Free Resources for Speech Apraxia Treatment

[Crimson Wife]

I'm doing an online seminar today through my university on assessment of & intervention for Childhood Apraxia of Speech. The presenter gave her spiel on CAS treatments with research evidence to support them, and one that I hadn't ever heard of before is called Rapid Syllable Transition (ReST). The manual and a bunch of other resources are available for free on the University of Sydney (Australia) website.

 

If you can get speech therapy by a trained & experienced SLP, obviously that is going to be better than trying to DIY at home. However, if you cannot access SLP services, this is something that may be helpful.

[PeterPan]

Observations. One, they already have to have sounds. It's more of a fluency thing (rhythm, prosody) than actually helping them learn the motor planning. Two, their study specifically excluded children with ANY developmental disability. In other words, axe all our kids with ASD + apraxia. 

 

So it's not really a treatment for the underlying motor planning deficits of apraxia and not addressing the hierarchy of motor planning and how it builds. It's a bandaid for previously failed therapy that left holes.

 

It would be interesting to know what else is considered a "developmental disability" and got kids excluded from their study. Most of the kids coming into our therapy practice have Downs, ASD, CP, or something similar. Straight apraxia with no developmental problems would be an unheard of anomaly in this practice. 

 

Notice also their criteria about failure (in other words, they're not supporting correct motor planning or promoting correct, errorless practice, even though they're working on a motor planning disability. Notice also the astonishing amount of therapy hours they want for this and their specific observation that it was not easy for parents to carry over at home. 

 

To me, it doesn't make a lot of sense to work on doing faster and more fluidly incorrect motor planning. One of the biggest, BIGGEST errors of working with apraxia is pushing higher level skills without developing a motor planning foundation. They also assume generalization of the skill, which I guess they can, since they EXCLUDED the hugest, hugest chunk of apraxic kids, the ones with developmental disorders like ASD who wouldn't generalize.

[Dmmetler]

I'll take a look-As an adult who has functional speech, I can't see paying for more therapy (and I had therapy from age 2 to just before age 22), but also didn't get a dyspraxia DX until I was 25. There definitely are holes there. Having said that, I do have CP, so may fall into the "developmental disability" category.

[Crimson Wife]

The presenter was from the Mayo Clinic and she is apparently really reluctant to diagnose CAS in kids with autism. She presented the findings of a researcher named Lawrence Shriberg at Wisconisn-Madison about how CAS is supposedly overdiagnosed in kids with ASD, saying it's mostly speech delay and "persistent speech sound disorder" instead. I read through the article she discussed and I don't know enough at this point to judge the merits of the argument.

 

I definitely think that speech delay *IS* common in kids with ASD. My DD's articulation (now that she has her cochlear implant) is definitely more similar to a 5 y.o.'s than an 8 y.o. She is inconsistent on /r/ and /l/ (still often substitutes /w/) and does /d/ for voiced /th/ and /f/ for voiceless /th/. But that is clearly a developmental speech issue as opposed to a motor speech issue. If the child with ASD is highly unintelligible as opposed to just sounding "young" for chronological age, how can we know whether it is CAS vs. whatever "persistent speech sound disorder" is?

 

The presenter from Mayo did discuss PROMPT as being supported by the evidence and it is one of the techniques she uses depending on how the child responds during "dynamic" assessment. Basically that's a trial-and-error where she starts with an auditory-based method called Dynamic Temporal Cuing and then moves to tactile cues (PROMPT) if the child does not respond to DTC.

[PeterPan]

Yeah, that's how you get people who know a little PROMPT, have a phd, and they just pile it higher and deeper.

 

If she's certified in PROMPT, then she's qualified to say that. Otherwise she's piling it higher and deeper.

 

Look her up on the provider map. Is she certified or isn't she? We have someone here in Ohio who had a phd in SLP who thought she knew PROMPT because she had done ONE course. Yup, like the intro, the basic. I know as much as that. I kid you not. One course and the woman, with her pile it higher and deeper, was qualified to express opinions.

 

Actually someone who has done enough PROMPT *can* distinguish apraxia from a developmental delay. There are motor planning issues that are quite obvious. It's total baloney to say you can't distinguish them. There used to be the crap about we won't know it's apraxia till they start talking. Seriously, that's what someone told me when ds was 1.5, that she would cue, work on "communication," and when he started talking then she would know if it was apraxia. Went to someone who was CERTIFIED in PROMPT, and she could demonstrate the motor planning difficulties quite readily. They look at patterns with jaw movement, rounding, etc.

 

Think about ds: phonological processing (he's dyslexic), apraxia (the motor planning piece), AND now diagnosed with a language delay on top of that (both directions, expressive and receptive). How does that fit into her jolly b&w paradigm?

 

Utterly stupid. If you demonstrate he has motor planning problems, you do PROMPT. If there is communicative intent and you're respecting what he's intending to communicate (ie. working at the pace of the language delay), and you bring in the motor planning supports to facilitate obvious, demonstrable motor planning deficits, THERE IS NO ISSUE.

 

So look her up and see if she's certified. Everybody has an opinion. I'm just saying there are some alternate opinions.

Edited June 17, 2017 by OhElizabeth

[Crimson Wife]

The PROMPT directory is acting wonky for me right now because it's returning 0 records in the entire state of MN. That seems unlikely.

[PeterPan]

There was a point where it really felt like we were teaching the motor planning of EVERY. SINGLE. WORD. to my ds. His phonological processing deficits were so severe, and the whole gig so ungeneralized, that learning the motor planning for one word was not translating into another. We were literally motor planning individual words, and it was too much!

 

So I pulled him from speech for a time, did LIPS with him, and we went from motor planning single syllable, simple words to BAM doing multi-syllable, longer, much more complicated stuff! It was phonological processing, and also it was WORKING MEMORY.

 

So I totally agree, absolutely that these things come together. But I'm saying in my ds' case we had all of them going. It hasn't been one thing. It wasn't ONLY motor planning or ONLY a delay or ONLY phonological processing or whatever. We've literally had to work on ALL of it. And frankly, I have yet to meet one SLP who COULD do all of it. It takes so much to learn any of those components, it's not like they're doing it ALL. 

 

I mean, that's why I teach him myself and don't use an OG tutor. It's why I still continue to be flabbergasted that he does so well at reading, because what I did was SO fascinating, the way we combined LIPS and PROMPT and Barton. To this day it blows my mind. Other than Russian linguistics from back in college, it's really the most interesting thing I've done in ages. It was just so interconnected, so right with his brain. And I don't know ANYONE talking about that. And yet it's the true intersection of what she's saying.

 

Think about the irony of what she's saying too. You've got the Eides swearing up and down that their MRI evidence PROVES that you can't have autism and be dyslexic, that if you are diagnosed dyslexic then the autism diagnosis was in error. They literally say in their book that they wipe that away, bop him down, that it wasn't really autism. But here you've got Mayo PhD swearing up and down that autism and severe phonological processing deficits DO occur together! And what do we diagnose dyslexia by at age 6? Phonological processing deficits.

 

So you gotta love the PhDs... They can say anything because they have letters behind their names.

 

Me, I just live it.

[PeterPan]

The PROMPT directory is acting wonky for me right now because it's returning 0 records in the entire state of MN. That seems unlikely.

 

Hmm... But yes, it is wonky. Also she'll be listed under her residence, not work address, most likely. And sometimes the directory is out of date.

 

But it would also not be shocking for people to have opinions about things when they're underqualified. Me, I claim nothing. I'm a nobody. I just work miracles on my pool of one, kwim?

[PeterPan]

Working memory--> the ability to hold all that phonological processing junk in your head while you slog through the motor planning junk so it can actually come out as a word. 

 

So bumping working memory has a HUGE effect on what you can stretch them to in therapy.

[PeterPan]

Ok, a little diatribe. I'm cynical, yes but I've been around a bit. I've been to one of these blended, hack SLPs who swore her methods were good. She messed ds' speech up in ONE SESSION. I kid you not, one session! It was unbelievable. 

 

Anyways, my real rant. I want to plant a seed of cynicism here. PROMPT is an extremely challenging methodology to implement. It's very hands-on, very fast, and the therapist has to be VERY fast on their feet to juggle the hardest clients. Take my ds. He struggles so much with behavior that you're going to probably have to change the game on the fly. You have to have language preplanned or be mentally flexible, thinking through his targets, and on the fly making it work for a new game. He's going to throw you curve balls and have behaviors, and you're going to have to stay calm, react in an instructive way (or a way that complies with the behavior plan) and then go right back to doing this really physically intensive work!

 

It's not flashcards, not prescripted, not easy. It's not tidy little lists of non-sense syllables they can publish in a book. It's the prosody AND articulation AND social goals AND ABA goals AND and and and... all in one session.

 

It's wicked complex, especially with the hard kids. 

 

How many therapists REALLY want to do that? How many are REALLY up to that? Be honest. Like be seriously honest. It's like doctor vs. brain surgeon specialist. They both work on the body, but one went WAY BEYOND, getting really specialized training. 

 

And when people are like yeah I'm a heart surgeon + OB + nutritionist + chiropractor... I'm going to go ok, which of those are you really GOOD at? 

 

PROMPT is not easy, and it takes multiple years to get certified in it. That's after you made the effort to get that masters. And to be GOOD at PROMPT, well that's an additional thing. Remember, I've been studying PROMPT for over 6 years now. I have tons of observations, can do pretty much all the level 1 stuff have read through the level 1 book, have enough background in linguistics and speech production that I know what I'm seeing, etc. I drive over 2 hours each way still, because when that person lays her hands on my ds and really DOES it, really knows how to do it and has the TOUCH, he sounds better.

Edited June 17, 2017 by OhElizabeth