Apraxia touches so much of our journey with Noah, I thought I’d take this opportunity to explain what it is.
According to the American Speech/Language Hearing Association, “Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words. ” There is a lack of information being processed in the brain about how to make skilled movement.
There are three types of apraxia:
- Oral apraxia – this involves the motor planning required in feeding and swallowing. Babies with Down syndrome often have trouble sucking and swallowing because of poor muscle tone and strength. It is usually not due to apraxia. (Noah had great difficulty nursing as a baby. His tongue would also slip out of place and he’d wind up sucking on it instead of a food source. This type of feeding pattern is common in children with Down syndrome due to their anatomy and poor muscle tone, so I don’t know if it was oral apraxia or not.)
- Motor apraxia – this involves use of muscles required for gross motor activities.
- Verbal apraxia – this is the inability to access or form speech motor plans which move the idea of the word from the child’s brain through the pathways in the brain to the mouth and out through the lips. (This is the type Noah most certainly has.)
It is quite common for a child to have only verbal apraxia, although many therapists wrongly assume that if a child has verbal apraxia, it will also show up in gross motor and oral skills.
A child with verbal apraxia will be able to say some words sometimes and at other times be at a total loss. They will often look like they are groping for words, or that a word is on the tip of their tongue but is refusing to come out. A frustrating characteristic about this condition is that the harder a child concentrates on saying a word, the more their motor planning abilities come into play, and the harder it is for them to say the word they are attempting. Often times their best speech production will be in spontaneous utterances leaving mom and dad saying, “Where did that come from, and how can we get him to say it again?”
For parents of children with Down syndrome, it is heartbreaking (for a while) to accept the diagnosis of Down syndrome and then to deal with all the therapies and sequelae that go along with raising these special children. Once a diagnosis of apraxia is made, it can be overwhelming to have another condition to tackle, more hurdles to overcome. The good news is that once diagnosed, apraxia can be treated effectively. But I’ll save that for a future post.
A special thank you goes out to Kay J. Giesecke, MS, CCC-SLP http://apraxiadallas.com/about_us. She is known among SLPs as the guru of apraxia, and I learned a lot from attending her workshop at the 2012 TSHA convention. An easy to follow handout of her workshop can be found at http://www.txsha.org/_pdf/Convention/2012Convention/2012Handouts/Giesecke,%20Kay%20-%20The%20Changing%20Nature%20of%20Childhood%20Apraxia%20of%20Speech%20Characteristics%20and%20Treatment%20Strategies%20Over%20Time.pdf.