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"Parent Friendly" Signs Of Verbal Apraxia

parent friendly signs from a professional

Parent friendly signs from a parent

Verbal Apraxia vs. Phonological Processing Disorder Or Late Talking / Articulation Disorders

Dear Parents;

All these terms thrown at you and nowhere to go to get a comparison or answer to your child’s diagnoses. Here are some critical differences that may help you to determine what and if your child is Verbally Apraxic. Your reports from therapists may contain the statements in italics.

 

bulletYour child may say the same word four different ways. Sound errors are significantly inconsistent!!!
bullet 
bulletYour child adds vowel sounds to the end of words that finish with a consonant (Up-pa). Intrusion of a vowel.
bullet 
bulletApraxic children may be able to produce sounds in imitation, which they do not use in connected speech.
bullet 
bulletYour child gets less and less understandable as his speech unit gets longer. Severity of apraxia increases as the length of the word or utterance increases.
bullet 
bulletYour child tends to mix-up consonants within a word. Sound swapping errors are common (efelant vs elephant). Metathetic errors are frequent.
bullet 
bulletYour child may drop final consonants in single syllable words (omission errors) simplifying their speech unit to contain consonant-vowel pairs in short strings. “Cat come home” = “Ca co hoe”.
bullet 
bulletYour child may not be able to change his pitch during speech production. Prosodic disturbances of speech, pitch, stress and rate are frequently in error.
bullet 
bulletYour child may use only /b/, /m/, /d/, /g/, /z/ with simple vowels like /uh/, /ah/, /oh/, but not /p/, /t/, /k/, or long vowels /ay/, /ee/, /i/ or /ow/. Voicing errors, nasal resonance errors, and lengthening vowels before omitted consonants are present.
bullet 
bulletYour child has difficulty repeating two different consonant +  vowel pairs over and over again. Marked difficulty repeating series of speech sounds in diadokokenetic series /patika/.
bullet 
bullet

Other elements of difference include:
bullet- a big discrepancy between the child’s ability to move their lips, tongue and jaw for eating or non-speech activities and the use of these parts during speech on command.
bullet-general normal EEG/MRI results
bullet-the ability to understand everything said to them. Normal receptive language.
bullet-the ability to understand everything said to them. Normal receptive language.
bullet-traditional speech therapy techniques are ineffectual. General speech progress is slow and requires intensive, appropriate, speech therapy.

bullet

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

Parent friendly signs from a parent

My son Tanner was diagnosed with both severe oral as well as verbal apraxia, but each child is different, and some may not go through all the signs that Tanner had, with his severity, and/or some children may have other aspects.  

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."  

bullet

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.

 

bullet 2.  Tanner did not go through normal speech development as he aged, he would say a sound (before 3,) or word (3 and up,) and not say it for months, or ever again.  Most children with delays of speech will learn sounds and words and build from that with a typical pattern.

 

bullet 3.  Here is another frustrating aspect of verbal apraxia we all deal with, even when Tanner learned how to say a sound like "p" before a vowel, he could not say the same sound after a vowel, so he would either drop it, or change it to another sound.  For example, if the therapist modeled (said) the sounds "pa," Tanner could say "pa."  If the next word the therapist modeled for him is "up," Tanner would say "uf."  It has to do with changing tongue and mouth positions, something like that.  Professionals refer to this as "motor planning."  (Which is why apraxia is also called a motor planning disorder.)

 

bullet

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.

bullet 5.Even when Tanner learned to say the sound "t" if he tried to say the word "pot" it would come out "pop" because he will switch the "t" to a "p."  They say this is because of (same word again) motor planning and children with apraxia will carry the sound from the beginning of the word to the end.

 

bullet 6.  Tanner's  intelligibility will "break down" the longer the word, or
sentence.  Even with a model, he can't repeat back a longer sentence using all the words yet, he will repeat back only a few of the words.

 

bullet7.Tanner never "picked up" speech like other children.  He also seemed to regress and didn't talk at all when he was around large groups of children that were talking and playing, even when they tried to play with him.  He tended to do better with one other child, or his brother and maybe one more.  Then he would try to talk too.  Even before I read all the importance of one on one therapy with apraxia, I saw that as a mom with Tanner.  Tanner's older brother was also a late talker, but that was because of birth injuries that he was in therapy for from birth.  (He's doing great now!  He's 6 and unless I tell someone, they never would have known.)  Where Tanner wilted in
groups of children, Dakota thrived, and he did "pick up" on any delays when I put him in a wonderful preschool a few times a week.

 

bullet

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?"

bullet 9.  Tanner's apraxia still affects his ability to use the back of his tongue to say sounds like "k" or "g."  He substitutes the "k" for the "t," so cookie is "tootie."  And the "g" for the "d," so girl is "dirl."  He has yet to make either the "k" or the "g" sound, but we are working on it.  When Tanner said, "hud n' tiss," the other night, I had to stop and switch the "d" and "t" to know he was asking for a hug and a kiss.

 

bullet 10.  Tanner talks better when he is singing, or playing, when he isn't
thinking about it.  

 

bullet 11. I could go on, but another one Tanner has developed now that he is really pushing himself is stuttering (dysfluency.)  This does not always happen, it's partly developmental, but it's not uncommon with apraxia.  Many children with apraxia can get "stuck" here for a bit.  I say how cruel, he has trouble talking, and to add stuttering to that is like insult to injury.  Many experts say his brain is working faster than his mouth.  You can visibly see him struggle to talk when he does.  Lots of thought goes into each word, you don't see that with late talkers.  I never did.

"soft" neurological signs that are not uncommon to apraxic children

I thought Tanner only had apraxia, with no other issues, but I was
wrong.  These other "issues" however are typically overlooked by us as
parents, and by many pediatricians.  Tanner also had other "neurologically based" signs, hypotonia and sensory integration disorder.  I know that sounds severe, and perhaps they could be, but fortunately because Tanner had early intervention, he is overcoming them, and they are now only noticeable to experts.  Both of these are treated by Occupational Therapists, but can be addressed by Physical Therapists and Speech Professionals as well.  

Hypotonia, or low tone, gave Tanner the appearance of a Cherub, and that was his nickname when he was 2, "Cherub Boy."  Everyone said that Tanner looked like a Cherub, but because he was so cute.  Hypotonia however needs to be addressed because it affected Tanner's truncal strength, and breath control, which is important for many reasons, including speech.  

Tanner also had mild sensory integration (SI) issues.  There is lots of information online about SI, but mostly it makes the child seem like the tantrum child, for "no" reason.  They don't sense things like we do the same way all the time.  One example from when Tanner was a baby (and this is before I knew what SI was, or that Tanner had it) is that he would sometimes "freak out" when I tried to bring him into a store, he would scream like he was in intense pain, like there was a pin in him, tighten his whole body and act hysterical.  Other shoppers would look at me like "what are you doing to that child!"  My sister, who is a certified nanny, was many times with me when this happened, and we would check his diaper, offer a bottle, take all his clothes off, looking for what was causing the screaming, but we never found it.  This same child would go for shots and wouldn't cry.  I used to call him the "tough one."   More recently, I was tickling his arm and he said, "ow!  hurt me."  I asked him, "does this hurt?" and tickled him again.  He pulled his arm away and said, "yes." Sometimes if I pat his head he says "ow" too.  SI is another unknown one, and it can affect different senses.  For Tanner it's touch.

Dr. Marilyn Agin is in private practice as a Developmental Pediatrician, and the Medical Director for Early Intervention in New York City.  She is very knowledge about oral apraxia, and lectures to the medical communities about apraxia.  She and Developmental Pediatrician Dr. Larry Laveman are two of the doctors involved in the CHERAB Foundation, and on our list.  Lori Roth MS CCC/SLP is the Oral Motor Expert for the CHERAB Foundation.  These are just a few types of professionals on our list.  If you have medical, speech, or educational questions regarding "Late Talker vs. Apraxia," why not join our list  

 

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Date of last update: February 17, 2003

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"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." -- Margaret Mead, anthropologist

Send mail to Support with technical questions or comments about this web site. 
Copyright © 1998 
Last modified: Friday, June 03, 2005

To find your way around the CHERAB part of this site please click here for the index.

"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." -- Margaret Mead, anthropologist

Send mail to Support with technical questions or comments about this web site. 
Copyright © 1998 
Last modified: Friday, June 03, 2005

To find your way around the CHERAB part of this site please click here for the index.

"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." -- Margaret Mead, anthropologist