Apraxia of speech (also called developmental childhood apraxia of speech, verbal dyspraxia, developmental dyspraxia)can cause a child to have severe speech difficulties. The difficulties arise when the child is unable to coordinate the muscles of speech accurately and smoothly to produce sounds, syllables and words. To explain it simply, the signals from the brain to the muscles of speech (the lips, tongue, jaw. palate) are not working efficiently so speech is uncoordinated and the sounds in words are mispronounced or missed altogether. The child may know exactly what he wants to say, but just cannot say it clearly. Often a child with apraxia of speech has other difficulties and a more global dyspraxia which might affect other fine and gross motor skills. The causes of apraxia are usually unknown, but they can be caused by a genetic disorder or syndrome, or a stroke or brain injury.
Signs of Apraxia
A young child with apraxia may not “coo” or babble as an infant and be late to say their first few words. When they start using more words, there speech might be obviously delayed and they only produce a few consonant and vowel sounds. Children with apraxia are often messy eaters and can drool a lot because they have difficulty coordinating the muscles of the mouth to manage food and saliva. As the child gets older they present with an obvious speech delay, even when their level of understanding is good. When the child tries to talk their is sometimes an obvious groping when they try to coordinate their speech muscles to form words. Longer phrases and bigger words present much greater difficulties than shorter ones. Sometimes intonation can be affected and speech can sound monotonous with stress on the wrong syllables.
Assessment and Therapy
Although the term “developmental childhood apraxia” is often used, children will not grow out of it, and speech will only improve with therapy and regular practice. The child will need to visit a speech pathologist / therapist for a speech and oral-motor assessment and therapy. Research shows the children with apraxia have more success when they receive frequent (3-5 sessions per week), intensive treatment. Although this level of treatment is rarely possible, if parents are prepared to practice regularly with their child, this can make a huge difference in the success of treatment.
Therapy intervantion focusses on improving the planning, sequencing, and coordination of muscle movements for speech production. The therapy does not seek to strengthen muscles, but instead, improve coordination. This therapy can be in the form of articulatory drills, and phonological awareness activities. Articulatory drills help strengthen the links from the brain to the speech muscles , while phonological awareness therapy helps the child develop their awareness of the sounds in words, the links to their word store, and the motor programs that help them articulate the words. To improve speech, the child must practice regularly and can get feedback from their other senses such as visual cues (e.g. watching their tongue movement in the mirror), and listening cues (recording and listening to speech production).
For more rare and severe cases, where speech does not improve significantly despite therapy, some individuals may use alternative communication options. This might involve learning sign language, having a communication book, or using a portable device that produces speech. Some individuals may use these modes of communication while they have therapy and until their speech improves. To read more about assistive communication click here.
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