Apraxia of speech is not a developmental disorder but a neurological disorder. A pediatric neurologist evaluation along with a speech assessment from an experienced speech therapist will be crucial for an accurate diagnosis. 

After that the therapy approach should focus on the motor planning issue as well as the language issue. Reading and writing expression will need consideration as well. Just presenting a word as a model will not meet an Apraxic Child’s needs for therapy. Visual cues and kinethestic or tactile information must also be provided. The goal of therapy should always be to increase the automatic movement of speech and increase functional communication as quickly as possible.

If I can be of help to parents and professionals alike, please write (email: lorislp@att.net)  or call me at 973-540-8884  

Lori Roth MS CCC/SLP

1.  It took forever for Tanner to learn how to say ANYTHING other than the word "ma" or the sound "mmm," which was his only "words" up until almost 3 years old.  Even though the therapy he received was not appropriate for apraxia, (we didn't know this at the time,) it was some type of therapy, and it took months of this speech therapy, 1/2 hour sessions, two or three times a week (from 2 years, 4 months, to 2 years, 8 months) for him to learn simple sounds like "t" or "ch" or "sh." sounds most babies and toddlers say when they babble.  

During this time, even though Tanner was in speech therapy, we followed our pediatrician's advice that Tanner was a "late talker" and never knew Tanner was qualified for early intervention by the state (a federal program) so we got to pay out of pocket for all the therapy since insurance didn't cover it, and even though we appealed, at that time, we didn't know how to fight the denials.  Tanner did babble with some of these sounds, rarely though, but many apraxic children have very little babbling.  The problem was that when Tanner 'wanted' to use one of these sounds, on command, he didn't know how to.  Many parents of apraxic children have examples, like us, of their child 'starting' to develop speech, and then for some reason, they lose it.  Since there is still no large research on apraxia, even though it is not rare, nobody knows why this happens.  In a small research project by Tom Campbell out of the Pittsburgh Hospital, they found it required 81% more therapy for apraxic children to show results as children with severe phonological delays.

4. Tanner understood us, and what he wanted, and developed his own "sign language" to try to communicate.   They say this is very common with apraxic children.  When Tanner has more to tell us than he is able to say yet with words, he now also uses sound effects with his unique sign/body language when he "tells us stories."  He's actually pretty good at making himself understood.  (Remember Harpo Marx?)  Many children with apraxia have high receptive (understanding) ability, and low expressive (talking) ability.  There was never a doubt to anyone that Tanner was intelligent, and apraxia does not affect a child's cognitive (intelligence) ability.  I ask parents who take their child for evaluations what it says about expressive and receptive ability.  Most don't know what receptive ability means.  

It is horrible that apraxic children are sometimes misdiagnosed as autistic, or even mentally retarded.  Apraxia can co-exist with conditions like autism, cerebral palsy, downs, etc., but apraxia many times is there "alone."  (I'll explain later on.)  To often, children are diagnosed as having "receptive" delays, when they don't.  Receptive delays are a "red flag" that there could be cognitive issues going on.  It's one thing if there really is, but seek second opinions privately from a speech and language pathologist, developmental pediatrician and/or neurologist that are knowledgeable about apraxia and other disorders.

8. When Tanner started to use words, he would repeat the same sound over, using sentence inflictions,  rather than saying the different words.   A good example is, he would point to the door, or out the window, while saying, "die, die, die, die, die."  Of course that meant, "I want to go outside."  I heard some apraxic children are monotone, that wasn't Tanner.

We would have to say to Tanner, "I...want...to...go (he would say doe)...outside." really emphasizing and waiting after each word, so he would or could repeat it.   Tanner can now say many words clear, but he still does better on many when he hears someone say them first.  Now at 4, Tanner will say by himself, "I doe side now peas.  Tay?"