Is My Child Apraxic? Answers to a Parent’s Questions
Apraxia is a difficult diagnosis to understand. First I’ll tell you the “official” definition, and then I’ll tell you how I explain it to families that are on my caseload. At the end, I’ll give you my best advice for treating apraxia and can send you in the right direction for additional resources.
Apraxia is a neurological speech disorder that affects a child’s ability to plan, program, execute, and sequence the precise movements of his tongue, lips, jaw, and palate that are necessary for intelligible speech. Characteristics that help make the diagnosis of apraxia:
-Limited babbling as an infant
-Few or no first words
-First word attempts don’t develop into understandable words by 2
-Poor ability to imitate words
-Understands much more than he can say
-Makes errors with vowel and consonant sounds
Apraxia can be called developmental apraxia of speech, developmental verbal apraxia, or dyspraxia. The root word “praxis” means movement. “A” means “without,” so apraxia is supposed to mean a more severe form of the disorder, but in reality, most speech-language pathologists use the terms interchangeably.
Apraxia can exist alone and be the child’s main developmental challenge, or it can be part of a larger issue. Many children with autism or PDD, Down Syndrome, Cerebral Palsy, children who were premature, or those with other developmental delays can also exhibit symptoms of apraxia. Children with apraxia may often have sensory integration differences as well and seem to be at greater risk for future educational issues such as reading challenges (dyslexia), auditory processing disorder, or ADD.
Now for how I explain this to my clients’ families. I think about apraxia as “short circuitry” in the brain. A child with apraxia knows the word he wants to say, but then it gets “lost” somehow between “planning” and “saying” it.
How apraxia looks in real life:
-A baby doesn’t babble very much at all. She may only make noise regularly when she cries. She may even laugh without making much of a sound.
-When a toddler does begin to try to talk, he may say the same sound such as “da” for everything.
-You might notice that he’s moving his mouth to talk, but no words come out. Or he watches your mouth intently and then “struggles” or “gropes” trying to say the same word, but it still comes out off-target.
-She can’t usually imitate words, even words that you’ve heard her say on her own.
-He says a word perfectly one time and then never again.
-A child says a word fairly often and then one day, it seems to be gone.
-She makes errors with her vowel sounds too, which is unlike other speech problems. For example, she says “bu” for boat.
-A toddler may say words with a ‘g’ or ‘k’ sound which are later-developing consonant sounds, and not be able to say words with ‘m, p, or b’ which are early developing sounds.
-He may use only a single sound for a word, such as “c” for car. Or she may reduce all words to one syllable such as “ma” for Mama or “bu” for bubble.
-A child may say “Dada” correctly one time, then pronounce it two minutes later as “Gaga.”
-She may become “stuck” on a word. She repeats a word she previously said by mistake, or she says the same word over and over.
-A kid uses his mouth fine for eating, but then when you ask him, he can’t stick his tongue out, lick his lips, or copy other movements
-A toddler may not try to talk very much and resort to communicating by pointing, grunting, and leading, because on some level, he knows he can’t say the word, and even if he tried, nobody would understand him anyway.
-Once a child has lots of words, it’s difficult for him to sequence them into phrases.
-There may be a family history of speech problems. For example, all boys don’t talk until after 3. Granddad can’t pronounce difficult words like statistician, Episcopalian, or medical terms.
The good news is that children with apraxia can get better with speech therapy. Many children with mild or even moderate apraxia progress to the point that no one (except for maybe an over-analytic, picky speech therapist) would even notice a problem as they get older. Children with severe apraxia may take a long time, but then they do make progress. My best advice is …… Don’t give up! Make yourself a parent-expert on apraxia. Be an advocate for your child and insist that he get every minute of service he can qualify for. Read everything you can get your hands on about apraxia and implement those suggestions at home.
My best resources on apraxia for parents:
Becoming Verbal with Childhood Apraxia is a book by speech-language pathologist and expert Pamela Marshella. This only costs about $15 and can be ordered from www.superduperinc.com. It’s a thin book and an easy-read filled with great ideas for little guys.
For older children - Easy Does It Approach for Apraxia. This is a standard for treating preschool-aged children.
I also recommend the book The Late Talker by Seng and Agin. (I hope I spelled their names correctly. I have loaned out my well-worn copy!)
The best resource on the Internet is www.apraxia-kids.org. There’s a whole section for parents starting with a “newly diagnosed” section.
There’s my best “short” answer about apraxia. Please look for additional upcoming posts because I’m working on a feature-length article with more therapy tips for parents working with children with apraxia at home.
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Comment by Jessie on 23 February 2008:
Thanks for this site…it is great…my son has been getting ST for about 7mo now…and has added new words…actually a lot of new words…I think he is up to 130 now…but his intellagibitly tanks when he puts words together…I look forward to all the great info I can get from here!!
Comment by Karen on 27 February 2008:
All of this info has pulled me up by my bootstraps and revved me up again! Our son has been working 2-3 times each week with an SLP since last June, but we only specifically diagnosed apraxia last week. I was feeling quite low about it today when I stumbled onto your website. I’m going to grab the books you recommended right away, and I eagerly await every shred of info you have to share on apraxia. Thank you, thank you, thank you! My son has so much to say, and we want to do everything we can to elicit every little sound. I’m so grateful for finding you today!
Comment by Laura on 28 February 2008:
Karen -Thanks so much for your positive comments! You’re exactly the kind of mom this site is for! I am working on a new post about the activities I do in therapy sessions for kids with apraxia, so look for it by the beginning of next week. I wish you all the best on your quest to help your son! He’s lucky to have you for a mom! Let us know how he progresses, or if there’s any other specific information you’d like to see on the site. Laura
Comment by Lil1 on 1 March 2008:
Karen-I really look forward to hearing your ideas for helping apraxic children at home. My son will be 4 in June and has been seeing SLPs since he was 2 1/2 yrs old. Although he has many words and does well with sequencing he is still very hard to understand and the more words he gains, the harder it is becoming. I get so down sometimes about the help he’s getting but we’re stuck with the school distict slp. She has never given me anything to do with him to help him at him and keeps telling me his doing good and making progress. When I question her about certain letters he can’t pronounce, I’m told it’ll come with time. I have done a lot of research and read the book you recommended, which was great by the way and now I just don’t know what to do any more. The older he gets, the more worried I am he’s going to start falling behind when he starts school. He is so smart, above his age level in many areas and has no other ‘issues’ besides his speech. Any suggestions will be greatly appreciated. I have already tried some of your other suggestions in other areas of your site such as the word card games and look forward to more. Thanks so much and I’m glad to see attention finally being brought to this issue. To all the other moms out there just starting their battle, its a long and fusterating one for sure but you’re your child’s best advocate and have to keep fighting even when you feel you’ve hit a dead end.
Comment by Lil1 on 1 March 2008:
Oh ya one more thing sorry, his therapist is constantly trying to make him sit still and she plays games,reads books, plays with playdough etc for therapy. My son like many other 3 yr old boys I’ve seen, don’t want to sit still but yet she never tries any other types of therapy with him that could involve movement. Because she can’t keep his attention, the also had him seen by some other therapist,ei. OT and behavioral therapist and they indicated without saying it that they thought he could possible be border line ADD. I was outraged to say the lease and totaly put a stop to that idea they were having. My son does sit still when he’s interested in something and I feel he’s too young for a diagnosis like ADD. I think a lot of people jump to ADD disgnosis too early these days, what do you think? Thanks and sorry for rambling on.
Comment by Laura on 1 March 2008:
Lil 1 - Thanks so much for sharing your story with us. It is very frustrating to watch your child struggle to learn to communicate. I applaud your efforts to work with him and to be concerned about his academic success. Keep asking his school SLP for more suggestions for home. Tell her that you are very serious about doing the specific things she suggests. Until you get ideas, I hope the ones you read here will get you headed in the right direction. I am putting the finishing touches on the apraxia article this weekend, so it will HOPEFULLY be posted in the next few days. Again, thanks so much for your comments! Laura
Comment by Lil1 on 1 March 2008:
Oops I guess I should’ve read my posting a little closer, lot of typos for sure
Anyways thanks for responding so quickly. I have asked for ideas to do with him at home and have never received any. She knows I am serious because I was the one who found out about Apraxia on my on through website and then asked her if my son had it. Then and only then did she say that she believed he did indeed have apraxia. Have you had any experience with adding fatty acids to any of your ‘kids’ diets to help with their speech? Its one thing I haven’t tried as of yet and was wondering your experience with it. Thanks again Laura.
Comment by Laura on 2 March 2008:
Lil 1 - Keep on asking your SLP for ideas at home. The squeaky wheel gets the oil! Tell her that she’s the expert and you need her help.
I have had many families talk to me about fish oil, vitamins,etc… Most parents seemed to be pleased with the results. It’s so hard to know what’s working with a kid. Is he better because of the supplements, or because of therapy, or because Mom & Dad are diligently following through with ideas at home, or is it maturation, or a combination of all of the above. Truthfully, I never care WHY a kid gets better - only that he does!
I always recommend that parents do their own research to decide about supplements.
Good luck on your quest to help your son! Laura
Comment by Karen on 13 March 2008:
Hi, again, Laura - what’s your take on PROMPT? I’m trying hard to find a definition/explanation written in layman’s terms so I can actually understand it…I am initially hesitant as I don’t think my son will take well to a new therapist touching his face, but I don’t dare underestimate him as he proves he can be a superstar every day! So we will see a new therapist next week in addition to his current SLP, but the new one has basic training in PROMPT. We’ll just see how it goes and then decide how to proceed. Thanks for anythin you can share on this!
Karen
Comment by Laura on 14 March 2008:
Karen - There are lots of clinicians using PROMPT for the treatment of apraxia in toddlers. First let me say that I am not PROMPT certified, so my information is not as thorough as someone who is. I believe that PROMPT began as a treatment technique for older children.
If your child can tolerate the facial touching, I would definately give it a shot. If I were using that method, I’d make sure that I established a warm, nurturing, FUN relationship with him first, then moved on to the more direct, in-your-face stuff. If a child were tactile defensive, that is if he resists touch, I’d do lots of sensory warm-up activities first to make sure I got him in his “best place” to be able to tolerate touch. Your SLP should provide you with ideas for how to accomplish this right before she arrives, or she may include this as part of her treatment, if he really needs it.
Again let me reiterate that I believe that play-based strategies should be at the core of all speech-language therapy for toddlers. It doesn’t make sense to me to do it any other way. Laura
Comment by michelle on 4 May 2008:
I think it’s a miracle I came upon this site. It had so many answers that I’ve been looking for. Thank you. I will continue to read and get the help my 3 year old needs.
Comment by Gretchen on 16 October 2008:
Thank you for this website. I just found it today and I can already tell that it will help me get my three-year-old son (who’s been recently diagnosed with apraxia) the help he needs! Really…thank you!
Comment by Betsy on 20 February 2009:
My twelve year old son has been doing PROMPT therapy for 3 months, five times per week in addition to Neurofeedback four times per week. The progress has been good, but this combination of therapeutic intensity is what he has to have long term.