Bristol Trask, Speech Therapy Patient
On July 8, 2011, Bristol, a beautiful baby girl, entered the world and was the answer to the prayers of her parents, Gidget and Matthew Trask. Throughout her toddler years, Bristol developed just as normally as every other child her age. However, as she turned two, her parents noticed Bristol was having trouble communicating.
“I knew Bristol was having trouble with vowel sounds, but she still comprehended everything that others would say to her,” explained her mother, Gidget. “I decided to talk to Dr. Nagel, our family provider. He determined that Bristol would need speech therapy, but I held off until she was three because I felt she would be able to cooperate better with a therapist at a later age.”
Shortly after Bristol turned three, she began to see Diane O’Connor, Speech Language Pathologist, at Iowa Specialty Hospital in Clarion.
“Bristol was referred to me by Dr. Timothy Nagel in September of 2014. During my evaluation, I assessed Bristol’s speech skills, as well as her receptive language (comprehension) and expressive language (ability to use language). The results showed that her comprehension (understanding of language) skills were appropriate for her age. Her speech skills, however, were severely delayed. She was only able to produce a few vowel sounds and a few consonant sounds. Bristol was able to say a few intelligible words, but most of her attempts to verbalize were not understandable.
Through my evaluation of her skills, I determined that her speech deficits were due to Childhood Apraxia of Speech (CAS). Due to the severity of Bristol’s speech skills, her ability to use language for communication was also severely delayed. Typical 3 year-olds have an extensive vocabulary and are able to communicate using sentences of 3-5 words. Bristol was able to say only a limited number of single words, and most of them were unintelligible.
Since that evaluation and diagnosis of CAS, Bristol has come to see me two times per week for speech therapy. Therapy for CAS involves graded therapy tasks to facilitate a child’s ability to form sounds. Then, therapy focuses on facilitating the child’s ability to connect and sequence the sounds to form words and sentences. Bristol’s therapy has also incorporated tasks to further develop her use of language due the significance of her expressive language delay.”
Childhood Apraxia of Speech
Childhood Apraxia of Speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not due to muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. A child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to speak the words.
Not all children with CAS are the same. Some symptoms may include: lack of cooing or babbling as an infant; delay of first words or missing sounds; ability to pronounce only a few different consonant and vowel sounds; problems combining sounds; long pauses between sounds; simplifying words by replacing difficult sounds with easier ones; or potential problems while eating. However, signs and symptoms vary by child, and it is important to have your child evaluated by a speech language pathologist who has knowledge of CAS to rule out other causes of speech problems.
Bristol was scared at first, according to her mother. It was a completely new environment for a young child.
“In fact, she sat on my lap for several sessions. I was nervous too. I wondered about my daughter’s future, but it didn’t take long for Bristol to warm up to Diane.”
Speech therapy has been both educational and entertaining for Bristol, with similarities to preschool.
“At first we had to reach out to Diane often for guidance when something happened at home. She always made herself available, and it really helped during those difficult times. Also throughout her therapy, she’s learned a lot with Diane, such as numbers, letters, and colors, but in ways that were enjoyable for her.”
When asked what she thinks of her visits with Diane, Bristol comments, “It’s fun. I like to play ‘Go Fish’. I can win.”
O’Connor explains, “I use puzzles, games, and other activities to interact with a young patient. The goal is to engage them so they not only want to pay attention, but participate while working on their speech and language skills.
I use specific types of cueing (visual, auditory and gestures) to help Bristol to say the sounds and form sentences. Initially, I helped Bristol to use other means of communication, such as sign language and pictures, to help her to better communicate until she was able to effectively communicate through speech alone.
Bristol is now almost five and has made remarkable gains. Currently, she is speaking in sentences of 4-5 words, and she is intelligible to familiar listeners most of the time. She has mastered most of the sounds which are appropriate for her age. Recent testing has shown that Bristol’s expressive language skills are also now at an appropriate level for her age. She continues to struggle to produce longer words which contain more complex sound sequences. However, I am very happy with her continued progress.”
Heather M. Clark, PhD, Division of Speech Pathology - Mayo Clinic
“I first evaluated Bristol’s speech when she was just barely over 3 years old. Her parents were concerned because Bristol didn’t start talking until she was two, and even a year later was using only a few words and just beginning to combine words. Based on the speech and language evaluation conducted by Diane O’Connor, Speech Language Pathologist at Iowa Specialty Hospital in Clarion, Bristol’s understanding of language was normal for her age, but she was delayed in her ability to express herself, and she struggled to produce speech in ways that led Ms. O’Connor to diagnose Childhood Apraxia of Speech (CAS).
I focused my evaluation on Bristol’s ability to select and sequence movements for producing consonants and vowels. At that first visit, in addition to making sounds incorrectly, Bristol often left off the ends of words and produced longer words with incorrect intonation. My observations confirmed the diagnosis of CAS, so I provided recommendations for Bristol’s continued therapy with Ms. O’Connor.
Bristol came back to Mayo Clinic every three months for re-evaluation and updated recommendations. Each time, Bristol showed improvements in her speech. Her vocabulary expanded, and she combined words for longer and longer sentences. She could produce more consonants and vowels correctly. Early on, Bristol used a combination of signs, picture communication, and speech to express herself. As her speech became more understandable, she relied less on signs and pictures. All the while, Bristol was also learning how to help listeners understand her better, by speaking slowly and repeating herself when necessary.
Bristol’s speech therapy was different from the therapy that children without CAS receive. She had to learn to pay close attention to the movements of her mouth and tongue, not just for single sounds but also for moving from one sound to the next. This often required that she closely watch the speech language pathologist’s movements and even make the movements as she watched. Sometimes she had to make the movements slower until she learned the movement pattern, and then could go faster.
I last saw Bristol when she was almost 4½ years old. She continues to struggle to be understood sometimes, but has shown tremendous progress. A year before, Bristol’s parents, and even her speech language pathologist, weren’t sure how long it would take for Bristol to be a talker. Now we all know that Bristol is a talker, and we can’t wait to hear all she has to tell us.”
It Takes a Team
The Trasks have a lot of admiration for O’Connor. She became like family and has been a huge part of Bristol’s childhood. So much so, that Bristol includes Diane in her nightly prayers.
“Diane was an answer to our prayers,” further commented Gidget Trask. “I’m sure there are a lot of people who can become speech pathologists, but in my opinion, it takes a special person to work with young people. We were lucky to have early intervention and to encounter just the right people,” shared Gidget before continuing with a laugh. “Be careful what you pray for. Once I wondered if my daughter would be able to talk, now Bristol loves to talk.”
But O’Connor will be the first to say that a comprehensive team approach has been crucial to Bristol’s therapy. Since her initial visit, she has seen O’Connor two times a week, she sees a school speech therapist once a week, and travels to Mayo every three or four months for progress assessments with Dr. Clark.
Bristol’s family has been a huge part of her success. Not only does her family share in the duties of taking her to required appointments, but they also work with Bristol at home on materials provided from her therapy sessions. That additional practice is an important piece for her continued progress. O’Connor is quick to praise the Trask family also. “Speech therapy doesn’t just happen for an hour during an appointment. It takes hard work at home, too. A family wants nothing more than to communicate with their child and for their child to be able to communicate with them. Much of Bristol’s progress is attributed to the efforts of her family. It takes a team.”
A team is just what Bristol has now. The Trasks have started an annual tradition of participating in the Walk for Children with Apraxia of Speech in West Des Moines. The event is designed to raise funds and awareness about CAS. O’Connor is even a member of the Words 4 Bristol team, showing that her support goes beyond the walls of the hospital.
Team shirts have an imprint of a pink heart wrapped by a blue ribbon, the symbol for CAS, with the words, I Wear Blue for Bristol, on the front. On the back they read, Overcoming Apraxia One Word at a Time.
Speech therapy is available at Iowa Specialty Hospitals & Clinics with Diane O’Connor, MA, CCC/SLP, in both Belmond and Clarion. Please consult your healthcare provider for a potential referral for speech therapy if you have concerns about your child’s speech and language development.
To learn more about CAS, visit: http://www.asha.org/public/speech/disorders/ChildhoodApraxia/
To learn more about Walk for Children with Apraxia of Speech visit: http://casana.apraxia-kids.org/site/
To learn more about Speech Therapy, visit: http://www.iowaspecialtyhospital.com/services/rehabilitation--therapy/speech-therapy/