Tag Archives: Speech Therapy

Apraxia – Is there a Time to Drill and a Time to Not Drill?

Noah has been back riding the horses at Red Arena for a couple months now.  I’ve been blown away by his instructor,  Miss Emily.  She adores my little guy and although she is not a SLP, she has worked with him extensively on his speech and is getting great results.

A few weeks ago she told me about all these words he was saying and how he was putting phrases together on his own.


She said he had said words like throw, rock, water, snake.

Again, seriously?

I prompted him to say “water” right there in front of her, and Noah grunted as usual.

“No, no,” she said, “He really said it.”

“Okay, whatever you say,” I thought.  (I didn’t say it outloud, did I?)

So last week at Noah’s session, Miss Emily produced a video.  Proof.  The little boy on the video is not the little boy I know.  He was throwing rocks in the water and asking for more rocks, water, putting words together.  It was like she said.  He said “water,” he really did.

So I mentioned all this to Noah’s speech therapist and asked for his take on why Noah does so well in that environment, but I don’t get the same results.

“Well, Mrs. Dunn, you are Noah’s mother, Noah’s homeschool teacher, and his speech therapist.  It’s probably too much.  Take the speech therapy drilling out of his routine, and just work with him on his school work.  Work on prompting speech from his lexicon during real-life opportunities, but leave the speech therapy to me.”


Okay.  So I horribly misquoted the speech therapist, I’m sure, but that’s the gist  I got.


Stop drilling?  The kid has got apraxia, he’s barely verbal, and he’s 7 years old.  You can’t stop drilling a kid with apraxia.  Everybody knows that.

So I fumed for a few days.  Noah is darn tooting lucky to have a Mom who is willing to drill with him every day.  Stop drilling?

But you know, as I thought about it, I think the speech therapist may have a point.  Maybe.  Or maybe I’m just tired and welcome a break.

But going on the notion that the speech therapist might have a point – Noah actually excels at drilling.  He can make most of the consonant and vowel sounds in isolation.  It’s words and phrases that he struggles with.  I think I tend to wear him out in our speech sessions, so then when I try to prompt speech in real-life activities, he responds to it like its another speech session and resists.  Perhaps it might be better for my wanna-be speech therapist persona to fade into the background and just stick with Momma.

You know, I think what really got me was the notion that somebody other than myself might hold the key to helping Noah find his voice.  I mean, we don’t farm out our kids education, academic or religious, we don’t pay other people to take care of our kids; we feel like we’re wholly responsible to give our children what they need.

So this idea of “leaving speech therapy to the experts” just doesn’t fit.

But I think he might be right.

But I also think, in looking back, that Noah needs different things at different times.  I think he needed traditional speech therapy when he got it at age 3-6.  And I think he needed PROMPT once he turned 6.  And I think he needed the drilling we did over the past year.  But I think, perhaps, the speech therapist was right.  Right now, he just needs his Mom.

So Mom is what he gets, even if Mom is going to still be capturing every teachable language moment she can, even if Mom is still going to be prompting for speech and teaching sign language, even if Mom is still going to be on the lookout for predictable books and opportunities for speech.

What do you think?  Am I caving, or does this make sense?  Where do you think the balance should be between what a speech therapist does in weekly sessions and what a mom should be doing at home?


Apraxia or Not Apraxia – the VMPAC, Down Syndrome and Apraxia

Our courageous hero underwent the VMPAC (Verbal Motor Production Assessment for Children), which was a formal assessment for apraxia.  He did the entire test in one sitting, and he came out of it smiling.  Amazing stuff!  So, the test got scored, and if Noah didn’t carry the diagnosis of Down syndrome, he would definitely have the diagnosis of apraxia.

But since apraxia is technically (depends who you talk to) a condition only present in the absence of other neurological conditions, Noah doesn’t carry the diagnosis of apraxia.   In fact, because the has Down syndrome, he never really should have been given the test to begin with.  The reason it was administered was because I’ve been pestering his speech therapist to formally assess him for apraxia for a year now.  So, I think it’s safe to say Noah has all the verbal features of apraxia, but he probably will never be diagnosed with it.

The bright side?  Well, the speech therapist Noah has been working with is an expert in PROMPT therapy, and that is the method he has used for the past year.  I searched him out when I became convinced that Noah had apraxia, and I think his use of PROMPT is the exact thing that Noah needs.  So diagnosis or not, his treatment is consistent with that of apraxia.

I don’t know why this issue of diagnosis versus no diagnosis is so important to me.  I guess in a way it’s the first time Noah has been excluded from anything based on his Down syndrome.  Not all kids with Down syndrome have apraxia.  Kids with apraxia do not tend to progress without very specific apraxia therapy.  There are thousands of kids out there who have Down syndrome and are not progressing in speech therapy, and it is being blamed on their Down syndrome.  In talking with countless parents of these children who have not progressed with conventional speech therapy, I am convinced that the majority have apraxia-type symptoms.  They are not being considered or treated for apraxia.  I was fortunate that Noah’s first speech therapist was willing to use Kaufmann cards with Noah, which are part of the Kaufmann Apraxia Protocol.  She too was uncomfortable diagnosing Noah with apraxia, but she was willing to use apraxia materials with him.

This is my opportunity to plead with you speech therapists out there and parents too.

If you have children with Down syndrome who are not progressing with traditional speech therapy, DO NOT WRITE IT OFF TO DOWN SYNDROME.  These super-kids with Down syndrome who are speaking so clearly – I’m betting they do not have apraxia symptoms.  Apraxia is TREATABLE!!!!  If you suspect your child has apraxia, ask for a formal assessment, if for nothing else to get an objective black-and-white record of all his features consistent with apraxia.  And then it may be best to avoid the apraxia/Down syndrome argument, but insist on apraxia-based treatment to address the motor planning and sequencing issues that treat apraxia symptoms.

Speech and language pathologists – I know it’s political, and I know it’s a hot topic, but please, please, please, look at the evidence.  We need to look at apraxia differently, and we need to get objective diagnoses of apraxia even in the context of dual diagnoses.  Children with Down syndrome with apraxia or apraxia-type symptoms NEED apraxia protocols.  We lose such precious time when you dismiss the possibility of apraxia and insist on traditional speech therapy methods.  Look at these kids with an open mind, and if you are seeing apraxia, PLEASE speak up!  Our kids with Down syndrome need SLPs who will advocate to diagnose and treat them no matter what their co-existing diagnoses are.  May I humbly suggest that it is time to redefine the term “apraxia” in order to secure the treatment these kiddos so desperately need?

Noah’s Courage – A Speech Breakthrough!

Both Marcus (Noah’s speech therapist) and I have noticed Noah being a lot more verbal lately.  It’s exciting, and yet I hold my breath because I know that this could just be another phase that will fade away rather than prove to be a new pattern in his speech progress.  He’s been willing to mimic back attempts at almost any word I prompt him with (as long as he is in the “mood”).

The other night he did something, though, that I consider quite a breakthrough.  He was lying in bed as I was tucking him in, and he said an unintelligible word with a lot of energy.  When I didn’t understand and started rattling off a list of words that I thought he might be trying to say, he said no to all of them.  But whatever it was he wanted, he really, really wanted.  He even grabbed his mouth to try to force the shape of his lips to help him say the word.  I still couldn’t decipher it, and Noah gave a frustrated sigh that I could tell was an inward disappointment that he couldn’t say the word.  He tried SOOOOO hard!!!!  Finally, even though I’m always so relieved to get everyone one in bed, I let him out of bed to show me what it was he wanted.  He wanted the phone so he could say goodnight to his Daddy who is at our new house tonight trying to get it ready for move in.  I dialed for him and he had quite a conversation (mostly made up of “Daddy” and “yeah.”)

So, of course, it’s great that he initiated speaking with both his father and me, but what was really different was the pressure he was putting on himself to say the word “phone” and the energy he put into it.

Noah has proven he can do most anything he really, really wants to do.  And as hard as he works at speech, I’m never sure just how much he wants to talk because he finds so many other ways to communicate, and speech takes such a HUGE effort on his part.  So many times he tries to say a word and then gives up after one or two attempts, usually frustrated with me because I’m trying to make him do something he really doesn’t care to do once he realizes how difficult it is.  The other night he wanted to do it more than he wanted to give up.


I really want to help Noah’s attempts at speech be succesful.  i think if we can channel his attempts in such a way that they end up feeling successful to him, this kind of effort and persistence on his part will continue; but if they end in his perceived failure, he will stop trying.  Oy.  So difficult because my courageous hero gets very frustrated with me when I say “Good job” too enthusiastically.  I hate to say it, but I think he really doesn’t like feeling like his efforts are a result of being manipulated by his mother.

Typical male.

(No pun intended.)