#335 Oral Alerting Activities (or Not!) for a Toddler With Markers for Apraxia


Several weeks ago an SLP I’ve struck up an email friendship with emailed me about one of her little clients. Here are snippets from our conversation…

Ali – How about kids who are noisy, show good comprehension skills, 10 of the precursors, imitating actions and gestures, but not imitating verbally? They seem like the brain is telling the mouth what to do but the mouth is stuck. I recently had another therapist swear by oral motor alerting strategies- vibration, massage, foods, nuk brush.  I would love your thoughts!  I have a 2.5 year old like this on my caseload right now.

Me – Does he have other markers for apraxia?

Ali – He JUST was able to imitate us a bit yesterday- sound effects and word approximations!  After many months! In terms of apraxia markers:

Yes- he shows some groping and he will often remain with his lips closed. He can imitate mouth movements, but not on request without a model. Yes, inconsistent errors he will say a word and then not again. He said “this that” approximation (di-dae) often for a month or more while pointing at things in books and then stopped. 

Yes to all of these:

  • Few or no words by age 2
  • Early word attempts are “off-target” and may not be understood even by parents 
  • The child usually understands much more than he can say.
  • Dad had speech therapy as a child
  • He can be a picky eater but he is not messy
  • He is imitating lots of gestures and signs and gross motor actions

My biggest puzzler came when a friend SLP said – you have got to do oral alerting activities- vibration, massage, foods, nuk brush.  I used to do these things when I first started as a therapist, but I don’t any more, due to lack of research, etc. How do you feel about those kinds of activities?

Listen for my answer as we continue this conversation on the podcast! Join us as we “think out loud” for this little guy!

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