Answering Readers' Questions: Part Two

What is Apraxia?

Childhood Apraxia of Speech (what it is officially called now), is a pediatric motor speech disorder.
"For reasons not yet fully understood, children with apraxia of speech have great difficulty planning and producing the precise, highly refined and specific series of movements of the tongue, lips, jaw and palate that are necessary for intelligible speech."(http://www.apraxia-kids.org)

Basically they know what they want to say and typically have normal receptive language (understand what others are saying)...HOWEVER, when a child with apraxia tries to communicate an idea they experience difficulty making their articulators (tongue, lips, etc) produce speech.

They have problems with “motor planning”…

I like to use sports examples when explaining motor planning to parents.
In basketball, a player has to create a "motor plan" for shooting a basket. He has to bend his knees, position his arms, hold the ball, visually line up the ball with the basket, release the ball with the correct force so he doesn't over shoot or undershoot. All these aspects of shooting a basketball have to come together in that motor act. With enough practice the basketball player doesn't have to think through each separate piece of shooting a basket...it becomes automatic.

Speech is a complicated motor act. Typically developing kids develop speech automatically and store motor plans for a ridiculous number of syllable and sound combinations.
Unfortunately for children with apraxia they have to start from scratch each time they want to speak. It is more difficult for them to create and retrieve motor plans.

The Apraxia-kids website explains it this way:
"Usually once syllables and words are spoken repeatedly, the speech motor act becomes automatic. Speech motor plans and programs are stored in the brain and can be accessed effortlessly when they are needed. Children with apraxia of speech have difficulty in this aspect of speech. It is believed that children with CAS may not be able to form or access speech motor plans and programs or that these plans and programs are faulty for some reason."

Children with CAS typically demonstrate good receptive language and poor expressive language (i.e., they understand a lot and say very little if anything).
CAS should not be diagnosed until a child is at least 3 years old. It may be suspected before 3 but should not be officially diagnosed at that time.

Some of the most common speech characteristics of CAS include:
-abnormal prosody (i.e., the sing-song aspect of speech)
- vowel errors (children should have all vowels by the age of 3)
-initial consonant deletion (“ar” for “car”)
-variable error patterns (say a word differently each time they attempt to produce it)
-difficulties with sound sequencing (linking sounds together)

Because of the nature of this speech disorder it requires frequent (at least 3x a week), intensive (30 minutes) one-on-one speech therapy. Just like you would need short, frequent practice to improve on any motor task. It also requires an SLP who has worked with the disorder before and knows what techniques to use to facilitate speech production. Kay Giesecke has been working with CAS for over 14 years and is very successful at getting kids with CAS to talk. Some of her kids were nonverbal at the age of 7 and now speak in full sentences!! She is amazing and i feel lucky to have been mentored by her in this area. Check out our website: http://www.apraxiadallas.com

I'm sure over the course of this blog i will discuss Childhood Apraxia of Speech several more times...so that is all for now!