Apraxia of speech (called verbal apraxia or dyspraxia) is a speech disorder in which a person has trouble saying what he or she wants to say correctly and consistently. It is not due to weakness or paralysis of the muscles of the face, tongue and lips. The severity of apraxia can range from mild to severe.
Q: What are the types of apraxia?
There are two main types of speech apraxia. Acquired apraxia of speech can affect a person at any age and involves the loss or impairment of existing speech abilities. The disorder may result from a stroke, head injury, tumor or other illness affecting the brain. Acquired apraxia of speech may occur together with muscle weakness affecting speech production (dysarthria) or language difficulties caused by damage to the nervous system (aphasia).
Developmental apraxia of speech (DAS) occurs in children and is present from birth. It appears to affect more boys than girls. This speech disorder goes by several other names, including developmental verbal apraxia, developmental verbal dyspraxia, articulatory apraxia and childhood apraxia of speech. DAS is different from what is known as a developmental delay of speech, in which a child follows the “typical” path of speech development but does so more slowly than normal.
Q: What causes developmental apraxia?
The cause or causes of DAS are not yet known. Some scientists believe that DAS is a disorder related to a child’s overall language development. Others believe it is a neurological disorder that affects the brain’s ability to send the proper signals to move the muscles involved in speech. However, brain imaging and other studies have not found evidence of specific brain lesions or differences in brain structure in children with DAS. Children with DAS often have family members who have a history of communication disorders or learning disabilities. This observation and recent research findings suggest that genetic factors may play a role in the disorder.
Q: What are the symptoms of developmental apraxia?
Children with developmental apraxia of speech generally can understand language much better than they are able to use language to express themselves. Some children with the disorder may also have other problems. These can include other speech problems, such as dysarthria; language problems such as poor vocabulary, incorrect grammar, and difficulty in clearly organizing spoken information; problems with reading, writing, spelling, or math; coordination or “motor-skill” problems; and chewing and swallowing difficulties.
The severity of apraxia of speech varies from person to person. Apraxia can be so mild that a person has trouble with very few speech sounds or only has occasional problems pronouncing words with many syllables. In the most severe cases, a person may not be able to communicate effectively with speech, and may need the help of alternative or additional communication methods.
Q: How is it diagnosed?
Speech-language pathologists play a key role in diagnosing and treating apraxia of speech. There is no single factor or test that can be used to diagnose apraxia, and speech-language experts do not agree about which specific symptoms are part of developmental apraxia. The person making the diagnosis generally looks for the presence of some, or many, of a group of symptoms, including those described previously. Ruling out other contributing factors, such as muscle weakness or language-comprehension problems, can also help with the diagnosis.
To diagnose developmental apraxia of speech, parents and professionals may need to observe a child’s speech over a period of time. In formal testing for both acquired and developmental apraxia, the speech-language pathologist may ask the person to perform speech tasks such as repeating a particular word several times or repeating a list of words of increasing length (for example, love, loving, lovingly). For acquired apraxia of speech, a speech-language pathologist may also examine a person’s ability to converse, read, write and perform non-speech movements. Brain-imaging tests such as magnetic resonance imaging (MRI) may also be used to help distinguish acquired apraxia of speech from other communication disorders in people who have experienced brain damage.
Q: How is it treated?
In some cases, people with acquired apraxia of speech recover some or all of their speech abilities on their own. This is called spontaneous recovery. Children with developmental apraxia of speech will not outgrow the problem on their own. Speech-language therapy is often helpful for these children and for people with acquired apraxia who do not spontaneously recover all of their speech abilities.
Speech-language pathologists use different approaches to treat apraxia of speech, and no single approach has been proven to be the most effective. Therapy is tailored to the individual and is designed to treat other speech or language problems that may occur together with apraxia. Each person responds differently to therapy, and some people will make more progress than others. People with apraxia of speech usually need frequent and intensive one-on-one therapy. Support and encouragement from family members and friends are also important.
In severe cases, people with acquired or developmental apraxia of speech may need to use other ways to express themselves. These might include formal or informal sign language, a language notebook with pictures or written words that the person can show to other people, or an electronic communication device such as a portable computer that writes and produces speech.
10 Considerations for an Appropriate School-Based Speech Therapy Program for a Child with Apraxia
- The clinician working with the child should have experience with childhood apraxia or at least an appropriate background.
- The child should get a full speech, language and cognitive evaluation. Most children with apraxia are at risk for co-occurring problems such as specific language impairments, reading problems and even some difficulty with social skill development.
- Treatment should be provided on as intensive a basis as possible when the child’s speech is affected severely or when they first start treatment.
- Treatment programs should include lots of practice: parents and speech aides should work with the child afterschool.
- A means of communication should be targeted from the start of treatment. Alternative-assistive communication devices and gestures should be used from the outset of therapy.
- Parents should be involved in the treatment plan and should receive training from the as to what to do when they help their child practice speech sounds.
- Speech should be targeted from the outset of treatment; avoid oral motor movement drills if possible.
- The speech-language pathologist should work with the teacher to provide assistance in how to best help the child with apraxia in the classroom.
- Consider the need for summer therapy as part of the treatment plan. Many children with apraxia regress if they do not get some treatment over the summer.
- Children should be evaluated at least two times a year and the IEP modified appropriately.
Resource:
NIDCD Information Clearinghouse, Bethesda, MD (800) 241-1044.
http://www.nidcd.nih.gov/directory
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