An Amazing Moment with Apraxia

Over the course of my career I have had the privilege of working with many children with a diagnosis of childhood apraxia of speech (CAS). CAS is described as a “motor speech disorder that makes it difficult for children to speak. Children with the diagnosis of apraxia of speech generally have a good understanding of language and know what they want to say. However, they have difficulty learning or carrying out the complex sequenced movements that are necessary for intelligible speech.” – www.apraxia-kids.org Children with apraxia may have difficulty with aspects of speech such as speech clarity, prosody (the rhythm and intonation of speech) and fluency (the ability to produce speech smoothly).

There is no known cure for apraxia, but I have found that appropriate treatment can help children improve their speech tremendously. Treatment should not look like “typical” speech therapy since children with apraxia have different needs. I have found that a combination of three techniques works for most children. These include motor planning, repetition/drill, and functional communication. 

Motor planning is at the heart of apraxia. The brain misfires when sending the signal to a muscle to move. So, a child who is trying to say the M sound, may end up saying “eeh” or “p” instead. As therapists, we help the child motor plan by using motor planning tools or even using our hands to help them get into position. Once a motor plan is established, repetition and drill is KEY. We need to place this motor plan in the rote memory storage center of the child’s brain. Think about driving a car. You are not consciously thinking about pushing the petal and steering the wheel, but your brain is still doing that thinking in the rote memory center of the brain. This is how children with apraxia learn to speak. When you are first learning to drive you do think about pushing the petal and how hard to push it, but as you learn to drive, you don’t have to be as aware because it becomes natural. How does that happen? From driving a lot. This is true for kids with apraxia. The more they drill and repeat, the better they get at pulling the words out of rote memory. The third prong is providing functional communication as quickly as possible. This means teaching some carrier phrases they can apply to most situations (may I have _____, I’m all done with___) or teaching specific sentences (I’m all done, stop, more please, I want it, I’m hungry). This way the child can communicate their wants and needs faster and their frustration decreases. That’s a win win for everyone.

And finally, a success story. I have successfully treated many children with apraxia of speech over the years, but one special client comes to mind. His is a story of perseverance. I sat in front of this little boy 3 days a week for a year applying the techniques and principals of treating apraxia with little success. You should know that the harder the job, the harder I work. Even though he didn’t say anything, I felt he was getting something out of our work and things were clicking.  I kept going 3 days a week, every week bringing some of the same materials and some new, but always sitting together and working toward the goals. Then one day, he said his first word: “bubble”. His mom came in the room and secretly recorded our miracle day. We all cried and kept working. As I write this blog, that little boy is a 6 year old chatterbox with an amazing vocabulary and developmentally appropriate sentences. He has so many varied interests including traveling (even virtually through google earth) and birdwatching. We still meet 3 days a week, but now we are working on prosody and fluency. As a therapist and a parent, our job is to always find a way to help a child find their voice. Even if it takes a while; don’t give up.

Written by: Rachael Rose, Owner/Founder