What is apraxia?
Childhood Apraxia of Speech (also known as verbal apraxia
or dyspraxia) is a disorder of a child’s verbal coordination skills for
speech. Speech is a very complex motor
activity for any child to develop, but when CAS is involved, it may be very
difficult for a child to control the mouth movements for precise sound
production and sound sequencing.
What are the signs
of apraxia in a young child?
The child…
·
may have
been very quiet as an infant and not much of a babbler.
·
shows
that he/she wants to communicate but either isn’t or is struggling when trying.
·
seems to understand what you say to him/her.
·
may “refuse” to speak when asked to do so.
·
may use a word once, but then does not use it
again, even when asked to do so.
·
may show extreme frustration by his/her limited
communication.
·
may have speech that sounds like “jibber jabber”
when talking.
·
may be able to say a sound correctly in one word
but not in another.
·
may also show some difficulty with non-speech
oral tasks, such as licking and chewing.
(This may be due to an accompanying oral apraxia).
When should I be
concerned as a parent?
Parents have excellent intuition when it comes to their
children. Recognizing that your child
wants to communicate, but can’t or won’t, is a good sign that help may be
needed. A child’s (or parent’s!)
frustration over communication difficulties is enough to warrant a speech
screening or evaluation. A
speech-language pathologist can help sort out a child’s abilities and
weaknesses. If it is determined that
there is a need for therapy, the therapist will create a treatment plan and
provide the family with home programming suggestions.
We may determine that the child does not have apraxia,
but is developing speech but with a delay.
Therapy can provide such a child with the ability to catch up to his/her
peers. In some cases, particularly when
a child is not speaking at all or very minimally, a therapist may need to defer
an apraxia diagnosis until the child has been talking for a while. Therapy in these situations will first
target helping a child to just begin using sounds, syllables and words.
What can I do to
help my child who has speech difficulties (especially apraxia)?
The number one recommendation is to let what your child is saying (or trying to
communicate, even via gestures and pointing) be more important than how he/she is saying it. Most often, a parent is a child’s safe
harbor, knowing what he/she is trying to communicate when no one else
does. If your child just grunts and
points, act as if he/she actually said the word, model the word, and
acknowledge what your child wants.
Do not pressure your child to speak. If a child has apraxia, it may be extremely
difficult for him/her to say something when asked to do so (even if the child
often says the same thing spontaneously).
One of the difficulties of apraxia is that sometimes the child can say
something without thinking about it, but when asked to speak, cannot get it
out. This leads to frustration on the
part of both the child (who wants to comply) and the parent (who thinks the
child is being stubborn). Instead, make
simple comments about things and then pause.
Your child just may surprise you and say something back. Listen to what your child is trying to say
and do your best to interpret his/her intent, so that you can make a comment
back. For example, if your child points
to a dog and says, “dah”, you can say, “Yes, I see the dog. Do you want to pet the dog?” Letting a child know that his/her best is
good enough will propel your child to feel successful and to try more and
more.
Try to provide opportunities for your child to
need to communicate. Put a desired toy
up on a shelf (or a clear jar with a tight lid) so that your child will need to
communicate with you to get it. Even a
tug on your shirt and a point toward the toy is communication. Use the opportunity to model the word (e.g.,
“Oh, you want the bear. Buh. Bear.” ) Then just wait with a smile to see
if your child will try saying the word.
If not, that’s OK. Just say,
“Buh. Bear. Here’s your bear.” Take a
jar of bubbles with the child’s anticipation that you will blow them. Hold the wand and say, “Bubbles? Buh.” Then just wait (again with a smile). If your child makes any sound, say, “Bubble!”
and then blow them. If your child
doesn’t say anything, just repeat the word and then blow the bubbles. Gradually, your child will understand that
using “words” is very powerful!
Model some “routines” for your child. For example, when pretending to feed a teddy
bear, say “Eat, eat, eat.”
“Mmmmmm.” Then when putting the
bear to bed, say, “Night, night bear.”
“Shhhhh.” Remember to pause and provide
your child with silent time to see if he/she will try the same. If we
do all of the talking, the child doesn’t have the opportunity to do so. Plus, the child’s motor system may need that
extra time to be able to speak.
Providing
a simplification of words is a great technique, as long as you include the true
word in your model (e.g., “Buh.
Bubbles. Buh.”) While a child may not be able (or thinks
he/she is not able) to say the full word, a sound or syllable may be simple
enough to give your child confidence to try.
Relax and have fun!! You will see that, with the right support,
your child will get there!! Oh, and
beware….they do make up for lost talking time later!!
- Donna Conti M.A., CCC-SLPLabels: Parents, Sernoffsky
