Apraxia – What it’s All About

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:

  1. 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.)
  2. Motor apraxia – this involves use of muscles required for gross motor activities.
  3. 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.


3 thoughts on “Apraxia – What it’s All About”

  1. Do you use sign language with Noah? I used it with my son when he was very young, and he still uses some signs when he can’t get the words out. I think it’s the autistic stuff that prevents him from wanting to communicate – but it could be what you’re describing. No one ever diagnosed my son with it, so I wasn’t aware of it. Anyway, the signing is a huge help. When the words won’t come, the gestures can still get the point across. By the way, his favorite sign is the one for “eat.” 🙂

    You are so right – it’s heartbreaking to have one diagnosis, but then having to deal with another (or multiple) condition really makes you want to scream (or swear, which I’m not proud of, but occasionally happens – I have to ask for forgiveness a LOT). I keep telling myself “His grace is sufficient, His grace is sufficient.” Then recently I met a lady whose son has Downs, full-blown autism, and PICA on top of all that. So whenever I think I have it tough, I think of her and the grace she must operating under.

    My mom once gave me a plaque that read, “What you’re born with is God’s gift to you, but what you become is your gift to God.” As mothers of special needs sons, we are learning patience, mercy, compassion and longsuffering. Just think of the gift we are becoming for Him!! 🙂

    1. I do use sign language with Noah. He was signing when he was still totally nonverbal, and he does very well with signs. I love sign language and the Lord has been very kind to give my brain the quiet space it needs to absorb a new language. (Just thinking through what I’m going to cook for dinner tonight can be a struggle sometimes.) Noah loves “eat” too, but “milk” has got to be his number one favorite. We also use PECs a lot when he’s learning something new, but usually not to communicate.

      About the apraxia – I encourage you to visit http://www.apraxia-kids.org/. Just see if any of the symptoms of apraxia ring a bell for your son. I am passionate about getting the word out, because a lot of speech therapists were taught in school that apraxia doesn’t really exist, ESPECIALLY in children with Down syndrome. The problem with that is that, one, it does exist, and two, it requires a very specialized speech therapy regimen and without it, the speech issues related to the apraxia do not improve even with years of therapy. When these children do get specific treatment, they usually make good progress. There is a great protocol out there that’s been around for a while called Kaufman, and there are some newer ones too. I think for Noah, I don’t see that anything is keeping him from wanting to communicate, it’s just something is not clicking. He will try to tell me something, and then he winds up grabbing my hand and dragging me to it or he pats me and then makes that hugely exaggerated “come on” gesture, and then he’ll take me to what he is trying to say.

      His grace is sufficent. There are times in my life when I’ve clung to that Truth, but I come up short. And I protest, “No, Your grace is not sufficent. It does NOT feel sufficient right now.” But in hindsight, it was sufficient, because I am still here, and God is still on His throne. A good reminder that His plan and His ways are not my plans and my ways, but His are always better than my own. Noah reminds me of that every day. I could have never imagined what that little boy would do to my life . . . and how thankful I’d be that he or is it HE) did it.


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