Oral Motor Exercises and Childhood Apraxia of Speech

For those of you who are following the apparently very controversial article “Oral Motor Exercises” and all of the comments, here’s a follow-up I received today from Dr. Lof. Here are his comments specifically related to oral motor exercises as they are used with children who have been diagnosed with apraxia, and of course, a few of my own comments.



Laura,

I just read the response to the response….
 
Please encourage everyone to read the ASHA position paper on Childhood Apraxia of Speech(CAS).? Remind them that practicing/exercising muscles will not improve speech…it is CASpeech!!!!? In CAS, kids have problems with muscle movements for SPEECH, not problems with muscle movements…if that is the case, then they would have dysarthria, not apraxia.? So movements without speech is meaningless.?
 
And just putting sounds with the movements may not work…it is sounds that have meaning ….so using simple syllables (some people do not believe you should ever work at the sound level, but at the syllable level as the starting point) would be better.
 

Hope this helps.

So? What does this mean for you if your child has been diagnosed with apraxia? Children have to practice SPEECH, not movements without any sound or movements with just a sound (such as “p” for /p/)?to be able to learn to talk.

Dr. Lof’s mention of working at the syllable level means that sounds aren’t practiced alone, or in isolation, as your SLP might say. Most early interventionists and pediatric SLPs use this approach since we work on WORDS in the context of daily activities or play. Sometimes SLPs (myself included) will cue the sound?in isolation, or by itself, to be sure the child is capable of producing the sound as well as to heighten a child’s awareness of the sound.

Your SLP might also use verbal, visual, or tactile sound cues such saying “Use your popper sound” for /p/ while pointing to her lips, or your “throaty” sound for /k/ while touching under your child’s neck. Again, this kind of practice should be very limited (no more than a couple of repetitions) and shouldn’t be the focus of the session since we’re talking about toddlers and young preschoolers here! Individual speech sounds should be placed in words pretty quickly so that the sounds make sense AND so that you don’t lose a child’s attention in this process. Cognitively, most children aren’t ready for intensely focused sound production practice until after 3.

Sound practice for children with apraxia isn’t recommended since it’s the SEQUENCING of sounds that usually causes the problems with intelligibility. He or she may be able to say the sound alone perfectly, but then it falls apart in the word or phrase. Practicing the individual sound over and over is often pointless since this is not the real problem. Let me also reiterate one more HUGE principle that I’ll emphasize yet again. If your child is really young and his LANGUAGE skills (vocabulary size, phrase length, using words to ask for things and respond to you, etc…) are?NOT age-appropriate, all of these speech or sound issues should take a back seat to helping him learn to be an effective communicator.  The time to address all of the specific sound errors is AFTER his language skills are well on their way to matching those of his same-age peers. Focus on WORDS and COMMUNICATION. Intelligibility will come, but it won’t matter anyway if he has nothing to say! Laura

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Comments

  1. Anon says

    Ok so the if your chid has apraxia oral movement with sound only is no good then? Sorry it’s all a little confusing and I’m just trying to figure out what’s what. Oral movement with words are useful for apraxic children though right? So does that mean therapy should consist say of practicing the ‘f’ sound like 3x’s then move right onto a word starting with’f’? I’m just trying to figure this all out because my therapist is doing oral movement with sound like first she’ll have him do tongue movements for 5x’s then she’ll add like the sound to the movement and then finally vowels to the sound. Is this correct for him or should it just be words? Thanks as always Laura

  2. Amy says

    I have a question regarding this. My son’s therapist has been working on vowel sounds with him for a couple weeks now (aaah, eee, ooh, primarily). He is still struggling with these basic sounds. We’ve been working on stringing them together (like ooh-eee-ooh-aah), and he’s having a very hard time with it. So is practicing these sounds, getting to a point where he’s not struggling (at least not as much as he is now) with them, not beneficial to him?

  3. Laura says

    Anon & Amy- I’m soooo sorry for all of the confusion!!! I should have just said – practice speech to make speech better! To say practicing using “sounds” or “words” with oral motor exercises is redundant since that is TALKING! I initially did say sounds with movement because I do see value with little guys in getting them to produce a sound alone to see if they can produce it AND to help heighten their awareness, and move it to a word pretty quickly. The thing with apraxic kids is that even if they can produce a sound alone (in isolation), it doesn’t mean they can necessarily produce it in a word since SEQUENCING sounds consistently and accurately is a big problem for kids with apraxia.

    But back to your question – when we combine oral motor movement with words – that’s talking! And THIS, according to the research, is what’s effective.

    Now using non-speech oral motor exercises isn’t harmful – the research just says it’s not effective.

    Again – hope I have clarified this without confusing anyone even more!

    I am not going to make any specific recommendations about what any specific SLP is doing with any specific child since I can’t and haven’t seen your children. There may be very good reasons why she’s doing what she’s doing, so I suggest that you have a conversation about this with her.

    Thanks again – Laura

  4. Miranda says

    My younger son is 2 yrs, 4 mo old and has a great vocabulary – spoken and heard – but great difficulty in articulation and being understood. It’s to the point where it’s very frustrating for him (and me, but I try not to let that through). For example, he’ll pronounce “John Deere” and “Daddy” and they are almost the same (dawdee for the former and daadee for the latter). He’ll usually pronounce the first syllable and then blur the rest, with occasionally a good word thrown in like “house” or “cow.” He will say 6-7 word sentences but I only catch 1 or two words at best.

    Everything I’ve read about speech delays and development doesn’t seen to address enunciation and clarity. I’m not sure if I should be working with a speech therapist, a speech pathologist (are they the same?) or an oral-motor therapist? And what activities or exercises can I do at home with him to help?

    Thanks!

  5. Laura says

    Miranda – I’m glad your son is doing so well developing his language skills. He may need a speech pathologist if he doesn’t seem to be correcting his sounds as he gets a little older. By 24 months children should be understood at least 50% of the time by their parents, and by 3 years old, parents should understand about 90% of what their child says, so he should be between that range to be considered typically developing. Some SLPs will start to work on specific sound production with a 2 1/2 year old whose language is age-appropriate, but 3 is really a better age for this since children are then able to understand and follow more complex directions (“Do this with your tongue”) or attend for longer periods of time when it may not be so fun.

    I’m not sure what state you’re in, but all states have early intervention programs and provide free assessments and free or low-cost therapy to children who qualify. You can google your state’s name and then the phrase “early intervention” for contact information. Some states will not qualify a child on the basis of articulation alone, unless it’s a very, very severe case. If this is the case, public school systems evaluate a child for free when he turns 3, so you could wait until then and see how he matures, or obtain an evaluation from a children’s clinic or hospital paying privately or using your insurance.

    Just for the record, SLP, or speech-language pathologist, is the “correct” and more modern name for our jobs, but some folks still use the term “speech therapist” since it jives better with physical therapist, occupational therapist, etc… It’s the same training -a masters degree.

    I hope that you’ve read the other posts about oral motor exercices. The current research is telling us that working on SPEECH is what makes speech more intelligible, or easier to understand.

    Hope I answered your questions! Good luck! Laura

  6. Sarah says

    Laura,
    I’ve just discovered your site and I’m so glad. My son is 3 yrs. 4 mo. and his communication is amazing, just not with many clear words. Others can’t understand him, so I have to translate. Lately, he’s been so excited to try new sounds so that he “can say words good like daddy”, and while they are clearer, he’s still difficult to understand. He’s not putting his tongue in the right places in his mouth to form the sounds correctly. We had him evaluated at the public school and he’s begun sessions once a week there, but all she does is point to a picture and have him repeat the word she says (we have him repeat words at home, so I don’t see how this is different than what I do). He’s frustrated that he’s not saying it right, but he loves to talk. As a former teacher, and a stay-at-home/homeschooling mom in Michigan, I’m looking for things that I can do with him at home. Some people say, “just give him time, it will come” and others say I should look for someone who will help him work with his tongue. I want to help him, but I don’t know what to do? Thank you for your help.

  7. Laura says

    Sarah – You’re doing the right thing by having him in speech therapy. Ask your SLP to explain to you what she’s doing so that you understand WHY he’s having a hard time with intelligibility and exactly WHAT she’s doing to help him with specific sounds. If she doesn’t have an explanation that makes you feel better about therapy, then I’d look for someone else.

    In the meantime you may want to check out my DVD Teach Me To Talk with Apraxia and Phonological Disorders since this outlines speech therapy strategies you can use to work with him at home to target speech intelligibility. While it’s not a substitute for speech therapy with a professional, it will teach you strategies to use so you can do some of this at home yourself which is ultimately what’s going to help him improve in the first place! Thanks for your question – Laura

  8. Erika says

    I have a little boy who is 2 years old. He has a mild to moderate hearing loss. He uses 2 word phrases in sign language and probably has at least 100 words in sign language. The thing is, he isn’t talking or even verbalizing. He seems very hesitant to use his voice and the only sounds I hear are throaty sounds and sounds that sometimes come from his nose. Do you think this could be a sign of apraxia? He is also very sensitive to sounds (phone ringing, kids laughing loud). His audiologist turned his hearing aids down a little and he isn’t as scared or sensitive to sounds as much now. What should I do about his spoken language?

  9. Anonymous says

    Hi Laura

    My son has sounds but can imitate a bit delayed but cant imitate sounds I require your suggestions on this How do I help him to talk

  10. Laura says

    Anonymous – That’s what this whole site is about. Keep reading! Try ideas in the expressive language section. Read the older entries first since they contain the most “how to” information. Laura

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