The majority of cleft kids will go through some sort of speech therapy since the cleft affects the production of sound in some way, shape or form. In Ella's case we started Birth to 3 in the Summer of 2010. That program provided a dedicated therapist who met with Ella on a one-on-one basis approximately every two weeks. The first therapist we were assigned wasn't a great match so we wasted quite a bit of time trying to find the right fit. We were eventually reassigned a fantastic new therapist, however we didn't have a lot of time remaining with her before Ella turned 3.
At that point we were turned over to the Madison Metro School District. After Ella was evaluated, we met with our case manager and went through our various options; we could send her to our home school where she would meet one-on-one with a therapist once a week for 30 minutes - OR - we could enroll her in a Phonology Clinic that was more intense. She would be one of 12 kids who attended 2.5 hours per day for 4 days a week, for 6 straight weeks. After weighing all of our options we felt like the highly focused, consistency of Phonology would be the best thing for Ella.
We were told that most kids attended anywhere from 3-6 sessions (a session = 6 weeks on & 6 weeks off) before they no longer needed Phonology. We started our first 6 week session in November '11. The teachers were fantastic and we were able to notice a difference right away. It seemed like Ella was talking more (not sure how that's possible) and clearer than she had in the past. Every Friday she looked forward to her homework and everything was positive.
Within the first 6 week session Ella coincidentally had her hearing evaluated by one of the school audiologists - which she failed. When the teachers informed me I really didn't worry that much since most of those tests are based on audio cues and she typically doesn't do well due to lack of focus. I wanted to be safe and not sorry so I immediately set up an appointment with our ENT to have her ears looked at. Long story short - the tube in her left ear had fallen out and there was quite a bit of fluid built up, which had lowered her hearing levels in that ear.
tube replacement surgery for February 1, 2012. For some reason I was super nervous, maybe because she was big enough to tell me how she was feeling - but everything went fantastic and we were in and out before we could blink. She even threw two thumps up on our way home from surgery ----->
After our first 6 week break, March 6th marked the start of our second 6 week Phonology session. I was looking forward to it because I hoped that with her hearing in tip top shape, we would see even more improvement - and we did! This second round wrapped up last week and this past Monday we had Parent Teacher Conferences to talk about next steps.
Of course I was traveling the first portion of this week so Joe went alone (other mothers reading this will know why this is an issue.) After 2 complete sessions, the teachers feel that Ella has gained all she can from Phonology Clinic and have recommended that she get some one-on-one therapy from our home school. She has mastered all of the sounds that typically developing kids her age do - with the exception of "S." They feel that meeting with a dedicated therapist, even for 30 minutes a week will help her to focus solely on that sound and improve upon it.
I have very mixed feelings about this recommendation. While I'm all for one-on-one therapy - if we get a bad therapist through the school system, we're kind of stuck. I also feel like 30 minutes once a week isn't nearly enough time, especially in comparison to the intense phonology setting we were doing. That being said, I am open to trying a new therapist - I just want the option to go back to Phonology Clinic if needed. In my mind, Practice makes Perfect - so why not continue going, even if the only goal is repetition?
Our insurance provides us with 4 speech therapy visits per year (a whole different story.) I have taken Ella in before basically just to have a second opinion. At this point I plan to set up another appointment to see if they note any improvements and have recommendations on how we can best move forward. I'm also hoping they will be better equipped to weigh in on whether or not any surgical procedures can improve Ella's speech production and hyper-nasality. Stay tuned!