[phono-tx] Initial Consonant Deletion

I'm working with a boy who is just turned 2 this week. He is taken care of by a
nanny who talks to him in Spanish. He parents do not speak but a little
Spanish. They speak English with him.

About a month ago he started to put two words together. Right before he did
that, he started spontaneously repeating words said to him. He is now putting
two words together frequently and will repeat some 2 word phrases. He hasn't
put 3 words together yet. He produces at least 6 different final consonants.

These are great developments. However, he drops a number of initial consonants
of words e.g. down, sun, sand, train... I've asked his parents to keep a list
of the ones he's dropping to see if there is a pattern. Right away what jumps
out at me is the clusters and fricatives which are later developing sounds.

This child presents with low facial tone and frequent drooling. We are teaching
him that his chin is wet and asking him to wipe it. I've asked the family to
talk about swallowing while they are eating so it will make sense to him when we
ask him to swallow before or when he shows drool.

Initially, he had difficulty matching vowels. He is starting to get an idea of
the rhythm of speech, but he was a child who was very quiet. Now that he is
more active physically--climbing, running, interested in jumping, and that he's
interested in songs, he seems more open to rhythm. I don't really know how to
explain this, but I was very concerned about his ability to generate language
and prosody, but am not so much anymore. He can repeat sounds and words and
seems to combine them with ease.

So my biggest concern is Initial Consonant Deletion. I know that it is not
normal developmentally for kids who speak English and or Spanish. From the time
he started saying words, he produced clear final consonants. In fact, some
initial sounds may have dropped off of words he initially produced with initial
consonants.

He's doing so nicely otherwise and his parents have an interest in him stopping
speech.

I'm going to try adding gestures to indicate beginning sounds he's dropping and
see if he starts putting them back in.

Has anyone seen this? Is ICD likely to resolve on its own?

I've considered putting therapy on hold for a few months and seeing what
develops. If he is having difficulties, it would be easy to reinstate therapy
or if not, discharge then.

Thanks in advance for any input you can offer.

Janet Farr

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