“She doesn’t need to talk. She communicates just fine.”
It has been a long road in the Apraxia world. My Baby Bee, KB, was diagnosed with Expressive Language Delay due to Apraxia two years ago. What does Expressive Language Delay mean? For KB, it meant that she couldn’t talk to you or tell you what she was thinking. If she needed or wanted something, she would either get it on her own OR point. At first, it wasn’t a big deal but looking back it on it now is heartbreaking.
KB understood very quickly by using her visual and auditory learning skills.
When you can’t speak because your brain isn’t telling your mouth what to do, it is beyond frustrating. KB knew what we were talking about from early on and that was how I didn’t see the signs when I should have. Even when she was being evaluated, she was off the charts on her scores. She is completely “perfect” on paper. Luckily for us, the talented case manager understood what KB was doing and knew immediately. Fast Forward. Outgrowing Apraxia is a blog post from May of this year. Please read it to see how far we have come in her short journey.
Apraxia is different for every child. No two children are a like and they all have various issues other than just Apraxia. I sometimes think that the term Apraxia is a catch all. Since I only have experience with KB, I will talk about her skills. She is very VISUAL. These days, it’s almost all visual learning. Being a Visual Learner is great for me. I am a visual learner as well as my other two, especially Rea. We are born to do worksheets.
KB is in Pre-K this year. She doesn’t know the alphabet. To be honest, it makes me want to cry. What 4 year old doesn’t know the alphabet? Rea was reading in Pre-K and is breezing through chapter books faster than I can read a magazine. So this delay is gut-wrenching. KB loves our whiteboard. I have Rea write out the alphabet letters and after a few hours of trying, KB is up to letter H. H is for HUGE. This is huge for us. It is not that she is just saying the letter but she is associating the letter sound with the written letter. When it comes to KB learning new words and then being able to put them together with letters, it is like we won the lottery.
As for auditory skills, we put on cd’s or have her listen to us. We have her repeat what she hears and if she can, we have her explain it. That latter part is more advanced for her but she is trying.
What type of learning skills do your kids use?
According to The American Speech-Language-Hearing Association ::
What are some signs or symptoms of childhood apraxia of speech?
Not all children with CAS are the same. All of the signs and symptoms listed below may not be present in every child. It is important to have your child evaluated by a speech-language pathologist (SLP) who has knowledge of CAS to rule out other causes of speech problems. General things to look for include the following:
A Very Young Child
- Does not coo or babble as an infant
- First words are late, and they may be missing sounds
- Only a few different consonant and vowel sounds
- Problems combining sounds; may show long pauses between sounds
- Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)
- May have problems eating
An Older Child
- Makes inconsistent sound errors that are not the result of immaturity
- Can understand language much better than he or she can talk
- Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
- May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
- Has more difficulty saying longer words or phrases clearly than shorter ones
- Appears to have more difficulty when he or she is anxious
- Is hard to understand, especially for an unfamiliar listener
- Sounds choppy, monotonous, or stresses the wrong syllable or word
Potential Other Problems
- Delayed language development
- Other expressive language problems like word order confusions and word recall
- Difficulties with fine motor movement/coordination
- Over sensitive (hypersensitive) or under sensitive (hyposensitive) in their mouths (e.g., may not like toothbrushing or crunchy foods, may not be able to identify an object in their mouth through touch)
- Children with CAS or other speech problems may have problems when learning to read, spell, and write
How is childhood apraxia of speech diagnosed?
An audiologist should perform a hearing evaluation to rule out hearing loss as a possible cause of the child’s speech difficulties.
A certified-SLP with knowledge and experience with CAS conducts an evaluation. This will assess the child’s oral-motor abilities, melody of speech, and speech sound development. The SLP can diagnose CAS and rule out other speech disorders, unless only a limited speech sample can be obtained making a firm diagnosis challenging.
An oral-motor assessment involves:
- checking for signs of weakness or low muscle tone in the lips, jaw, and tongue, called dysarthria. Children with CAS do not usually have weakness, but checking for weakness will help the SLP make a diagnosis.
- seeing how well the child can coordinate the movement of the mouth by having him or her imitate nonspeech actions (e.g., moving the tongue from side to side, smiling, frowning, puckering the lips)
- evaluating the coordination and sequencing of muscle movements for speech while the child performs tasks such as the diadochokinetic rate, which requires the child to repeat strings of sounds (e.g., puh-tuh-kuh) as fast as possible
- examining rote abilities by testing the child’s skills in functional or “real-life” situations (e.g., licking a lollipop) and comparing this to skills in nonfunctional or “pretend” situations (e.g., pretending to lick a lollipop)
A melody of speech (intonation) assessment involves:
- listening to the child to make sure that he or she is able to appropriately stress syllables in words and words in sentences
- determining whether the child can use pitch and pauses to mark different types of sentences (e.g., questions vs. statements) and to mark off different portions of the sentence (e.g., to pause between phrases, not in the middle of them)
A speech sound (pronunciation of sounds in words) assessment involves:
- Evaluating both vowel and consonant sounds
- Checking how well the child says individual sounds and sound combinations (syllables and word shapes)
- Determining how well others can understand the child when they use single words, phrases, and conversational speech.
An SLP may also examine the child’s receptive and expressive language skills and literacy skills to see if there are co-existing problems in these areas.
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