All these terms thrown at you and nowhere to go to get answers to your questions about 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 phrases in italics below.
Your child may say the same word four different ways. Sound errors are significantly inconsistent.
Your child adds vowel sounds to the end of words that finish with a consonant (Up-pa). Intrusion of a vowel.
Apraxic children may be able to produce sounds in imitation, which they do not use in connected speech.
Your child becomes less and less understandable as his speech unit gets longer. Severity of apraxia increases as the length of the word or utterance increases.
Your child tends to mix-up consonants within a word. Sound swapping errors are common (efelant vs elephant). Metathetic errors are frequent.
Your child may drop final consonants in single syllable words (omission errors) simplifying his/her speech unit to contain consonant-vowel pairs in short strings. “Cat come home” = “Ca co hoe”.
Your child may not be able to change his pitch during speech production. Prosodic disturbances of speech, pitch, stress and rate are frequently in error.
Your 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.
Your child has difficulty repeating two different consonant + vowel pairs over and over again. Marked difficulty repeating series of speech sounds in diadokokenetic series /patika/.
Other elements of difference include:
a big discrepancy between your child’s ability to move his/her lips, tongue and jaw for eating or non-speech activities and the use of these parts during speech on command.
general normal EEG/MRI results
the ability to understand everything said to him/her. Normal receptive language.
traditional speech therapy techniques are ineffectual. General speech progress is slow and requires intensive, appropriate, speech therapy.
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.
Lori Roth MS CCC/SLP