by Katie, SLP and Contributing Writer
Dear Katie:
I would love to know at what point apraxia is considered “resolved.” I’ve heard so many different viewpoints on this. Some say it’s when a child no longer requires speech therapy and others say the process goes from apraxia, dyspraxia, phonological, articulation, and each is new diagnoses. It’s so confusing.
Quoting Kate Hennessy, a young adult diagnosed with CAS and the daughter of Kathy Hennessy, CASANA’s Director of Education, “Apraxia is something that will never go away. Though I am resolved today, it still affects so many aspects of my life.” I believe this statement is insightful, and it reflects my personal opinion of the disorder.
My focus as an SLP is, in essence, assessing and treating the symptoms of CAS. In my experience, as a child diagnosed with CAS makes progress, his speech production begins to follow more developmentally appropriate patterns (e.g., using phonological processes, having difficulty articulating only later developing sounds). The basis of the disorder remains CAS even though the symptoms may change.
Often children are dismissed from speech-language therapy when their overall speech and language skills reach “normal limits” or “average” according to standardized testing, especially where insurance reimbursement is concerned. However, some areas of deficit may persist. When a child diagnosed with CAS nears dismissal, I would encourage parents to ask their SLP to “deep” test any areas of deficit to determine if specific skills are indeed functioning within normal limits.
For example, if a child “passes” an overall language assessment such as the Preschool Language Scales-Fifth Edition (PLS-5) but continues to exhibit errors in grammar and syntax, administration of the Structured Photographic Expressive Language Test-Third Edition (SPELT-3) may reveal these specific skills to be functioning in the below average range. Likewise, a child may achieve an average score on the Goldman-Fristoe Test of Articulation-Third Edition (GFTA-3) based on the number of errors he demonstrated. However, clinical judgment may override an average test score when considering the difficulty a specific child has previously shown integrating new sounds into conversational speech.
Even when a child achieves speech and language skills within normal limits, and his CAS appears “resolved,” I would propose that the apraxia remains at some level. Certain words, sound sequences, auditory processing tasks, etc. may present occasional challenges throughout his lifetime, all of which can be overcome using principles learned in early therapy sessions.
Dear Katie:
Apraxia and multilingual families … Any thoughts on how to target treatment and get a child ready for school when they are English learners? My son speaks very little, but can say sounds not typical in English because of the two other languages used at home and because of CAS, has a very tiny single word vocabulary. Anything parents can learn to do at home with kids?
No matter a child’s lingual background, in the case of CAS I would always recommend addressing the building blocks of speech production as a means of improving his speech and language development. Focus on laying a foundation by helping him imitate individual consonant and vowel sounds which make up all the languages you wish for him to learn. When he has multiple consonants and vowels in his repertoire, begin having him imitate simple consonant-vowel combinations (e.g., bo, bee, bye), especially those that approximate functional words.
Here is where Nancy Kaufman’s Speech to Language Protocol enters the picture in my world. Customized pictures and syllables may be created with your SLP to address sounds not found in the English language. Overcoming CAS, as I see it, involves the process of learning to produce and sequence sounds. This principle is true for all languages.
One thing your SLP can assist you with is identifying which consonants and vowels your child is already able to produce. From there, she can formulate appropriate approximations for words you and she choose to target – words which have the most meaning and communicative power in your child’s life.
As a child increasingly learns to produce sounds and varied syllable shapes (e.g., consonant + vowel, vowel + consonant, consonant + vowel + consonant, consonant + vowel + consonant + vowel), it is AMAZING how his expressive language growth takes off! His little brain begins to simplify difficult words independently, and before you know it, he will even form simple two-word combinations.
Dear Katie:
Is it common or are there cases that a child with apraxia, once talking, has problem with language (language delay or language disorder)?
Absolutely. In my experience, most children with CAS display expressive language deficits in particular. Once a child begins producing single words and phrases, he may leave out small words (e.g., articles, prepositions) and word endings (e.g., -ed, -s). The child generally focuses on getting his main point across in the simplest way possible. Adding these words and word endings requires greater sound sequencing, which is where children with CAS have difficulty. As a child’s sentences become more complex, choosing correct word order may also prove to be challenging.
When a child produces a string of related content words that do not include prepositions, articles, or word endings and may be in the incorrect order, his ability to clearly express his thoughts and ideas is negatively impacted. Answering and asking questions may be tough. A child may appear as though he does not understand something when actually he is simply having difficulty expressing his answers.
* Katie is Jake’s former SLP and one of the many things I loved about her was that she was always open to my questions/concerns as a parent. Last week in the Apraxia Kids Learning Activities & Support Facebook group, I asked parents if they had any questions for her and these were a few of the responses we got. Thanks for your help, Katie!
Bio: Katie is a speech-language pathologist who has been serving children of all ages for 15 years in home, daycare/preschool, school, and clinic settings. She earned her Bachelor of Science degree in Psychology from Presbyterian College in Clinton, SC, in 1996 and her Master of Education degree in Communication Sciences and Disorders from the University of Georgia in Athens, GA, in 1999. In her free time, she enjoys working out and running.
Jake's Journey with Apraxia 