Not quite apraxia, definitely not dysarthria, it looks like Noah has landed with Motor-Speech Disorder Not Otherwise Specified. Pure apraxia exists in children without other neurological compromise, and one of the features of apraxia is inconsistent errors. Obviously, since Noah has Down syndrome he is not without other neurological compromise, and most of Noah’s speech errors are consistent, so we can’t quite land on apraxia. Motor-Speech Disorder is the umbrella under which apraxia and dysarthria fall under; the NOS is a relatively new addition to the group.
The biggest part of the apraxia dilemma is that there is no official criteria, so a child presenting to one SLP may be diagnosed according to her criteria and not be diagnosed at a different SLP based on her criteria. This is the kind of stuff that drives a momma whacko.
The good news is that since apraxia is a motor-speech disorder, and since PROMPT is all about addressing oral/motor/speech issues, the fact that Noah is landing in motor-speech disorder NOS versus apraxia means the treatment is the same regardless. So, I continue to think we’re in the right place as far as treatment goes.
There’s not much literature out there on MSD NOS now; although Marcus (Noah’s SLP) says there is research currently being conducted. So in time we’ll have more information – I’m fairly confident the research will tell us PROMPT (tactile cueing) is the right road to be on.
As far as Noah’s progress, Marcus says he is doing well. He is able to produce more accurate sounds and I think his jaw sliding is improving. Marcus is starting to add concepts like positional words into their sessions, so Noah is getting language as well as speech practice. I’m so anxious to see carryover from Marcus’ sessions and my work with Noah into his natural language routine. That is coming so very, very slowly. In theory, it will happen in time and practice as we continue on with speech therapy.
One bright spot to our week – Noah has started saying “Caelie” and “Leah.” He has done it a few times on his own without any prompting. This is a huge distinction in my eyes – being able to mimic a word is great, but it’s not really communication. Having Noah run towards me shouting “Caelie, Caelie” since he knows we’re going to be meeting her for lunch is definately communication.
I’m so thankful for the little things along the way that show me he is moving foward.