Possible Oral Apraxia or Oral Motor Warning Signs

Posted: June 26, 2006 by cherab

There are two types of oral motor problems.

Why More Should Know What Oral Apraxia Is

Oral Apraxia is a disorder where the child, who typically is a “late talker” is unable to coordinate and/or initiate movement of their jaw, lips and tongue (articulators) on command.

An Oral Motor Disorder, which could be a different oral motor problem than apraxia (could be from weakness/dysarthria for example) is the second type, in which the child is unable to coordinate and/or initiate movement of normal eating movements (vegetative activities.)

Here are some possible warning signs of the two types of oral motor problems, written by Lisa Geng, the parent of two children who were diagnosed by a neurologist (Trever. DeSouza MD) and a neurodevelopmental pediatrician (Marilyn Agin MD) with two different types of oral motor problems, with help from Cherab’s advisor, Sara R. Johnson, CCC/SLP.

Can your child do the following regularly or on command:

  • smile?
  • kiss or make a kiss face?
  • stick out his/her tongue?
  • try to touch his/her tongue to his/her nose?
  • make raspberries?
  • lick peanut butter off his/her upper, side, or lower lip?
  • imitate making a funny face?
  • blow out candles or blow bubbles? (a typically-developing ten-month old can do this)
  • bite his/her lower lip?
  • show vvarious emotions in facial expressions?
  • blow his/her nose on command?

(undocumented, off the record sign of apraxia that is reported as a problem by most parents of all aged, even teen apraxic children through the CHERAB group. This aspect of apraxia can also be overcome through strategies/therapies to assist with motor planning. These children have no trouble breathing through their nose or mouth all day long, but when a tissue it brought to their nose and they are told to breath out, they will breath in instead. There are nose horns developed by Sara Johnson CCC SLP which help a child learn to motor plan this activity as well. Breath control on command is essential for verbal speech.)

If your child cannot do all or some of the above, this may be a sign of Oral Apraxia, which is worth looking into with medical and speech professionals.

Or does your child…

  • drool excessively?
  • bite straws when drinking or put the straw more than 1/4 inch into his/her mouth?
  • overstuff his/her mouth when eating?
  • have an open mouth posture?
  • have a protruding tongue?
  • look like he/she is smiling all the time?
  • prefer one brand of baby food carrots over another?
  • have a limited diet?
  • swallow without chewing?
  • grind his/her teeth during the day?
  • have a history of difficult nursing (or did you “not make enough milk” for your child to nurse)?

If your child does all or some of the above, this may be a sign of Oral Motor problems, which is worth exploring with medical and speech professionals.

Oral Motor Dysfunction; Exercises and Therapy for Autism and Apraxia

If you are seeing any of the above signs, seek out the services of a Speech Language Therapist for an evaluation of these skills. This can be done through your State’s Early Intervention Programs, a free federally funded program for qualified children from birth to three years of age or through your school district’s preschool disabled program, a free program for qualified children between the ages of three to 6 years. You can also contact the American Speech Language-Hearing Association in Rockville, Maryland for a list of certified clinicians in your area. It is very important to have an ACCURATE assessment completed by a skilled clinician. You may also want an evaluation from a developmental pediatrician, or pediatric neurologist to look for signs of low tone (hypotonia).

A reason to know the warning signs of oral apraxia

 

Videos and photos of a child with oral and verbal apraxia

Category: Apraxia, Disorders, Therapy

12 Comments on “Possible Oral Apraxia or Oral Motor Warning Signs”

  1. I have a 9 month old baby boy with symptoms similar with the one you described for Oral Motor Disorder.
    He was seen by ENT and GI , diagnosed with ” Mild Laryngomalacia” and ” GI reflux” , treated with Prevacid currently. Also seen by Speech Pathology.
    However , there is no diagnosis so far and no improvement. Can you recommend us an Oral Motor Disorder specialist with experience in this relatively rare pathology. Can travel anywhere.
    Thank you very much, your help is greatly appreciated.
    Alex
    Morgantown, WV.

    • Hi Alex,

      I know an SLP in Maryland Barbara Taylor CCC SLP who specializes in oral motor therapy. She may be the closest to you that I know but that doesn’t mean there isn’t someone else. Please join our support group on facebook at http://www.apraxia.org We have a number of SLPs that are members (including Barbara) that can maybe answer your concerns there. If there are feeding issues that would be one type of therapy that is very easy to get covered by insurance. I do have this page to help too http://pursuitofresearch.org/2016/05/31/5-ways-to-get-free-or-affordable-speech-therapy/

      Lisa Geng
      President CHERAB Foundation
      cherab.org
      Communication Help, Education, Research, Apraxia Base
      Conceptualist for IQed “Approved for the Feingold Diet”
      getIQed.com
      772-335-5135
      “Help give our cherubs a smile and a voice”

    • Hi, my 9 month old son hasn’t babbled consonants, also has laryngomalacia and mild reflux. I had a speech eval and they suspect apraxia and will be treating him for such. Are these conditions related whereas I should see a neurologist for something bigger?

      • Hi Jamie,

        9 months old is way too young to even suspect apraxia. Apraxia is a motor planning impairment -here are some parent friendly signs https://cherabfoundation.org//2006/parent-friendly-signs-of-verbal-apraxia/ many SLPs will say you can’t definitively diagnose apraxia until the child is 3 years old- but if they have oral apraxia http://pursuitofresearch.org/2017/02/03/why-more-should-know-what-oral-apraxia-is/ you may be able to diagnose that as young as 18 months.

        Where do you live that an SLP would diagnose a 9 month old with suspected apraxia? Is that a typo?

        If it is a typo and he’s older -apraxia in itself is just a motor planning impairment -these are the other conditions that you may see co existing with apraxia http://pursuitofresearch.org/2014/07/29/parent-friendly-soft-signs/ which would be diagnosed by a pediatric neurologist or developmental pediatrician. I’d recommend taking your child to one if that was a typo and he’s older to confirm or rule out soft signs if apraxia is suspected.

        Again if he’s 9 months old I’d recommend finding another SLP -not all graduate at the top of the class- some barely squeaked through. As a new parent, you won’t necessarily know a good one from a terrible one- but if not seeing progress within 3 months reevaluate therapy, therapist, and/or diagnosis. Also keep in mind 75 percent of late talkers are just that -kids that talk late. JIC he is 9 months -here’s a late talker handout from the Cherab Foundation https://cherabfoundation.org//2011/late-talker-handout/

        Lisa Geng
        President CHERAB Foundation
        Communication Help, Education, Research, Apraxia Base
        Conceptualist for IQed “Approved for the Feingold Diet”
        772-335-5135
        “Help give our cherubs a smile and a voice”

    • Alex I don’t know anyone dealing with a 9 month old, but can you join our support group at apraxia.org as I can tag a few SLPs who specialize in oral motor dysfunction and they may have some suggestions.

      Thanks,

      Lisa Geng
      President CHERAB Foundation
      Creator IQed Smart Nutrition
      “Help give our cherubs a smile and a voice”
      Please consider a donation to the Cherab Foundation
      Donations are tax-deductible, our federal tax ID number is 22-3685234

  2. Hello, sorry for replying so late. It was not a typo. I actually got two opinions as well. The therapy location im attending is joe dimaggio in Florida. The SLP has been working 26 years and specializes in apraxia and is prompt certified. I can’t help but wonder how two SLPs can say that to me so young unless it’s very bad and obvious? And with the other neurological symptoms I am starting to become worried. He is supposed to start therapy next week as we were just affected very badly by the hurricane.

    • Hi Jamie -my son went to Dr. Renai Jonas CCC SLP who is in Boca Raton -I so highly recommend her. I’m going to share this at our group at http://www.apraxia.org as well to see what they say. I know oral motor therapy can start early, especially if there are feeding issues. My older son Dakota was in therapy overseen by a neurologist from 3 weeks old (weeks) for crushed facial nerves- but at that age the therapy was done by an OT (in the neurologist’s office) I wouldn’t be so nervous yet about anything -whether you start therapy or not -I’d still get more opinions. I again highly recommend Dr. Jonas -but she STILL doesn’t have power or internet from Irma. Get started with the therapy- it’s not going to be hurt and if anything at worst will just be a waste of time and money -but in a week or so contact Dr Jonas for another opinion. 2 other SLPs I know in south Florida you can check with – Dr. Francine Hamel, Ed.D. CCC-SLP
      Clinical Supervisor Coordinator Speech Language Pathology Program-Miami Campus -she’s been helping us with our Late Talker documentary project and she specializes in apraxia and is PROMPT certified -and I just met with Alana who is an SLP in Boyton Beach originally from up north who also specializes in apraxia http://bendyourbrain.com/contact-us

      Right now just take it as a “working” diagnosis- but again from all I’ve heard 9 months is too young for a diagnosis of apraxia. I could be wrong -let me know what the PhDs say!

      Lisa Geng
      President CHERAB Foundation
      Communication Help, Education, Research, Apraxia Base
      Conceptualist for IQed “Approved for the Feingold Diet”
      772-335-5135
      “Help give our cherubs a smile and a voice”

      • Hi Jamie,

        As promised I shared this to our group and all the SLPs agree you can’t diagnose apraxia in a 9 month old. https://www.facebook.com/groups/cherab/permalink/10159438530115602/ Please join the group- I’ll approve you as a member and you can share more there. You will have to have a facebook account.

        Lisa Geng
        President CHERAB Foundation
        Communication Help, Education, Research, Apraxia Base
        Conceptualist for IQed “Approved for the Feingold Diet”
        772-335-5135
        “Help give our cherubs a smile and a voice”

  3. Hi Lisa,
    My 2 year old grandson has been diagnosed with oral-motor weakness. He didn’t qualify for Birth to Three services in NYC but his parents want to start him on speech therapy anyway. He talks CONSTANTLY but only he knows what he is saying. He only has about 10 words we understand. Otherwise, developmentally he is totally on target and has normal receptive vocabulary skills. They live in Brooklyn, New York. Can you recommend an oral motor specialist in the New York City area?
    Thanks for your help.
    Karen

    • Hi Karen,

      I would continue to see if he qualifies for early intervention through the state. Just because he didn’t qualify when they last checked, as he ages more is expected- he just needs enough of a lag to qualify. In the meantime, you can use this to help with securing more therapy https://pursuitofresearch.org/2016/05/31/5-ways-to-get-free-or-affordable-speech-therapy/

      I used to live in Jersey so know therapists there -but you can use this to find an oral motor therapist https://talktools.com/apps/find-a-therapist/ I typically look to find an SLP who is skilled in more than one area- so many conditions can overlap and you want an SLP who can diagnose and treat whatever is going on. Not being so married to one technique that they only depend on that. Saying that it sounds like you may want to confirm or rule out dysarthria -phonological issues. On the other hand, he’s still young and didn’t qualify for EI and 75 percent of late talkers are just that -kids that talk late. Hopefully, that is all that is going on. But good you are all on top of it just in case!

      Here is a page on oral motor therapy http://pursuitofresearch.org/2012/07/22/oral-motor-dysfunction-exercises-and-therapy-for-autism-and-apraxia/

      Best,

      Lisa Geng
      President CHERAB Foundation
      Creator IQed Smart Nutrition
      “Help give our cherubs a smile and a voice”
      Please consider a donation to the Cherab Foundation
      Donations are tax-deductible, our federal tax ID number is 22-3685234

  4. Hello good day . I have a 25months old baby girl and can’t talk yet but she can hear clearly… She only says ahhhhh too much loud sometimes and mama sometimes only when she cry.. Is it normal?? When you call her name there is no response but sometimes she look on you when you call on her name .when you say kiss she do and give you a kiss.. She know to point alphabet but no words come in her mouth but she can hear clearly… When you say ahhhhh too much loud she follow and shout also ahhhh… Is it normal or a delayed on speech?? What am i going to do??

    • Hi Dulci,

      I would seek a speech and hearing evaluation just to confirm or rule out any issues with hearing, and also to see if she qualifies for early intervention therapy. 75 percent of late talkers are just that -kids that talk late -but no harm in seeking therapy early as it can’t hurt. Here is what is normal for her age and signs of concern

      Typically seen in first 18-24 months
      · Uses mostly words to communicate · Begins to use two word combinations (more cookie etc) · By 24 months has more than 50 words, or word approximations

      Cause for concern in first 18-24 months
      · Relies on gestures to communicate · Limited vocabulary (speaks less than 50 words)
      · Does not use any two word combinations · Limited consonant production · Mostly unintelligible speech · Regresses in language development: Stops talking, repeats phrases inappropriately

      Typically seen in first 24-36 months
      · Engages in short dialogues · Expresses emotions · Begins using language in imaginative ways · Begins providing descriptive details when speaking · Begins to use articles and word endings (a, the, ing,) uses plurals (cats)

      Cause for concern in first 24-36 months
      · Words limited to single syllable and no final consonants · Few or no multiword utterances · Does not demand a response from a listener · Asks no questions · Speech difficult to understand · Tantrums when frustrated · Echoing of speech without communicative intent
      https://cherabfoundation.org/2011/late-talker-handout/

      Here are some other ways to secure more therapy https://pursuitofrese016/05/31/5-ways-to-get-free-or-affordable-speech-therapy/

      So while it does appear to be a delay -you’ll need an evaluation to know for sure what is going on. But again it’s harmless to seek therapy and if she is one of the kids in the 25 percent with an impairment of speech vs a delay- you’ll be happy you started therapy sooner.

      Best,

      Lisa Geng
      President CHERAB Foundation
      Creator IQed Smart Nutrition
      “Help give our cherubs a smile and a voice”
      Please consider a donation to the Cherab Foundation
      Donations are tax-deductible, our federal tax ID number is 22-3685234