Don’t Understand Apraxia? Information and Tips to Help Your Toddler Coordinate Articulators and Motor Plan

/

Childhood Apraxia of Speech (CAS) is often a diagnosis that brings a lot of emotion. Like any diagnosis, parents need to internalize the information before they will be ready to research and help their child move forward. The American Speech Language Hearing Association’s Ad Hoc Committee states, “Childhood apraxia of speech (CAS) is a neurological childhood (pediatric) speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g., abnormal reflexes, abnormal tone). CAS may occur as a result of known neurological impairment, in association with complex neurobehavioral disorders of known or unknown origin, or as an idiopathic neurogenic speech sound disorder. The core impairment in planning and/or programming spatiotemporal parameters of movement sequences results in errors in speech sound production and prosody.”

In my experience with children who struggle to speak, parents have often thought that CAS was a permanent diagnosis.  I strongly believe that with good therapeutic tools, (and speech-language pathologists) frequency and intensity of practice, and a positive team approach, apraxia is truly a continuum. I absolutely love the New Oxford American Dictionary which describes a continuum as “a continuous sequence in which adjacent elements are not perceptibly different from each other, although the extremes are quite distinct“. Cari Ebert, a speech-language pathologist, who I believe is a pioneer in the field of apraxia for Early Intervention, describes the continuum as going from apraxia to phonology to articulation. I bought her Suspected Apraxia of Speech in Early Intervention DVDs and found them to be phenomenal because they provided information on diagnosis and treatment. They were comprehensive and left me with tons of new ideas for therapy.  If you’re a parent looking for tips and tricks to help your child motor plan for speech, I highly recommend purchasing these DVDs or going to a seminar. However, if you purchase the DVDs, you can always review the information as needed. In addition, Cross Country Education sends a manual with the slides, which is also very helpful. If you’re a speech-language pathologist struggling with where to start or where to go next with therapy, I recommend Cari Ebert’s products (depending on age) or attending one of Nancy Kaufman’s workshops. The tips and tricks that I offer come from advice given by both Cari and Nancy as well as personal experience from working with children with apraxia in early intervention and preschool. My suggestions are geared more toward the toddler-preschool/kindergarten age range.

Whether you’re a parent who isn’t sure if you should seek a speech-language evaluation or a speech language pathologist, first check oral motor skills. Can the child protrude and retract his tongue? Can he puff air evenly into his cheeks? Can he lateralize the tongue? Can he elevate and depress the tongue? Can the child pucker lips and round them? Find out about eating habits. Is the child a picky eater? Does he stick to only soft foods that don’t require much chewing? Does the child often gag on foods? It is important to differentiate between oropharyngeal difficulties vs speech difficulties. If you’re a parent and feel that there are red flags in these areas, call your pediatrician and ask for a referral for a speech evaluation. If you’re a therapist, determine the appropriate level for you to begin targeting. Don’t feel like you have to rush into working on words. If the child doesn’t have the foundational skills to control articulators, he won’t be able to produce speech sounds successfully! Here are some ideas if the child is at the oral motor level:

Bubbles (don’t roll your eyes!) will help the child coordinate breath while working on rounding lips.

Straws-Cut them in half so the child has greater control over where the straw points. Hold a feather and let the child blow the feather so he has a visual cue. Blow pom poms across the floor or table. Blow ping pong balls. They are light weight and it’ll change things up for the kids.

Get a bubble pipe: Bubbles are motivating for kids and if they see you blowing bubbles through a bubble pipe, they will want to do the same. They’ll be motivated to coordinate their breath to get those bubbles to come out of the pipe. If they don’t coordinate lip rounding and breath, there won’t be any bubbles. It’s another great visual cue for kids.

Bring out the lipstick (chapstick for boys)! Smear the lipstick on the child’s bottom or top lip. Model how to rub lips together to spread the lipstick. Then, get a piece of paper and go to town! Let the child kiss the paper to transfer the imprint of her lips onto the paper. Encourage the lip smacking sound with a strong pucker. Many of the kids with apraxia won’t have a strong pucker and won’t smack lips together.

Get some kazoos, horns, and whistles. Focus on the lip rounding (not holding instruments between top and bottom teeth. This will work on the labial muscles as well as oral control. The kazoo, if it is a good one, will require the child to produce voicing in order for it to make noise.

Parents, if your child is able to do all of the aforementioned skills with ease, it may be time to work on speech. A speech-language pathologist will need to assess what sounds are in his repertoire and determine which consonants and vowels are appropriate to target. Further, the speech-language pathologist will then have to determine what type of syllable structures are most appropriate for the child. When you have that information, collaborate with the therapist. Sit in on the sessions if you cannot watch through a two-way mirror or on camera. YOU, as a parent, are a crucial part of your child’s success. Ask the therapist if Nancy Kaufman’s apraxia materials are appropriate for the level at which your child functions. Your child’s speech-language pathologist should be giving you things to work on daily at home.

Finally, everyone must be patient. Therapy for apraxia of speech is a long road. Every child is different and every individual’s ability to motor plan, and essentially rewire the brain, differs. What works for one child might not work for another, which is why it is crucial to practice every day to find out what will help the child be successful. I hope this blog was informational. Here are some resources you may find useful:

  • http://www.apraxia-kids.org
  • http://www.asha.org/public/speech/disorders/ChildhoodApraxia/

Thanks for reading!


References:

  • American Speech-Language-Hearing Association. (2007). Childhood apraxia of speech (position statement). http://www.asha.org/policy
  • Citation [Def. 1]. (n.d.). In New Oxford American Dictionary, Retrieved October 23, 2015, from http://www.oxforddictionaries.com/us/definition/american_english/continuum.

The picture featured was created using Smarty Symbols Images. All rights reserved, 2011-2015.