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.
Real-life Signs of Apraxia in a Child:
-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 Marshalla. 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.
My own DVD for treating apraxia is Teach Me To Talk with Apraxia and Phonological Disorders. Parents and professionals PRAISE this valuable resource as the tool that got them headed in the right direction for easy and effective strategies with toddlers.