Gifted Issues Discussion homepage Forums Twice Exceptional The latest IEP issue

Please don't quote me since this will be another deleted post.

DS9 has what I would consider apraxic speech that is related to developmental coordination disorder. His rate of speech is too slow, he has some distorted vowels, inappropriate pitch, sing-song cartoonish voice...basically poor prosody. This was addressed by the school SLP (a different school) back in K-1st grade and he ended up speaking in a monotone. So she fixed the "pitch" and "sing-song" issue but not really other issues. DS originally qualified for speech services with the school because of having a "voice disorder" (which includes prosody issues) plus articulation issues. He was at the 1st percentile for articulation at age 4.

In the last year or so, the latest school SLP has not addressed the prosody issue at all. Her idea of treating it has been to give him cues when the pitch gets out of hand and he starts shrieking (the pitch goes up when he is either trying to talk to someone in a different room, yell--whether angry or not--, or he gets excited or upset). Otherwise, she has not been doing any sort of actual speech therapy at all, because she does not hear any articulation issues. So, it turns out, a year ago, they decided that his 8 hours per month of speech/language in his IEP would not actually be "speech" but it would be a social skills group. She may have been working on the articulation issues, which she couldn't hear, in the social skills group, since it was still in his IEP, but I don't really know. It probably was just for paper only. I knew they were putting him in a social skills group but had no idea they had stopped speech therapy! To make matters worse, she keeps talking about his "fast rate of speech" which is the most ridiculous thing I've ever heard because he actually speaks way too slow! Even the neuropsych said "rate of speech too slow and dysfluent speech" in his report. So I suspect that the school SLP keeps telling DS to slow his speech down. I confronted her about this and she said that he would not be understandable if he doesn't slow down his speech. I said "But I don't want to encourage abnormal prosody to rectify articulation." She clearly did not agree.

I sent a video of his speech to an SLP who specializes in apraxia. And she was like "Ummm, yeah. Choppy speech, incorrect vowels, articulation errors, definitely not speaking "too fast". I took DS to primary care doc to get a referral for an assessment and he was like "Well obviously there is a prosody issue" and Dx him with "Verbal Dyspraxia" right then and there and gave me a referral. But now it turns out our insurance might not cover it unless I take him to one of two places, and those two places do not include the person who specializes in apraxic speech. This whole thing is incredibly frustrating.

The school SLP clearly does not know what to do with him. I am going to have to pay a large amount of money out of pocket for private SLP even though he qualifies for school services. Do I ask for it to be taken out of his IEP? Because I think it would be very difficult to put back later. But if she works with him and doesn't know what she's doing, we run the risk of her messing up his speech and interfering with what the private SLP does.

Anyone have any advice?

You might try having the private SLP talk professional-to-professional to the school SLP, so they can more effectively coordinate services (e.g., to use consistent cueing language with him regarding articulation, prosody, etc.). You will, of course, need to share the history of speech issues and therapeutic strategies with the private SLP at the outset of therapy, so she understands what some of your goals are in coordination of care, and has some context on possible responses from the school-based SLP, who may be a bit defensive about being contacted by a private apraxia specialist.

Then you can let the school SLP continue to work on social skills, while the apraxia specialist works on articulation. Speech/language stays on the IEP...and you're still out a lot of money, but at least the speech services are probably net positive.

Is there any chance of getting the district to pay for private therapies if the person in the school doesn't have the qualifications or training for the disability? I'm thinking it is a long shot but is it even possible at all?

Last year I got sick of tussling with school SLP and took DD for a private speech eval at our state flagship university's speech and hearing clinic. General eval covered by insurance. SLP there diagnosed dysarthria and expressive language disorder. I then took that back to our district along with a request for IEE in speech.

The most respected SLP in the area - the one most sought after for IEE - actually specialized in pragmatic speech issues not the artilculation issues DD had. I spoke with her, though, and she agreed to do a document review and help determine who would be best to evaluate DD. She and the person handling our case for the district (DD's self appointed 'protector' who has made it her mission to assure that DD gets what she needs after seeing the awful way we were treated by the district a few years ago... - and who is also an SLP) - both agreed that DD really should be evaluated by the big wig oral motor specialist on the other side of our state. Because DD's protector really pushed for it, and also because it was obvious school SLP had totally blown DD's eval and services, the district agreed to pay for both evals as IEE's.

Oral motor guru found that DD's tongue was *very* tied but in a way that was almost impossible to find and sent her on to an ENT for surgery. Local highly respected SLP wrote a detailed report outlining all of DD's non oral motor issues. Her in school speech program now includes 2 hours a week of work on articulation issues and 5 minute sessions twice a day doing the oral motor excercises. Old - not very good - school SLP who insisted DD's issues were purely the result of high rate and low volume - totally dismissing any and all concerns I had about vowel sounds and minimizing issues with /R/, /s/sh/th/, /th/f/, etc went on maternity leave and was replaced (permanently) by very good SLP who DD loves working with... Oh and those rate and volume issues seem to be related to breath support issues - ie, she appaarently tries to get her speech out before running out of air. This is something that needs to actually be addressed by the SLP not just by telling DD to slow down and speak up.

Bottom line I think you once again need to look at IEE. Don't let them take it out of the IEP - instead make the IEP and services more accurately reflect what he needs. HTH

Thanks Pemberley, that is very interesting. DS is always gasping for air in the middle of sentences. Breath patterns obviously abnormal.

Right now they need to update his IEP and I told her to keep in speech/language at 1X per week, doing the social skills group and putting a "hold" on the prosody issue until I can get him independently assessed. I'm hoping that we can get an out of network referral but I have to prove that we tried before to get services from the in-network people and it didn't work. Two years ago I had taken him to the hospital clinic, which is in-network, and the SLP completely blew me off and told me he doesn't need services, but wrote things in her report like he doens't know where to put the inflection in words, he can't move his tongue back and forth in his mouth, he is speaking in a monotone, etc. She said "no services recommended" and "Keep working with school SLP" (at that time it was a different one). What?

So now I'm supposed to go back to that place and try to get a report for the school of what they should be doing w/ him? I don't think so. Luckily the primary care doctor seems to be taking an interest in this and I hope he will help us figure this out. I have another appt. with him this week so we can go through all of this school stuff in more detail. I think I am going to have to take him somewhere for a full eval, but I don't want to request an IEE because the school will want to do their own eval first, and they will mess it up. The eval will come out justifying their pre-determined conclusions. Been there, done that (with DD).

He is due for a 3 year eval in the fall but they wanted to do it now. I told them I want to wait til the fall. I had a horrible thought last night that they want to do it now because they want to drop the IEP altogether. The reason that the OT gave me for dropping services was because it's a "related service" and he has already shown that he can write letters (never mind the horribly illegible classroom work samples). Again...it just leaves me scratching my head.

Don't they have to do a re-eval though? At least to some degree?

Blackcat I suggest that if possible you change the title of this thread so that it reflects that you are asking about speech issues. There are people on this board with a ton of experience getting speech services both inside and outside school but they may not read and respond if they don't realize that is what is being discussed on this particular thread.

Our IEE was in response to school SLP's eval that was done as part of DD's triennial. If speech services are included in your DS's IEP then I assume they WILL be doing this eval. You then reject that eval and request IEE by a provider of your choosing, ie the apraxia SLP your insurance doesn't cover. I knew in my mom gut that school SLP was bad and the eval she did was worthless. I did the full eval covered by insurance for my own peace of mind and so I would know what to push for as part of the IEE. It also gave the "protector" something to use as she had to know the school SLP's eval was garbage but her hands were tied.

So no don't go back to the hospital clinic. You don't want a student or resident doing this eval. I went to the state flagship university with an excellent speech and hearing clinic and had a faculty member do the eval while 2 grad students and I observed through one way glass. As someone told me students are being trained to look for horses not zebras but our kids ARE zebras. We need someone who already knows all the rules and can recognize when a kid is outside the lines not who is in the process of being trained what the rules and lines are. In so many areas my DD would make a student or a resident's head explode. When top people who have been seeing the most unusual of cases for their decades long careers have never seen anyone like DD how could a student or early career person possibly know what to make of her? Choose the most experienced person you can find and talk to them in advance to be sure they understand his issues.

The oral motor guru trained the new school SLP to work with DD. The protector SLP also attended the training session so that she will be able to train the next person if this one moves on. Old school SLP never would have agreed to attend this training. She was very happy with her limited knowledge set being applied in a way she was comfortable. Unusual situations require creative problem solving. This is where an outside advocate or consultant can be very helpful. Mine has been worth his weight in gold. Yes I pay him and now I can basically do this stuff on my own but his skill at getting the district to provide services and pay for evals has been priceless. That's how I would be looking to spend money now if I were in your shoes.

Thanks Pemberely. I'm going to talk to the advocate w/ the disability law center and see if she has any advice.

But then I keep wondering why I am pushing for services from people who are clearly incompetent. I shouldn't have to tell the SLP that there are articulation issues when they are obvious. How in the world is she ever going to do anything w/ him. I would probably actually be more competent if I was trained.

Same with the OT. I shouldn't have to explain what "dysgraphia" is. I shouldn't have to tell her that DS is holding the pencil about 2" too high. I shouldn't have to explain that he might learn the skills but if he doesn't use them, they will be lost. I shouldn't have to tell the special ed teacher that it is useless to try to get him to write a 3 page story using handwriting--he needs to use AT. But he still needs to become functional w/ short samples of writing, like filling out a form.

We went around and around in circles and they put what I wanted into the IEP but I doubt they are actually going to change what they are doing with him on a long-term basis. They do whatever it is that's routine for them. So the SLP doesn't want to go into the classroom and find out why DS thinks everyone hates him. He needs to come into the social skills group and she does her social skills curriculum. It's not individualized at all. I'm sure all of the kids had the exact same goals in their IEPs for social skills (being able to identify when someone has a "weird thought" about them--sounds like a GREAT strategy to use with a kid who already has self-esteem issues...eyeroll).

There may be staff changes next year which is the only reason why I am holding onto this and not letting them drop things.

Does anyone know if it's possible to have ONLY DAPE in an IEP? Because that is the one thing I don't want to let go anytime soon.

Did you get the surgery for the tongue tie. Had to get my DD's tounge-tie cut when she was 4. Made a HUGE difference in her speech and it was really a very simple and painless procedure. (She was having other surgery when they did it.) In our case since DD was born with a cleft & there was a physical disability from birth, she was already under care of an ENT so we had little difficult with insurance for both speech & the surgery.

For the original OP. I would suggest you see if the private specialist can talk with the public one. I have had this work for me. It depends a bit on the ego of the school therapist. Are they willing to learn something new & listen to the private therapist?

Just a little disturbed by this. Federal law says re-evals in the area(s) of suspected disability must be done every three years (although what evaluative techniques constitute a triennial is somewhat negotiable state-by-state). In order to not do so, and stay in compliance, the school needs to notify the parents that they are recommending a waiver of assessments, and that the parent has a right to request an evaluation anyway.

http://idea.ed.gov/explore/view/p/,root,dynamic,TopicalBrief,4,

Perhaps the parents' right to request a reveal is being buried somewhere in the paperwork sent out on the non-testing re-eval meetings.

Parents can also request early re-evaluations no more frequently than every two years. Keeping in mind, of course, that every time a re-eval meeting is held, one is re-opening the eligibility discussion.