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For people with special communication needs
What Is Developmental Apraxia of Speech?
By Diane Paul-Brown and Roseanne Clausen
A child with developmental apraxia of speech has trouble correctly
producing and sequencing sounds, syllables, and words. Generally,
there is nothing wrong with the muscles of the face, tongue, lips,
and jaw. The problem is thought to arise from difficulty accessing
the "motor plan" from the brain for saying a sound or word.
This means that children with developmental apraxia of speech may
know what they want to say, but they just can't say it. For example,
an older child with the disorder may know the answer to your question
is "buckle my seatbelt". He can think the words. He may even have
said those same words in the past. But it is not under his control
to say them when he wants-no matter how hard he tries. Somehow, his
brain just isn't telling his face, tongue, lips and jaw how to produce
The cause of the disorder is unknown.
What does this mean for my child?
Knowing what you want to say and not being able to say it can be
a very frustrating experience. And as the child grows, difficulty
producing speech and being understood can lead to other difficulties
with written language and academic and social skills.
Children who have apraxia of speech can have other communication
and developmental problems as well. These problems can include oral-motor
weakness, expressive language problems, delayed language development,
"soft signs" of neurological involvement such as difficulty coordinating
fine motor movement, and/or oral sensory-perceptual deficit (a problem
with tactile/motor feedback that is also known as "oral stereognosis,"
perceiving an object or form through the sense of touch.)
How do I get help?
Help starts with professional diagnosis and a treatment program.
Any child who has difficulty communicating or who does not seem to
be developing communication abilities at an age-appropriate rate should
be assessed for possible speech, language, and hearing problems.
ASHA-certified speech-language pathologists and audiologists can
pinpoint the types of problems your child is having and set up a treatment
program specific to your child.
For children who show symptoms of developmental apraxia of speech,
as ASHA-certified speech-language pathologist will coordinate diagnosis
How will my child be assessed?
Assessing apraxia of speech is a multidimensional activity that includes
several important steps. Hearing problems should be ruled out by an
ASHA-certified audiologist as a necessary first step. The speech-language
pathologist will assess your child's speech sound production and sequencing,
muscle development, speech mechanism function, and other physiological
functions such as breath control and voice intonation patterns.
What will a treatment program consist of?
The treatment program your child's speech-language pathologist develops
will likely focus on improving skills in planning, programming, storing,
and retrieving motor patterns related to speech production. The success
of treatment will depend on several factors:
- the severity of the disorder
- whether there are additional problems and how severe they are
- how ready your child is to pay attention, follow oral directions,
and commit information to long-term memory
- parents' commitment to treatment sessions and home practice assignments
- what other services the child receives and how much time is committed
to those services
One focus of your child's treatment will be to create a supportive
environment that helps the child feel successful in communicating
his or her ideas. The speech-language pathologist will provide intensive
treatment that will probably involve several shorter treatment sessions
each week rather than one longer session per week. Parents also may
be involved through short home assignments requiring daily practice.
Your speech-language pathologist may use treatment strategies that
include oral-motor, tactile, auditory, visual, imitative, and phonemic
Repetition or "drill" is important for rehearsing syllables, words,
and phrases to make them automatic. Improved communication is the
most important goal of your child's treatment, and consideration of
an augmentative or an alternative communication system may be an important
first step toward achieving that goal.
Resources for parents
Probably one of the most important things for a parent to remember
is that treatment for developmental apraxia of speech will take time
and commitment. Without it, the problems associated with the disorder
may persist into adulthood.
The following are resources available to parents of children with
developmental apraxia of speech. Your speech-language pathologist
also can point you to local support and informational resources.
- Referral to an ASHA-certified speech-language pathologist in your
area, through ASHA's Action Center, 800-498-2071
- The Childhood Apraxia of Speech Association website and email discussion group that offers ongoing discussion of clinical issues and research. To join, send an email message to: email@example.com with no subject and "subscribe apraxia-kids firstname lastname" [insert name where indicated].
- Rreadings such a Developmental Apraxia of Speech: Theory and Clinical
Practice (1993), by Penelope K Hall, Linda S. Jordan, and Donald
A. Robin, and Clinical Management of Motor Speech Disorders of Children
(1999), by A. Caruso and EA. Strand (Eds.)
Signs that can indicate developmental apraxia of speech
Very young children
- does not coo or babble as an infant
- produces first words after some delay, but the words are missing
phonemes (sounds) or have difficult phonemes replaced with easier
- produces relatively few different consonant sounds
- simplifies words by replacing or deleting difficult phonemes
- may have feeding problems
ASHA November/December 1999 ....in older children
- makes inconsistent sound errors that are not the result of immaturity,
e.g., uses a favored syllable for all words, uses a real or nonsense
word in place of other words, or leaves out sounds when speaking
- can understand language better than he or she can produce it
- difficulty imitating speech
- may appear to be searching for something when he or she tries
to produce sounds or coordinate the articulatory
- has greater difficulty saying longer phrases
- ability to speak appears to be affected by anxiety
- listener has difficulty understanding the child
Other names for Developmental Apraxia of Speech
- developmental verbal apraxia
- oral motor planning disorder
- developmental verbal dyspraxia
- childhood verbal dyspraxia
- verbal dyspraxia
- developmental articulatory dyspraxia
Other useful resources
Drew Bledsoe of the New England Patriots has established
the Drew Bledsoe Foundation Parenting With Dignity
program. Bledsoe says of his success "my
parents helped me the most to be what I am today" and
his goal is to help other parents give their children the
best possible start. For more information, see http://www.drewbledsoe.com/.