Apraxia Mondays: Virtual Group #2

Here we are with another installment of “Apraxia Mondays.”  Hope you all had a nice weekend!  We were celebrating Kate’s 5th Birthday and I am utterly amazed at how this sweet little girl has grown–physically, mentally and verbally.  I look back on these last two and a half years and think, “Wow–she has come so far.”  It’s been an intense journey–just generally speaking (ha!) as a parent, but also a parent of an apraxic daughter.  I couldn’t be prouder to see her carry on and chatter with her friends at her Birthday party–something I so badly wanted to see her do at an earlier age.  But she’s doing it now!! 

And if you are just starting out on this apraxia journey, you will get there, too.  This second session of our apraxia group focuses on what CAS (Childhood Apraxia of Speech) is all about.  And what it’s not all about.  Typically there is some good discussion and participation…and 2 hours of time devoted to this topic…so bear with me. 


Speech Apraxia has about 500 different names.  Curious as to what they are?

 Developmental Dyspraxia.  Developmental Verbal Dyspraxia.  Developmental Aphasia. Developmental Apraxia of Speech.  Childhood Apraxia of Speech.  Oral Apraxia.  Verbal Apraxia.  Oral Verbal Apraxia.  Developmental Verbal Apraxia.  Executive Aphasia.  Congenital Articulatory Aphasia.  Dilapidated Speech.  Articulatory Apraxia.  Phonetic Disintegration.  Afferent Motor Aphasia.  Efferent Motor Aphasia.  Little Broca’s Aphsia.  Ataxic Aphasia.  Sensorimotor impairment.  Pure Motor Aphasia.  Speech Sound Muteness.  

Apraxia and Aphasia are NOT the same thing!  These descriptors were only included as historical interest.  In the early days of CAS–100 years ago or more–few clinicians knew how or what to call it.  These were some of the terms they used.  If you have interest in learning more about childhood aphasia, please refer to this website, http://wwwhmc.psu.edu/childrens/healthinfo/a/aphasia.htm

 O.k.—so maybe “500” is an exaggeration, but you get the idea.  (Actually, since 1937, the real number is closer to +/-21).  Why are all of these terms important to know?  Well, as a curious parent, a studious scholar, or treating clinician you will likely do some literature searches on the condition.  Your librarian, your brain, and your search engine will get quite the work out as you type in all of these terms to get the information you want.  Can you say, “tedious?!”  

Why so many different terms to describe one phenomena?  What all of these terms have in common is the root word, “praxis.”  Hummm….what is praxis, you wonder?  Praxis can be defined as planned movement, and apraxia is the lack of planned movement.

 O.k., I know that’s still not enough information.  Bear with me. 

Childhood Speech Apraxia (CAS) as most pediatric SLPs will call it, is best defined by what it is not.  Historically, it’s been one of the most debated disorders in the field of Speech-Language Pathology.  It took practitioners quite some time to to find an easy, agreed upon definition, symptomology, cause, and treatment.  But they did!  Most current research leans heavily towards the motor learning theory as the best available therapy. 

 If we were to define CAS in a table format, it would look something like this: 

A muscular disorder A neurologically-based motor speech disorder
A cognitive disorder A neurobehavioral (genetic/metabolic) disorder
  A disruption in spatio-temporal parameters of speech movement (difficulty moving articulators through space with correct timing for accurate sequencing of sounds)

It’s not a black and white answer; and if this is still a bit confusing, don’t lose heart.  The ASHA (The American Speech & Hearing Association) offers the following definition of CAS: “A neurological childhood (pediatric) speech sound disorder in which precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits.  Remember diagramming sentences in grade school?  We’ll do just that with this definition. 

“Neurological” refers to the nervous system (brain and spinal cord to start with), “childhood/pediatric” generally refers to the ages of birth to adolescence (more on this later), “precision and consistency” refer to the accuracy of speech sounds each and every time they are spoken.   “Movements underlying speech” refers to movements of articulators in smooth, sequential, and overlapping gestures necessary for intelligible speech–which all has to do with precision and consistency related to speech.   The oral structures of the mouth  are tongue, lips, jaw, and palate.  “Neuromuscular deficits” are things like abnormal reflexes and weakness and incoordination of muscles, not necessarily tone…those are the muscles that are controlled by the brain to produce speech movements.  What that is really saying is that these kids have completely normal facial tone and musculature.  Their reflexes are normal, yet they still can’t coordinate their thoughts with their mouth.  

The folks who wrote the ASHA Technical Report would impress upon us parents that when SLPs give the diagnosis of CAS, they are ruling out any weakness, decreased range of motion, low muscular tone, and incoordination as contribuatory factor to your child’s CAS.  These kiddos can still possibly have co-occuring conditions such as dysarthria, phonological errors, and low tone. 

The problem with CAS occurs when the brain tries to tell the muscles what to do and the message gets scrambled somehow.  The child typically knows what she wants to say, but her brain is not sending the correct instructions to move the mouth the way it should move.  Thus, motor execution is affected.  Words may or may not come out…and if they do, they are often unintelligible.  Generally speaking (no pun), the more a child wants to communicate, either to meet a need or to express something creatively, the harder it will be.  Automatic speech is easier.  Sometimes, a word or a phrase will just “pop” out and it may never happen again. 

 Feeling discouraged yet?  Just think of how your child might feel when she is trying so hard to tell you something. 

 What Can You Do?!  Are you a SLP (maybe)?  Are you a linguist (maybe)?  Communication expert (maybe)?  When your child was first diagnosed with apraxia, were you suddenly an “expert?”  Of course not!!  No one waved a magic wand over your head and said, “Bippity-Boppity-Boo–you now know all there is to know about Childhood Apraxia of Speech!  Here’s a magic pill to give to your child so that he can communicate to you with words.  Here’s another magic pill for your patience and teaching skills.” 

If we were in a small group setting, I would have you write down your (former) occupation on a notecard and attach it to your shirt.  Go ahead, write it down…think about what your job entail(ed)s.  What skills and knowledge must you know and do to carry out your job to the fullest?  What must you do to reach your potential and help your company?  I’m not going to tell you that your child is equvilant to your job and that you are now “working” for her (that is sort of true, but not where I’m going).  What I want to suggest is this:

  • It took you awhile to get a grasp of your occupation, it will take you awhile to get a grasp of this apraxia thing, too
  • The skills and knowledge that you apply(ied) to your work  will really help you and your child.  It doesn’t matter what you were (are) doing for employment…just think of how you can shape that into the needs of your child now. 
  • Some of the participants from former in-person groups have been in nursing, teaching, psychology, case managers for adolescent pysch programs, accountants, bank managers, and you what….almost all of them had an answer as to what they could extract from their work and infuse it into their “work” with their apraxic child. 
  • Managers said things like, “I get really good at managing time, appointments and fitting practice in at home.” 
  • Number folks (bankers/accountants) mentioned that they were really into the standardized testing, reaching the next level, and creating charts, behavior modifaction programs, etc.
  • Teachers are good at lesson planning, making practice fun…
  • Psychology related moms were concerned about socialization, reaching out, and finding additional support.
  • Moms with nursing backgrounds had heard a little about apraxia through their schooling, had some knowledge of the motor-neurological piece and wanted to know more about how they could help…

Of course, the purpose of this exercise is not to stereotype professions, or to suggest that you have to have come from such a background, it’s just to illustrate that you can help your child regardless of your background or occupation.  You can!  You are!

That’s not to say it’s going to be easy.  You’ll certainly need to educate yourself on this disorder.  Read all you can get your hands on.  Look for answers, ask questions.  Try to work on skills that need a little brushing up…and you thought you were out of school?!  Seems us parents have to get right back into the saddle once kids hit the scene.   But that’s not so bad…think of how much smarter you’ll get in the process, too! 

Good luck this week!  And let us know how your background can benefit your apraxic child.

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