Of Verbal Apraxia
friendly signs from a professional
friendly signs from a parent
Apraxia vs. Phonological Processing Disorder Or Late Talking /
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.
child may say the same word four different ways. Sound
errors are significantly inconsistent!!!|
child adds vowel sounds to the end of words that finish with a
consonant (Up-pa). Intrusion of a vowel.|
children may be able to produce sounds in imitation, which they do not
use in connected speech.|
child gets less and less understandable as his speech unit gets
longer. Severity of apraxia increases as the length of the word or
child tends to mix-up consonants within a word. Sound swapping errors
are common (efelant vs elephant). Metathetic
errors are frequent.|
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”.|
child may not be able to change his pitch during speech production. Prosodic
disturbances of speech, pitch, stress and rate are frequently in error.|
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.|
child has difficulty repeating two different consonant +
vowel pairs over and over again. Marked
difficulty repeating series of speech sounds in diadokokenetic series
Other elements of difference include:
|- 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
|-general normal EEG/MRI results|
|-the ability to understand everything
said to them. Normal receptive language.|
|-the ability to understand everything
said to them. Normal receptive language.|
|-traditional speech therapy
techniques are ineffectual. General speech progress is slow and
requires intensive, appropriate, speech therapy.|
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
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.
I can be of help to parents and professionals alike, please write
or call me at 973-540-8884
Roth MS CCC/SLP
friendly signs from a parent
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."
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
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.|
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.)|
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
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.
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.|
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.
|7.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.
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?"
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.|
10. Tanner talks better when he is singing, or playing, when he
thinking about it.
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
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
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
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Date of last update:
February 17, 2003
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