Developmental Apraxia of Speech

Developmental apraxia of speech is a disorder of the nervous system that affects the ability to sequence and say sounds, syllables, and words. It is not due to muscular weakness or paralysis. The problem is in the brain's planning to move the body parts needed for speech (e.g., lips, jaw, tongue). The child knows what he or she wants to say, but the brain is not sending the correct instructions to move the body parts of speech the way they need to be moved. There is no known cause of the disorder.

Signs of Developmental Apraxia of Speech
In Very Young Children
The child:
  does not coo or babble as an infant 
  produces first words after some delay, but these words are missing sounds 
  produces only a few different consonant sounds 
  is unsuccessful at combining sounds 
  simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (Although all children do this, the child with developmental apraxia of speech does so more often). 
  may have feeding problems.

In Older Children
The child: 
  makes inconsistent sound errors that are not the result of immaturity 
  can understand language much better than he or she can produce it 
  has difficulty imitating speech 
  may appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement 
   has more difficulty saying longer phrases than shorter ones 
  appears to be worse when he or she is anxious 
   is hard for listeners to understand.

Some children may have other developmental and communication problems as well. These problems can include weakness of the lips, jaw, or tongue; delayed language development; other expressive language problems; difficulties with fine motor movement; and problems with oral-sensory perception (identifying an object in the mouth through the sense of touch).

Assessment
In order to rule out hearing loss as a possible cause of the child's speech production difficulties, an audiologist certified by the American Speech-Language-Hearing Association (ASHA) should perform a hearing evaluation. Contact Paradigm Rehabilitation Services at 630-904-5660 to find one near you

An ASHA-certified speech-language pathologist should examine the child's speech mechanism. He or she assesses the muscle development of his lips, jaw, and tongue, checking for signs of weakness. He or she evaluates the coordination of the speech mechanism for purposeful movement by having the client imitate non-speech actions (e.g., moving the tongue from side to side, smiling, frowning, puckering the lips, etc.). The speech-language pathologist will also evaluate the coordination and sequencing of muscle movements for speaking by having the child repeat strings of sounds (e.g., puh-tuh-kuh) as fast as possible. 

The coordination of breathing with speaking, another skill that requires planning and sequencing of muscle movements, is evaluated too. 

  Can the child take in a breath and then effectively use this air to produce a phrase or sentence? 
  Does the child begin speaking before he or she has inhaled sufficiently? 
  Does the child seem to "run out of air" in the middle of utterances? 

The speech-language pathologist checks to see whether or not the child uses breathing efficiently to change the intonation of speech. For example, when asking a question, does the child have enough air to raise the pitch of the voice at the end of the question?

Speech articulation (pronunciation of sounds in words) is evaluated. Along with pronunciation of individual sounds and combined sounds, overall intelligibility of the child's speech is assessed, in single words as well as in conversation.

The speech-language pathologist evaluates expressive and receptive language skills to determine if speech difficulties are part of a larger language problem. The speech-language pathologist evaluates:
  the child's understanding and use of vocabulary as well as the ability to understand and answer questions, follow directions, and comprehend verbal passages of increasing length and complexity; 
  the child's ability to use age-appropriate grammatical constructions in sentences and in the context of longer utterances (e.g., when explaining how to perform a task or when retelling the plot of a favorite movie or book); 
  whether or not the child has age-appropriate understanding and use of word forms (e.g., using -ed at the end of words to indicate that something has already happened); 
  social communication skills paying particular attention to whether or not the child has modified the communication because of any speech disability. For example, does the child refuse to participate in classroom discussions because he or she is ashamed of and/or frustrated by his or her speech?

Based on these findings, an appropriate plan for treatment is developed. 

Treatment 
Intervention for the child diagnosed with developmental apraxia of speech often focuses on improving the planning, sequencing, and coordination of motor movements for speech production. The child is taught exercises that strengthen the muscles of the lips, jaw and tongue as well as those that improve the coordination of the speech mechanism. For example, the speech-language pathologist uses tactile (e.g., pushing the tongue against a tongue depressor), auditory (e.g., listening to his or her own speech on a tape recorder) and visual (e.g., "watching" a picture of his or her speech on a computer screen) feedback to help the brain tell the speech muscles what to do. With this feedback, the child repeats syllables, words, sentences and longer utterances to improve muscle coordination and sequencing for speech. If assessment reveals expressive and/or receptive language deficits, treatment will include improving these skill areas as well.

Some clients may be taught to use an augmentative or alternative communication system (e.g., a portable computer that writes and produces speech) if the apraxia significantly hinders speech production. This communication system provides them with a means to communicate their ideas when communication through speaking is not a viable option. Once speech production is more effective, the system is used less often or withdrawn completely. 

The client and his family are provided with home assignments to accelerate progress and to facilitate carryover of newly learned strategies outside of the treatment room. 

One of the most important things for the family to remember is that treatment of developmental apraxia of speech takes time, commitment, and a supportive environment that helps the child feel successful with communication. Without this, the disorder can persist into adulthood with years of speech-related anxiety and frustration.