Here are quotes from actual emails sent
to us that may help answer your late talker vs.
apraxia questions. Answers are from Lisa Geng, and approved by the
experts from our nonprofit
How can you tell the
difference between a child with verbal (not oral) apraxia
and one that is a late talker?
You have a terrific website, but I could not find the answer to my question. How can you tell the difference between a child with verbal
(not oral) apraxia and one that is a late
talker. My son is 25 months old and communicates largely by
saying ah, pointing and verbal expressions. He makes lots of sounds and
shows no signs of oral apraxia. I'm
planning to have him tested by an audiologist and speech therapist this
month. Their results will be turned over to a speech development
specialist. Before going through all this cycle I'd like to get a better
understanding of what sets a late talker apart from a child with verbal
apraxia. Do you know? I can't seem to find the answer to this question
Thanks you for bringing up such an excellent question first of all!
I left the late talker vs. apraxia questions to be answered by links and
evaluations from experts, however, there are "warning" signs of
apraxia that I can point out from a parent's perspective. Even
though I'm a parent, like you, because I feel like I had to study for my
masters in apraxia in order for my son Tanner to receive appropriate
therapy, I forget that it takes time to understand some of the expert's
First of all, (from the experts) oral
apraxia can be diagnosed as young as 18 months, while most experts
believe that it's difficult to get a definite diagnosis of verbal apraxia
until the age of 3. You say your son is 25 months with no signs
of oral apraxia. This said, it's also
believed that if apraxia is "suspected" to begin the appropriate
oral motor therapy right away because it won't
hurt, and the earlier the better for therapy with apraxia. Even with
early intervention, some children with apraxia may always need an
alternative way of communicating/to assist communication (sign language, picture exchange
communication, computer, etc.) but many will learn how to overcome the
apraxia: enough to talk and be understood.
Through Early Intervention (free
through your state birth to 3, and through your town's
school from 3 up) or through private, insurance,
out of pocket, an expert (SLP, OT, developmental ped, neurologist, etc.)
will evaluate your child's ability to move his tongue on command, and will
"test" his strength in various areas, (physical, language,
emotional, social, and intellectual development) all fun ways though with
toys, so he'll love it. I recommend that you are in the room with
him, I was ALWAYS there with Tanner, for all his evaluations, testing, and
therapy, except when he started the preschool disabled program. (We
now can watch from a two way mirror when we want) Some therapists
want to be alone with the child, some parents feel their child behaves
better. I believe that since my husband and I are with him most of
the time, we are also so important for "carry through" therapy.
For us this has worked the best.
Your child may be a late talker for a number of reasons outside of
apraxia. Most likely it is a delay, but like I said, early
intervention is a free, federal program your child is entitled to if he
qualifies, for whatever the reason for the delay in speech. There is
lots of research in to the birth to three brain stimulation, so the
"play therapy" your child would receive from early intervention
will most likely benefit him for whatever the reason for the delay of
speech. If your child just starts talking perfectly a week or a year
later...great! And then do you really care what the reason was he
was a late talker? Since no large research has been done yet on the
neurologically based condition apraxia of "unknown origin," all
of us as parents of children with apraxia have questions, but we may not
have those questioned answered before our children are teenagers, or
adults. Our main goal as CHERAB
Foundation is to help all children learn to talk, and we do know what works for teaching a child to communicate, overcome
apraxia, reducing frustrations for a "late talker" for whatever
the reason, etc. A few of the late talkers out there do
have apraxia, and the fact that your out there researching on the internet
shows you are the type of parent who's child is in good hands for whatever
the reason he is a "late talker." Knowledge is so powerful
in helping us to help them.
list addresses late talker vs. apraxia, with a focus on medical
research, early intervention and education. We have medical, speech
and educational professionals on this list from our organization who have
volunteered to answer your questions. We also have many other
wonderful parents and professionals on this list from all over the
world. You may wish to post some some of your questions there.
Here are the "late talker vs. apraxia" or delay vs.
disorder signs that I saw/see in my four year old Tanner
as he was/is "learning to talk."
Apraxia is a disorder, and it will not self resolve:
typical delays of speech will self resolve (meaning even without therapy
the child will "learn to talk.") Here
is a link that will lead you to
"parent friendly" signs of verbal
apraxia. Here is a link that will
lead you to "parent friendly" signs of oral
2. How can you tell the difference between a
child that's not talking because he's shy, and one that has apraxia?
'Based on what I have read, I believe my 3 year old son has
oral apraxia as
he has many of the symptoms. For the past year he has been in
speech therapy and has made some progress. His current speech therapist
attributes his speech delay solely to shyness. I know that his
shyness is only a small element of his speech delay. Although he is
saying many words, his speech is very unclear to anyone outside of the
family. He still cannot say any 4 to 5 word sentences confidently.
It takes a lot of prompting from me to get him to expand his speech.
Recently he was tested to see if he qualifies for the school district's
preschool speech therapy program. During the assessment I asked the
speech therapist for her impressions. She said she thinks (our son)
has poor oral motor planning, but would have to consult (our son's)
current speech therapist for confirmation of this diagnosis.
The IEP for (our son) is scheduled for next Friday and I'm
about what they will propose for therapy. From what I have read,
individually with a speech therapist is most effective. I know
going to push for him to be in a small group preschool format.
will fight for what is best for (our son) . How often did
Tanner meet with his
I am thankful to have found your website. Any additional information
Tanner's therapy that you can give me will be greatly appreciated.
add me to your e-mail list. I would like to watch the Inside Edition
T.V.'s segment on apraxia and The Children's Apraxia Network.
The fact that you are continuing to learn
more is wonderful. Keep up the great work! We always say late talker vs. apraxia, but now we have
(your son) "shy vs. apraxia!" I believe this is an easy
one to answer!
About the diagnosis of apraxia, according to that experts, it's difficult
to give a definite diagnosis of verbal apraxia until the age of 3, (your
son's) age. Oral apraxia, which you say Kevin shows signs of, on the
other hand, can be diagnosed as young as 18 months.
My son Tanner used to seem or be shy because he was dependent on people he
felt comfortable with to communicate for him, or understand him, but that
"shy" behavior disappeared as we provided alternative means of
communication. I didn't think of it as much as shy as I did
His speech disorder didn't go away when his shyness did. In other
shy or not shy, Tanner has a speech disorder. Also, does (your son)
clearly in front of anyone? Like you or your husband, his mom or
(your son) ever, or frequently speak in clear sentences at home, or
anywhere? If so, then perhaps your therapist is correct. If
not, to help with any shyness/dependency, have you tried Picture Exchange
Communication? That would be where (your son) points to a picture of
a juice box vs. a cup when you ask him what he wants his juice in for
example. You can do this for
breakfast choices, anything! Also, let (your son) know that
"everybody has to learn to talk." It's true, your just
leaving out the details!
Even though (your son) is showing improvement, which is great, it concerns
me that (your son's) therapist believes that his lack of speech, and his
unintelligibility, is from shyness, and yet he is showing signs of oral
apraxia. Again, oral apraxia is something that could be diagnosed as
as 18 months. Apraxia is neurologically based, and it is not a
psychological disorder. Even though children can develop low self
esteems from communication challenges, (your son) is still so young to
know for sure that
what he is going through is not normal. If he does have shyness
affect his speech, then that's an issue you can deal with in simple ways.
But I would highly recommend that you seek a second opinion from an SLP
that is knowledgeable about apraxia and other motor planning
In addition to oral apraxia, it's not
uncommon for apraxic children to have
other issues (Don't freak out-treatable ones) like low tone/hypotonia
looks like the cherub baby, or sensory integration issues. He's at
where you may start to notice these other added surprises and it's good to
know what they are so that you can help Kevin if he has either. But
your getting second opinions on the "shy vs. apraxia" situation,
other things to ask about.
About sentences. With Tanner, at 2.8 he was in therapy 2 to 3x a
week for 5 months at that point working on basic sounds, and he couldn't
even put "ch" together with "oo." When he was 3
years old, (your son's) age, he had a surge and was up to 20 or so words!
But they were all pretty simple words, and he wasn't up to even 2 word
sentences. Tanner turned 4 this past June, and he is talking in 2 to
8 word sentences now that are understandable to anyone.
The reason I am telling you this is because
if (your son) does has apraxia, I
would let the experts on apraxia guide him to longer sentences when he is
ready. Tanner's therapist had a great example of how many words in a
sentence Tanner was capable of saying.
This is something you could try:
Buy 2 blow horns, and you blow into one and give the other to (your son).
Imitate (in a fun way) each other's toots. Let him take the lead,
take the lead. If (your son) can't imitate 3 or 4 toots of a horn,
he is not
ready for 3 or 4 word sentences yet. It has to do with breath
control. (this response then went into IEP concerns for school,
which I believe is covered in this next question.)
3. Is it
appropriate to ask for 5x a week, one on one therapy for a nonverbal 10
"We have a 10 year old son that is
completely non-verbal. He has been getting speech therapy since he was 3,
although not very intense. Would it be unreasonable to ask for half
hour a day, 5 days a week from the school?"
There are so many unknowns to directly answer your question. For
example, has your son ever had a diagnosis that explains why he is
nonverbal? If so, who diagnosed him, and when? Was he ever
diagnosed or misdiagnosed as having cognitive issues/autistic/mentally
retardation, etc.? Have you taken him privately to a developmental
pediatrician, neurologist or speech and language pathologist that is
knowledgeable about apraxia and other disorders? Does you child use
picture exchange communication, sign language, or augmentative devices to
communicate now? Is he mainstreamed, and if so, how does he perform
in school both academically and socially? Does he play
appropriately, with friends, or alone?
Your son's school is required to provide him with appropriate therapy,
either in district or out of district. They aren't necessarily going
tell you this of course. What this means is that once you know what
child requires (even if that is 5 days a week, intensive one on one
"appropriate" therapy) if that's what experts evaluate that he
seek diagnosis and therapy outside the school) because of his diagnosis,
then they need to provide "appropriate" therapy. If they
can't within their
own program, then they are required by law to find alternative situations.
Again, this can include paying for you to take your son to an outside
therapist, paying for an expert to work with your son in the school and
direction to the school based SLP to follow, or even out of district
placement. This means of course that a private school could be paid
your school system if they are not providing appropriate therapy.
Of course your son's school system will most likely say they are providing
him with appropriate therapy, have done so for the past 7 years, and that
he is not responding. If however, your child is severe apraxic, the
therapy he has received does not sound appropriate according to the
experts, but without knowing what his reason is for being nonverbal, or
what therapy he receives, that's hard to say. This is again why it's
so important to have some experts outside of the school overseeing your
child, It's important to have a hero for your child on the outside of the
school, especially since your child is 10 years old and non verbal.
These same "outside the school" experts on apraxia and other
(developmental pediatrician, neurologist, SLP, OT, etc.) can
reason for him being nonverbal, watch over your child, provide
often as you can afford, and make sure your child is meeting the IEP
(individual education program) goals that he/she helped to set. I
you will need to pay for these second opinions or therapy sessions
(hopefully through your insurance,) because if they are on the school's
salary, I don't believe results are always going to be unbiased, which is
what your child deserves/needs. Know that you can have it
written into the
IEP that you want evaluations (from now on) every 3 weeks, 2 months, 6
months, whatever your son's (private) therapist believes is necessary.
people, like me and my husband, thought IEPs are yearly, they are
between the school and you and your child. Just like any contract,
negotionable. In your child's case, you've given the school 7 years
help, and perhaps they have done "everything that is
appropriate," but why
wait another day if they are not.
Again, it's a federal law that they are required to provide your child
appropriate therapy. And also again, please find out what that
therapy is for your child from outside experts, and then fight to have
offer that to him. Of course you can use information found on the
but that's once you have a diagnosis. Squeaky wheels do get the
It's good to look into other town's programs, out of district, or paying
your private therapy. I noticed some of the responses to your
other parents said their child's therapist was only in the school for 2
a week, so they couldn't receive any more therapy. If you show they
providing appropriate therapy, then you can have them pay for your private
therapy sessions, or pay for your private therapist, or another expert on
apraxia, to come to your son's school as a consultant once or more a week.
With some creativity and willingness, things can be worked out in most
without having to go to a special ed attorney (another option of course.)
If your school tells you things that make you uncomfortable or that you
believe are not accurate, tell them, "That's interesting. Could
that in writing for me?" (For example if they say they can't
than two or three days of therapy a week) Also know that you don't
need to sign the IEP right away. You can take it home and show it to
before that, you can take others with you to the IEP meeting, including
child's private SLP, or a parent advocate, or even a tape recorder!
Use the severity/Intervention matrix link found as a link on our website-
and if your son is apraxic, the page and links which show the importance of one
on one therapy for apraxia stated by various experts-one after
another, there are also numerous links to other sites which have a wealth
of information if your child is apraxic.
You are an expert on your child, and you can back that up with your
knowledge/experts on apraxia, or whatever the reason your child is
nonverbal. Together, you are a powerful team that will find
therapy for your child. Have you seen "Ask the Dr.?"
Dr. Agin is
brilliant, and can probably help as well.
4. What are some
strategies to help my child deal with his frustration due to speech
" My son Gabriel, who is
now three, has been recently diagnosed with apraxia. He has improved
drastically over the last three-four months. But he gets frustrated very
easily. The harder he tries to say something, the more scrambled the words
come out. I
don't know what to say or do to help him, help me understand. what are
some at home activities that we can do to help him? During the week
I only get to spend about
three hours with him before he goes to bed and I want to make it count.
Also,how can I go about finding a speech therapist in the Houston area
that specializes in apraxia?"
Both our children were "late
talkers" for different reasons, so when we saw our children
getting frustrated, we automatically would say things like "Oh I
remember when I was learning that sound when I was your age. Your
doing better than I did!" You can also say things like,
"Just remember what you want to tell me so that when you learn to
talk you can tell me. OK?" Our son Tanner used to smile
when we talked to him about how one day he will be able to tell us all
his secrets, and sing songs to us. Now here it is a year later,
and he is! Tanner still has a way to go, but he really is doing
Today our older 6 year old son's speech
challenges are undetectable to anyone but a professional, but we
continue to use this approach for our 4 1/2 year old with apraxia.
Neither of our children were ever self conscious about the way they
talked, and it's worked so well to boost their confidence that both
children will talk or sing in front of groups of strangers, even our
child with apraxia! When we won the competitive grant from Seton
Hall University's Law School Tanner sang to a roomful of lawyers, maybe
that's why we won, because he won their hearts! Each child is
different, so perhaps the approach we did wouldn't work for your
child, but it's something you may want to try.
Here is another trick to reduce frustration,
we remember what our child says in our head so we don't have to ask him
to repeat it. Scott Bilker
uses a digital recorder so that he can play back the word or words
again and again without asking his apraxic son to repeat. He's
got a great site to visit anyway to listen to children of various ages
with apraxia speak.
Sometimes people, even family, may talk about
child's "not talking yet" right in front of him. With
family or friends I will usually cut them off with a look, and then say
"yes, he's learning to talk right now, and he's doing great!
Aren't you (your child's name") And then let them know I will talk to
them more about how well (your child's name) is doing after he goes to bed, or
whatever. I've use the same approach with children (or adults) we
don't know who ask,"why does he talk funny?" I'll say,
"He's learning to talk, and he's doing great" In my
experience that approach stops the questions immediately.
For any child learning to talk, research
shows "alternative" means of communication are helpful
for both reducing frustrations, and encouraging healthy language
development. This includes, but is not limited to, sign language,
even baby sign, picture exchange communication, (for example where you
have a child point to pictures of breakfast foods instead of telling you
what they want for breakfast) augmentative devises, etc. It's a
good idea to let your child "play" on the computer with age
appropriate games if he is interested.
I just read a book that was interesting as
well written by Jill Smith, MA and Howard Diller, MD called "Late
Talking Preschool Children Children who may be diagnosed as PDD"
The children studied in this book were not necessarily PDD, but they may
be classified as such. The book is only about 80 pages, but the
information was interesting in that they show the most important issue
is to raise the self esteems of "late talking" children as
soon as possible, and just like we did (parental instinct I guess) keep
them from knowing anything is wrong with them. The research
involved teaching preschool "late talking" children to read,
which increases their confidence, gives them another way to communicate,
and (hopefully) prevents future learning disabilities. The book
outlines the system they used to teach nonverbal preschool children to
There are quite a few home activities links
and information you can find both at our site,
as well as information on sign language and picture exchange
communication. Apraxic children in general respond well to one on
one time. Therapy comes in many disguises, so it's easy to
"just be a mom" while you are incorporating some helpful
therapy techniques into the time you spend playing and hugging him.
As far as a therapist in Houston that
specializes with apraxia, have you checked with ASHA? We have
their link at our site as well. If you still can't find someone,
and nobody emails you with names, let me know.
5. Are all late
" You mention that both your sons
were "late talkers", but had apraxia. I
thought there was a difference, meaning some kids are late talkers, but do
not have apraxia. Did I misinterpret?"
if our story is so confusing, but I hope this explanation will
clear things up.
The easy answer is yes, a child can be a late talker and not have
apraxia. But because you brought up my two "late
talking" kids, we go to the tough question! The pediatric
neurologist diagnosed our older son, Dakota, with oral apraxia
at 2, but Dakota never had
oral or verbal apraxia in the way our son Tanner does. Dakota's
"apraxia" was used as a symptom (like if you
look up the word apraxia in the dictionary and use it as a definition
describe what is happening. Loss of ability to...) The word
used for Tanner as a diagnosis. Tanner has oral and verbal
Up to now there are so many names for apraxia - the neurological based
disorder we are talking about when we say "Children's Apraxia
example, names such as dyspraxia, verbal apraxia, oral apraxia,
developmental apraxia, global apraxia, limb apraxia, oral motor
etc. and because the speech and medical community are not always on
page, names are used by professionals that are very confusing, or that
conflict at times. Some neurologists are knowledgeable about
some are not, some are knowledgeable about apraxia, but use other
describe it. I'll explain.
Tanner was diagnosed as severe oral and verbal apraxic by various SLPs,
and by Dr. Marilyn Agin, however the same pediatric neurologist who wrote
in an evaluation that Dakota has "oral apraxia,"diagnosed Tanner
as having a "phonological motor processing disorder which effects motor
speech." You see, this neurologist used the term
"apraxia" as a symptom
rather than a diagnosis since in his medical opinion the diagnosis
was not clear. "Apraxia of what? The limbs, the eyes,
it's to vague a
term!" is what he said to me in a frustrated way.
"I don't like this name
apraxia, it's to vague!," he also said. So even
though this neurologist
knew Tanner was diagnosed as having oral and verbal apraxia by many
other speech professionals, and by a medical professional, and even though
he understood what apraxia was, he still did not want to use the term
"apraxia" to diagnose Tanner. He preferred the diagnosis
"phonological motor processing disorder," but if you run that past some SLPs, some
will say that means something different than apraxia!
Since Dakota, our older son had "facial palsy" from crushed
among other things, from a traumatic delivery, it created "oral
this was describing the action of the nerve damage, not diagnosing him
being oral apraxic. It's complicated, but yes, even though both
had oral apraxia, only Tanner has apraxia, the neurologically based
disorder of unknown origin. So for all of you with one child
trying to explain this to family and friends, imagine us! Thank
Dakota today is mainstreamed and getting top grades in school!
can't wait until Tanner makes it out of the woods as well at some
Once again though, our situation is unique and isn't the best example
typical "late talkers." One was a late talker from
birth trauma, and one
was a late talker from apraxia, but they both were described as having
apraxia. The average late talker does NOT have apraxia.
Apraxia is not
rare, but it's not that common either.
6. Is there an association between apraxia and
"Hi! My name is Candace and my
three year old son has apraxia. I have a few questions for
anyone who is familiar with this language disorder. First, Is
there an association with apraxia and mental retardation? I
asked a professional what they did 25 years or so ago with children who were
late talkers and she said alot of them were labeled mentally retarded.
Also, she said the an IQ test is based so heavily on language development.
What are your thoughts? Second, people say that when my son does
use his words ( which is the approx. of 20) that he sounds like a deaf child.
Although my son had alot of sinus infections, he did pass a hearing test. He
has no high and low pitches to his voice and he mostly picks up the vowels.
Is this typical with apraxia kids? Third question, my son
also babbles like a baby at times. When we are out in public, people tend to look at him.
What do I do?"
I'm sure you will receive many responses
to your excellent questions, but I wanted to address some of your
questions right away that I have the ability to even though I'm a
parent, not a professional. (This is because of my e-degree,
and life degree in apraxia research!)
A child can have apraxia and have normal
or brilliant intelligence, from what I've read, seen, and heard,
most do. Just so you know however, a child COULD
have apraxia and other issues, such as apraxia and mental
retardation, or apraxia and autism, or apraxia and cerebral palsy,
or apraxia and downs, etc. (Just like they could have a broken
leg and autism) This is why it's so important to bring your
child to developmental pediatricians, or/and neurologists who are
knowledgeable about apraxia as well as other issues. Don't let
anyone treat or educate your child as having cognitive challenges
unless you know for a fact he does. And don't leave it
up to your child's school to "find out" and classify him
or her as mentally retarded. Find out by having your child
privately evaluated by a medical authority, or two, that you
respect, and who has experience and knowledge of apraxia and other
Careful of "receptive" language
evaluations on written reports. Your child can have a severe
expressive delay, but if they write a "severe expressive and
receptive delay" it means something different. That's a
red flag that there could be cognitive challenges going on. It
translates (in parent language) to "Your talking to this child,
but there is nobody home." If that's the case, again, see
a medical professional, but if that's not the case, your child does
understand and can follow simple commands, these are the first baby
steps to misclassifying apraxic children. Take it seriously
and find out privately.
Don't just depend on one diagnosis,
especially since many apraxic children have been misclassified or
misdiagnosed. This is one of the reasons we so highly
recommend Dr. Marilyn Agin, because she has the background of an SLP,
but is now a developmental pediatrician who specializes in autism
and apraxia. She does lectures to medical and other
professional communities about these issues and others, and tries to
raise awareness so that apraxic children will no longer be
misdiagnosed, and will receive the appropriate therapy and early
intervention. On top of that, Dr. Agin is the Medical
Director for Early Intervention for New York City, the largest of
it's kind in the USA. Dr. Agin states that since so many
apraxic children are intelligent and know they aren't being
understood, some tend to withdraw, and be misdiagnosed as autistic.
Her information is at our website under "Ask The Doctor."
Again, apraxic children can be brilliant
and misdiagnosed or misclassified. What's fortunate is because
of the internet you can speak with the children who have grown up
with apraxia or their parents to prove this point.
The way apraxic children speak varies.
You can listen to various apraxic children at "The Talking
Page" and you will find that link at our site as well.
Our son Tanner used to sound deaf when he spoke, but what's
funny is that now that he goes to a school for the hearing impaired
and deaf, he no longer sounds like he's deaf, and he has many
inflections when he talks, or sings! Lori Roth, who has
worked with both many deaf as well as apraxic children believes that
they both may learn to speak in similar ways, which is why so
many apraxic children have done well in schools for the deaf or
hearing impaired. It's something to look into anyway.
Dr. Agin can explain why apraxic children sometimes sound deaf from
a medical aspect as well.
As far as people looking at your son
when he babbles, I know how you feel! Tanner is a big kid, so
even when he was only 3 he looked 4, and now at 4 and a half he
looks like he's at least 5 or 6. At three he had only a few
simple sounds or words. He went through the
"babbling" stage after three too. His SLPs say that
is typical, and a good thing, since it's an important stage in
language development that our apraxic children either miss, or don't
fully go through when younger. Apraxic children typically go
through most of the "normal" stages of language
development if they are getting appropriate therapy, but just LOTS
slower and later than a typical "late talker" that is not
apraxic. Today Tanner talks "like a baby" using
3 to 5 word sentences, and not only are we all proud of him, but
he's proud of himself! We don't want to lose that healthy self
confidence, so if he doesn't notice any strange looks cast his
way, I ignore them. But if these people say anything, or
Tanner notices them staring at him, I use my now classic, "He's
learning to talk, and he's doing great!" Works like a
charm! Also read "What's wrong with him?" at our
site, it's pretty funny.
Lisa Geng, President of both nonprofits,
CHERAB Foundation, and Children's Apraxia
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