Apraxia Monday: Assessment and Diagnosis, an excerpt from Chapter 4

By Leslie Lindsay

Here’s chapter 4 from Speaking of Apraxia: A Parent’s Guide to Childhood Apraxia of Speech.  Here, you’ll get a glimpse of what it’s like to go to the very first (initial assessment) appointment with your child, what the SLP is doing and why…read on to learn more.

At the Appointment :

You’re there. You might be excited, nervous, indifferent, or in complete denial. Depending on the type of SLP you have—and how she or he prefers to work—you’ll likely see a combination approach to formal and informal testing at your first appointment. If your SLP is completely informal, you may be skeptical of his or her approach. “How can playing with Play-Doh and blowing bubbles really help?” you may wonder.

Your SLP should have enough toys to hold your child’s attention for a good hour or so. You’ll want to feel like you just walked into a toy superstore. But on another note, it should be organized and well-maintained, and not too overwhelming. A good SLP will know this and perhaps only bring out a few items at a time.

Besides developing trust and rapport and assessing your child’s behavior, your therapist is busy evaluating. Remember how your child’s job is to play? Well, your SLP’s “play” is her work. Here are some components of a typical speech-language evaluation:

• Behavioral Observations: How your child engages in play, whether or not the play style is developmentally appropriate/similar to other kids this age, alertness/attentiveness/excitability. Be sure to point out to your therapist if the behavior is an accurate representation of your child’s abilities.
• Pragmatics: Your therapist is evaluating how your child uses language to communicate with others in his environment. Examples of pragmatics include: responding to other’s vocalizations, point to/show/give objects, making eye contact, responding to greetings, and controlling behavior.
• Gesture: How does your child uses gesture to express thought and intent without spoken language? Examples of gestures include taking on/off articles of clothing when asked, “dancing” to music, pushing a stroller/shopping cart.
• Play: Time for fun! Really this piece of the evaluation determines your child’s development of representational thought. This is really a fancy way of saying, “your child’s ability to think in analogies; to understand symbols and infer meaning.” Can he show how to play with a toy in different ways? Hand a toy to an adult for assistance? Group objects together? Use two toys together? Put toys away when asked? This is also an opportunity to see your child’s temperament and personality; important for planning future speech sessions.
• Language Comprehension (Receptive Language):  Determines how well your child attends to, processes, understands, retains, and integrates spoken language with and without linguistic cues. This      may be tested by asking your child to pick just one object from a group, follow two-step commands, identify body parts/clothing items on himself, and perhaps follow novel commands.
• Language Expression (Expressive Language):  Examines how easily your child can put words together to express himself verbally to others. If your child is able to sign certain concepts such as      “more” or “thank you”—it’s still considered “expressive language,” though not verbal. Your therapist is looking to see if your child can shake his head yes/no, name an object, say several meaningful words, consistently identify 5-7 familiar objects when asked, or use single words correctly and frequently. (See Chapter 2 for more information about receptive and expressive language.)
• Speech and Articulation: What speech sounds are in your child’s repertoire, and how accurately and meaningfully does he      produce them? Does “down” sound like “done?” If so, he is unable to      differentiate her speech. Does your child have one word that represents several different concepts? (Kate’s word was “nanni.” It meant “Grandma,” “pacifier,” and “blanket.”) Does your child appear to be looking for the right word,  but come up empty-handed (groping)? Does he grunt, squeal, and scream to      get his needs met?
• Motor-Speech Examination (MSE): An essential tool for speech pathologists faced with diagnosing CAS is the MSE. The child is asked to imitate utterances of increasing length and complexity. Your SLP is looking to see if your child can make the same sounds in different contexts. When the SLP makes modifications to the MSE by slowing down the rate or by giving the child cues (by touch or gesture), she can begin to determine severity, and even get clues for determining the prognosis.
• Oral Motor Skills: Do your child’s tongue, lips, jaw, and facial muscles work together to formulate words? Are facial and oral features symmetrical? Can he smile, frown, and press his lips together? Your SLP might use a flavored tongue depressor and gloves (mention if your child has a latex allergy) to examine his mouth. This can be tricky—some kids hate the idea of having someone’s gloved hand in their mouth and some kids are painfully reminded of the dentist or doctor. Your SLP should ask you and your child if this is acceptable. Some therapists will allow your child to play with the instruments used for this examination.
• Feeding: Your child may be asked to eat something like a cracker or cookie and take a drink of water (or  juice). This will assess whether your child has any difficulty drinking, swallowing, chewing, or aspirating (drawing in air and liquid at the same time—choking). Your SLP will also ask if you have observed any eating difficulties at home. Pay close attention to the texture of foods that your child eats well and those he doesn’t (does he hate applesauce, but eat yogurt in earnest?). Mention them to the SLP, as well as any food allergies or insensitivities your child may have.

Leslie Lindsay is a child/adolescent psych R.N. turned author.  Speaking of Apraxia: A Parent’s Guide to Childhood Apraxia of Speech is the first-ever book written for parents exclusively on this complex, neurogically based motor speech disorder.  Published by Woodbine House, Inc (March 2012), a publisher providing high-quality special needs parenting resources since 1985, www.woodbinehouse.com.  Speaking of Apraxia is also being offered through www.Amazon.com