[Below is a transcript of the podcast]
My name’s Debra Fenton and I am a speech-language pathologist in Denver, Colorado. I own a pediatric therapy clinic called Lowry Speech and Occupational Therapy. And as the name states, we provide speech and occupational therapy services, as well as we provide a lot of academic support. Today I’m going to talk a little bit about childhood apraxia of speech.
We do get a lot of questions about how to know if a child may be apraxic or not. And for those of you who aren’t familiar with the term apraxia, apraxia refers to a motor planning disorder and it can be specific to speech or it can also be related to motor movements. We do have children who do have apraxia in some of their gross and fine motor skills, so difficulty planning those skills. But today I’m going to really focus on childhood apraxia of speech. So children with apraxia of speech, I think one of the biggest indicators for a child who may be apraxic, really is a child who is really engaged as a toddler. They seem to understand everything really well in their environment. They seem advanced in their understanding of language. However, their ability to produce language is a complete mismatch. While they seem to understand everything they’re really limited in their ability to communicate although they may really be able to use gestures and pointing and maybe some sign language very well. So these are the kids that it just seems like it’s not coming together for them as far as their speech output, their spoken output. A lot of what these kids may say may sound really unclear. They tend to use mostly vowels. They tend to really have a difficult time with consonant sounds. The longer the word or the phrase they’re trying to say, the more difficulty they have. The underlying problem really has nothing to do with their ability to move their mouth with regards to eating. They’re able to chew food. They have no signs of any muscle weakness. Everything just seems like it’s in place except for the speech.
When we look at apraxia of speech a lot of times this difficulty planning does not carry over to feeding or eating difficulties. Although it can, but for a lot of these kids they’re eating just fine, they’re chewing their food, they’re able to purse their lips around a straw or a sippy cup just fine. But for whatever reason when it comes to speech, the sequence of movements needed just does not come together. These little kiddos early on tend to not make as many sounds that we would see most infants making. We talk about cooing and babbling when an infant says “ba ba ba, ma ma ma.” We see more just open vowels and not a lot of consonants. Around their first birthday, while they’re understanding really well, they’re following some directions or understanding routines, they’re really not using first words effectively to communicate. And a lot of these kids become really proficient with guiding parents to what they need, pointing, and a lot of parents at this age will start to use some basic SEE signs with their kids you know requesting to request more. They’re able to quickly learn how to use their hands to make signs but the speech is still lagging behind. Between the ages of 1 to 2. We see that these kids, their language is developing and they’re trying to say more but the clarity just doesn’t really come into place. They’re very difficult to understand and you may even see signs of frustration or avoidance when the child realizes that they’re not successful communicating using their mouth. They tend to maybe use the guiding the pointing and even some behavior to make their needs met.
When looking at a diagnosis of apraxia, it’s important to rule out contributing things. We want to make sure that the language skills are intact. Language and speech are two different things. Language is the system where they have the vocabulary their understanding spoken words. Speech is really more of the execution of the speech sounds on their behalf. Children with apraxia of speech often having inconsistencies in their errors. They may be able to say a word right one day or for a few days and then if they don’t practice it they’ll lose it and have a hard time saying it again. A lot of parents will say, “Well he used to know that word or he used to say it just fine and now he’s having trouble.” And that’s kind of one of the flags for an apraxic child is just the difficulty maintaining and building on their vocabulary.
So I’d like to just run through a few early indicators of apraxia and just kind of provide a list and you can kind of listen to that list and see if your child meets some of those or not. In very young children, the lack of sound play as an infant so they’re not cooing, they’re not babbling, they’re not making a variety of noises and using consonants in their early sound development. They’re late in establishing first words and when they do say their first words they might be missing a lot of sounds or just using vowel sounds. When they do start combining words it sounds very choppy and again missing a lot of the consonant sounds which makes it very difficult to understand. In older children, we see that they’re trying to talk a lot. But again that clarity piece is missing and sometimes it can be very difficult to pinpoint a specific sound that is difficult for them. It rather seems to be most sounds across the board are difficult for them. We see kids leaving a lot of ending’s off of words, dropping syllables in words and sometimes omitting words altogether. We also see some variances in their prosody or their speech rhythm, when they speak it may sound a little choppy and the way they form their sentences just doesn’t really match with what a typical speaker would do.
As far as treatment for apraxia, one of the most important things first is to really ensure that you have the appropriate diagnosis. The treatment for apraxia is very different from treating regular speech sound disorders in a child. So you really want to make sure that you get a good diagnosis and sometimes that is a little bit of a process. And usually, it takes a clinician a couple of visits with a child to confirm the diagnosis of apraxia. It’s a very difficult diagnosis to make in one single session. And when it is suspected usually prior to the diagnosis, treatment is initiated and the child’s response to treatment is a good indicator as to whether or not the child is considered apraxic. With regards to treatment for apraxia, like I said it’s very different from treating an articulation disorder. Apraxia is an underlying difficulty with motor planning. It’s not difficulty with strength, it’s not difficulty with auditory discrimination or difficulty learning sounds. It’s really just difficulty coordinating the motor movements needed for speech. So therapy for apraxia really is more of an intensive regimen. Most children with apraxia are seen three to five times a week with maybe shorter sessions but more frequent sessions and a lot of intensive drill practice. Basically, the treatment involves creating motor patterns and gradually increasing the complexity of the motor patterns and then gradually transitioning those motor patterns into meaningful speech. So it’s a very systematic protocol. It starts with working on some simple syllables with certain sounds and then gradually expanding those syllable shapes and the length of the syllables over time. If your child has apraxia and they are working with a therapist on more of an articulation approach where you’re working on a single specific sound, for example, you’re just working on the “G” sound, the “guh” sound, the child typically doesn’t progress as quickly in therapy because they’re not getting the motor practice opportunities that they need and the systematic approach to motor therapy that they need to develop their motor planning capabilities.
As far as finding a therapist who works with apraxia, that can be a little bit tricky because a lot of therapists know a little bit about apraxia, but it’s really important to find someone who has really received specialty training in apraxia and really understands the motor based approach needed to support a child with apraxia. There’s not a single program that’s kind of one fit for all. A lot of therapists will use a combination of approaches and tailor it to meet that child’s needs and figure out which program is really accelerating that child’s skills more quickly. There’s a great resource it’s called apraxia-kids org. and this website is really dedicated to providing resources for families with children with apraxia and it provides a list of therapists in all the different regions of the country that do have the specialty training. It provides a lot of information about the various treatment approaches as well as information about ensuring you are able to get a good diagnostic evaluation for your child.
Apraxia for many children is something that persists throughout their developing years and oftentimes by five or six most of the symptoms are you know usually resolving. However, there are some children where difficulty does persist and they will continue to need some ongoing support as far as literacy development. There are some additional things to think about as far as literacy support for children with apraxia. We learn to read and spell and we get a lot of feedback from our mouth and the way we say and shape our sounds and sometimes it can be really difficult for children with apraxia. So that’s also something to consider is literacy support for your child if they do have apraxia and getting a jumpstart on literacy development at an early age.
As far as the causes for apraxia, there’s really not a known cause although there are possibly some genetic components linked to apraxia. So if there is somebody in your family that has a history of apraxia then there may be a stronger tendency for related family members to be susceptible to it. But as far as developmental apraxia in families, developmental meaning something that is present from birth moving forward. There are different types of apraxia that can occur as a result of accident or injury and we often see adults acquiring apraxia after a stroke or some sort of head trauma. But that’s you know a very different type of apraxia than a developmental apraxia of speech that we see in young children.
So the takeaways for today are apraxia is a motor based speech disorder and it requires a very specific diagnosis which often takes place over the course of a few sessions with a speech-language pathologist and ensuring a diagnosis is really important because that really helps determine the treatment approach. As I mentioned earlier, the treatment approaches for a speech and language delay or an articulation disorder are very different than the approach used for apraxia. So making sure that you have the right diagnosis and the right treatment are extremely important. I hope I helped answer some of your questions today. We do have more information on our website lowrystot.com. And as well I provided a resource earlier on and I will repeat this it’s apraxia-kids.org. It’s a really fantastic resource for learning more about childhood apraxia of speech. Thanks for listening.