Is My Child Apraxic? Answers to a Parent’s Questions

Teach Me to Talk with Apraxia and Phonological Disorders

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.

Laura

16 Comments

  1. Jessie on February 23, 2008 at 10:38 am

    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!!

  2. Karen on February 27, 2008 at 6:48 pm

    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!

  3. Laura on February 28, 2008 at 6:57 pm

    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

  4. Lil1 on March 1, 2008 at 8:25 am

    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.

  5. Lil1 on March 1, 2008 at 8:55 am

    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.

  6. Laura on March 1, 2008 at 6:50 pm

    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

  7. Lil1 on March 1, 2008 at 9:12 pm

    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.

  8. Laura on March 2, 2008 at 3:50 pm

    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

  9. Karen on March 13, 2008 at 6:48 pm

    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

  10. Laura on March 14, 2008 at 6:16 am

    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

  11. michelle on May 4, 2008 at 2:58 pm

    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.

  12. Gretchen on October 16, 2008 at 4:48 pm

    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!

  13. Betsy on February 20, 2009 at 10:46 am

    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.

  14. Sarah on October 22, 2009 at 3:41 pm

    Laura,

    My daughter, Isabella, is now 20 months old and I have been trying unsuccessfully to acquire speech services for her since she was 18 months. We live in Finland, where they do not typically treat children with speech and language issues until they are older than two years of age. The only “help” that we have gotten so far has been a few consultations / evaluations with SLPs. All agree that she definitely needs some help, but have not been able to take us on to their case load. As you might imagine, I am becoming increasingly worried that we are losing valuable time for my daughter and would like to know your thoughts on might be causing her difficulties and what we can do at home to help her.

    A bit of history:
    Isabella was a bit on the quiet side as a baby, but did produce “mamama” sounds right around six months. Overall, however, her babbling has not contained many repetitive syllables. Most of her babbling today is quite simple: mmmm, puh = her approximation for ball and only word, vvv. At one time or another, I have heard a large variety of consonants in her babbling (m, b, p, v, k, g, r, w), but now the number of consonants seems more limited (m, b, p, v). She’s also said a few words once and never again, germa = grandma, ernie.

    Her receptive language is excellent in English and fair in Finnish, having significantly less exposure. She follows commands well, e.g., give me a kiss, give the cat a ride in your stoller, put your cup back down on the table.

    Sign language has been our saving grace! We started using it around Isabella’s first birthday and have made huge strides. To date, I believe she produces about 170 signs, even making short sentences, e.g., “Daddy phone,” “hat on,” “give me please.” Signs help us not only know her basic needs, but give us a window to what she’s thinking and help us see how bright she is, even without speech.

    We are still waiting for her hearing test, which will be in mid-November. Based on her comprehension, it would seem strange if she had any hearing loss. In any case, we still need to rule it out.

    I have tried lots of things, many from your website to stimulate speech and sounds, without much success (lots of talking, short sentences, repetition, expanding on her signs and utterances, animated, playful interaction; repeating her sounds; bouncing on a therapy ball and making sounds; animal sounds; vehicle play; uh-oh; whee, etc…). She has only recently started repeating any sounds and will only even attemp the few sounds in her current repetoire – either consonants (m, b, p, v) or vowels (aaahh, uuuh) in isolation, never CV syllables. She definitely understands the concept of imitation because she can imitate all the signs and lots of other things she sees us do (e.g., talk on the phone, water the plants, wipe off the table). Somehow, she’s just not able to imitate many sounds. Do you have any suggestions on how to get her to imitate more? Based on what I’ve read, I’m starting to wonder if she might have apraxia.

    Thank you for reading our long story. I would love to hear your suggestons and thoughts.

    Thank you,

    Sarah

  15. Laura on October 22, 2009 at 9:02 pm

    Sarah – First of all, thank you for sharing your story and secondly, let me just tell you what a great job I think you’re doing to help your daughter. I hate that your guidelines don’t allow treatment until after 2, but there’s nothing you can do about that.

    As far as a potential diagnosis goes, I’m sure you’re aware that many experts don’t believe children should be officially diagnosed with apraxia until they are 3, and Isabelle is not even 2 yet. However, according to what you’ve said, she is exhibiting some of those red flags.

    I do have a new DVD with strategies for treating apraxia and phonological disorders at home, so this may be of help to you, since you’ll be able to see the techniques rather than just read them. I will also tell you that motor planning issues are among the toughest to treat, even for speech-language pathologists!

    Short of seeing those strategies, my other recommendation would be to keep reading and trying the ideas here on the website. She is very, very young, and just because she’s not responding yet doesn’t mean she won’t begin to make progress tomorrow, next week, or even next month. Keep working with her. More often than not, kids get better.

    If she’s still not hitting the speech milestones by age 2, then start over with another round of evals. By then you’ll be able to tell an SLP exactly what has and hasn’t worked at home which will be great information to help them tease out exactly what’s going on with her.

    Feel free to write back with any other specifics you need help with! I love hearing from Moms – especially those as committed as you – and who have no other choice but to do this themselves. I admire you!! Laura

  16. Sarah on July 16, 2017 at 10:14 pm

    Hi Laura,

    I know from your website and other resources that Apraxia is not usually diagnosed until after age 3, but my 22 month old seems to exhibit a lot of the red flags. His level of comprehension is above average and he can follow 2-step directions very well but, to date, the only consonant sound we’ve heard from him is ‘m’ and he can’t mimic sounds we make other than ooh, ahh and ut oh. Occasionally, I’ll notice him trying to move his tongue around in his mouth when he’s trying to mimic us, which is why I think planning issues might be the cause of his delay.
    We recently started working with a speech therapist through our state (Texas) early intervention program but it’s only 1x every other week (after only 1 session I have no idea if it will help). We are also enrolling him in a Montessori preschool next month and of course will work with him at home on the exercises given by the EI SLP. Is this enough?? Should I push for more sessions with the SLP at this age? Find a private SLP in addition to the EI SLP? (we are capable of paying out of pocket for any services if they will help). Or, should we just wait and see how things go over the next 3-6 months? I would appreciate any advice you could provide.
    Thanks again for your great website.

    -Sarah

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