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 words.

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 and treatment.

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 development activities.

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.
Web site with a broad sampling of current literature and links to related sites: Http://www.apraxia-kids.org - The Apraxia-Kids Web site, a comprehensive informational site for professionals and parents.
Http://www.apraxia.org - The Childhood Apraxia of Speech Association Web site
E-mail discussion group that offers ongoing discussion of clinical issues and research. To join, send an e-mail message with no subject and "subscribe apraxia-kids".
Readings 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 ones.
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.

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