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tell me about apraxia, please


cathmom
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My twins have been in speech therapy for nearly 2 years. Their therapist told me today that she thinks they have apraxia. The little reading I've done online suggests that they will be in speech therapy for years to come. AHHHH!!!!

 

They just turned 5, and I was thinking maybe 2 more years of therapy. Now I don't know. I'm so tired of not being able to understand them.

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We are on year 3 (she is 9 ..started late) and expect to have services for a number of years. You should look into the LIPS program to do at home even as they get speech. It has helped me prompt my dtr with where and how the sounds are made. It is a great investment because it moves into reading and spelling also. Is your therapist trained in PROMPT?. My therapist received training over the summer and has been using it with my dtr. Believe me their speech does get better but they will need alot of support over the years.

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Cath, my ds age 2 is moderately verbally apraxic. I read so much about the ineffectiveness of traditional speech therapy for apraxia that I decided to drive much farther and take the plunge with a PROMPT-certified speech therapist. If you do some googling, you can read about it. The developer of PROMPT (which is not the same as prompting) has a 45 minute video on youtube where she explains it. It gives sensory input to specific points, helping the brain to make the connections. Apraxia is a motor control problem. PROMPT is shockingly effective for it. My boy went from nothing to talking in the very first session! He had at his evaluation 2 sounds and 1 word, that's it. Now, after a month and a half, he has numerous words and will attempt all sorts of things. It's just a radical change.

 

Yes, PROMPT can help with articulation and understandability with the apraxia. The PROMPT therapist uses a very specific order in working through the sounds in order to build a motor skills foundation. Sometimes the child will approximate or fudge how they produce the sound, getting something that sort of sounds right but isn't produced correctly and isn't using the proper motor control. PROMPT identifies this and has things the therapist can to do bring it into check.

 

What is amazing to me is how much progress you can make with PROMPT. Most people do 1-2 sessions a week, and then the parent carries it over at home. I'm taking the parent workshop now to learn how to implement it better in the home. I participate in our therapy sessions, and the therapist shows me how to do the things with him. She has me practice on him so he's comfortable accepting it from me when we get home. So even if you have a long drive (mine is 2 1/2 hours each way), you can accomplish a LOT in those sessions, enough to make it worth the effort.

 

I wouldn't continue on with someone who doesn't know anything about apraxia. Now for PROMPT there are two levels of workshops and then a certification process. The person I'm going to is certified, the only one in our state, and she's AMAZING. Some people claim to do PROMPT who have never even taken the workshops. Some people take the workshops, I think more for continuing education credits than because they plan to actually implement it. I know there are those claiming to do PROMPT who don't, because I had a therapist try it with me. Needless to say, when I contacted the PROMPT organization and got the list of people who had done the workshops or who are certified, I was upset! As you are seeing, the consequences are pretty serious with this. PROMPT is giving us amazing, immediate results. Our therapist has also delved into other areas with us (fatty acid supplements, diet, how he chews, tonsils, etc.). The therapy itself is only one component of treating the apraxia. I have my ds on a flax oil supplement, on the advice of my nutritionist, rather than the fish oil many people use. His growth is fine, on the high end actually, so I decided not to pursue the Nutriveyda that many people are using. But for some Nutriveyda has been helpful. My ds is a bit low tone in the mouth and the chewing of meat, etc. fatigued him. No wonder he seemed hungry all the time! We've since started taking more care to puree or chop his meat fine. (He was avoiding it because it was hard for him to chew.) We give him fats like avocado that are easier to eat.

 

I've heard different things as far as timetables. Who knows how that might shift with PROMPT?

 

Here's a link to that video I was thinking of. http://www.youtube.com/watch?v=oa9KOMtY-N0

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Oh my. I am not happy about this.

 

What other options do you have?

 

I know a young boy (11/12) who carries around a device that speaks for him. He presses on the picture and the device speaks. I can't imagine what the future holds for him. How do you go to college if no one can understand your speech? How do you get a job? How do you get through the day?

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My 12 ds has not been officially diagnosed w/ verbal apraxia however he has been recieving services since he was 18 mos. old.

 

It has been a long journey of therapy first w/ Birth to Three, then preschool services in public school setting, then in home speech ther, and now at at speech ther. office.

 

I must say it has been a long journey but a blessed journey-we have met wonderful, caring people along the way.

 

Speech therapy sessions are just away of life for us and we really can look back and see much progress-

 

Those that have know DS since the beginning are amazed at his speech now. We are struggling getting through vowelic R's right now but even those are coming along.

 

It can be overwhelming at times but my only wisdom would be to look at it for what it truly is -a gift from God for His purposes-I love to read how God used Moses one who was not eloquent-who knows what plans God has for our kids.

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At age 3, no-one could understand my dd and her sisters were not interpreting for her. She was diagnosed with articulation below the 1st percentile for girls her age. Three years later, we were told by a different SLP that she probably should have been diagnosed with apraxia, but we were seeing the remnants of it and a diagnosis would no longer be helpful.

 

She was in speech therapy until age 9 - just dismissed a few months ago. She has numerous other diagnoses and was also in OT for 2 years. The OT did Interactive Metronome and Therapeutic Listening Program with her, and we've definitely seen improvement in her language skills while using these programs. We use Barton Reading & Spelling and WWE for school. She has just started level 2 of WWE and she is nearly finished with level 3 of Barton. We used LiPS before starting Barton.

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My 7 yo had really bad articulation, but it got cleared up in about a year and a half of therapy, and he's really clear now. But the twins just aren't making much progress. I understand them maybe 50% of the time. I don't think signing would help because it's the more complicated things they are saying that I don't understand - we'd all have to learn a lot of signing!

 

Their therapist asked me if they were picky eaters - does that go along with apraxia? Because they are the pickiest eaters I have ever encountered!

 

I will have to ask our therapist about this PROMPT thing. They are going to have to switch therapists next year because of our insurance, so we could take the opportunity to find somebody that can do this.

 

They don't seem to need any OT. My 7 yo still gets once a week OT.

 

I could give them supplements. I will have to look into that.

 

I was really hoping they would be done in a year or two with all therapy because we really want to live overseas temporarily - like 3-4 months if we can do it - but if they need therapy still that's not going to work. Plus it just takes so much time to deal with all this therapy!

 

We are considering finding some kind of preschool situation for them, to give them motivation to speak better. At home, they understand each other perfectly, and my 7 yo understands them 90% of the time, so it's like they are in a little bubble where it doesn't really matter that they can't speak well. Does anyone have an opinion on that? Good idea/bad idea? My dh and I are just so tired of having 3 dc we can't understand (right as 7 yo graduated from speech, our 2 yo began it LOL).

 

Thank you everyone. I am adjusting to the idea.

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Sorry, I'd give anything to have 3 kids I can't understand.

 

(It's just one of those days. We waited 10 years for this one and no more seem to be on the way.)

 

It just goes with the territory with apraxia. If you want a preschool for them, is there a deaf school near you? It's a long drive, but there is a deaf school in our state that has an apraxia program.

 

Definitely look for PROMPT. The results are so radical, it might turn around your feelings on the preschool thing. You might find yourself wanting them home so you can implement it with them. It's not required or anything, but I've fallen in the routine of working with my ds about an hour a day. We do targeted speech practice using PROMPT, then sing (using the sounds he has, hehe), then we watch a Signing Time video. Signing works the same part of the brain as speech, and the speech therapists consider it interchangeable. Your PROMPT therapist would tell you what she wants you to pursue.

 

Yes, feeding issues go hand-in-hand with this. The SLP I'm using treats only apraxia and feeding disorders. Aside from my ds tiring too soon from chewing and hence being constantly hungry, he doesn't really have any feeding issues. But it's definitely something the SLP went through with us in her questionaires and whatnot.

 

My particular therapist does PROMPT 1-2 X/week with most clients and has good results, but this assumes parent follow-up in the home. She spends time in each session teaching me the PROMPTS, practicing them with me (and me on him) to make sure I'm doing them correctly. Because our drive is so far, it's the only way this could be reasonable. We are getting quite good results. She is also certified in PROMPT and quite experienced. Every SLP is going to have where they are in the process of learning PROMPT, how they are implementing it, etc. This thing of 1-2X/week follows the recommendation of the developer of prompt and does seem to be working for us so far. There is actually some thought that the sessions are SO challenging to the child and intensive (when done straight) that it would really overwhelm their systems to do it 3-4 days a week like traditional therapy. They'll actually tell clients to back off if they have been doing that and not getting good results. So there you go, just another perspective. I was pretty nervous about that pace, but so far so good for us. Like I said, it is actually what Deborah Hayden, the developer, recommends. So if you have a long way to go, you might be able to get away with once a week or double sessions every other week. I think our SLP has even done things for people from out of state (with older dc like yours) where they came in, did intensive therapy for a period of time, and then went home. She saw them again after a few months. You just do what you can, kwim? PROMPT is wonderful in that it IS something you can carry over at home and continue with them. Your therapist can show you exactly where their glitch is motor skills wise and why the sounds are not clear. I think it's great for us as homeschoolers because it gives us a pro-active way to participate in the process.

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We have a good friend whose younger son has apraxia. His speech was absolutely incomprehensible and his behavior (perhaps out of frustration at not being able to make himself understood) was so bad that his own grandparents refused to babysit him. It was a very bad situation.

 

But his mother went into Mama Bear mode. She got him a lot of therapy. She joined the Apraxia Foundation, became a fundraiser, arranged seminars. The whole deal.

 

Today her son is as sweet a boy as you would ever know. And unless you knew his past one could barely detect anything unusual in his speech. I'm amazed at what was accomplished. It took work and commitment, but her boy has a radically different life today that might otherwise have been the case.

 

Bill

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Does apraxia also include grammar issues and just fluency issues? I often think that my twins sound like English is not their native language (while I do speak German to them frequently, I don't think that's the issue). Just now, one of them wanted to say, "I see the Christmas tree lights (reflected) in your glasses." He said, "I see the lights (long pause) from your glasses." It was like he was trying to think of the right preposition, like one would do in a foreign language.

 

They frequently say things like, "Him is mine" "Where is your toys?" etc.

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Does apraxia also include grammar issues and just fluency issues? I often think that my twins sound like English is not their native language (while I do speak German to them frequently, I don't think that's the issue). Just now, one of them wanted to say, "I see the Christmas tree lights (reflected) in your glasses." He said, "I see the lights (long pause) from your glasses." It was like he was trying to think of the right preposition, like one would do in a foreign language.

 

They frequently say things like, "Him is mine" "Where is your toys?" etc.

 

I don't know if those issues are part of the apraxia, or if they are co-morbidities. But my dd did the same thing for years. She still sometimes makes grammar errors or searches for the right word, but not as much as she used to.

 

My dad spoke German before English but didn't struggle with correct English, so I would agree with you that speaking German to them is not the problem.

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There are actually different aspects to apraxia. I'm not using the right words. For instance the OT said my dd has some mild apraxia that comes out with spatial issues and how her brain works. If you show her something like itsy-bitsy spider, she CANNOT do it. I'm utterly serious. But if you tell her she can. And when given a writing assignment (where you have to go from what you think to what the body does), she just stares at the paper. This has happened with every single type of writing we've done save things that are original (already in her head) or research-based. And the OT did an interesting exercise with a rope, trying to get dd to list things she could do with a rope. They were literally all in the same category! Same thing happened with listing all the animals she knows (all similar), then there was this long pause and they started rolling out. She finally decided to give herself a structure using the alphabet, and she could get them out. The other word the OT has used is initiation, that apraxia in all forms creates an initiation hump.

 

I'm not sure I'm understanding all this correctly, just throwing it out. I think when you have an initiation hump connected to a motor skill or a slowness of it coming out (words, thoughts, whatever), that could very well be the apraxia. That's what I've concluded. For the record, my dd11 has NO issue with her speech, haha. But pulling narrations out of her is like removing cacti from a walrus. (Not easy to get in, even worse to get out.) I do think there's something there that is the wiring, and I don't understand it yet. I continue to experiment with ways to improve her structure system in writing and getting it into her head. For my ds2, I'm pretty scared, frankly, about what we face. If he's worse than dd, that's gonna be rough. At least I CAN get the thoughts out of dd. My only hope is that maybe the therapy will, over the long haul, improve that initiation issue.

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My dd, now eight, was diagnosed with verbal apraxia and began speech therapy when she was about a year and a half old. If her pediatrician had not encouraged us to go in for the therapy I would have been inclined to wait, but I am So glad we started when we did. She was in speech therapy, with someone familiar with apraxia, for about 2 years and her speech improved enormously! At four, she still didn't have her "r's" very well, and there were a few other oddities, but we kept reminding and encouraging her to work on those things, and now her speech is perfectly clear. As far as the grammar issue, her grammar was much less correct than her brother's. I figured it was because we couldn't understand what she was saying and repeat her words back to her in correct English. Once we Could understand her, we started to do this, and the grammar issues have cleared up.

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Cath, I think maybe some practitioners are becoming more proactive about looking for it. I'm ALL FOR that. My ds was under 2 when we became convinced he had an issue. I got so much of the "oh it will come, just wait" mess. Lots of people have stories about their kids not talking and later being fine, but these people aren't quite as precise in their definition of "not talking" as a speech therapist. The parent might not realize that animal sounds are talking. My ds could never imitate sounds, a common symptom. He had no sound when playing, not animal sounds, not car sounds with his cars, nothing. If he was playing, it was utterly quiet, a HUGE red flag. He did say a couple words, but anything he said he only said 2 or 3 times (sometimes only once), and then you NEVER could get it out of him again. Losing words is the biggest red flag for verbal apraxia. So we had next to no sound, no forward progression, and lost any sound or word he ever made. I've read different numbers from different practitioners, but I think 20 words by 18 months and 50 by age 2 is considered a marker. Below that and you want to be evaluated. My speech therapist doesn't buy into the idea of late talkers, not for anyone. The more I've watched, the more I've noticed that many of the late talkers who supposedly were fine without therapy turn out to still have remnants (difficulty with writing, getting out their thoughts, etc.).

 

So my ds at age 2 had 1 word, 2 sounds, and had lost any and all words he ever said (door, dada, moo). He is considered moderately apraxic. Some therapists say you can't diagnose apraxia until they start talking, because they define apraxia by its affect on the actual speech. (If he's delayed but talks perfectly when it comes out, then he wasn't apraxic???) Other therapists, ones who do a lot of apraxia, are more tuned into it, see the profile, and will diagnose earlier. A lot of the weird things with my ds, like his extremely good fine motor skills, are common with apraxia. There are patterns to these kids, so the experienced therapists can see it.

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How can children be diagnosed so young with this? What were the warning signs?

 

Our friend's son had such severe apraxia that he could not articulate any words at all. She began to understand some of what most people would take as meaningless grunts, but even she was often bewildered by what he was trying to say.

 

It wasn't like the first doctor she saw had the correct diagnosis either. And the school system doctors tried to have her sign off on his being autistic (because they could get funding for special aides that way). She refused and found professionals who finally figured out the correct cause. But it wasn't easy.

 

But what a success story after all the trials and tribulations.

 

Bill

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I'm tutoring a boy with apraxia.

 

His mom said that once they switched to speech therapy that was specifically for apraxia, things moved along fairly fast. I think he had 2 years of speech therapy. I didn't even realize he had speech problems, he speaks normally now. (Most other speech problems, there are lingering signs that I notice.)

 

However, because of his apraxia he needs more help learning phonics.

 

Webster's Speller has been very helpful for him. It also helps build his confidence. While he can say words like strap or ring or rang in normal speech, when trying to read them, he has problems. He can, however, read an "easy word of 3 syllables" like botany when it is divided up into syllables. He is also finding my syllable division rules helpful, he has trouble dividing words up on his own.

 

The syllabary helps with problem sounds like str. When he reads the str syllables and then a few str words, that helps him figure it out better than just working on a few words with the str pattern. (stra stre stri stro stru stry straight, strap, etc.)

 

He also finds marked print very helpful--my UPP is far more helpful for him than it has been for any of my other students. It has been helpful for many of my students in the past, but none as much as for him.

 

He also is using a different marked print with his mom--the markings in the 1879 McGuffey readers. The markings and sounding out the difficult words first are enabling him to read the stories much easier than he can normally read a story.

 

All these different markings don't seem to bother him, he finds them all helpful. I normally would not have two different marking systems going with a single student, but he is very bright and finds markings helpful, so I am doing two with him.

 

Leigh Print is my favorite marked print. It also has the same markings for German and English, so you could show them in both!

 

I am learning a lot from working with him. For example, from his trouble with ts at the end of words, I found that this is actually pronounced as one sound. I took one semester of Russian and showed him the single letter that they have for the sound "ts," he thought that was cool.

 

Webster's Speller is allowing him to progress even while he's stalled going over or, ar, ir, ur, er; ou, ow; au, aw; and 3 letter blends 1,000 times. In his own words, "I can sound out the 5th and 8th grade words. It's the 1st grade words that I have trouble with."

 

I am working my way through John McWhorter's DVD "Understanding Linguistics: The Science of Language." I've struggled through some linguistics books in the past, and let me tell you, the ones I've read are not written in English. John McWhorter actually explains these things in plain English! Plus, the DVDs show some really great charts that either I had not seen before or had not made sense to me before because they were not explained in clear English. I highly recommend it to anyone whose child has speech troubles or who is interested in learning about linguistics. (I bought it on sale as a set with "The History of the English Language" by Seth Lerer.)

 

You might want to try some phonics and spelling with a marked print with them, I would think that it would be good to integrate these things and show the connections between them.

 

Also, he, even more than my other students, does better with short bursts of work and breaks. I give all my young students breaks, and it is helpful for all of them, but he really needs them.

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We have a good friend whose younger son has apraxia. His speech was absolutely incomprehensible and his behavior (perhaps out of frustration at not being able to make himself understood) was so bad that his own grandparents refused to babysit him. It was a very bad situation.

 

But his mother went into Mama Bear mode. She got him a lot of therapy. She joined the Apraxia Foundation, became a fundraiser, arranged seminars. The whole deal.

 

Today her son is as sweet a boy as you would ever know. And unless you knew his past one could barely detect anything unusual in his speech. I'm amazed at what was accomplished. It took work and commitment, but her boy has a radically different life today that might otherwise have been the case.

 

Bill

 

Yay for Mama Bears!

 

My student was evidently not saying anything either before his Mama Bear found a good speech therapist (we were moving through different states at the time!)

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My twins were 3 when they started speech and couldn't put two words together. In fact they had a generic word that they both used that meant anything they wanted it to - very efficient, huh? We knew that at least one of them was delayed at their 2 yo checkup, but I felt they were making progress and wasn't worried about it until their 3 yo checkup and they still couldn't really talk. If I had known then what I know now, I would never have waited. That's why my 2 yo is in speech now - when the therapist said that she couldn't really understand him and wanted to evaluate him, we let her.

 

ElizabethB, thanks for typing all that out. I'm not sure what it all means but I will try to decipher it tomorrow. their therapist will be here Monday morning and I will discuss this with her. Like I said, they are going to have to have a new therapist next year anyway, so we can search for one with experience with apraxia if that's what we think they really have.

 

thanks all for the info and support!

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Our friend's son had such severe apraxia that he could not articulate any words at all. She began to understand some of what most people would take as meaningless grunts, but even she was often bewildered by what he was trying to say.

 

It wasn't like the first doctor she saw had the correct diagnosis either. And the school system doctors tried to have her sign off on his being autistic (because they could get funding for special aides that way). She refused and found professionals who finally figured out the correct cause. But it wasn't easy.

 

But what a success story after all the trials and tribulations.

 

Bill

 

In our parent workshop we watched a video of a boy whom you would have assumed was autistic or on the spectrum to some degree, given his behavior, lack of eye contact, etc.. I think he was 4 or 5 in the video. After 4 months of PROMPT, he was totally different. My ds is not on the spectrum by any means, but even so I did not realize how disconnected he was from us because of this. After 6 weeks of therapy, he has really begun to blossom and come out of his shell. The hitting (which I had actually had threads about, long ago) has largely disappeared and is now in the realm of more typical boyishness and correctable. He's just so much more engaged and alive with us. He actually comes up to us and WANTS us, wants to communicate to us. He never did any of that before, and I didn't realize it because it was just such a gradual thing. Think about it. If you can't communicate, you withdraw and give up. So yes, the SLP's posit that there are misdiagnosed kids because called autistic who are actually apraxic. And then of course there's the variant of austic AND apraxic. Kind of scary when every practitioner you take your kid to (SLP, OT, etc.) does an autism screening, but just goes to show how common it is.

 

Cathmom-You did the best you could with the information you had. At this point it sounds like it would good to find an SLP more experienced with apraxia. Would you be able to change any sooner? Good ones will have a waiting list.

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ElizabethB, thanks for typing all that out. I'm not sure what it all means but I will try to decipher it tomorrow. their therapist will be here Monday morning and I will discuss this with her. Like I said, they are going to have to have a new therapist next year anyway, so we can search for one with experience with apraxia if that's what we think they really have.

 

Well, I was mostly babbling, typing what has worked with him and what has been different from my other students. Some of it was things that will be important down the road when you are teaching them to read.

 

But, quick things that are important to you soon: 1. If it is apraxia, it might actually fix quicker than you think with the correct treatment. From what his mom has described, I think he was either getting PROMPT therapy or something similar. She also worked with him at home, and found that he learned better in shorter, more frequent sessions, which is apparently true for most children with apraxia. 2. For working with them at home, it will help to understand some linguistic things. I like this website and the McWhorter DVDs. I wish I had watched the DVDs before I took German, even after 2 years of German and 4 years of living in Germany, I could never figure out how to say the ch sound in ich. After watching the 30 minute lesson about the sounds of consonants, I learned enough to finally be able to pronounce the German ch sound correctly! (I could hear the difference, I could just never figure out how to say it.)

 

And important later when you're going to start teaching reading and spelling: diacritical markings and syllables. I recommend Webster 1908 to teach reading and spelling and the 1879 McGuffey readers for reading practice after some phonics has been learned. You'll probably also have to explicitly teach syllable division, there are rules and worksheets for that on my how to tutor page.

 

I also think that you might want to try to teach them to read and spell soon and integrate that into their speech practice. Phonics, properly taught, helps reinforce things that are going on with speech and can clear up lingering problems. For example, with my daughter, when she said something slightly incorrectly, I would write it out and show her which sounds it should have and then she would be able to pronounce it correctly, it's easier to communicate these types of things when you can explain it in written as well as oral form.

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In our parent workshop we watched a video of a boy whom you would have assumed was autistic or on the spectrum to some degree, given his behavior, lack of eye contact, etc.. I think he was 4 or 5 in the video. After 4 months of PROMPT, he was totally different. My ds is not on the spectrum by any means, but even so I did not realize how disconnected he was from us because of this. After 6 weeks of therapy, he has really begun to blossom and come out of his shell. The hitting (which I had actually had threads about, long ago) has largely disappeared and is now in the realm of more typical boyishness and correctable. He's just so much more engaged and alive with us. He actually comes up to us and WANTS us, wants to communicate to us. He never did any of that before, and I didn't realize it because it was just such a gradual thing. Think about it. If you can't communicate, you withdraw and give up. So yes, the SLP's posit that there are misdiagnosed kids because called autistic who are actually apraxic. And then of course there's the variant of austic AND apraxic. Kind of scary when every practitioner you take your kid to (SLP, OT, etc.) does an autism screening, but just goes to show how common it is.

 

 

The frustration of not being able to communicate must be intense. None of us had ever heard of apraxia. The behavioral problems were rather severe. The boy's mother could only be grateful it was the younger boy and not the older, as the boy with apraxia could become physically abusive. It was really rough.

 

I can imagine in other scenarios that the boy might have been written-off as "crazy" and even institutionalized. But what a fine young man he is today. It kind of breaks my heart thinking what might have been if his mother had not been as dedicated to her son as she was.

 

There was a lot of therapy and hard work. But words fail me in describing what a profound difference it all made in this boy's life. Best thing is I don't really think he has a clue of what his alternative life might have been. But he does know he has a mother who loves him.

 

Bill

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Just to throw out an opposite track, I've heard mention of hyperlexia in late talkers (which for the sake of argument we'll consider apraxic). They learned by whole word and went back with the phonics later. I taught my dd (not verbally apraxic) with SWR, which is a curious blend of whole word and serious phonics. In reality, I think it was that work with words on flashcards (all of which she understood phonetically but all of which she nevertheless memorized) that got her reading. The hours of audiobooks then filled in the cracks. I got a picture dictionary from a place at the convention last year and thought I'd pursue that line of thought even a bit further with my ds.

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Cath, I think maybe some practitioners are becoming more proactive about looking for it. I'm ALL FOR that. My ds was under 2 when we became convinced he had an issue. I got so much of the "oh it will come, just wait" mess. Lots of people have stories about their kids not talking and later being fine, but these people aren't quite as precise in their definition of "not talking" as a speech therapist. The parent might not realize that animal sounds are talking. My ds could never imitate sounds, a common symptom. He had no sound when playing, not animal sounds, not car sounds with his cars, nothing. If he was playing, it was utterly quiet, a HUGE red flag. He did say a couple words, but anything he said he only said 2 or 3 times (sometimes only once), and then you NEVER could get it out of him again. Losing words is the biggest red flag for verbal apraxia. So we had next to no sound, no forward progression, and lost any sound or word he ever made. I've read different numbers from different practitioners, but I think 20 words by 18 months and 50 by age 2 is considered a marker. Below that and you want to be evaluated. My speech therapist doesn't buy into the idea of late talkers, not for anyone. The more I've watched, the more I've noticed that many of the late talkers who supposedly were fine without therapy turn out to still have remnants (difficulty with writing, getting out their thoughts, etc.).

 

So my ds at age 2 had 1 word, 2 sounds, and had lost any and all words he ever said (door, dada, moo). He is considered moderately apraxic. Some therapists say you can't diagnose apraxia until they start talking, because they define apraxia by its affect on the actual speech. (If he's delayed but talks perfectly when it comes out, then he wasn't apraxic???) Other therapists, ones who do a lot of apraxia, are more tuned into it, see the profile, and will diagnose earlier. A lot of the weird things with my ds, like his extremely good fine motor skills, are common with apraxia. There are patterns to these kids, so the experienced therapists can see it.

 

Is apraxia lifelong? Dd was in therapy through Early Intervention for about a year and a half starting at 17 months. This was one of her worst issues, but the OT freaked out when I even mentioned apraxia, saying it was MUCH too early to diagnose that. She absolutely fit what you described as verbal apraxia (had one solitary word, then acquired one other word and lost her first word, no imitations or babbling or any sort of speech development on her own, etc) but they wouldn't label her. After her therapy (for "severe sensory and communication issues") she improved greatly and now she's hard to understand sometimes but it's within age-acceptable range, like not saying "l" at 3. Definitely no apraxia now, acquires new words independently now, etc, although she fit it well earlier. Is that usually what happens, that it corrects with therapy? Or is it permanent when it's true apraxia?

:grouphug: to the OP!

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Izumi-The first speech therapist I visited with ds was like that. The lady gave me the worried mother routine, told me EVEN BEFORE SHE ASSESSED HIM that they'd work on "communication", that apraxia couldn't be diagnosed, etc. So I left that woman's office, irate that she had: 1) claimed to do PROMPT when she had never taken the workshops even, 2) acted like I was excessively worried (when I was there on the advice of my ped and had a kid fitting every red flag), and 3) would only offer "communication." I didn't need him to COMMUNICATE. He can already communicate! I needed him to TALK, and talking was not something she could make happen. So she would do something, teach him sign, blah blah, but she couldn't help him TALK.

 

Took my ds to a speech therapist who does only apraxia, totally different scenario. The woman immediately saw tons of flags and things typical of the pattern of moderate apraxia. And the VERY FIRST day of therapy she had him talking using PROMPT. NOT just communication, nope TALKING.

 

Well mercy, I sound like I'm getting riled up! I am though. It makes me angry the way therapists cover up their own incompetence or inability to help the problem by saying "oh, he's within age-range." Thanks, but what if your kid is NOT average or if that is NOT normal for that particular dc? My dd never went through an incomprehensible stage with her speech. If that's not normal for kids in my family, then why should I blow it off because my ds is apraxic? Now Deborah Hayden (founder of PROMPT) did say in the parent workbook that speech does not finalize until around 4-5, meaning kids may need therapy until then. And my SLP says that sometimes when things click, kids just take off. So your dc got therapy, is now speaking, and has some remaining intelligibility issues. It's not like motor control is and on-off switch. It's a matter of degrees. I've read that if the hang-up is around certain letters, it could indicate that they proceeded forward without all the motor skills in place. It's actually possible to get approximately the right sound but form it INCORRECTLY. I'm not a therapist, don't know much more than that. If it concerns you and you don't see the forward progress you need, you might look into PROMPT or a fresh evaluation to see if there's a remaining issue.

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How can children be diagnosed so young with this? What were the warning signs?

 

I don't know enough about apraxia to give a good answer as to how they diagnosed her with developmental verbal apraxia. It was a difficult time for us in other ways, and I didn't do much research. I thought/think it was something to do with the way she was very talkative -- clearly chattering away -- and you couldn't understand a word she said. The therapist said that her brain wasn't "telling" her mouth muscles how to move right.

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Ds#2 was diagnosed with apraxia at 27 months. We knew he was delayed at 18 months, and at 2, our family doctor put in the referral for speech. He was evaluated both by our Birth-3 regional center and a private SLP, and was dx by both. He started therapy with the private SLP as well as an in-home SLP through the regional center. Both of them were amazing in terms of working with apraxia (recognized it for what it was rather than just an artic issue). After his first session, he had two (verbal) words - banana and apple. :D They were the greatest things we had heard! (He had tons of signs as we've taught the kids signs from birth, but we were running out of signs to teach him without learning more complete ASL ourselves.)

 

When he turned 3, he started speech through the school district (just speech though - not preschool). He continued to make improvement, but there were still huge issues with his speech (he couldn't blend consonants very well at all, and some digraphs-to-vowels were broken up as well; he could string a couple words together but not make full sentences by any means, and was still probably only 50% understandable, especially to anyone other than dh, ds#1 and me).

 

When he was just over 3 1/2, though, we went gluten free as a family. I had been told by a couple people that it may be contributing to his issues (he also had undiagnosed, yet very glaring, sensory issues ... we debated having him evaluated for them but the speech was such a big issues, we decided to tackle that one first). We went GF in June, at the end of the school year for speech, opted out of "summer school" for speech as we were going on vacation and felt everyone needed a small break (one month basically - but we also had a newborn at home by this time as well). When we started speech back up at the end of the summer, he was suddenly speaking almost fluently!

 

I can still remember walking back to the car after his first session back. Ds#1 was 5 and we were working on beginning phonics/reading, so I had him sound out the word "stop" on the stop sign. After he sounded it out/read it, ds#2 said "stop" as one fluid word. Not /s/, /t/, /op/ like normal. No break in his speech. Just "stop". I think it sounded better than his "banana" and "apple" did way back when he started speech therapy. I realized later that it had been about 30 days since we had gone gluten free (most of what I had read suggested it took about 4-6 weeks for the gluten to leave the body).

 

He continued speech therapy for that school year as it seemed to have shifted from an apraxia issue to more of an articulation issue, and he continued to make huge improvements. His SLP graduated him that next June saying his speech was on-par with his peers, for the most part.

 

We still have a few issues and are looking to have him re-evaluated, though I don't think it's the apraxia anymore but possible auditory processing issues. Reading and spelling were a bit tough in the very beginning, but between Phonics Pathways and All About Spelling (probably the biggest success for him as it helped him break down the words and "see" them phonetically), he is reading and spelling above grade level. He still has some speech issues (mostly inserting /r/ in places where it doesn't belong ... for instance, he says "gurd" instead of "good" and "pursh" instead of "push" ... basically that /oo/ sound always has an /r/ attached to it), and we may re-enter speech to help with it. But, I attribute his "overcoming" his apraxia with going gluten free. For him, at least, it was like the gluten was clogging everything up neuro-wise. It may not be a solution for everyone, but I definitely like putting it out there in case it may help even one other person unlock speech and language for their child.

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Guest nikole957
My 12 ds has not been officially diagnosed w/ verbal apraxia however he has been recieving services since he was 18 mos. old.

 

It has been a long journey of therapy first w/ Birth to Three, then preschool services in public school setting, then in home speech ther, and now at at speech ther. office.

 

I must say it has been a long journey but a blessed journey-we have met wonderful, caring people along the way.

 

Speech therapy sessions are just away of life for us and we really can look back and see much progress-

 

Those that have know DS since the beginning are amazed at his speech now. We are struggling getting through vowelic R's right now but even those are coming along.

 

It can be overwhelming at times but my only wisdom would be to look at it for what it truly is -a gift from God for His purposes-I love to read how God used Moses one who was not eloquent-who knows what plans God has for our kids.

my son has apraxia. we were very fortunate that the most experienced apraxia slp for hours happened to have done his intake evaluate. He had therapy from age 2- 8. kids with apraxia need 2-3 sessions a week one on one, with an SLP who really knows how to treat it and you should be doing homework everyday. It just became second nature for me to cue my son's speech. It is excellent that your therapist picked up on the apraxia at this young age.

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  • 1 month later...

I think you have been given some good information here. Apraxia (dyspraxia) is lifelong, but once you have learnt how to make the sounds no ine can tell the difference any more. A new language will mean new sounds to learn.

 

Some children are affected more than others. However, ds9 was probably not as severe as dd5 but as they finally got diagnosed by the same lady on the aame day, she was four years younger than him when effective therapy began. It took about 1.5-2 years of intensive 30-60 mi ute therapy divided throguh the day in 5 mi ute chunks.

 

By the time we found someone who did prompt and got to the top of the waiting list, the other intervention had worked so it wasn't necessary. I would also look up cued articulation as this made a difference for us.

 

I knew by 18 months with ds9, dd5 and ds2 that they had serious speech issues. There was a long delaying diagnosis while we went from person to person, and we got lots of poor advice. It is a specialist area. Ds2 is only 26 mo this, but we have already known for while he is too. You get accustomed to it. Speech therapy becomes part of your daily routine, and you can see the improvements over time. We had 7 years of therapy with ds9, 2 years with dd5 who was particularly severe, and are just easing into it with ds2 after a year that no one was in therapy.

 

By the way, for dd5 we had a nanny who was early childhood teaching student 3 or 4 days a week, ot once a week, and a speech therapist twice a week for an hour. It was Intensive and exhausting, nd emotionally challenging, but she is five now and fine. At 3 she was severely delayed.

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