Speech Evaluation

Annabelle had her speech evaluation today with Mrs. Crystal at the North Druid Hills outpatient center of Children's Healthcare of Atlanta. Mrs. Crystal diagnosed Annabelle with a mild articulation delay, and she is recommending speech therapy for an hour a week until Annabelle is able to master the sounds she is using incorrectly that should be mastered by age 3 (n) and by age 4 (ng and y). Annabelle also has problems with l, ch, sh, j, r, z, s, v, and th, but these sounds are not expected to be mastered until a child is 6 (for the l) and 7 (for the remaining sounds).

I guess at this point I am past the denial stage as the diagnosis came as more of a relief (i.e. Thank goodness she actually is recommending speech therapy so that I'll have some assistance to help Annabelle correct these errors) versus an insult (i.e. My child needing speech therapy? How can that be?).

As Annabelle's primary caregiver, I have completely blamed myself for her speech delay, and I'll probably never feel differently no matter what anyone tells me. I honestly feel that if I didn't talk so fast that Annabelle would speak more clearly herself. I think she has a hard time understanding me (which is definitely warranted), so I think she is only speaking what she hears.
I cannot even begin to explain the embarrassment and frustration I have felt as a result of her speech delay. Up until probably March of this year, I have had to reiterate almost everything that Annabelle would say to anyone. I can only imagine how frustrating it must have been for her as well. If I am recalling correctly, it wasn't until December 2009 that she finally mastered saying her own name. She used to refer to herself as "Dannabelle." This is a word that she has heard every day of her life, but she couldn't even say that correctly. That was heart wrenching to say the least. Oddly enough, she has a friend named Annalee, and she's been able to say Annalee correctly since they became friends in March 2009, but she continued to struggle saying her own name.

And my frustration would escalate even more when anyone besides hubby or me would try to help her sound out words. It was as if they were saying, "Hey mom, if you sound things out, she'll learn to speak correctly. Don't you realize that mom? Let me show you how to teach your child to speak correctly." Actually, that still irritates me as that is my job as her mom and teacher.

And, one could probably see steam coming out of my ears when other people would repeat the words back to her just as she said them because they thought she sounded cute with her mispronunciations. I was working hard to help her sound them out correctly, and then someone would say the word incorrectly. Oddly enough, she would often respond with, "No. I said blah, blah, blah." She did this because she knew they were saying it wrong even though she didn't seem to realize that she was saying it wrong herself. This happened more out in public with random people that we had never met before. I know people mean well, but when a child already is struggling with speech, there is no need to point it out even more to the child and the mom.

But, overall, I think we tend to blame ourselves for anything our child is possibly behind on. Because we should have done this or that differently. Oddly enough, several of my friends have children receiving speech therapy, and the thought has never crossed my mind that they did anything wrong as they are wonderful and very attentive moms. So, why should I blame myself? Human nature, I guess. Or maybe because I can truly notice a difference in Annabelle's speech when I, myself, slow down with my talking.

So, I'll get off my soapbox and on with more detail of the speech therapy.

Mrs. Crystal first asked if we had any specific concerns regarding Annabelle's speech. I had been listing out words that Annabelle says incorrectly, so I identified those for Mrs. Crystal. These are the words I identified with Annabelle's mispronunciation of the word.

crunch = cunch

blue = boo

play = pay

Christmas = kissmas

Kroger = koger

them = em

driving = diving

school = duel

three = free

stool = duel

squirrel = turl

Mrs. Crystal then mentioned that these specific sounds are called "blends," and they often aren't mastered until ages 6 or 7.

Then, Mrs. Crystal started by asking Annabelle to sound out several different sounds including "puh" for P, "tuh" for T, and "cuh" for C. Annabelle seemed to do fine with these.

Then Mrs. Crystal did some tongue exercises with Annabelle. She would stick her tongue out and ask Annabelle to do the same. She also moved her tongue all around in her mouth (from one cheek to the other, from the top of the mouth to the bottom of the mouth), and she asked Annabelle to do the same. Annabelle got tired of this exercise very quickly. "I can't do it," she would say. She was clearly frustrated.

Mrs. Crystal asked Annabelle to say "buttercup." Annabelle repeated her. Then Mrs. Crystal asked Annabelle to say "buttercup" over and over again 10 times. Annabelle told her, "I don't want to until I get home." I asked if she'd do it for Mommy, and she finally agreed and looked at me and repeated "buttercup" over and over.

The last portion of Mrs. Crystal's evaluation included the "Goldman Fristoe 2 - Test of Articulation." She showed Annabelle pictures and asked Annabelle to tell her what she saw on the picture. Mrs. Crystal was specifically focusing on certain words to identify any articulation issues. It was quite interesting because some of the words she wanted her to say were words I knew that Annabelle struggles with on a daily basis. Following are some examples:

banana = bana

yellow = jello

plane = pane

blue = bwu

flowers = fowers

frog = fog

slide = swide

stars = jars

For stars, I thought Annabelle always said "tars," but according to the test results according to Mrs. Crystal, Annabelle is saying "jars."

Mrs. Crystal listened to Annabelle's articulation of 53 different words. They focus on the initial, medial and final sounds in each word. She made me a copy of the test results which report the spelling of the word, the correct sound of the word and for any that Annabelle mispronounced, she crossed out the correct sound and wrote down the sound that Annabelle actually uses.

After she finished testing Annabelle, she took her to select a few toys to play with while she left to "score" the test. Besides Annabelle's hearing tests (at birth and yesterday) and seeing tests (at 3 years of age), this was one of Annabelle's first "tests." And, it was her first test that had to be "scored." She scored slightly below average. That is tough for any perfectionist to handle! I will have to teach her how to shoot for the stars and make straight A's one day and graduate summa cum laude. Because that is really important stuff!


Dear Annabelle,

If you are reading this one day when you are older and in high school or college, I hope you know that I never expect you to make straight A's. In all honesty, I hope you'll live a little and not take life so seriously. It is alright if you don't make a 100% on everything! If you continue to apply yourself and live your life with the highest integrity, you'll still get that high-paying job you think you want. Straight A's is not a requirement! But, life is too short, so live a little! But, please, please, please, stay away from the drugs, alcohol and boys, most definitely the boys!

Love,

Mommy


Anyhow, Annabelle received a standard score of 82. According to Mrs. Crystal, they want them to fall within a range of 85-115 at her age. She scored in the 16th percentile. Mother, do I need to explain the percentile thing to you again? And, her test-age equivalent was 2.3 years. Again, heart wrenching!

I meant to ask Mrs. Crystal what the 2.3 year test-age equivalent meant. She did say to call if I had any questions, so perhaps I'll call. But, I have theorized that this is based on articulation alone since the "Sounds-in-Words Score Summary" detailing this information was within the "Goldman Fristoe 2 Test of Articulation." Mrs. Crystal asked other questions when we began regarding Annabelle's listening skills, etc., so I don't think she was testing for any other issues besides articulation. I personally have a hard time believing she's behind regarding her knowledge and intelligence. Instead, I think she falls into the 16th percentile for articulation because she is being compared with other children her age who have already mastered the 6 and 7 year sounds at an earlier age, so that brings her average down because it counts as an articulation error.

They cannot focus on everything, right? She just learned to throw a Frisbee a few weeks ago at her age. Doesn't that count for something?

According to Mrs. Crystal, Annabelle has problems with intentional tongue movements and that we need to focus on strengthening her tongue. She was not able to put her tongue all the way to the side of her cheek, and according to Mrs. Crystal, this is often a sign of articulation issues. Of course, maybe I'm missing something, but I asked Annabelle to put her tongue to her cheeks at home, and she didn't seem to have a problem then.

Mrs. Crystal recommended that we focus on increasing her awareness of her tongue movement by encouraging her to lick an ice cream or put peanut butter or milk at the corner of her lips and encourage her to lick it off. She also said it is a good exercise to have her move a Cheerio from one cheek to the other cheek. Or we can encourage her to clear out food from her cheek with her tongue.

These are all exercises she recommends between now and when speech therapy will begin. And, now that it has been determined that Annabelle needs a little speech therapy, we may have to wait 5-6 months before we can even start speech therapy! Of course, Mrs. Crystal is going to check with other Children's Healthcare of Atlanta locations to see if they have a shorter wait period. I told her I didn't mind driving to the Medical Office Building of Scottish Rite or the Duluth location.

It is definitely in our best interest to get Annabelle in as soon as possible because our current insurance plan will cover 30 visits. But, the deductible must be met first! We've already met the deductible with Sophia's birth, so this year is our best year to pack in any and all necessary medical expenses.

In a nutshell, Annabelle may break the piggy bank before she's even 5 years old!

P.S. I did ask Mrs. Crystal if there was anything I have done wrong or could have done differently (so I don't make the same mistake with the next one). She told me, "No, some kids just don't pick up on some sounds because they do what is easy." Of course, I felt her eyes said something different, but maybe I was reading into it too much. But I replied, "And I've responded and answered her when she's said the word incorrectly." She just nodded.