Unbabbled Episode 5: Apraxia

Understanding Childhood Apraxia of Speech, With Expert Nancy Kaufman

Childhood Apraxia of Speech expert Nancy Kaufman explains the unique disorder while discussing her treatment approach and steps parents can take toward diagnosis and treatment.

Nancy is a speech-language pathologist, renowned expert in childhood apraxia of speech, and the owner and director of the Kaufman Children’s Center. Since 1979, she has dedicated herself to establishing the Kaufman Speech to Language Protocol (K-SLP), a treatment approach to help children become effective vocal communicators. Nancy lectures locally, nationally, and internationally on the subject of CAS and other childhood speech-sound disorders. Families from around the country and the world travel to the KCC to participate in her intensive and specialized therapy programs.

To learn more about Nancy and the Kaufman Children's Center, visit https://www.kidspeech.com/.

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Stephanie:                        00:05                   Hello and welcome to Unbabbled a podcast that navigates the world of special education, communication delays and learning differences. We are your hosts, Stephanie Landis and Meredith Krimmel, and we're certified speech language pathologist who spend our days at The Parish School in Houston, helping children find their voices and connect with the world around them. Today we'll be speaking with Nancy Kaufman as certified speech language pathologist and renowned expert in childhood Apraxia of speech or CAS. Nancy is the owner and director of Kaufman's Children's Center in Michigan where she practices the Kaufman speech and language protocol, a treatment approach that she developed to help children with apraxia become effective vocal communicators. In this episode, and Nancy will describe Childhood Apraxia of Speech and how it differs from other speech disorders; discuss how her treatment approach is used to increase speech production and expressive language; and give advice to parents who think their child may have CAS.

Stephanie:                        01:07                   So welcome Nancy. We're so glad to have you here with us today. Before we delve too much into it, would you like to mix a little bit more background about yourself?

Nancy:                               01:15                   Oh my goodness. Well, first of all, I'm always excited to be here. And um, this is my 40th year in the field of speech and language pathology. I started out in a hospital setting for the first 13 years of my career and then opened up on my own. And when I say my own like myself and an answering machine. Um, and man, that's been another about 26 years of being in private practice.

Stephanie:                        01:41                   And that's come a long way. I've been to Nancy's clinic and it is beautiful and amazing and definitely not her and a phone book anymore because she now has a variety of different services there to treat the whole child, not just the language and speech side of it. So we can starting out in your own private practice, what led you into the direction of becoming focused in and national expert on childhood Apraxia of speech?

Nancy:                               02:05                   Well, you know, I think, and I'm not even actually positive of how I really got more deeply into apraxia of speech, but I think it stemmed from that I was doing enter a hospital internship in for both children and adults. And so what the adult, I'm learning about queuing and using melody cues and gestural cues and working with adults with apraxia of speech. At the same time I was working with children who really struggle to speak and um, my mentor at the time was somebody who was very innovative and really taught me about how to teach successive approximations toward full target words. And um, so learning about that and then pushing him what I was learning about adults in terms of cueing, I was also taking a phonology course and it was interesting because in the phonology course, this is kind of technical

Nancy:                               02:58                   But we were learning that we could look at errors in terms of final consonant deletion cluster reduction of fronting and staffing and all these terms, which were really about how children's simplify difficult speech-motor behavior. So they're trying to simplify what's hard for them. There's simplifying adult forms of words. And so I was thinking to myself, wow, here are some children who are simplifying way lower than their actual motor coordination capability. And so I thought if we actually taught them how to simplify with natural phonological processes because they weren't doing it the way that neuro typical children were, that would be a way to understand how to teach an approximation that makes sense and it's natural and then keep moving them toward full target words, phrases, sentences and so forth. And then implementing the cuing systems that we were, we were learning from what we knew about adult or acquired apraxia. And knowing what we know about articulation and knowing what we know that children have to process and comprehend language also to be effective vocal communicators as well.

Meredith:                         04:15                   And I want to back up just a little bit. Can you tell us what his childhood Apraxia of speech and what's the difference between that and other articulation and phonological disorders?

Nancy:                               04:24                   Well, so childhood Apraxia speech is difficulty executing and sequencing the oral motor movements that are necessary to produce and combine consonants and vowels and to then form intelligible speech. And it can coexist with just about anything that you want to rule out. Yeah. And so that's what makes it a little bit more complicated. And there are signs and symptoms of childhood Apraxia of speech. Well, how does it differ from other speech disorders? Um, it's more about combining movement, meaning the movements that we need for the fine motor skill of speaking, um, and um, articulation errors or about inaccuracies, isolated consonants and involves which then carry through to be inaccurate in connected speech as well. Phonological disorders, um, are more predictable and consistent errors. However, and I may not be representing all of us SLPs, but I really do see, um, uh, these speech disorders on a continuum. Cause you can't really remove the motor aspect of speaking, how to speak. And so I really see this continuum as being a child that may have difficulty even executing the underlying oral motor movements to produce consonants or vowels and isolation to children who really have many consonants in their belts that they can produce what they struggle to combine them and therefore they have replacement errors and distortion errors and substitute or, or, uh, um, omission errors or deletion errors. And then they might be able to start combining words and then they, they may have some residual leftover issues with speech, motor, um, behavior and then maybe end up with a few leftover articulation errors. So I've, I really have tended to look at these kinds of speech disorders as a continuum.

Stephanie:                        06:34                   A bit of clarification. For those listeners who may not be familiar with these terms, phonological processing disorders are a set of errors that are predictable and affect more than one sound. They also follow a set of rules. An example would be a child leaving off the endings of words like Bob or Bob or cut or a child only making one consonant sound where there should be two together like tap for stop or boom for blue. An articulation disorder typically has individual sound errors such as difficulty with S, L or R examples of this would be a child saying wed for red or a child with a lisp sounds in isolation is a single sound produced on its own. Just the s sound, just the T. This is often the first step in therapy as an involves focusing only on producing that one sound connected speech is when sounds are put together either in words, short phrases or conversational speech. This is more complex since the child must focus on producing multiple sounds all together.

Stephanie:                        07:34                   I have seen children who still struggle with, they might have apraxia, but going through that they also have some phonological things comorbidly and as you've said, you've treated kids who have a range, so they may also have an autism diagnosis or other diagnosis and still with it have the apraxia and other things. So it's, it gets very tricky to piece apart and then just hone in on one thing, which is why I think it's fantastic that you, um, bring in other aspects of therapy and really look at the whole child. You said there are some red flags there. Are there things that parents and educators could be looking for it at night then in the direction that this would be a child who might have apraxia of speech?

Nancy:                               08:19                   Well, there certainly are. I mean, some of the staples are, um, in con inconsistent productions of words over repeated trials.

Stephanie:                        08:30                   I had, it would be like saying the same word and having a different production or different error when they're saying that word. So they might say like butterfly and say it incorrectly like bubberfly, but then have a different error. So they're not saying bubberfly every time for butterfly. They're just saying it differently each time.

Nancy:                               08:49                   Yes. Okay. And then there are vowels errors, but they're tricky because if you have vowel errors in isolation, you're going to then also have them in connected speech. But I think more of a staple of the vowel errors we're talking about in CAS are that the children can produce the vowel accurately in isolation and then collapsed them in connected speech. But also diphthong vowels can also be problematic in isolation because there are two movements and CAS being a movement disorder, a speech motor movement disorder, it may be difficult to coordinate both movements in a diphthong vowel. Well, so they might be collapsed even in isolation.

Stephanie:                        09:33                   And in a diphthong, the two together would be like, bye.

Nancy:                               09:37                   So I is an Atwood an and pull my 80 as an opportunity. And an a is an ad to an e an hour is an ad to a do those kinds of, of vowels.

Stephanie:                        09:49                   You really don't think of it as being two separate movements that they're putting two of them together, which increases the complexity and increases the demand for them to motor plans that go through any other ones that,

Nancy:                               10:00                   so, um, they may have, um, pop out words that are very automatic for them to say, hi, bye. Wow, me, come, go. Um, but sometimes when you ask them to say those words on direct invitation, they may fall apart. Um, they, um, have difficulty with syllabic sequencing. So, uh, children with CAS may be able to produce a consonant word pretty well, I know by day. Um, and then as you add syllables, you might start seeing an increase in errors so that certainly when they get to multisyllabic words, you're going to see an increase in errors there. So that's another staple of childhood apraxia of speech.

Stephanie:                        10:44                   And that would look really different than a child who has an articulation hair because they're going to say, even in isolation, that one sound, that t that are the l they're going to say the same error over and over again. They're going to say it in isolation. And same thing with a child that might be on the phonological side of it. They're always going to reduce, um, bottle to Baba and make really predictable errors when they go through.

Nancy:                               11:13                   Another aspect of CAS are prosody issues and, and you know, so often we have children that are so young that we don't have a lot of speech to examine. You know, they're not necessarily talkers. Um, but the only way to really decide if a child truly has CAS is to have a child who talks so that we can look at their error patterns. Um, and some of them have such a struggle with like almost like an executive, apraxia and that's the executive apraxia. I always, I always think of a child holding a briefcase. You know, it's hard to diagnose, but the privacy issues are seeing, especially in children who are talkers.

Nancy:                               11:54                   Um, but they will have unusual pauses, maybe inbetween syllables in between words. They also may have difficulty with melody and I'm sounding very monotone and choppy in the way that they speak and they might have to kind of think more before they speak in order to make the executions of the speech motor movements too to help themselves to be more intentiona.

Meredith:                         12:22                   As a parent, what kinds of things would you suggest they talk to their speech language pathologist about if they maybe have some suspicion that their child has childhood Apraxia of speech, is there anything that they should be asking or any information that would be important for them to know?

Nancy:                               12:40                   Well, certainly the informed parent is best. Yeah. And there's so much that can be looked at on the internet and stuff. Good or bad. It certainly can. So I really, I really come across many parents who are coming in for an evaluation and they say, you know, I suspect that my child may have CAS and this is why. And then informed parents is going to help, uh, any individual who's doing the evaluations to look more closely for it, to know that the parent is open to hearing something like that. Um, and so, and I would ask an SLP if they have much experience with CAS and if they don't, do they know somebody that really could be more helpful. Um, but I, I definitely think that information is helpful. Um, we always tell parents though that there's so many coexisting conditions with CAS that you almost can't talk about it as a one subject matter. You know, you, you almost can't say all children with CAS do this and all children with CAS do that. Right. But what, what does draw them together are the characteristics that comprise the disorder. Yeah.

Stephanie:                        13:59                   And also because of that, just because a child might not be showing one part of it or showing other things with it doesn't mean it's not CAS.

Nancy:                               14:08                   Yes, correct. And like there's something also called oral groping that gives us an idea about apraxia speech. But sometimes you don't see that in an evaluation, but that as you're working with the child and you're trying to help them to position four different sounds and sequences, you can see them really not knowing where to place the articulators and they, they grow up for that positioning that their brain is telling them better articulate with what to do and they're not listening.

Stephanie:                        14:36                   So I know that many parents when their child is having difficulty with the articulation and they're not talking much and they want to focus in on the sound. One of the things that I really love about, um, your philosophy is that you support the language with developing the words in the silence. Can you talk a bit about the importance of doing both together?

Nancy:                               14:57                   Yeah, sure. Um, so in, in CAS, in the K-SLP method. So let me to talk about that. So the Kaufman Speech and Language Protocol, the premise of the approach is that, um, we're trying to teach children some vocabulary and we want them to use it functionally. Yes. And many of the words that are important for the child, but maybe a favorites list contain consonants and vowels that they don't even have in their repertoire and they're not still available for them either. So no matter, let's say they don't have a like a k in their repertoire and though cookies are really something special for them, they love eating them. We can't wait until we can gain that "c" in the repertoire, not only to gain it in isolation, we have to gain it in co-articulation. And so we're going to keep trying to work on getting that cut into the repertoire. But at the same time the child is saying "du-du" for cookie. And so that's where we're going to say, okay, what's a natural phonological process for children that can't produce a cup and it's fronting, which is a tough, and we might then just tell the child or a healthy child to say "toot-tee" for cookie. I know that feels awkward that you're actually teaching a child a different way to say a word then how you're supposed to say it. But it's meant to be temporary and functional. And so I'm actually going to say, try to say toot-tee and they might be able to say it, but I'm going to then model it as cookie. Yes, it's a cookie. Did you want some cookies? Tell me toot-tee. They say toot-tee, they get cookie.

Nancy:                               16:41                   But in the meantime I'm going to continuously work on the cup. And actually once we get it, you might have to reconfigure it. That word to cook, which means that they get to move from one cup to the same placement and then remove the e. So let's try it this way. Cook-ee, we are no longer going to accept toot-tee as their aproximation for cookie and now we're going to replace it with cookie until they can then make it solid and, and smooth and fluent. And in the meantime, as we're teaching an approximation of a word, we want the child. Do you use that word functionally? Yes. And we want it to be a request because young children do a ton of requests, as you parents know, daily and and so we want them to say cookie in order to get cookie. We want them to say it as best as they can with the repertoire that they have and that their stimuable for. But we're going to continuously work on things that they're not stimuable for, gain that stimuability, gain those consables and vowels and then successively move toward the target. And so basically what we're doing in the K-SLP are simplifying the motor plans of words temporarily for functional expressive language.

Meredith:                         18:01                   And what a great way to do it. I mean it's life changing for families, but everybody in the family knows two D is cookie now. So they had a question about what they're requesting and then the child is so much more successful with their language. It's great.

Stephanie:                        18:13                   And beyond that, when you go ask the community, many people are used to children saying toot-tee and a two year old comes up to you and is like, want toot-tee, they're going to know cookie. But if they come out, the child comes up to you and instead, so it's like Duh, Duh. The Stranger was going to be a little more confused and making it functional. And yes, it does feel awkward replacing an error with an error, but at least it's one that people are more familiar with. It makes it functional and is bringing in the ability to have them use that expressive language side of it because there is two components to it. You have to have the language development in there as they're doing and working on these words so it becomes functional and it can have a conversation with people instead of just having these words in isolation and the sounds in isolation.

Nancy:                               18:59                   Well, I think it improves the children's confidence are more successful communication definitely. There are, um, uh, practicing SLPs that don't feel comfortable actually teaching approximation rather than just accepting the child's approximation. And I just want to make sure that everybody understands that that is not the end goal. It is a means toward the target word and it helps the listener and therefore it, it, it, um, drives successful communication, right. Because whatever the child was saying in place of their best approximation had to be very difficult to decode. Yes. And then they're going to be constantly met with miscommunication and frustration and frustration. Yeah. So temporary success of approximations or simplifications of motor plans of words is always moving them. I had, whenever they are able toward those full target adult forms of words. Yeah. And also we're going to go ahead on word combinations that we can't wait til children have perfect articulation to then work on word combinations.

Meredith:                         20:13                   Well that's not typical language development either. I mean, children combined two words before they have certain sounds in their repertoire. So yeah. That, that's, that's more functional. More natural. Yes. Yay. Right. Why would we not want our children to be developing naturally when they can as close as possible. Right.

Nancy:                               20:32                   We joke about this, but it's really a true statement that so many of us go to words like more, want, help, please. And the thing about those words are that they're so on that and very often that's us. If the children are not even able to be vocal at all. Those are some of the set, the first signs that are taught and um, from um, people that were board certified behavior analysts as to why those are not the most effective words or signs to teach because of a child walked into my room and they signed more, what would I know? I wouldn't know any what they would want more of and then they might scroll to want and I still don't know. They'll scroll to please because that melts all of our hearts. But I still might not understand and might screw to help. And the thing is is that I'm at a loss and they're going to get more frustrated. And so I was taught and it was wonderful to have this opportunity to learn from, um, BCBA is that it's better to teach a one on one match to highly preferred items in activity words. And that's again why we need to go with approximations because we can't work on just full words over and over and over again. I'm going to take us into the language that is necessary to teach. So we'll put a more, a want or a please along with another word that helps the listener to understand more cookie or whatever that is.

Nancy:                               22:08                   But even when we're getting into two and three word utterances, when you're talking about getting into expressive language, maybe rather than using general where it's like that to get into two word utterances, we might want to use descriptive words or attributes. So the child's been saying truck or they might be saying is tut and they're doing it as a, as a, uh, request and they're getting the truck. But maybe they want a specific truck. So now we, we would want to teach maybe a color word with truck or a size word with truck that gets them not only into a two word combination, but it gets them a more specific response to their desire.

Stephanie:                        22:48                   And it's teaching developmentally appropriate attributes to have and language skills to go along with it. Right?

Nancy:                               22:55                   And it takes us out of the, I want phrasing that we kind of overdo. And so now children, even if they're naming an item, they'll say, I want in front of it. And so I'll say, whats this? I want apple! Right. Um, but that's our fault because we taught them to overgeneralize that phrase.

Meredith:                         23:11                   You mentioned about your intensive from, with children from all over. If a family is interested, how does that process work? Do they contact you and travel to you based on your schedule or how do, how do you manage that?

Nancy:                               23:25                   So, um, they'll contact me, usually you either by email or phone. And the first thing that I say is that I need to see some recording and see some video because first of all, I'm not sure that the K-SLP methods are the appropriate methods for this particular child. I don't know if I think that they have CAS, they may need another professional of whom I'm very well aware to send them to. They may need, um, to, to have other, uh, diagnoses, uh, uh, revisited or, or additional evaluations before they come as well.

Meredith:                         24:01                   Which is great. Otherwise you'd have kids coming into your office blind and make it very difficult to treat that.

Nancy:                               24:08                   Right. And I want to put a family in that situation and certainly not myself either. Um, and it's, I have to say almost a hundred percent of the time it has worked out so very well. Um, so I'll watch some video. I will call the parent and their SLP if they're interested to collaborate with me. I tell the parents, if the SLPs aren't really on board with the K-SLP methods, because not everybody is, I don't know why they couldn't possible be, and I know how biased I am. Um, but I've had 40 years of experience with effective outcomes. Um, so, um, if the SLP is not interested in the K-SLP, it would be very tough to, to collaborate. And so coming out would be great. But then going back and not having that opportunity to work together isn't the best situation. Um, so, but sometimes the parents will bring their SLP with them and that's always wonderful to have somebody right there with me. Um, and um, I, I'll do an evaluation and then I do half hour sessions. It depends on the child's nap schedule. Yes, because they are pretty young, so we try to do everything in the mornings and then some additional sessions in the afternoons. And some of them also come for an additional OT evaluation, um, and have some sessions there. Um, and then I try to coach the parents too. They're always watching. We have one way observation windows. Um, they're watching in the last few sessions. I'm going to coach the parents as to how to implement the goals through play. And that's a lot of fun too.

Stephanie:                        25:47                   Which is the most natural way for parents to be interacting with their children anyway and the most natural way for children to learn to sit at the dinner table and be drilled by their parents and it's not going to be functional. It's not going to carry over. And that's such an important piece. I mean, parents, they see their kids the most, they can get the most out of it and it's, they have that functional way of communicating and they can help queue them and they can help get them. Then their ability to increase their child's outcome just increases and increases exponentially. So I love that wonderful parents side of it that you do.

Nancy:                               26:21                   And well meaning parents, some feel that they need to drill the children and that is going to wreak havoc on their relationship. And I think that it gives them a feeling of relief and I'm saying, hey, you shouldn't really have to use any therapy materials at all, just know what the goals are and then let's put a whole huge toy on the floor and see what we're going to do with it. I had a um, uh, a mom that was very distraught because her child just wouldn't work with her anymore. And every, she said to me, every time I bring out pictures my child runs out of room. So we really talk about that if you have to use materials, because you need a visual reference for certain word types you do, but you want to pair those with bringing out highly preferred toys and activities so that when materials come out, so do those fun things. And then the children will say, Hey, I like those pictures because they signal that my life was going to get better and not worse. Um, but anyway, I, you know, this, this one, um, mother, I said, well if she came, came to Michigan from quite a distance. What's your child's favorites? Yeah, tell me some things about your children's faith. Your child's favorite thing. She's like Orca whales. Oh, okay. Well, easy enough to work with. We found a seaworld toy and gathered up a lot of sea creatures. Cause you know those toys that you buy at the store come with one extra item, right?

Nancy:                               27:52                   So gathered up a bunch of different seaworld toys and then we decided on a pivot phrase and we were talking about language. That's part of the K-SLP too. We call them pivot phrases. They're just words or phrases that stay constant and then you don't have to really worry about them anymore. So my, I'm going to get off my subject, so get me back to the Orca whale. My, the pivot word, because you can stay constant: my nose, my ears, my toy... Open, another type of pivot word. Open eyes, open mouth, open toy, open box. And even pivot phrases like I want of course is one of them because it stays constant. But I need, I want to. And then verb. And how about putting the word second? Come blank with me. And then they know the common, the width and the me and they only have to change up that verb and it's nicely social. But so we have pivot frame, I pivots syllables too. Syllables that remain constant like that. And why? So then we have bonding money, honey pony. We just have to remember that to mix that very, that task with others so that they don't overgeneralize anything ends in "y", right?

Meredith:                         28:55                   They go into their next session and say orca need.

Nancy:                               29:00                   So we got out, um, all of us, the toys and we had an orca whale too. I don't know how I found that but happening. And then decided on the pivot frames. So how about go in water and even if it had to be "go in wa-wa", that's okay. That's about our moving into expressive language. But we still might have to simplify the motor plans even with those words. We're not going to go too far too fast because then there'll be unintelligible. So we're going to stay with maybe two word utterances. Even when we get the three word utterances there, they might just be telegraphic minus all the little linking words that are difficult to say and add too much motor planning to that particular phrase. But we did go and water and then we can do each different item: orca go in water and fish go in water and she was right there really excited. The mom was was just joyful watching her child feel so good about all of this practice and it really worked out well. Then she wanted to go in the water, picked her up and she pretended to die and she did go in water and then she pointed to me. The interesting thing about the pointing is that I like to teach parents and caregivers that we have to try to anticipate what the child is trying to convey with their gesturing and maybe non-speech vocalization. And as soon as we can understand what you're trying to convey, we're going to help them to convey it. So she just pointed to me now, I knew that that meant I want you to go in the water. She wouldn't have had to say anything, but because I knew that, I put my, put my questions, put the answer of my question into the question, Oh, do you want me to go in the water? You want to get a yeah because that was a yes/no question, and then tell me that you want me to go in the water, tell me you go in water. And then she did. And then I pretended to dive in too, um, so there's so much to talk about in terms of scripting language in the natural environment. What words do you choose and how do you simplify and, and, um, figure out what the best approximation would be.

Stephanie:                        31:22                   And that is, that's the hard task. It's difficult task. And to tell parents just to go home and do it without giving them that training is really hard. It's much easier for parents to imitate the drill. But then when the children get disengaged with that and it's not going to carry over that functionality to increase the joy and the opportunity for the play and the connection and you were hitting shared imagination and so many other things and not one activity that at drilling, you know, general practice at the table, they wouldn't get so...

Nancy:                               31:56                   I have, um, an ecourse through northern speech on the K-SLP methods and also little clips of how to use materials. Yeah. Um, no, I, I put materials together because I wanted them, I didn't put them together because I had all this, these visions of selling them. Right. But one thing led to another and so I love to create and then I love to have the access to them to use them in my therapy sessions. Um, so, but I have a course that explains all of that from northern speech. And I have a webinar through apraxia kids. So it's apraxia-kids.org. They have a whole library of webinars and one of mine is practice through play with the K-SLP methods. So that would be something that would be available.

Stephanie:                        32:47                   A resource for teachers, for parents, for other speech language pathologist, just starting out to learn how to do things through play as well or to help refer parents on so they can learn how to do this because play is just such a natural way for the children to learn. It's the most functional

Nancy:                               33:02                   And apparently is the best way to build the brain.

Meredith:                         33:05                   Yeah, those connections are so much stronger when learned through play and I was on your website recently and watching some of your videos and those are just such a great place to start. You go through your materials, then you talk about the pivot syllables and the pivot, you know, phrases. So, um, if anybody is interested, that's a really a great place to start on your website and just watch some of those videos and learn about your materials. So very helpful - those videos.

Nancy:                               33:30                   We really tried to keep it current, but that one is kids speech, kidspeech.com. Or you can look up Nancy Kaufman and you'll get somewhere.

Meredith:                         33:37                   If you Google Nancy Kaufman, there's a lot to be found.

Stephanie:                        33:41                   Well we've really enjoyed speaking with you and chatting with you and learning more today. We have one question that we ask everyone. And your answer can be specific to uh, childhood apraxia of speech or life in general. But if you had one tip to give parents, what would you get? Let me put you on the spot.

Nancy:                               34:04                   That's a very interesting question. Um...

Stephanie:                        34:07                   Because we know that you have a plethora of experience coming from the clinical practice and being a parent yourself and just live life experience and interacting with so many families from different areas.

Nancy:                               34:20                   I think that two things, children are pretty resilient and they have amazing capabilities. If you just find the right team to, to help you with that. And the other thing is, is that though this is very stressful, I would look for the joy - anywhere possible. Um, and then the parents demeanor is exuding both positive emotions. Even though you're worried and feeling sometimes very desperate, we're, we're, or you know, overwhelmed. The feelings that you exude are going to be the feelings that are received by your beautiful children that will help them to feel good about themselves.

Meredith:                         35:13                   I like that. I love that and applies to everything like that. We know. We all worry. All parents worry.

Stephanie:                        35:23                   It was wonderful having you today. Thank you again. Thank you very much and we look forward to seeing you again next year.

Nancy:                               35:30                   I look forward to that.

Meredith:                         35:34                   Thank you for listening to the Unbabbled podcast. For more information on this episode, including links to the Kaufman's children's center website and apraxia resources, as well as definitions of special terms we mentioned in our conversation, please see our episode description. For more information on The Parish School, you can visit our website at www.parishschool.org. And if you're not already, don't forget to subscribe to the Unbabbled podcast on your app of choice, and if you like what you're hearing, we'd love for you to leave a rating and review. A special thank you to Stig Daniels, Katie McCarthy, Amanda Arnold, and Amy Tanner for all their hard work behind the scenes. Thanks again for listening.