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.


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



  1. Anon on September 18, 2008 at 11:11 am

    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 on September 18, 2008 at 3:14 pm

    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 on September 18, 2008 at 6:53 pm

    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 on September 25, 2008 at 3:19 pm

    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?


  5. Laura on September 25, 2008 at 5:55 pm

    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 on March 8, 2010 at 2:12 pm

    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 on March 9, 2010 at 8:20 pm

    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 on August 27, 2010 at 2:02 pm

    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 on February 14, 2011 at 7:28 am

    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 on February 18, 2011 at 11:59 pm

    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

Leave a Comment

Teach Me To Talk Testimonials

Happy Therapists, Teachers, Parents & Children

"Gosh, I love all of your emails/podcast/website, just everything!! I work in early intervention as a behavior analyst and am learning so much from you!"

Thank you!




I love your work! I am a professor of early childhood special education and a speech language pathologist! I have worked to help children learn to communicate and I know how valuable the information you share is for both early interventionists and pediatric speech language pathologists!

Thank you for systematically organizing and explaining essential steps for young children to learn and develop. You are having a great impact on our profession, the ECE profession and families!"



"Thank you.

If this is Laura herself reading this email let me take this opportunity to thank you from the bottom of my heart for all that you have put forth for us professionals. I own every manual (except the autism manual) and have watched every course on DVD. I have listened to countless podcasts. All of what I’ve come to be as an Early Intervention speech therapist was absolutely to your credit. With your resources at my side I have never needed to scramble for answers and strategies and above all the clear language I use when communicating with parents. My fun, animated affect and key phrases I use have been learned through watching your example. So….thank you! May you be blessed."


"I just wanted to thank you so much for your incredible help! You are so kind and lovely and every time I implement something you've taught in your manuals or videos it is always a success, I cannot thank you enough. I really appreciate how specific you are in giving us examples of wording to use and how to use a toy in therapy with your videos, it is exactly what I need to properly help my little students. I also really appreciate your list of books of list of toys. I have seen my little students make significant progress thanks to you. I'm looking forward to watching more of your videos, taking more of your CEU's, and reading more of your materials. From the bottom of my heart: thank you so much again!!"


"Dear Laura,

What an inspiration!

Thank you for helping me be a better Developmental Therapist. I often listen to your podcasts which help me help families.

Your enthusiasm, professionalism and
the sheer volume of information is so great.

You are part of my team.

I just wanted you to know I appreciate you."


"Dear Laura,

Thank you for your generosity in sharing so much knowledge in such a clear and enthusiastic way.

As a retired audiologist with a fabulous and language delayed grandson, I used your podcasts and outstanding publication, The Autism Workbook, to inspire and guide me over the past year.

It works!! He went from barely verbal, no gestures, didn't respond to his name etc etc to a verbal, social, curious, ready to imitate anything, fill in the blanks on familiar "set" speech, generate his own totally appropriate and mostly understandable sentences...not just short phrases anymore... full little paragraphs...about imaginary things, what he did during the day, what he wants. True communication!

You make a powerful difference in this world! ❤"

With gratitude,

"Laura Mize, you are a Godsend. I don’t know how one human can have so many helpful things to say in a beautifully organized way, so often. Always amazes me when another super helpful email comes from you, and for free. With free YouTube videos and cheap CEUs. THANK YOU!!!"

Sheila, Canada

"I purchased the book on autism and have watched the #400s series podcasts. Laura Mize has been more effective in teaching autistic tendencies, than many professors, shadowing professions, and the 100s of books, articles and classes or videos, or live workshop speakers, have been at teaching effective practices for a child with ASD. Some of the many lessons she has taught, which I will now use, to be a more effective Interventionist, include but are not limited to: red flags, typical behaviors, self-stimulating behaviors, not taking away toys, rather showing child to play with toy appropriately. She gives examples of child's actions, "inappropriate," explains the reason for: why the child is engaging in these behaviors and how they can be replaced with more appropriate, effective fuctional and age-appropriate skills."

"I’m sure Laura gets these messages all the time, but I thought I’d share. I stumbled across Laura‘s "Autism or Speech Delay?" YouTube video when I really needed it. This video finally listed and explained some of the red flags my son was showing for autism. I share the link anytime a parent is questioning in my FB autism group. This mother I don’t even know said Laura's video changed her life. I know exactly how she feels because It changed families too. Thank you to everyone at Teach Me To Talk."


"Good Morning Laura,
I received your book (The Autism Workbook) yesterday and it is absolutely amazing! As I evaluate young children (0-3) for developmental delays and write plans for them with their parents, there are a ton of ideas that are ready to use. Others that reinforce what I have been doing, and saying, all along. Thank you so, so much for writing this incredible book and pulling everything together in one place!"


"Thank you very much for sharing your knowledge, experience, and guidance.
I’m a parent who bought the autism workbook and it’s the only clear resource I found to make a change in my son. I’m really thankful to Ms. Laura for helping out people like us all over the world."

"Laura Mize, all I have to say is that ALL YOUR STRATEGIES WORK."

ANNE, YouTube viewer

"We have 7 SLPs in our preschool (public) program for special needs children (ages 3-5) and we use your courses, books, and techniques every day! :-) We have seen our preschoolers make such great gains!"


"I just received Teach Me to Play With You, and it is ALREADY WORKING! WOW!

Girl…my son is 3 years old, and he NEVER asks for something using words. We were playing “Get Your Belly” (from Teach Me to Play WITH You), and after several times, he laughed and screamed "BEWIEEE!!!"  It was a hoot. And I can't believe he said it! I have played with him like this before, but this time I took your advice and acted CRAZY!! I will act like a total lunatic if it will get him to talk to me!  Now I can give him "the look" from across the room, and he will say it. That manual is so amazingly practical, and it is a GODSEND right now! Thank you SO MUCH!”

"I wanted to send you a quick email to say thank you. I started watching your videos/podcasts about 4 months ago. My son has gone from losing words he previously used, only having about 7 words at his 2 year check up in August (assessed at a blended 10 month language level) -- to now having so many words, increased social engagement, following commands, spontaneously requesting things, and naming letters & numbers (not in order) as well as colors. We had our monthly meeting with our SLP through the state infants & toddlers program and it felt like we were just bragging the whole time, but I knew in the back of my head it was because I have been using strategies you taught me.

We still have so much work to do with our sweet boy, but I know in my heart he would not have succeeded without the education you provided. I will continue to read your emails & watch videos as we go along this journey and face challenges, but credit is due to you, Laura.

Thank you so much, endlessly."


"I just want to tell how fortunate I feel to have found your website and you!! I became a special instructor in EI almost a year ago and I started with hardly any applicable training. I felt so lost and confused as how to help the kids I work with learn how to use words and play. Honestly, I didn't even understand the importance of play, although I always played with my kids. But, once I started to watch your podcasts and get some of your manuals I felt a weight had been lifted off my shoulders and that I could finally teach these kids and their families something of value from a real therapist and based on research!. Thank you so much for seeing the need to help other EI service providers and providing a forum to share your knowledge and years of valuable experience. I'm sure you get a lot of these emails every week if not every day, but I wanted to make I could add to those notes of gratitude!! THANK YOU again!!"


"Just wanted to say a HUGE thank you for these emails and your books, I have them all and they have seriously saved and improved my sessions with my kiddos. Huge thank you."


"I was very frustrated with how speech therapy was going for my child. I would take him and drop him off and not hear much of anything from his therapist and teachers other than, "He had a good (or a bad!) day." Your materials were invaluable for us because I learned how to work with him on his speech. I learned how to teach him to talk and play. I learned how to pay attention to his cues and work with him to teach him to communicate. Without it, I have no doubt he still wouldn’t talk."


"Hi! I just wanted to say (from an SLT perspective) how incredibly useful I am finding absolutely all of your articles, blogs and resources - I only discovered your site last month and have just received all your books which I feel I am learning more than on my entire university training course!! But also the way in which you give specific, realistic, fun, encouraging ideas for working with parents is really just fantastic, I only wish I have your site sooner! Thanks so much from the UK! Kind regards."


"I just wanted to reach out to say thank you for making things a little easier to manage for me this year. I made the transition from school SLP to private therapist about a year ago. While the change was welcome, it was a lot, and I was just getting my footing in the clinic when I began teletherapy full time. Your website has been a huge lifeline in helping me work with late talkers and coach their parents in an accessible but effective way, even remotely. I look forward to getting your emails each week. I am floored by the amount of valuable, free information that your website provides, and I’m looking forward to investing in your workbooks soon. A sincere thank you for all you do!"


"You are an inspiration! I am truly grateful for the way you put into words and writing how to do what we do as SLPs. At this time in my 13 years of practicing, I find your encouragement keeps me going. As a single mom, I find it a stretch to buy materials these days and I am so thankful for the freebies you so generously share that help me teach my families. I don’t have much time to put together lists or quick references for parents!! Much gratitude!!"


"I just really appreciate your courses! I have two new clinicians that I’m working with and have recommended these courses to both of them. I’ve watched quite a few and have learned so much about serving this population. To be honest, before I started implementing your strategies I was a little frustrated with the lack of progress. My skills with engaging these little ones have improved so much! Thank you so much for making these CEUs so valuable!" C, SLP