articulation problem vs. apraxia of speech?

[MegP]

What is the difference between just an articulation issue and mild speech apraxia?

 

Thanks!

[Dmmetler]

Well, my cynical side (having been diagnosed with an articulation DX and in therapy from age 5 to age 20, and then DXed at age 24 with constructive apraxia of speech) is that if it's apraxia, therapy for an articulation disorder just plain doesn't do much and doesn't "stick". I do think that I benefited in other ways from having years of Speech/language therapy, if for no other reason than it gave me a place of safety where I could go and cry and deal with my frustrations, and that I had an in-house advocate within the schools who could support me (something my therapists did a great job of).-but I wish the apraxia DX had been more commonly known and understood back then.

[PeterPan]

Apraxia is motor control, where I think articulation delays are developmental. So with apraxia, they CAN say it once you unlock the motor control problems. (Unless of course you have a developmental delay AND apraxia, but we won't go there.) My ds, who tested with only two sounds (m, a) and one word (mama) was able to TALK the very first day of speech therapy. He said: put, on, up, me, do, more... And he said words like this OVER AND OVER. We do PROMPT, which gives sensory input to make the motor control connections. So it's all there, not coming out, and the input tells the brain what to move.

 

Yes, there are gradations. The actual motor control problems have patterns that an experienced apraxia therapist (not run of the mill, grrr) can elicit. When you know what you're looking for, it's totally obvious. My advice, when you're thinking apraxia, is to go to someone who specializes in it. The best treatment is PROMPT. I'm not saying kids don't get helped with traditional speech therapy, but like the op said, the path can be really bumpy. PROMPT is the ultimate. Deborah Hayden has a 45 minute youtube video explaining it, and you can google to find it.

 

Basically go to the PROMPT website and use their interactive map to find the best qualified PROMPT therapist within whatever drive you can manage. They indicate the level of training of each therapist. Ours is certified, one of the only certified in a three state area. There are lower levels (I, II), but when you get into that, sometimes you get people who did the training only for continuing education credits and didn't really care enough to really LEARN it and get proficient at it. So buy beware, kwim?

 

But yeah, if you want to differentiate them, get the best PROMPT therapist you can find and get the eval. These therapists have NO need to keep you if you don't have a problem they can help. Mine is SO busy she can't keep up. She can fill an appointment cancelation with 2 hours notice, and people drive from other states to use her. Others at that level are similarly busy. I like to know they don't view me as a cash cow, kwim? She actually told us to take off for the winter, that after 1 1/2 years of PROMPT, his motor control is now age appropriate and the articulation will come. Bet you don't hear THAT very often from a regular speech therapist, eh?

 

So they're going to look at motor control. (jaw stability, rounding, that sort of thing) There are patterns and things they notice that we don't see. It will be obvious if it's there, don't worry. And if it's not, she may have a really good idea of what you do need. Also, don't be afraid to pick up the phone and call or email them. Mine talked with me at length, on her dime, before we ever went in.

 

Ok, I'm not being efficient here, but I'll add one more thing. An experienced PROMPT therapist can also distinguish motor control problems in an older, talking child. Some children with apraxia DO begin to speak. It may show up as being more shy or reserved, or by something the total opposite like talking really, really rapidly (to compensate for their lack of motor control). So it's still there and has things they can test and see.

Edited February 16, 2012 by OhElizabeth

[Dmmetler]

 

Ok, I'm not being efficient here, but I'll add one more thing. An experienced PROMPT therapist can also distinguish motor control problems in an older, talking child. Some children with apraxia DO begin to speak. It may show up as being more shy or reserved, or by something the total opposite like talking really, really rapidly (to compensate for their lack of motor control). So it's still there and has things they can test and see.

 

 

This last is me-I have extremely rapid speech and one of the things my speech therapist WAS able to do was to teach me to pace and slow down dramatically. I wasn't a late talker at all-simply an unintelligible one.

 

Having said that, one reason why I WAS eventually DXed with Apraxia is that it is entirely possible for me to lose a word between thinking of it in my head and getting it out-that, for some reason, my brain cannot tell my body to make that combination of sounds right then, so I either get nothing or something completely garbled. Another time, the same combination will be fine. Apparently, that was a red flag for the neuropsych that the problem was actually apraxia, not an articulation issue.

Edited February 16, 2012 by dmmetler

[PeterPan]

I understand, because when I did the parent training workshop for PROMPT, one of the moms (who talked really fast herself) had a daughter (age 8?) who was unintelligible because of talking so fast. They literally had to go all the way back to square one and build the motor control foundation. Just because you get the articulation doesn't mean they have the motor control to do it correctly. And when it's taking so much effort, it eats up the working memory and is just plain hard. I think that's why some of the kids end up reticent to speak or like you, losing their thoughts.