Apraxia can be developmental or acquired, and can impact at any age. Here's an overview, plus a real-world example of how one child progressing with speech therapy.
In this article we will discuss:
Apraxia, dyspraxia or apraxia of speech: are they all the same?
Generally, yes, all of these terms refer to the neurological problems that make it difficult for someone to create sounds for language. In medical references, you may sometimes see the word "dyspraxia," but it still refers to the same motor-issues that effect speech.
What is the difference between "developmental apraxia" and "acquired apraxia?"
"Developmental apraxia" describes a motor-skill neurological issue that exists from birth, and so usually refers to apraxia-of-speech in children.
"Acquired apraxia" refers to apraxia that is a result of an injury like a TBI (Traumatic Brain Injury) or stroke, and so will usually refer to apraxia that happens to an adult. But consider that an injury could happen at any time, and result in acquired apraxia.
What are signs my child might have apraxia?
The first signs of a communication concern that a parent often notices is that their child is difficult to understand. The child may be acquiring new words very slowly, and they are not making sentences. This lack in intelligibility and in acquiring new words could be due to an articulation delay or a disorder.
Can I tell if my child has an articulation delay or developmental apraxia or apraxia of speech?
With both an articulation delay and apraxia, the child is very intelligible or very inconsistent. But with an articulation delay, the child has trouble with a few sounds. This can usually be remedied fairly quickly. If apraxia is involved, therapy will take longer to help overcome.
Developmental Apraxia is a motor speech disorder that affects the coordination and planning of sounds and sound combinations. For proper production of speech sounds, the articulators (which are the lips, tongue, jaw, palate, and vocal folds) need to be well coordinated and flow in correct order from one sound to the next. Apraxia creates discoordination between all the articulators. Intensive speech therapy is currently the best remedy for this disorder.
The Mayo Clinic shared with us some key symptoms of articulation disorders and apraxia, see below:
Articulation disorders may be characterized by:
Substituting sounds, such as saying "fum" instead of "thumb," "wabbit" instead of "rabbit" or "tup" instead of "cup"
Leaving out (omitting) final consonants, such as saying "duh" instead of "duck" or "uh" instead of "up"
Stopping the airstream, such as saying "tun" instead of "sun" or "doo" instead of "zoo"
Simplifying sound combinations, such as saying "ting" instead of "string" or "fog" instead of "frog"
But with apraxia, those markers that are particularly associated with CAS include:
Difficulty moving smoothly from one sound, syllable or word to another
Groping movements with the jaw, lips or tongue to make the correct movement for speech sounds
Vowel distortions, such as attempting to use the correct vowel, but saying it incorrectly
Using the wrong stress in a word, such as pronouncing "banana" as "BUH-nan-uh" instead of "buh-NAN-uh"
Using equal emphasis on all syllables, such as saying "BUH-NAN-UH"
Separation of syllables, such as putting a pause or gap between syllables
Inconsistency, such as making different errors when trying to say the same word a second time
Difficulty imitating simple words
Inconsistent voicing errors, such as saying "down" instead of "town"
Speech therapy for apraxia starts off with an assessment phase:
The therapist will first look at what sounds and syllable structures the child has. The development of sounds and syllable structures follows a specific sequence for most children. However, for children with apraxia, these stages do not often follow a typical pattern. We focus on a strengths-based approach. We look at what sounds and syllable structures the child does use spontaneously, and use those productions to assist in developing new sounds and syllables.
The therapist will also look at which sounds and syllable structures the child is able to imitate when given a model or prompt in a structured task, but does not say on his own in spontaneous speech.
The therapist will determine the best course of treatment based on what sounds and syllables are developmentally appropriate for the child to produce at their age.
After assessment, the therapist will work with you to determine a therapy plan. Below we share a case study of one of our clients, as an example of the type of treatment we provide.
Case Example: Childhood Apraxia-of-Speech
I started working with a 4-year-old boy with suspected developmental apraxia. At the time of the evaluation, he exhibited the following signs:
His sound repertoire was quite limited. Spontaneously, he was able to produce the /t, p, d, m/ sounds.
He was able to produce the CV and the VC syllable structures (consonant + vowel and the vowel + consonant ‘bee’ and ‘up’) independently.
He had a great difficulty closing the syllable to produce the CVC words (consonant + vowel + consonant ‘mom’).
His intelligibility was approximately 25% or less especially to novel listeners.
At this age, children usually are able to speak in sentences, close syllables, and are at least 75% intelligible to novel listeners. The signs and the assessment resulted in a diagnosis of developmental apraxia.
Treatment for Childhood Apraxia-of-Speech
Since the child was able to spontaneously make the /t/, d, p, and m/ sounds, I took advantage of those strengths and started working on closing the CVC syllable structure, targeting words that contain just those four sounds, such as: mop, top, mom, pom, dip, and others.
Children who are not able to close the syllable on their own need to be taught to hear that there needs to be a consonant at the end of the words, since most English words require the closing of the syllable. For this particular student, the closing of the syllable was quite difficult with the use of a model and familiar consonants, so we used a strategy of creating space between the vowel and the last consonant, which also places more emphasis on the last consonant (ex. di_p).
Once the child became comfortable with following the structure of closing the syllables with a slight space between the sounds, I gradually introduced new sounds that were developmentally appropriate. He actually started trying different words on his own within the games we played which contained new sounds. I used those sounds to further develop his CVC word repertoire.
I modeled the words and emphasized all the sounds even if there were sounds he couldn’t produce yet. However, I accepted his production as he gave me and gradually shaped the sounds. For example, the child was not able to produce the sounds /k and g/ and would typically substitute them for /t and d/ as many children do. I accepted his production while modeling the correct form to stimulate those sounds over time. I normally model and ask the child to try the words three times before moving on.
Progress to Date (we will update this case as therapy continues)
In the span of several months of therapy, the child was able to produce more sounds independently including /sh, s, h, w, n/ in the beginning and end of CVC words.
He practiced over 50 CVC words that included all of his sounds.
He was able to retain his focus and stamina to repeat 30 words clearly within a 15 minute window.
He started working on functional words such as ‘help’ and ‘more’. He had been reluctant to repeat words in the past for the function of communication, but this improved with therapy.
In the beginning, speaking and imitating sounds and words was difficult for him. He was often distracted and noncompliant to practice his words. Gradually, as sounds and words became easier for him, he was able to maintain attention and participation for 15 minutes at a time.
His parents have noticed that he is trying new words and is sounding better at home.
If you would like to know more about how we create a customized version of our program for our clients, go to our program page and book a consultation. At Better Speech, we offer online speech therapy services convenient for you and tailored to your child's individual needs. Our services are affordable and effective - get Better Speech now.
About the Author
Svetlana Atenzon
With over 10 years of professional experience, I have been working with children and adults of all ages throughout my career. I have worked in a variety of settings such as home care, clinics, schools, and now teletherapy. I have worked with clients who had articulation disorders, language disorders, cognitive impairments, developmental delays, Autism, literacy delays, Apraxia, Dyslexia, fluency disorders, Down Syndrome, Traumatic Brain Injury, Cerebral Palsy, Parkinson’s Disease, Multiple Sclerosis, Progressive Degenerative Disorders, Aphasia, and much more. I also work with clients seeking Accent Reduction services.
When I am not helping others through my role as a licensed speech-language pathologist, I enjoy doing Yoga, listening to music, reading stories, and making art, especially when I can later incorporate those elements in my therapy.
