By Leslie Lindsay with Becca Jarzynski, CCC-SLP

Happy Halloween!!  It’s hard to believe it’s the end of October already.  I’ve been saving the best for last as I introduce Becca Jarzynski, CCC-SLP who hails from Wisconsin, is a mother, and a pediatric speech pathologist.  Be sure to check out her blog, www.talkingkids.org. She shares her insight on children with apraxia and prosody and volume control.  Both of which are concerns I have noticed in my own daughter, and from what I understand you, too have some of the same questions and concerns.

I’m turning it over to Becca now:

If you have a child with apraxia of speech, chances are you’ve spend a long time working very hard on getting your child to beunderstood by others.  Your little one has struggled to first make sounds, then to bring those sounds into syllables; from syllables into words, and from words into sentences.   When you finally arrive at the long anticipated goal of having a child whose speech can be understood by others,you all cheer (as well you should- it is a huge accomplishment!). And yet even when your child with apraxia of speech is speaking intelligibly in full sentences, something can still sometimes seem just a bit off.  Your child may speaktoo loudly, or not loudly enough. Or his speech may be a bit halting, or robot-like.
Or, his questions might sound like statements and vice versa. These all indicate difficulty with prosody.  

What Exactly Is Prosody?

Prosody is the rhythm or the melody of speech.   Without prosody, speech sounds robotic. Think of a time that you listened to a computer-generated voice. The sentences you heard the computer speak were articulated correctly—all of the speech sounds were there and spoken well. But the computer voice probably sounded a bit unnatural to you. This is because computer-generated voices lack prosody. In human speech, prosody isaccomplished in many interconnected and subtle ways:

We vary our loudness level, stress, and pitch to emphasize certain words that are important in what we are saying (“I can’t BELIEVE he didn’t call me to tell me he was going to be late!”)

We use rising and falling intonations (“You’re coming home soon?” is said with a rising intonation at the end to indicate a question; “You’re coming home soon.” is said with a falling intonation at the end to indicate a declarative statement).

We put pauses in particular spots of our sentences to emphasize meaning; we speak slowly or quickly depending on our mood and what we are trying to convey.

Why Do Children With Apraxia of Speech Struggle With Prosody?

Children with apraxia of speech may struggle with prosody for a variety of reasons. Two big ones are:

1.  Apraxia of speech is thought to be caused by difficulty executing the extremely complex movements required for speech sound
production.   Articulation, of course, requires precise and careful coordination of the articulators.  Prosody adds a whole different layer of
complexity.  To achieve prosody, we must not only move our articulators correctly, we must coordinate that movement with
very gradual and subtle distinctions such as loudness and stress.   This is, well, difficult.  The very nature of apraxia of speech means that difficult speech sound movements are harder to accomplish.  Children with apraxia of speech may compensate for their difficulty coordinating everything by turning
it all ON (all loud, all one stress, all one intonation) and by speaking slowly, with unnatural pauses between words. It requires time and practice for
them to learn to coordinate loudness, stress, intonation, and pausing with the articulation skills that they are executing.
2.  Some of the techniques we use to work with children who have apraxia of speech may end up exacerbating an underlying tendency to have difficulty with prosody. For example, children with apraxia of speech will often leave out the unstressed syllable of a word. They might, for example, say buhfly” for butterfly.   We combat this by overstressing the syllable that they left out (“Say ‘butTERfly’ ”) or by
stressing all syllables equal amounts (“Say ‘BU-TER-FLY’”).  This works….except that often leads to an unnatural production of the word, which shows up later as difficulty with prosody.

 What Can I Do to Help My Child With Prosody?

There are lots of ways to work on prosody. As with all things related to childhood apraxia of speech, you may need to experiment with
different methods to find the one that is right for your child.  That being said, here are a few tips of the trade that you and/or your child’s speech-language therapist may want to try out:
Keep prosody in the back of your mind.  As you model words and sentences for your little one, you will probably have a tendency to slow your rate of speech down and overemphasize the sound(s) that your child has left out or said
incorrectly. This is okay and  is probably a needed step, so that your child can learn to articulate correctly. However, as soon as your child can produce a
particular word or sentence correctly, make sure you move into more natural models for your child, so that his speech starts to take on a more natural
rhythm and melody.

If your child can read, work on prosody while reading. Read first to get to automatic, accurate production of speech sounds…then to work on prosody.

When teaching multi-syllabic words, use backwards-chaining. Instead of saying each syllable with equal stress and loudness (BU-TER-FLY), try this:
Have your child imitate the last syllable first (‘fly’). Then, have him imitate the last two syllables (‘terfly’). Then, finally, have him say all three together(“butterfly”).

As you do this, watch to make sure you are maintaining natural stress and intonation as you model the syllables.

When your child can produce sentences, work on prosody by having him answer “wh” questions that require him to put stress on the appropriate word. Say, for example, the target sentence was, “The mouse ate a banana.” Ask him “who ate the banana?” and he should say “A MOUSE ate a banana.”
Ask him “what did he eat?” and he should say, “He ate a BANANA!” Ask him “what did the mouse do with the banana?” and he should say “He ATE the banana!”
Practice volume control by singing silly songs like “John Jacob Jingleheimer Schmidt” that allow your child to practice gradually getting louder and quieter. Member that, for many children with apraxia of speech,  it will be easiest to either turn the voice ON (full volume) or OFF
(whisper). They will need practice with the in between.

And, most of all, have hope. As you have surely learned by now, all things will come with lots of hard word, lots of time, and lots of patience.  

Becca’s Bio:

Becca Jarzynski, M.S., CCC-SLP is a pediatric speech-language pathologist in Wisconsin. Her blog, Child Talk, can be found at www.talkingkids.org and on facebook at facebook.com/ChildTalk.