6 Year old not making progress

by Catherine

"Our daughter Isabella is our first-born child. She has 4 other brothers and sisters, none of whom have any speech issues so far. I remember being told at her 18 month check-up that she should be saying more words. Being that she was our first child, I thought they were overly anxious over nothing, and our happy and healthy daughter would continue to develop just fine.

By two years of age, she still was not saying many words, and the few words she did say were truncated, like "ilk" for "milk." At 2 1/2, we took her for an evaluation, and were told that she was still within in the boundaries of normal. By this time, I was considerably worried.

When her younger brother turned 18 months, and was talking better than his now 3 year old sister, my worry and fear intensified. I watched her brother continue to gain language skills that Isabella could not replicate, and I continued to talk to specialists and educated friends about my concerns. Most of the feedback I received was that she would be fine, and catch up soon, and not to compare the two children.

At 4 years of age, Isabella could communicate in 2 word sentences, and a few phrases, but to strangers, a lot of her speech was unintelligible, and she rarely communicated without multiple errors with pronoun usage, noun/verb agreement, etc. I took her to the school speech therapist, who tested her again, and agreed she was on the low side of normal, but still within normal range. She gave me some worksheets to help her at home, but I saw little improvement that summer.

By the fall, I took her back to the school, and even though she was not school age, they agreed to start therapy with her once a week. After a year of therapy, the speech therapist agreed that there was a problem, and wanted to do comprehensive testing to rule out any other underlying problems. Isabella was now 5 years old, and I was feeling desperate for her to be able to communicate. I wanted to know what my daughter was thinking and feeling, and I knew she didn't have the language to tell me. She began to have behavior problems that I believe stemmed from the frustration of thinking like a normal 5 year old, but couldn't communicate like a normal 5 year old. She had trouble recalling simple vocabulary, things I knew she knew, but couldn't remember the word. She started saying "I don't know" for most anything she was asked. The testing results were mixed. They said she was academically advanced (ready for 1st grade), yet because of her inability to explain her knowledge, tested at a lower IQ of 88. Their final diagnosis was the label, "Expressive Language Disorder".

The speech therapist recommended we use therapy that she typically uses with stroke recovery patients, and those with apraxia. Isabella is now 6 years old, and her progress has been slow. She has a private speech therapist and a school speech therapist. Both her father and I work with her daily as well. After further research, I feel strongly that she should have been diagnosed with apraxia. While she may not fit the diagnosis perfectly, it more accurately describes her disability. She has problems remembering simple nursery rhymes, and repeating 5 word sentences. Multi-syllabic words are very challenging. She leaves off the endings of words, and particularly struggles with adding the letter "s" to words. For instance, instead of saying "Where's my doll?", she'll say, "Where doll?" Notice that she left out "my" as well. When asking questions, it seems to get all mixed up in her head, and then comes out with words in the wrong order, and with missing words. There are family prayers that we have been saying since she was a baby, and she still cannot say them independently. She slurs the beginning and end of the words, and skips words. Her pronunciation on many words could be described as "soft", without the hard endings. The phrases and sentences she is able to say clearly sound "stilted", and lack the fluency of other children. She sounds like someone learning a foreign language.

I worry every day about her progress and future, and I know that her disability is affecting her socially. Little girls love to socialize by talking and creating stories, and she simply can't do that. To compensate, she tries to get other children to play "tag" as much as possible, as no communication is really necessary for that kind of play. To make matters worse, she is in the 99% percentile for height, and most people assume she is at least 8 or 9, until she speaks. Then they think she is either younger or a mentally disabled child.

As her mother, I feel guilty and anxious, and wonder if there was something I did while pregnant or afterwards that caused her problems. I wish someone could tell me what caused this problem, and how to solve it. A child of Isabella's age is able to have sophisticated conversations with their parents, peers, and teachers. I feel I have a hard time getting close to Isabella because she can't share with me what's going on in her head. I just want my child to be healthy and happy, but I can't reach her, and she can't reach out to us."