On" which I have never heard her say before. This is a meaningful new word because it is a VC (vowel consonant) word, and all of her others are CV sounds, particularly CVCV words where C1V1C1V1, ie Mama, Dada, ByeBye, PeePee, NightNight (NiNi).
In the end, I felt a little confused because the two evals differed so much in their assessments and recommendations that it makes it hard to know what to do. It is looking like Sweets does not have apraxia, though we don't know what she does have either yet. Or if she is "just a late bloomer" after all this.