Soft Signs of Apraxia

• Parent-friendly signs of oral apraxia
• Parent-friendly signs of verbal apraxia
• Parent-friendly soft signs
• Parent-friendly signs of limb apraxia

Parent-friendlyy signs of “soft signs”… from a parent

Why More Should Know What Oral Apraxia Is

Written By Lisa Geng as posted to the Cherab Foundation grouplist

Other than not talking yet -you can look for any neuro “soft signs” even before the trip to the neurodevelopmental doctor (developmental pediatrician or pediatric neurologist) If your child has any of the following signs-don’t panic -all of them in almost all cases can be overcome -and the earlier the intervention the better as always.

Without neurological soft signs -it’s harder to diagnose a nonverbal two year old – which doesn’t mean you can’t start appropriate therapy just in case if apraxia is suspected -can’t hurt and will probably help no matter what the reason. Even a two year old with “just” a simple delay in speech can be mentally stimulated to talk sooner while having fun with some early intervention speech therapy that may look lots like play to the untrained eye. A big question is did he ever have sounds that he lost -did he ever regress?

A neurodevelopmental medical exam will look at a number of things in your son outside of communication skills, or receptive and expressive language -including physical development and motor skills, thinking and learning cognitive development etc.

Soft signs in apraxic children are typically mild -but in most cases there -most of us just didn’t know what they were because up till Cherab nobody pointed them out. I try to raise awareness because if your child has any of the following -as a parent you will know once pointed out-and so will the neuro MD you bring your child to.

When you run a large support group -you tend to see what is happening in a group -so support groups are excellent for really getting to the facts and the “norm” -and I’ll get to the EFA question in that regard too. I try to put the neuro soft signs in a way that everyone will understand -and these soft signs are all based on my son Tanner -who I and everyone including his first pediatric group all thought was a normal baby other than he was just a late talker.

This same child showed all the strong warning signs -we just didn’t know -however -all the soft signs were picked up right away by all the neurodevelopmental MD’s Tanner has seen once I insisted on taking him (his regular pediatrician wanted to wait till three) -as well as by the PTs, OTs and SLPs too. I could now kick myself that I didn’t see them then -but how would I know? That’s why I want to let all of you know -to prevent it from ever happening to another.

With the following information that I learned from personal experience the hard way costing valuable early intervention time while Tanner’s brain was the most malleable – the many children like him could be receiving therapy younger and have a greater chance for success.

Here are a few quick parent friendly signs of oral apraxia:

If you put peanut butter anywhere on his lips can he lick it off or does he use his fingers? Did he blow out the candles on his birthday cake when he turned two? Can he imitate funny faces? If you take his picture and say “smile” does he smile?

Here are some quick parent friendly signs of mild hypotonia:

A child with hypotonia will feel heavier than a child of the same weight without hypotonia (kind of like the difference between picking up your child when he’s fast asleep vs. awake) Hypotonia can be anywhere in the body. Does your child appear to tire faster than other kids his age walking in the mall etc.? Will you and your wife not dream of taking him anywhere without the stroller because you know if you don’t bring the stroller you will be stuck carrying him because if you don’t pick him up he will sit on the floor crying with his arms in the air for you to pick him up again? And since he’s nonverbal -you will get looks from people passing by, or perhaps even comments -that your child is acting spoiled. When you pick him off the floor -it’s not as easy as it looks for you -or others that try! Most will say “wow he’s solid!” when picking him up. “Solid” is the word used by almost everyone to describe your child when people pick him up come to think of it. His body may look small and light -and many times both look like a cherub, and feel a bit like a marshmallow -rounded and soft. He may sit in the “W” position. If a child has severe hypotonia -he may look a bit like a rag doll (those are the children however that are spotted early however) -gravity just pulls them down. For a school age child -look for the child who can’t sit at the desk long before leaning down on it. The child who when waiting on line will either lean or sit down. The child (or adult) with rounded shoulders who is always being told “stand up straight!” or “sit up!” etc.

Here are some quick parent friendly signs of sensory integration dysfunction:

This is tough because it can affect any of the senses -touch, sight, hearing, motion, etc. So in a nutshell -Your child will seem to be bothered (or even in pain) by something that others aren’t and will not be bothered by something most are if that makes sense.

Here are some of my son’s signs that boy do I wish I knew this is what he had when he was screaming and people were looking at me like “what are you doing to that poor child”

Your child may insist on a certain color cup each time -and will throw a fit if it’s any other. My son for would carry a small cap from a pen or some other small strange object around for hours -and if you tried to open his clutched hand – he would freak out -even if
you thought he was asleep and tried to take the pen cap away so he wouldn’t choke on it while he was sleeping -he would wake up and freak out if he wasn’t 100% asleep yet. He wouldn’t cry for shots – but would say “oww” and cringe if you patted his head or tickled his
arm. When Tanner was a baby (after the fevers and regression) his screams when I brought him to public places like the store would sound like high pitched extreme pain screams and he would stiffen his body -his eyes would bulge out -and he would do this just once
in a while (Thank God) but when he did -he would cry till he fell asleep in a sweat -with nobody being able to figure out what was wrong (my Aunt has her PhD in nursing and my sister is a professional nanny -nobody had a clue) Just strange stuff that seemed quirky. DSI can also be the child that throws a tantrum like he’s in pain -while you have no clue what he’s crying about. Why DSI happens to a nonverbal child who is too young to let us know is a cruel joke -so it’s important for us to know if this is what your child has. The Out of Sync Child is one of the books most of us buy when our child is diagnosed with any multi faceted neurologically based communication disorder like apraxia.

Here are some quick parent friendly signs of motor planning problems in the body:
Just like with speech -your child may be able to do something once and then appear not to remember how to do it again. His actions look forced or planned -he’s slower because you can see he’s thinking before each movement. His development is a bit off in that he can do many things advanced -but for some reason can’t seem to do certain simple things that a much younger child even should be able to do. Again -just doesn’t make sense.

Then you have to know if movement problems are from weakness (hypotonia) or motor planning (apraxia/dyspraxia) -just like with speech. Again -it could be a bit of both -and again -both are neurologically based.
Update 2003 -Not just autism -according to Dr. Geier, there is a much higher 30% rise in speech disorders in our children in the past ten years.

“The 2001 U.S. Department of Education statistics showed in children born in 1983 there were a total of 7,801 cases of speech or language impairment. Among children born in 1994, this number had risen to 211,984 cases (an approximately 30-fold increase)”

Mark R Geier MD PhD who compiled the stats above, is vocal in helping raise awareness to the 30% dramatic rise in children in the US with speech disorders in just the past few years. Outside of his recent papers, there is virtually no awareness to the rise in speech disorders. In speaking with Dr. Geier, he told me that the rise in autism was small in comparison to the rise in the numbers of children with speech disorders.

Due to lack of awareness -too many of our late talker children with multi faceted communication impairments, that are not autistic, are labeled PDD, or PDD NOS.

What does multi faced communication impairment mean? Read above -whether you want to call it apraxia or not -it’s children that are late talkers who are not “just starting to talk” like we all pray they will -and in most cases -they are children that also have one or more of the neurological “soft signs” listed above. Apraxia and autism two different examples of multi-faceted communication impairments. There may be some aspects that overlap or co-exist. It’s more common to find apraxia in an autistic or PDD child than it is to find autism or PDD in an apraxic child. You need to treat the symptoms and not the labels however.

“Apraxia” is the strange name diagnosis that has been the best kept secret for years -and it’s probably far more prevalent than autism. Try doing a search on the (American Academy of Pediatrics) AAP website for apraxia. I did one in February 2003 and I came up with “No documents matched the query ”

How can you have a pediatric condition rising in what appears to be epidemic proportions in some areas (like NJ where there is an apraxic child on almost every block) and yet complete and total silence?

Autism is on the rise – so is apraxia -with and mostly without autism. Just like sensory integration dysfunction or mild hypotonia -both which could be found in most apraxic children -apraxia co-exists in a large amount of conditions, syndromes, disorders and impairments, including and outside of autism and PDD…and it also stands alone as the child who is as one mother of a four year old just said to me “so normal I could smack him”…except he can’t talk. (other than “ma” “da” and 4 other “words”) Some late talkers may have hard signs of neurological problems such as myelin delays. Due to the apparent “pocket areas of more kids with apraxia -(for example more children with apraxia in the suburbs around NYC than in NYC even though the parents in the suburbs see the same MDs in NYC) As an inventor -I suspected there is some type of environmental damage that is affecting our children’s myelin. I came to this conclusion based on the fact that almost all the children in our group once on the right formula of Omega 3 Omega 6 EFAs started to talk within one to three weeks of given just a few drops of fish oil a day -which sounds crazy -but it worked. I came up with the myelin/EFA therapy based on the fact that EFAs have very strong remylenating properties (and OK so I watched the movie Lorenzo’s Oil)

I then presented my theory on why I believe that our children have some type of subtle myelin delays and why EFAs are helping our children’s speech, focus, behavior/mood and movement to PhDs, MDs and the Cherab grouplist starting in 2001. Due to one of my postings I was told -I was called into UNDNJ hospital by the hospital attorney Fred Kipperman Esq. in 2001 to do a presentation about my theory to a panel of neurodevelopmental MD’s (including pediatric neurologist Xue Ming MD PhD) on why I believe that most of the late talkers today do have some type of myelin delay whether it shows up in the MRI’s or not. Apparently they had the same idea for autistic children -and did find that even though myelin delays don’t show up on the MRIs in all cases -they do quite often “show up in the lab” Read a recent front page article about the groundbreaking work UMDNJ is doing here. It makes me feel good to know that EFAs are now taken seriously by some of the top neurodevelopmental MDs in the world- I just wish they would acknowledge this for more than autism. It would be one thing if they didn’t know.

So back to the soft signs…

If you want an accurate diagnosis for your child -please do not supplement your late talker with any EFAs before a neurodevelopmental exam. Children with signs of apraxia or autism, PDD or even certain syndromes after the “right” omega 3-6 formula of EFAs are no longer presenting with the symptoms -leading parents are professionals to conclude that either their child was repeatedly misdiagnosed -or if you look at the group -almost 100% of the children in our group show the same positive changes in the same one to three weeks once supplemented. And the even better news is that the positive surges in most cases do not stop. EFAs appear to help the brain “rewire” somehow. Perhaps soon we will know how.