What Makes a Good SLP?

I'm not sure how many regular readers actually have speech concerns since I don't post about speech-related items too often now.  However, I still wanted to share this as a reference for myself and others.

We've had three SLP's in our home through Early Intervention programs .  Each experience was unique, and I know I have learned a lot.  (We had two additional therapists after M turned 3, but I am focusing on the therapists I interacted with regularly since the after three experiences were outside of my home.  One of those experiences was especially awful...)

The first speech therapist we had was temporary since we were moving out of state within a couple of months.  I was never impressed with him, but didn't know if my concerns were valid.  In his defense he was working with a young child, about 18 months. M, at the point, had one word MMM for more.  She did not have the diagnosis of apraxia yet.  But he still didn't do much with her.  It seemed his goal was to interact with her by making her laugh and sign "more."  She was already doing these things, and he didn't really encourage much else (by my memory).  I remember asking him how long he had been an SLP, and was surprised that it was close to 20 years, because, really, he just didn't seem to be experienced.

From the very first telephone conversation with M's second therapist (after our move), I was impressed.  She asked a lot of questions and seemed to look forward to meeting my little girl, so that left a positive impression.  From the very first session in our home, she was in control, leading purposeful play while highly sensitive to M's reactions and desires.  She was firm.  Just because M didn't want to do a certain activity, didn't mean M didn't need to do it.  Even a nonverbal child can be expected to make sounds.  This effective therapist motivated M to complete the activity.  She used familiar and new (or not often used) activities during each session.  This helped M be comfortable, yet excited for what was to come.  She asked questions about M's speech even though there was no or minimal progress for months and months.  She remembered what I said and documented it in her daily notes.  Based on the session and M's development, she would assign homework for us to complete with M.  Much of the homework was something we could implement easily into daily routines, too.  Despite the lack of speech for months, she still created purposeful homework for us.  (And when we had a newborn she wasn't phased when we didn't do much!)  When this therapist was stumped over M's lack of progress after months of therapy, she sought out more information.  She didn't wait for the apraxia diagnosis to change how she worked with M.  (Please note: the goals in M's plan did not need to change to reflect the changes in how she implemented therapy because she was still working toward those goals.)

M, age 2, and Ashley, our special SLP

All of the above actions by the speech therapist were important to me and M's success, but to me the way this therapist never stopped talking/singing the entire session was amazing.  Her high energy was important to keep my daughter interested.  (She kept ME interested, too!)  Her energy, interest in M, and the homework she assigned helped me to better understand the speech problems we were dealing with.  This woman was in our home twice a week for over a year.  Her energy probably made the biggest impact on M, as a child, and on me, as the mom who was trying to learn from her.

She became like family-a true friend.  Though I know that parents are really, typically, the only advocate for a child, this woman truly cared for M and her success.  Though at age 3 she stopped working with M (not our choice), professionally, she has not stopped being part of our lives.  This therapist will always get much credit for M's success, though M's speech didn't really blossom until after age 3.  (And yes, I believe she and I both cried when we said good-bye at our last therapy session...but we're still in touch.)

One last thought...don't let experience determine whether or not an SLP will be effective.  This highly effective speech therapist had only been working for a few years.

We had learned much from M's second therapist.  It may have been hard to teach us new and effective ways to help our son's speech, especially since he was only a bit behind.  My son's speech therapist may have been a good therapist, but I didn't feel that the sessions were effective.  He was not engaged much of the time.  She didn't talk or sing as much as I expected, but tried to play with him and tried to incorporate words, phrases, and sentences.  I didn't learn a lot from the sessions (but I had already learned much from M's former therapist).  The homework that was assigned was often things we were already doing to encourage his speech, though she did create some new tasks for us, too.  Despite all of this, I'm still glad we had E in therapy.  She helped us to remember that M's speech problems and E's were very different and needed to be treated differently.

Our days with Early Intervention (the birth to age three program) are over, but I had been thinking about SLPs, and how fortunate we were to have our special SLP.

I've written before about some of the techniques we learned to encourage and increase speech and vocabulary and about M's remarkable speech history.  Feel free to ask questions by leaving a comment or emailing me at derekannette [at] gmail [dot] com.

End of School and Coordinating Cards

My daughter just had her last day of preschool in her speech and language classroom.  This is a huge praise because it means that her speech has come so far.  She no longer needs such intensive services.  (You can read our big speech update here.) On September 1st she will begin school at a local regular school.  (Can I tell you how I fear that she will learn lots of bad things to say?)

M had a teacher, two aides, and an SLP at school.  I wanted to say thank you to each of them.  Should I tell you my plan for gifts so you can laugh at me?  My intention was to make them each a card, a wonder wallet, and a small gift card to go in each wallet.  I also wanted to make them my chocolate chip cookie pie to share.  (I chose to go with one pie to share since some people are hesitant to eat something from a child's home.  Not all, but some.)

The reality is that my husband was out of town last week, and my daughter was pretty sick (with an ear infection, strep throat, and cold).  We had two different doctor's appointments and a chest x-ray.  She missed three mornings of school, but thankfully did make it to school on her last day!  (Somehow my son stayed healthy.)

Based on my very limited time, I only made the teachers thank you cards and gave them gift cards.  So much for sewing and baking.  Speaking from my teaching career, the personal note is the most important part, anyway, and I made sure I completed that!

Recently I have figured out that card making takes a lot of time, but it's much more effective if I try to do more than one at a time or at least cut lots of things out at once.  I made four coordinating thank you cards.  The photo may not be great, but the cardstock background is cream with green and lavender details.  

Someday I am going to make cards in advance, but for now I just try to cut out extra shapes and even words from the Cricut.  I just love handmade cards, and try to make them for a lot of our card needs.

If You Have a Speech Concern...

This video could have been us.  Instead I listened to my gut instead of experienced moms...and I do not regret it one bit.  The bottom line is if you have a concern with your child's speech, it cannot hurt to have an evaluation!

(The Teri referred to in the video is the SLP who wrote The Big Book of Exclamations...an excellent book for children who are late talkers!  You can see my review here.)

ABC Speech Picture Book

About a year and a half ago, it became very clear to us that our daughter, then 2, was more than just a late talker.  At 27 months she was diagnosed with a speech disorder, apraxia.  (You can read our apraxia story by clicking the link.  We praise God for her leaps and bounds developmentally!)  

Knowing M would not outgrow this, but she could overcome it definitely motivated me to do what I could with her.  My husband and I learned a lot from M's speech therapist, but I also made sure that we played purposefully as much as possible.  M loved to complete crafts with me, and the ABC Speech Book is just one of the projects we had fun doing together.  

First, I cut all the letters of the alphabet as large as possible, of the alphabet.  (I just eyeballed the letters as I cut them.)

Please read the newly updated directions and suggestions for the ABC Speech Book at my new blog.

Amazing...Speech Update (and Speech History)

This is a bit emotional...filled with gratitude and amazement at what God has done.  I shared this on our family blog, but want to share it with my friends here, too.

In February of 2009 (at age 27 months) M was diagnosed (not just suspected) with verbal dyspraxia (also know as apraxia).  You can read my original post here, if you like.  Her therapist suspected apraxia, and after reading about it (which was incredibly hard) and clearly seeing the signs for myself, I scheduled a formal evaluation through AI DuPont Children's Hospital.  So it was over a year ago that she was diagnosed with it.

Read the fully updated story of how my daughter overcame verbal apraxia.

Who Has Speech Issues?

I'm curious about my readers.  Who of you experience speech delays or disorders with your children?  Would you leave me a comment below or email me at derekannette (at) gmail (dot) com?

If you want to, you could also tell me about some of your favorite resources.  Thanks!

Encouraging Simple Speech Through Books

ANY book can encourage speech, and highly repetitive ones are great for filling in the blanks.  (Brown bear, brown ____, what do you ___?  I see a red bird looking at ___.)   We also use books to label objects and characters.  Colors and shapes.  Counting and rhyming.  Books have been a great help in helping M learn to talk, but not all children respond to books the same way.  Though our daughter has always enjoyed books, she did not respond to them with sounds (the way I spoke of above) until quite recently...the last six months or so.

We have a few books that M returns to over and over again that encourage speech...simple words and phrases that are enticing to her as a 3 year old with a speech disorder.  These books are great books, but especially good for anyone who wants to increase sounds and words from a child.

Zip!  Pop!  Hop! ($1.29 at Amazon!) actually talks about fun words.  It begins, "Elmo likes fun words.  Would you like to say some fun words with Elmo?  Say zipper.  Now stretch it out: z-z-z-z-ZIPPER.  Words with z's make your mouth feel fizzy."    M really likes this book, and did long before she could say any of the words (other than pop).  It's fun and cute.  Most importantly, it encourages speech.

Richard Scarry's Splish-Splash Sounds  is a great book.  It goes around Busytown and you see all sorts of labeled illustrations with their sounds.  You see things like "bang," "owww-ee," "ring," and tons more.  M really likes this book!  She labels the objects in the pictures and tells me the sounds.

Oink, Moo, How Do You Do? is a rhyming book of animal sounds.  It's quite cute.  It taught M the word "shoo!" when the farmer says, "Scat, shoo!  Away with you!"

You might remember quite some time ago when I was all excited to learn about the Speak With Me books.  (Click to see more of what I said and where to find them.)  These were the first books that I was aware of that were designed for speech development

We also the book Grandma Rabbitty's Visit that had a lot of fun words for M to say in it.  (Click the link to read my review.)

I have another book to share with you called The Big Book of Exclamations; it is a truly unique book, and it deserves its own post.  It is designed and written by a speech pathologist and is specifically designed to promote speech development and the imitation of sounds, gestures, and words!  I will share about this book soon.  We just got it, and I already think it's a great resource for young children or those who have a speech delay/disorder.

Granola and Flax Seed

I have heard a lot of the benefits of Omega 3 fatty acids for health...for everyone.  My interest was first perked when I read a lot about it related to M's speech disorder, apraxia.

Flax seed is one of those strange health foods that I have only recently learned about, and it is high in the Omega 3 fatty acids.  At the local Amish store, I saw it (ground), and figured I should try it.  I brought it home and had no idea what to do with it.

At first I just put the flax seed in my (and M's) oatmeal.  Some had suggested putting it in yogurt, but that just doesn't appeal to me.  Then I saw a recipe for granola that called for flax seed.  That recipe was not appealing to me, but I searched for others...and found one that is customizable.  Yea!!!  It has a base recipe and then you can choose what to add to it!

I made this recipe twice, but changed it up some.  I definitely recommend using rolled oats, as the recipe calls for it!  (I didn't the first time.)  I thought I'd try honey instead of maple syrup, but don't recommend that either!  However, I do recommend trying this!

You may think I'm weird, but I don't mix the granola in anything.  I just eat it from the bowl with a spoon.  This was fun to make with M...and good to eat, too!  

Speech and School Update

M started school five weeks ago. She goes four days a week and loves it! She doesn't talk a lot about it, but she will answer questions. She can always tell me what she had for snack! Her favorite activity seems to be the jungle gym. She seems to like her teachers and speech therapist (and calls them by name). Though it is a speech and language classroom, I can't say that I have seen huge improvements in her speech. By this I mean that her articulation has not noticeably improved and she doesn't seem to be stringing longer sentences together. However, her vocabulary has been expanding. She also seems to talk throughout the day more. M has improved her alphabet, and she counts better, too. She counts past ten now (correctly, for the most part). Other than when we were counting steps, I never counted past ten with her. Oops. She also likes to try to remember the letters in her name, too. M rides the bus daily. This past Thursday I picked her up from school since I was in the area, as I am every Thursday. She wanted to ride the bus! She cried for about ten minutes, but at least she didn't throw a tantrum. Her bus ride is long, about 45-50 minutes. The classroom is about 25 minutes from our home, so it's not a surprise. Personally, I look forward to spending some time in the classroom. I want to see how it operates and how speech is incorporated into everything. When we visited before, we were quite the interruption, and I was not impressed with the speech incorporation. However, as a former teacher, I fully understand that what happens on a regular basis may not happen when a visitor comes. We will be changing the goals on her IEP to better meet M's needs. Basically, she can already meet the goals, so she isn't being pushed to do more. The SLP has to work on the goals, not go past them. The SLP and I have already spoken about changing goals. I am hoping to get paperwork this week. In case you are new to the blog, M has a speech disorder called apraxia. It is not outgrown, but is overcome. M is doing a fabulous job of overcoming it! She is still hard to understand, but she is doing wonderfully. If you are interested, you can read about M's situation.

The Final Countdown

My Oops: On Thursdays after M begins preschool, I will pick her up after Bible study (instead of the bus/van that will usually transport her). I wanted to see how long it would take for me to get from my Bible study to the school, so on Thursday, on the way home from Bible study I drove to the school. M has been asking to go to school, so I did not intend to disappoint her by showing her the school again without getting to go to it. I was shocked when M announced, "School!" Oops, I guess the building is a bit distinct. Thankfully she accepted that we were only saying "hi" and "bye" to the school and not playing. (If you want to read more about our classroom experience, go here.) The IEP: Thursday we also had our Individualized Education Plan (IEP) meeting. It was pretty straightforward. It included the results from M's evaluation report (which we had already received), goals/objectives, how the goals would be measured, and recommendations for services. They had recommended the speech and language classroom four mornings per week (as we expected). In addition, she will get speech therapy there. They had recommended one 30 minute group session and one individual session per week. We requested a third session (group), and Friday we learned that will happen. That makes me happy! M and her teacher will also have on occupational therapy consultation monthly, but no real therapy for M. The Question: We still don't know how M will get to school. The local school district provides transportation, and we are accepting it. However, I would like to prepare M. She thinks she is riding a bus, and will be horribly disappointed if it's just a van. I also think it will be easy for her to hop on a bus and say goodbye, knowing that she is going to school. A van (though she has never ridden in one) would not feel "special" to her. I was told that we should know by Wednesday. Ugh. That will be a long wait. Days Until M's Birthday: 8 Days Until Preschool: 9 Days Until E's Birthday: 15 So right before M's first day of preschool we'll have overnight company and a family birthday part. Then before her second week of preschool we'll have different overnight company and another family birthday party! WOW! I know some would think my life is rather dull, but we always seem to have something happening! We'd appreciate your prayers during this time. Nine (not including today)

A Tour

Today Derek and I took M to tour the preschool she will be attending a month from now.  It's a speech and language classroom. 

The building is new.  An entire wing is devoted to the intermediate unit's preschool programs.  Several preschool classrooms and therapy rooms are in this wing.

Oh.  The name of the building is the X County Technical College High School.  How funny is that??

M enjoyed the play area and participated a bit in a craft.  She really enjoyed the outside recess time on the playground.  At the present time there are 8 children in the classroom.  (Eleven is the maximum number allowed.)

This is the play area.  M enjoyed the play food. 

When it was time to leave, M cried.  She was the only one to cry while we were visiting...I think it had to do with sharing...and leaving.  Oh well. 

Just wanted to share a bit of what's happening with us. 

Changes...BIG

In about five weeks we will be making some BIG changes. 

M had her speech evaluation that will determine what type of services she will get once she turns three.  The SLP evaluating her did not even complete the articulation part of the eval since she had already heard enough of M's speech to know that it would be difficult for her and it was not needed to make a recommendation of...PRESCHOOL!

After her third birthday, M will begin attending a speech and language classroom in the county's developmental preschool.  All preschools are (supposed to be) language rich, but in this classroom, M will be required to use words more than in a typical preschool.  She will get speech therapy (hopefully individual and group) right there, and the teachers are experienced in helping children find their voices.  It will be four mornings a week, and is about 35 minutes from our home (though I don't know the specifics).

I don't consider this to be official, but it won't be official until very close to the start of preschool when the IEP (Individualized Education Plan) is written.  The SLP determined that preschool would be beneficial since she would need more than two half hour sessions of therapy per week to continue making good progress. 

This is what we hoped for, but this is still so hard to grasp!  We have many questions and really, it's just hard to imagine mornings with M away. 

I don't quite understand the emotions I am feeling, but it's pretty bittersweet, as you might imagine.  My baby is three years from kindergarten, yet she's going away to school...and not just in town...far away.  We do know this is what is best for M, it's just hard to comprehend what our future will look like.

Of course there are also the questions of how to prepare her for preschool.  Can you recommend some books that are appropriate for two/three year olds going to school?  I seem to be familiar with books for older ones mostly.  I know bedtime will need to change, too.  I remember hearing to change it 15 minutes at a time.  What do you think?  We'll visit the preschool, but what else can we do to prepare both M and us (the parents) for this transition?

Any thoughts you might share with us are greatly appreciated!  Thanks 

Books That Encourage Speech!!!

If you've been reading here for any length of time, you know I am passionate about helping M find her words and overcome her speech disorder called verbal apraxia.  Well, I am so excited!!  I have learned of books that specifically help children find their voice through beautifully illustrated books.  They aren't just for late talkers, they are for everyone!  A team, including a speech pathologist, has helped create these books written by Angela Holzer.  They are published by Speak With Me Books.  Since I know some of my readers also deal with apraxia and other speech problems, I wanted to share.

There are several titles, and each focuses on a different sound.

Here is a sample page.  I think M would really enjoy this, and she could help me read it, too!

Books are about $9 each, but you can get all six books at a discounted price.  There is also a CD available with slower songs on it.  We do not actually have any yet (nor have we borrowed from the library), but I'd like to get at least one book.

Check it out here.  If you place an order would you tell them I sent you?  Thanks!  Also, you might considering contacting your local library to help get these books on the shelves and accessible to children everywhere!

Another Speech Update

We had a wonderful weekend filled with LOTS of family visiting for E's dedication at our church. Before I forget, I want to share with you that we had a meeting to plan M's time remaining with Early Intervention before she turns three (in October). You might remember that we were quite concerned that she might lose services because with the evaluation that was used for her, she scored average, even on speech. You can read about those problems here. Thanks to the dedication of our therapists, M will continue receiving speech therapy 2 times a week and her teacher will come once a week. We decided to stop occupational therapy since it was only once a month and at this point, not super effective. A huge factor in this was M's speech therapist writing an "informed clinical opinion" to add on to the evaluation. It made it very clear that though her scores were average, she is not understandable, and she is not consistent with errors. (For example she will say "doom," "poon,", and "poom." All mean the word "spoon." The next big step is to get three evaluations from the IU. We actually had one today for occupational therapy. Another for a general eval is scheduled. The speech eval has not been scheduled yet. (This is quite upsetting to me because if M is going to preschool, I want to have time to prepare her. There is no sense changing bedtime without good reason. We truly have NO idea what will happen, but we hope she'll be going to the speech and language classroom with the developmental preschool.)

Speech Update

M is just two months away from her third birthday! WOW! She has come so far! First, we have an Early Intervention meeting scheduled for next week to see how her services will change. It's an annual meeting, and a follow up to the evaluation she had a few weeks ago that concerned me so much. It was explained to me that since the SLP, special education/early childhood teacher, and M's parents all want services to continue, they probably will. So I'm not so concerned now. Thinking of the future (the end of October) when she turns three, we have two of three evaluations scheduled for early September. These evals will lead to an Individualized Education Plan (IEP) that will determine what services M will receive from the Intermediate Unit. We are waiting for the third evaluation to be scheduled. Hopefully we get the call soon. M is making wonderful progress despite the apraxia. She said, "No. E (brother's nickname). Eat. Mama. Shoe." Five words! She also started adding -ing to words by telling her brother, "No talking." He was just jabbering in the car. A little. Since then she has added -ing to other words too! It's wonderful to hear. M is putting three words together at least once a day, too. Any time she has a longer sentence "mommy", "please", and/or "more" are usually used. M will say "thank you" and "bless you" at appropriate times! The words are very high-pitched and not understandable (without context), but they are there! Her vocabulary, in general, is growing all the time too. We're excited for all the new words!

The Problems of Average Speech

M has been in the Early Intervention program in Pennsylvania for almost one year. That means it is evaluation time. Problem: The Intermediate Unit (where she goes for speech when she turns three) needs to evaluate her too. The same evaluation cannot be used twice in a six month period. Solution: Use a different test called the DAY-C. Problem: This is less accurate in results and not the best test to evaluate speech (or other areas of development). Bigger Problem: It combines the receptive and expressive language scores, giving a child who understands well but speaks poorly an average score. Result: M scored in the average (low average) range on this test. (In this case an average score is not a good thing because it does not accurately reflect what M is capable of.) Biggest Problem: M could disqualify for therapy through the Early Intervention. (She would likely still qualify when she turns three because a different test would evaluate her for the Intermediate Unit.) Solution: Ashley, her SLP, and Ashley's boss will write up the evaluation together to try to demonstrate M's need for therapy, especially with her diagnosis of verbal apraxia. Result: Pray, as it is to be determined. And know that Derek and I have learned a lot in the past year on how to pull words from M. We may not be therapists, but we have some skills that would benefit her in the event that services are discontinued. We are thankful for all that Ashley, and her other two teachers have taught us and her. For those of you who don't know M in real life, her speech problem is very real. It's not just a matter of her being a late talker. She had to fight to learn to speak. Now she has to learn to speak so she is understood. Apraxia is very real. It is not treated with regular speech therapy, but differently. It isn't outgrown. It can be overcome...with intense therapy.

Speech Update

M is 33 months old. We're looking forward to all that October brings...less humidity, cool evenings, beautiful trees, pumpkins, and birthdays! Both M and E celebrate birthdays in October! Also in October, M might begin school, if she qualifies for the county's developmental preschool. I am in the process of filling out paperwork so she can be evaluated. A while ago I kind of stopped adding to M's word list that we were adding to often on our family blog. I stopped because each day she's saying new words with prompting and sometimes without! She is now putting two words together on a regular basis. Today I am certain I heard her say, "I got it." I had asked her if she wanted me to put a dress on a hanger. She wanted to do it. Last Sunday I asked her if she knew where we were going (church). She said "library." It was out of context, but I still understood it!! It was clear enough that others would have understood it, too! We are so thrilled. Each day we have several situations when we still don't understand M. It frustrates all of us. Yet, we're still encouraged. To give you some perspective, we were told of a ten year old apraxic boy. Since he was diagnosed with autism (and it is normal for autistic children to struggle with speech), the apraxia was not discovered until he was six years old! M's speech development is ahead of his. Obviously, the late intervention has not benefited this young boy, but his apraxia is much more severe than M's. We know that we have a long road ahead of us with years of therapy, but we are thankful for each day with her and all of her progress. On a side note, it is now hard to distinguish M's cries from E's! Now that he has some sounds they sound very much the same, at least until we hear the words Mommy or Daddy. (Recently we have heard LOTS of crying at night...several times each night from both children.) To help M sit on the potty for an appropriate amount of time to say that she "tried," I sing the ABC's. I begin very slowly, but once I hear the business happening I speed up and get a bit silly. She loves this! She will even start singing the ABC's herself in a high-pitched voice if I don't! She is not able to sing the ABC song, but she does pretty well when she tries. She doesn't quite have all the order to the letters, but I love her effort! She's also been helping me to read books, especially short, repetitive books or rhymes. One book is a baby prayer book. The last line is, "Thank you God for everything." She will even say the word "everything," AND it is fairly understandable! We continue to pray for our sweet girl's speech. Now that the words are coming with less effort, we look forward to clearer articulation, but that isn't a focus of therapy until age three. If it's done before that more damage than good can be done.

Speech Dx

In February of 2009, M was diagnosed with a motor speech disorder called verbal dyspraxia. It's why she didn't babble until she was more than 1 1/2 years of age and why she is struggling with language in so many ways. She has great communication skills, just not verbally. Dyspraxia is often called apraxia. Though they are actually different, the problem is the same. Though M may want to talk, she has to learn how to say each sound because her brain cannot tell her mouth how to move correctly to form the sound. Or at least that is my little summary. If you want to understand more about dyspraxia, check out the Apraxia-Kids and Can We Talk sites I have listed. M had her speech and hearing evaluated last spring. We have had her hearing tested twice, and will have it tested once more. She really does understand everything we say, but they have suggested for us to return again because it wasn't conclusive. Last spring, when M was 15 months old, her one word was /mah/. She used it mostly for more or to tell us she was frustrated or wanted something. It was not for Mom. Although she was borderline in need of speech at that initial speech eval, they knew I was a former teacher and that I was working with her already. So they gave us some tips and suggested calling if we felt the need and they would check in with us after three months. Three months later she had not progressed, so she began speech therapy. We were only in Maryland's program for about 5-6 weeks because of our move. Before we moved, I had lined up an eval here in PA. We are very pleased with her therapist and have seen M make great strides, especially recently. We suspected apraxia in December 2008 and scheduled a private speech eval. We did it in hopes of getting M more services. She now has speech therapy twice a week and an early childhood/special educator comes in once a week. An occupational therapist comes once a month, as well. Thankfully they are all in our home (until M turns three this fall). The problem with apraxia is that it is not outgrown. It is overcome with intense therapy though. So we have a long road ahead of us. Please keep us in your prayers as we advocate for M and really try to work with her. We know God has great plans for her! M has been making incredible progress. Though most of her words may not be understood by outsiders, she is now making words on her own and even stringing two words, sometimes three, together into simple sentences at the age of 32 months. We're very encouraged and thankful for the therapy she receives.