Apraxia Monday: ABCs & CAS (Why Reading is Hard, How YOU Can Help)

By Leslie Lindsay abc_book.gif

We know that having children with CAS presents a different set of challenges.  From not being able to commuicate clearly to learning to read, seems there is always something we need to help our little people with . 

Learning to read with CAS is topic that is often up for discussion.  Why is it so darn hard for these kiddos to learn to read?  And what can you do to help your child? 

Why Is Reading Difficult for Children with CAS?  Kids with apraxia have several problem areas to consider when reading comes into the picture:

  1. Kids who aren’t making sounds accurately (or at all) may have a decreased visual representation of what letters look and sound like.


  • Kids with speech-language disorders may have a distorted sense of what the symbols (letters) represent (letters are symbols which represent words).


  • Kids with apraxia may have “differently-wired” brains, affecting the way they read, learn, and interpret information.


  • Children affected with CAS may have a decreased ability to coordinate the vocal track in producing a word. 

When it comes to reading comprehension, researchers say that some kids with apraxia and other learning difficulties lack the appropriate strategies to allow them to understand what they just read. It’s complicated. Reading requires a lot: decoding words, visualization, understanding context, activating prior knowledge, a large vocabulary, and the ability to comprehend what you just read. For example, if a kid has to work really hard to understand (decode) the words on the page, then he may not have much energy left over for defining an unfamiliar word.

And now…how you can help! 
 (image source http://catholicblogger1.blogspot.com/2010/06/parent-involvement-in-ccd.html)

  • Read wordless books (Or have your child illsutrate her own). Don’t disregard books that have no print. They are important in getting kids to be the storyteller. Each time a child “reads” a wordless book, the story changes slightly. Of course, this may be harder to do if your child isn’t saying much. But the more you present the book, the more he will attempt.  
  • Engage in dialogic reading. What this means is you stop and ask your child questions about the book you are reading. “Oh, look. I see a little girl who is ready to go to school. She has a backpack. Can you say ‘backpack?’ What else do you see?”
  • Read riddles.Look for a riddle book the next time you are at the library. Great for long car rides or an after-dinner family activity. Riddles provide good exposure to, and practice with, the nuances of language.  Riddles also help develop a rich vocabulary and improve reading comprehension.
  • Explore letters and sounds.Develop a “Letter Center” at home if you have the space. Supply it

    with magnetic letters, alphabet puzzles, sponge letters, foam letters, sticker letters, rubber letter stamps, clay/Play-Doh and cookie cutters shaped like letters, and perhaps even computer software that focuses on the alphabet. In the same area, it may be a nice extension to offer different types of literacy materials: catalogs, labels, newspapers, empty cereal boxes, recipe cards, junk mail, and greeting cards. If it has print on it, it counts! 

  • Clap it out. You may want to start with a simple adaptation of clapping out syllables. Say, “I am going to clap my hands in a pattern. Repeat after me.” Then clap out a simple little sequence. Your child is listening to the rate and pattern of your claps. He should repeat it back to you. You can modify to add jumping or stomping in lieu of clapping. 
  • Play the “Letter a Day” game. Pick a letter and have it be the focus of your day. “Today we are going to focus on the letter B. Let’s see how many letter Bs we can find. Let’s try to say words that begin with the letter B. But first, let me show you what the letter B looks like.”  Everywhere you go, point the letter out in its uppercase and lowercase form. Practice making the /ba/ sound. Make a collage with the letter B. Play ball and say B words as you bounce or roll it to each other.  
  • Shop at home. Give your child a shopping bag. On the bag, write or attach a letter. Tell him to go around the house and collect things in his bag that begin with that letter sound. Talk about what he shopped for together. 
  • Make a name collage. Start by writing your child’s name on a large sheet of construction paper. Then look in old magazines and catalogs for items that start with the sound of his first name. Steven=stove, stop, stick, stone, stay, story. Let your child do some of the work.
  • Match letters to toys. Grab a few of your child’s favorite toys. Spread them out on the floor and make your own alphabet cards, making sure that you include some “correct” as well as “incorrect” cards. For example, say your grouping of toys consists of ball, doll, car, puzzle, and jump rope. Your alphabet cards would include the letters Bb, Dd, Cc, Pp, Jj. Throw in a couple of random letters as well, Rr, Zz, Hh. Have your child match the correct card to the correct toy. Practice saying the name of the object, as well as the sound the letter makes with your child.
  • Does this rhyme? Play this simple game in the car, in a waiting room, or even in the grocery story. Say, “I am thinking of three words. They are cat, bat, and ball. Which words rhyme?”

Be sure to check out and LIKE the FACEBOOK PAGE for SPEAKING OF APRAXIA.  Updated regularly with hints, tips, ideas, blogs, and more.  http://www.facebook.com/pages/Speaking-of-Apraxia-A-Parents-Guide-to-Childhood-Apraxia-of-Speech/235772599837084?ref=hl 

[This above was a modified excerpt from SPEAKING OF APRAXIA: A Parent’s Guide to Childhood Apraxia of Speech, Woodbine House, 2012. Like what you read here? Get the book! Available thru Amazon, B&N, and the publisher’s website, www.woodbinehouse.com]

Apraxia Monday: Tips for Teachers

By Leslie Lindsay

Teachers and the Push for Online Education

Your children may already be back in school–or you may have week or two before the big day.  In any case, you’re likely thinking about it–specifics, plus the extras like how you’re going to talk to your child’s teacher about CAS (if you haven’t already).  But what if you are a teacher who has a child with apraxia in your classroom this year? 

Here are a few tips and ideas from parents who may help you understand what all of the hoop-la is about. 

(retrieved from CASANA, 8.30.12, a YouTube video]   See this short video on Apraxia.  It’s a worth your 3 minutes!   http://www.youtube.com/watch?v=_nN9dG5F7M0

Tips for Teachers

If you are a teacher reading this, then hooray! I applaud your efforts to learn more about the kiddos in your classroom.

  • Read the child’s IEP.
  • If parents challenge your knowledge, make special requests, or argue for a special IEP meeting, remind them that you are on their side and please don’t take it personally.As parents we just want the very best for our children and we might get a little passionate about it.
  • Communicate privately with parents and never in front of other classmates,unless it is to give really good praise that will make your student feel really proud.These kids often know they can’t communicate as effectively as their peers and they may feel a bit defensive about it. Help build their self-esteem in every opportunity you can find.
  • Give parents advice and insight you learned from teaching their child. For example, “Kate did a great job teaching another student about how we sit at Circle Time. She loves to be in the helper role.” Parents love to hear praise and stories about their child doing well.
  • You may need to do a bit more “pre-teaching” when working with a child with CAS.Let her hear and practice vocabulary words ahead of time (send them home in backpack with a letter to parents indicating the upcoming unit).
  • You might need to work a bit harder to engage a student with apraxia in group activities.Don’t take it personally if she doesn’t respond right away (or at all); just keep trying.
  • Each day is a new beginning.What this student struggled with yesterday could be a non-issue today. Please don’t hold grudges.
  • Be sure you give your students with CAS lots of praise.It helps their confidence level and self-esteem. While you’re at it, praise her parents, too. They’re working really hard all day, every day, to help their child.
  • Relate something special about your student to the parents at least weekly.I can’t tell you how happy it made me to receive an out-of-the-blue email from our teacher saying something like, “Kate was really cute today in class when she started dancing and singing, ‘Mama Mia!’” Small accomplishments mean a lot to us parents.
  • Respond to parents in one way or another (phone, email, “I’ll get back to you later”), even if you don’t have an answer.Parents do not like feeling like they have been forgotten.
  • Realize that we all get burned out.Parents need encouragement and motivation, just like teachers. If we can encourage one another, then all the better!

[Excerpt from SPEAKING OF APRAXIA: A PARENT’S GUIDE TO CHILDHOOD APRAXIA OF SPEECH, Woodbine House, 2012.  Available thru Amazon.com, Barnes & Noble, and publisher’s website, www.woodbinehouse.com]

Apraxia Monday: Preparing Your Child for the First Day of School

By Leslie Lindsay

Hard to believe that back-to-school is amongst us–how is it even possible that it’s already August 6th?!  Here are some more tips and ideas to help you and your child ease your way into the school scene. 

Preparing Your Child for the First Day

Where your child is concerned, start early, but not too early, in prepping him for school. Be sure to drive by the school ahead of time. Point it out and get excited about the place where your child will be learning and playing. Then, a week or so later, pack a picnic and head over for lunch and some time on the playground. Your child will remember that you were there with her, so when she is playing with classmates, it won’t seem so unfamiliar. Teach her how to ask others to join her in play (see bullet points below).

The building may be big and potentially confusing.Either way, go to orientation and show your child around. Remind her that she will never be walking around the school without a teacher or parent. Take photos of your child with her teacher and the classroom and some common areas of the school (ask first). Print them out and present them to her in a little photo book. Study the photos and talk about them together. Have her carry the photo book in her backpack to look at on the bus.    


Speaking of which, if your child will be riding the bus, calm those fears too, but be careful not to create new ones. Kids often worry that they will get on the wrong bus or that they won’t make it home. Assure her that teachers will make sure she gets on the right bus and you will meet her at the bus stop. Kids who ride the bus are often better prepared to start the school day than if Mom and Dad do the drop off. Why? It gives kids a chance to be introspective and prepare in their own way. It also lessens the separation anxiety from you.

A final tip is to get to the local library and check out some books on going to school. Read those books periodically in the days leading up to the first day.

          Other ways to prepare: 

  • Describe the school-day routines (get a copy of the schedule from the teacher). Discuss what happens first, where her cubby is located, the bathroom, snack, and lunch routines, and going-home procedures. Answer any questions your child may have. This helps prevent any surprises.
  • Make sure you attend the “sneak peek day” with your child before classes start. Get to know people who may be able to help your child and point them out to your child. “If you ever need help being understood, look for this nice lady at the front desk. She will help you.”
  • Practice saying these feel-good confidence boosters:
    • “I know you can do this!”
    • “I trust you will do well at school.”
    • “You are very important to me.”
    • “I will always love and care for you.” 
    • “If you want to talk, I will listen.”
    • My youngest daughter liked this one: “Parents always come back [for pick-up].”

Make your own Social Story about a child going to school for the first time. It’s simple. Draw pictures (or have your child draw them) and then write a brief sentence on each page about what’s happening in the picture. Page one might go like this: “This is Kate. Today is her first day of school.” Page two: “She is going to kindergarten. Hooray!” Go through general steps and feelings. The book should be no more than 10 pages.

Next week, we’ll cover more specific concerns related to a child with CAS.

[the above was an excerpt from SPEAKING OF APRAXIA: A PARENT’S GUIDE TO CHILDHOOD APRAXIA OF SPEECH, Woodbine House 2012.  It is available thru www.woodbinehouse.com, Amazon, and Barnes & Noble.)

Apraxia Monday: Improving Reading Skills


children_reading-istimewa.jpg image by bankfotowol
By Leslie Lindsay 

If you have a child with CAS (childhood apraxia of speech), then you are probably aware that verbal communication is a bit of a…well, challenge.  It may also come as no surprise that reading and writing may also be a challenge for your little one with CAS.  You will likely start to see this struggle as your kiddo hits the later preschool years (Pre-K) moving into kindergarten.

Since it’s summertime, it may be a great time to practice these skills without the pressure to perform.  You and your child can progress at a rate that is comfortable to you….and come fall, your child with apraxia is ready to put those hard-learned skills into action.

But let’s start with the basics: why is it so hard for kids with CAS to read and write?  Aside from pulling out some heavy-duty texts to explain all of this, I will just provide a couple of basics:

1.  Kids who aren’t making sounds accurately–or at all–may have a decreased visual of what letters look–and sound like.

2.  Kids with speech-language disorders may have a distorted sense of what the symbols (those things we call “letters”) represent (words). 

3.  Children with apraxia may have “differently wired” brains, affecting what–and how–they read, learn, and interpret information.

4.  Children with apraxia may have a decreased ability to coordinate the vocal track in producing a word.

The National Institute of Child Health & Human Development (NICHD) created the National Reading Panel.  They determined that kids need a variety of techniques to learn to read:

  • Phonemic (sound) awareness
  • Phonics
  • Fluency
  • Guided oral reading
  • Teaching of vocabulary words
  • Reading comprehension strategies 

If that all sounds like blah, blah, blah to you…bear with me.  It’s not nearly as mysterious as it sounds.

So, What’s a Parent to do?!

Make it fun.  That, of course is your #1 goal when you work with your child on these often hard-to-master skills.  “If it ain’t fun, they ain’t gonna do it!”

Read, Read, Read!  You can start with a love for reading.  Let your child see you reading.  Really, anything counts…magazines, books, newspapers.  Just the fact that you are reading sets the stage for your child to do the same.  But also read with your child.  Start out with repetitive books.  Those stories that are predictable may be boring to you, but for your child they bring to life the idea that they can predict what is going to happen next (a very empowering skill), plus, they are easier to memorize in which it may look as if your child is “reading” it on her own.

Introduce rhyme.  Read books that rhyme, or just make up silly jingles while doing your everyday things…like preparing lunch or driving in the car.  “What rhymes with jelly?  Belly!  That’s right!  I’ve got a jelly belly!!”  Can you say that?!  Let me hear you…

Next, you can have your child discriminate rhyme.  “What rhymes with Sam?  Am or eggs?”  The sillier the better.

Then have your child produce rhyme.  It works like this:  “I am thinking of a word that rhymes with Sun, but starts with /f/ [fun].  Just make sure you make the sound of the letter /f/ and not say, F.  (A great activity to do on those summer road trips).

We’ll, talk more about helping your child with reading skills next week on “Apraxia Monday.”  Stay tuned, too for later weeks on writing skills.

Check out these blogs for a review of Speaking of Apraxia (Woodbine House, March 2012) and a chance to win a FREE copy of the book, where you can learn more information about helping your child with school-based skills like reading and writing in chapter 12. 

Special thanks to PediaProgress of Downer’s Grove, IL for information on the NICHD and rhyming examples from their April 5, 2012 presentation.  www.pediaprogress.com




Apraxia Monday: Chapter 5–Getting the CAS Diagnosis/Initial Reactions

By Leslie Lindsay

(An excerpt from Speaking of Apraxia: A Paren’ts Guide to Childhood Apraxia of Speech.  Chapter 5: “Getting the Diagnosis and Coping with Your Initial Reactions”).   

You may have been searching for years for some term to identify why your child isn’t talking like every other child. Perhaps you weren’t that concerned in the first place, but took your child to a speech-language pathologist because your friends, your mother, or a concerned neighbor or teacher urged you to. In either case, you now have a word to describe the phenomenon: Childhood Apraxia of Speech (CAS). What’s next?

Common Reactions

If it took you awhile to arrive at a diagnosis, you may be feeling like your competence as a parent has been challenged. 

 “Gosh, I knew there was something wrong, why wouldn’t (or couldn’t) anyone tell me what it was?!” 

You may feel some resentment toward any professionals you consulted who shooed you away, assuring you everything was “fine.”

“I knew I was right! Those doctors were so incompetent. Their lack of competency and time wasted really irks me!”

You might feel like I did: relieved.

“Now I know what to call this thing that was preventing my little sweetie from saying much more than ‘eh?’”

But you could also feel discouraged, as I also did.

“What now? What does this mean for my kid? Will she ever be able to talk? Where do I go from here?” 

Case in point: One of my playgroup mom friends said, “Oh, apraxia . . . that’s a tough one. I was so glad when Jackson didn’t have it after all. Call me if you want to talk about it.” I didn’t. Not to her, anyway. IfJacksondidn’t really have CAS, I didn’t want to get stuck talking with someone who would make it sound like the end of the world. Plus, I wanted to believe that it would be an easy fix.

Another mom friend of mine—who also has a daughter with apraxia indicated she felt naïve when she first got the diagnosis: “I just didn’t know what to think. Maybe one or two months of therapy and then she’d be talking normally.”

Really, the “fix” is somewhere in the middle. Receiving a diagnosis of CAS is pretty serious, but it’s not the end of the world, and it’s certainly not a quick fix. We’ll cover therapy approaches in Chapter 7.

Other feelings and emotions you might be experiencing after learning the diagnosis of CAS:

  • Disbelief /uncertainty
  • Confusion
  • Denial
  • Information overload
  • Numbness
  • Isolation
  • Loss
  • Shock
  • Anger
  • Guilt
  • Sadness
  • Yet, you may also feel acceptance, and even a proactive sense of duty

Here’s a blurb from my journal at the time, expressing my mishmash of feelings:

“I am feeling a bit dumbfounded about Kate’s diagnosis. I used to be in speech & debate [club]. I wrote and performed an oratory at a competition level; how could I possibly have a kid couldn’t talk?! Maybe I have been ‘chosen’ to help a little person—my Kate—navigate the road of apraxia. . . with my public speaking skills and child psych background, perhaps this is a perfect fit for parent and child. But I can’t help feeling like this is all too unfair—for me and for Kate.”

Some folks have a more positive reaction from the outset. They may even say they feel “blessed” or as though they were “chosen” to have a child with such a diagnosis. For example, here’s how one mother I spoke to came to terms with her child’s diagnosis:

I’m a nurse in a neuro-rehab unit. We see a lot of patients who are suffering from brain injuries, stroke, and such. I know CAS isn’t really the same, but there are a lot of similarities. I have a good knowledge base of neurological issues, so learning about apraxia isn’t so out of my comfort zone.” 

For now, sit tight with your feelings about your child’s diagnosis. Listen to them, accept them, and talk them over with someone such as a friend, your spouse, or your child’s SLP.

Where are you with coming to terms with your child’s apraxia diagnosis? 

Leslie Lindsay, R.N., B.S.N. is the mother of a little girl recovering from CAS.  Speaking of Apraxia: A Parent’s Guide to Childhood Apraxia of Speech is the first-ever book written for parents exclusively on this speech disorder.  You can pre-order your copy now through the publisher, Woodbine House (www.woodbinehouse.com).  The title is also being offered through Amazon (www.amazon.com). 

Apraxia Monday: Chapter 3 Excerpt

By Leslie Lindsay

If you have been following along recently, you know that Speaking of Apraxia: A Parent’s Guide to Childhood Apraxia of Speech will be released later this month.  It’s been a long–but overall good–journey in which I have been reading, writing, and revising to get this book into the hands of parents of children with CAS.  As a “count-down-to-release-day,” I am offering some excerpts of the book.  This one is on chapter 3:  Finding Help When You Suspect CAS. 

Here goes:

“As first-time parents, we didn’t want to appear “delinquent,” so when Kate was 15 months old, exactly, we headed to the doctor (the same one who delivered her) for her scheduled well-child check-up. I say “we,” because both doting parents were off work for the occasion. We came armed with our wiggly daughter; along with thoughts, questions, and toddler antics to relate to our doctor.

Kate was meeting all of her developmental milestones right on target. Except one: talking. She had only one word, “Hi.” I was excited that she had such a friendly and outgoing first word and proud that it was the one I had predicted she’d say first.

It seemed I had a natural extrovert (how did that happen with two self-proclaimed introvert parents?!). She was smiling and saying “hi” to strangers in the grocery store, on the playground, at the library.  After Dr. Baumgartner whirled into the exam room, plopped down and smiled at us, she asked a series of questions . . . was Kate doing this, doing that? Yes, yes, and yes, we nodded and smiled proudly. “Is she saying ‘mama’ and ‘dada’ and a few other words?” Nope. We held our breath, awaiting her response.

Sure, I was slightly concerned. After all, I had friends from childbirth class whose toddlers were jabbering up a storm. As a first-timer, however, I didn’t want to jump the gun. Kate was only 15 months old after all. She still wore diapers, took a pacifier when distressed, and was rocked to sleep. In many ways she was still a baby, and babies don’t talk, do they? Plus, I knew kids—through my years as baby-sitter and as a child psych nurse.

We told our doctor that all Kate was saying was “hi,” and that she started saying that around 13 months. Wasn’t that good enough? Our caring doctor probed a little further and eventually referred us to a local speech-language pathologist (SLP). “You can do it now, if you want to be aggressive, or wait until she is 18 months, if you want to take a conservative approach.”

I took the conservative approach. I finally made the call at 18 months. Kate still wasn’t saying “momma” and I wanted to hear my little girl call my name, instead of grunting when she needed me.

Enter the speech-language pathologist (SLP).  He or she is the key player in your child’s progress with speech and a sounding board for you.  He or she is also a professional with a master’s degree (some may have a PhD) with a background in communication disorders. SLPSs complete a practicum—usually a year in length—following their graduate program. SLPs are required to be licensed in the state in which they practice and must complete continuing education criteria to maintain their licensure. They are also accredited by the American-Speech-Language-Hearing Association (ASHA). They perform evaluations, deliver a diagnosis, carry out therapy, and recommend “homework” for you. They are also there to field questions and concerns and give you resources for additional information.

By the way, SLPs are the only professionals qualified to treat CAS. And while this is a subjective piece of information, you may also hear that an SLP’s diagnosis of CAS is more respected than that of another professional.”

Thanks for reading!  Like what you saw?  Want some more?  Head over to www.woodbinehouse.com for a $5 introductory savings off the book.  Speaking of Apraxia is also being offered by Amazon.  Pre-order now, book will be delivered to you hot-off-the-press in late March.

Apraxia Monday: Chapter 1

By Leslie Lindsay

Welcome to the first installment of a series of excerpts of forthcoming, “Speaking of Apraxia: A Parent’s Guide to Childhood Apraxia of Speech” (Woodbine House, March 2012).  Here we begin at the beginning: chapter one.  You may have some suspicions that your child isn’t talking like he or she should; maybe you’ve heard of apraxia (CAS), but you just aren’t sure if that is why your little punkin isn’t chatting like all of the other children.

Consider these scenarios:

“Sarah, age 2, was a puzzle to her parents. She was obviously quite bright and alert. She knew the names of all the birds in her Big Book of Birds and would point to the cardinal, chickadee, etc. when asked. But she struggled to say even the simplest words.”

Jake was an active three-year-old who loved cause and effect, an engineer in the making.  He appeared to be a typically-developing child, with one exception: he was not talking. His grandmother kept saying, “Boys are late to talk–don’t worry.” But his parents were concerned. Could something else be going on?”

Do these stories sound familiar? Does your child remind you of  Sarah or Jake? If so, your child could have Childhood Apraxia of Speech (CAS).

I’ll admit, when I first heard of Childhood Apraxia of Speech, I was totally stumped. We hadn’t covered this in nursing school! So what is CAS, anyway? Like you, I had a ton of questions and concerns and little time to learn about it. But most of all—my child needed help. You may be feeling the same way.

Here’s some nitty-gritty details about CAS that may help steer you in the right direction for getting a diagnosis.  Remember, you need a qualifed speech-language pathologist (SLP) to make the diagnosis and provide treatment.

CAS 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 find an easy, agreed-upon definition, list of symptoms, cause, and treatment. But they did!

The American Speech & Hearing Association (ASHA) offers the following 2007 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.”

Let’s break this down even more:

  • Neurological refers to the nervous system (brain and spinal cord to start with).
  • Childhood/pediatric generally refers to the ages of birth to adolescence.
  • Precision and consistency refer to the accuracy of speech sounds each and every time they are spoken.  
  • Movements underlying speech refers to the movements of the articulators (lips, jaw, tongue, soft palate, hard palate) in smooth, sequential, and overlapping gestures necessary for intelligible 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 the muscles that are controlled by the brain to produce speech movements.

In plain language, kids who have been diagnosed with “pure” CAS have completely normal facial tone and musculature. Their reflexes are typically normal, yet they still can’t coordinate their internal thoughts, shape them into verbal communication, and produce it in a manner we can all understand. (“Pure” refers to the fact that these children have no other diagnosis-able neuro-developmental conditions; they are struggling with only CAS).

Next week:  Chapter 2–All About Speech

You may also appreciate these artices, “Imagine Being a Parent of a Child with Apraxia of Speech” www.nspt4kids.com/therapy/imagine-being-a-parent-of-a-child-with-apraxia-of-speech-cas/

Or, “Speech-based Activities You Can do With Your Child with CAS,” www.specialneeds.com/children-and-parents/speech-or-communication-impairment/speech-based-activities-kids

For more information & additional resources on apraxia (CAS), see Apraxia-Kids at www.apraxia-kids.org