Apraxia Monday: Interview with Cari Ebert, CCC-SLP

By Leslie Lindsay

Today I have a special guest interview, Cari Ebert, CCC-SLP of Summit Speech Therapy and fellow speechie blogger.  Thanks a bunch for taking the time to chat with us, Cari.  We are excited to learn speech tips and tricks for the early childhood set from someone who is so well-versed (sorry, couldn’t resist), in the field.  Let’s start by getting to know you a bit. (image source: http://www.blogger.com/profile/06868042271330481283.  Reetrieved 1.21.13)

My Photo

L4K: When and how did you get interested in the field of pediatric speech pathology?  Is it something that has always been an interest of yours, or did it evolve along with your academic career? 

CE, SLP: I actually started my career working with adults in long-term care.  I worked in skilled nursing facilities and had a special interest in patients who had been diagnosed with Alzheimer’s. After having my first daughter, however, I was so amazed watching her grow and develop that I switched gears, and became a pediatric speech-language pathologist.   I now work primarily in early intervention (EI) with the birth to three population.  The primary purpose of EI is to empower parents by increasing their confidence and competence in facilitating their child’s development.  Parents are a child’s first and most important teacher which is why I believe so strongly in the power of early intervention. 

L4K: Can you tell us a bit about your educational background?  How long have you been a practicing SLP? 

CE, SLP: I completed my undergraduate degree at the University of Iowa (Go Hawkeyes!) in 1993 and my graduate degree at Southern Illinois University in Carbondale (Go Salukis!) in 1995.  I have been a speech-language pathologist for 17 years and have specialized in early intervention for 12 of those years.      

L4K: Do you have any tips for aspiring SLPs?  Keep an open mind about whether you want to work with adults or kids. 

CE, SLP: Depending on where you at in your life, your interests may change over time.  Also, be sure to shadow a few therapists in different settings before you declare your major in school.  You will pour blood, sweat and tears into this degree so be sure it is the one for you! 

L4K: Your area of interest and expertise has a lot to do with childhood apraxia of speech (CAS).  In fact, you lecture on and treat children with CAS.  Can you tell us a little about your interest in such a complex speech disorder?  Do you have personal experience with apraxia—did you or your own children struggle with the disorder? 

CE, SLP: Over the years I have evolved into an apraxia therapist and I strive to help families of very young children who are late to talk.  Early on, when a child is essentially non-verbal, I look for characteristics or “red flags” that make me suspect childhood apraxia of speech as the cause for the lag in expressive language and speech development. 

Because most of the toddlers I see in therapy don’t even know they have lips or a tongue (literally!), we start the therapy process by increasing the child’s awareness of his articulators, and progress from there.  I do have personal experience with apraxia as well.  My 8 year old son has autism and apraxia and he has taught me more about my profession than any book I have ever read and any course I have ever taken.  I love to learn and apraxia is such a complex disorder, that it keeps me on my toes!  (image source: http://pathways.org/pathways-center/services/speech-therapy/.  This is not an image of Cari Ebert, CCC-SLP)  Speech Therapy L4K: As you are well-aware, CAS is a challenging disorder/diagnosis.  What would you tell a parent who is suspecting CAS?  How do you usually give  the diagnosis? 

CE, SLP:  CAS is a SPEECH disorder, not a LANGUAGE disorder.  That means the child must actually have speech before it can be diagnosed.  Too many SLPs are mis-diagnosing and over-diagnosing CAS in non-verbal toddlers.  In young children under age 3, I recommend SLPs give the diagnosis of “suspected childhood apraxia of speech” until the child is verbal and the diagnosis can be confirmed

CAS is a dynamic disorder and speech characteristics can change over time with appropriate therapy and neurological maturation.  I usually don’t focus too much on the label in the beginning stages of therapy.  I am eager to help the child find his or her voice and experience some much needed success early on in the process.  This is so important because success breeds confidence (“I think I can”), which helps the child become a communication risk-taker (“I’m willing to try new things”).   

Becoming a communication risk-taker is crucial to building both competence and confidence.  I encourage parents to revel in the small achievements that their child makes, because all of those baby steps eventually equal a major milestone.  Progress will not be rapid and I am sure to remind parents of this because every parent will get frustrated at some point in the therapy process. 

L4K: What are some of your favorite parent-friendly resources for families walking the apraxia path?  (websites, clinics, books, groups, etc.) 

Computer References

CE, SLP:  I encourage parents not to google apraxia because I want to be sure the information obtained is accurate and beneficial.  Three of my favorite websites are:  www.apraxia-kids.org; www.kidspeech.com; and www.cherabfoundation.org.  My two favorite parent friendly books are The Late Talker by Marilyn Agin and Speaking of Apraxia by Leslie Lindsay–what an awesome resource! 

Along with these resources, I have personally created a hierarchy of developmental skills that need to be addressed in therapy to ensure success.  I also think finding or creating a support group can reduce the stress and anxiety that goes along with raising a child with special needs.  The support group I started about 6 years ago is called H.U.G.S. which stands for Helping, Understanding, Guiding, Supporting.  It has been a lifeline for me as I take this journey into the unknown. 

One thing is for sure, we need each other and we don’t have to do it alone!  Being with a group of people who understand my plight, strengthen me when I am down, and revel in my child’s successes has been priceless. 

L4K: Can you tell us more about your clinic, Summit Speech Therapy, LLC.  Do you have a website?  Are you actively taking new clients? 

CE, SLP: Because very young children learn best in their natural environment (home, daycare, etc.), I travel to the child instead of having the child come into a clinic.   I office out of my home and spend my days commuting from one family’s home to the next.  I do consult with families “long distance” via email, phone, & Skype.  Many parents send me videos of their child and I give them my thoughts and analysis based on what I observe.  Occasionally I have families who choose to come spend a few days here in Kansas City where I can consult with them in person. 

As I mentioned before, I strongly believe that parents are a child’s most important teacher, and it is always my goal to coach the parents on how to best facilitate their child’s development.  I recognize that young children learn differently than older children and my therapy style reflects this. 

L4K: I understand you blog as well.  How long—and what is your goal—with blogging? 

CE, SLP: I am not a techno-savvy person, but I decided to start blogging about 6 months ago when I was diagnosed with breast cancer and was unable to work.  Through blogging I was able to stay in touch with my profession and my clients and I know this helped me fight my battle. 

My blog website is www.learning-through-play.com My goal in blogging is to help parents and professionals understand how important play is in the development of young children.  You see, very young children do not learn best through flash cards and drill work.  Rather, they learn best through play that is relevant and meaningful to their life.  Too often, therapy with young children is ineffective because therapists are trying to utilize inappropriate therapy methods. 

Roman road in Hashofet creekL4K: One piece of sound advice for the road?  

CE, SLP: One thing I say frequently when I present is that talking does NOT start at the mouth.  A child must possess strong gross and fine motor imitation skills first because a child must imitate what we do before he or she will ever imitate what we say.  Too frequently SLPs put the cart before the horse and start trying to teach the child to talk, when in fact, the child may not even be able to motor plan gross and/or fine motor movements. 

WOW–what a bunch of great information, Cari.  Thank you so very much for offering your time and expertise to “Apraxia Monday.”

Leslie, I want to thank you for your time and commitment to helping parents understand more about apraxia!  And good luck to all your readers and their small talkers!

Say That Again?!: How SLPs Can Help Parents Cope with CAS

By Leslie Lindsay

(image source: http://flhealthykids.wordpress.com/2010/07/)

If you have been reading SPEAKING OF APRAXIA (Woodbine House, 2012) then you know each chapter concludes with a summary called, “Say That Again?!”  In spirit of the book, this series on Apraxia Monday will be the “Say That Again” series.   Ready? 

Future SLPs:  Our Children with CAS Need your TLC

By Leslie Lindsay, R.N. B.S.N.

You won’t soon forget her.  The red hair and blue eyes the size of saucers will linger in your memory.  So, too will the fact that she is as fire-y and energetic as that copper hair that cascades down her back, framing her freckled face with possibility. 

And when you hear her speak, you may have an inkling that she once suffered from moderate to severe childhood apraxia of speech (CAS), or you may be none the wiser. Although Kate is a bright, creative, and eager soon-to-be 2nd grader, she has overcome a road block most of us never have to deal with: a struggle to communicate expressively. 

And why do I share this? 

Since you are about to embark into an exciting profession of working with children and their families, I’d like you to have an inside view of what it’s like to raise a child with CAS.

  • We are hurting.  We feel a sense of loss in our child’s lack of verbal communication.  We are grieving.  We didn’t want this to happen.  Heck, most of us don’t even know what CAS is! 
  • We are frustrated.  We don’t know what we are doing wrong (some of us blame ourselves on our child’s inability to speak).  It’s hard to live a life where we only hear our child(ren) point and grunt to get their needs met. 
  • We feel all alone. It’s not every day you run into someone else who is also struggling with CAS.  It often feels like it is “us” against “the world.”  If you know of anyone else who is open to connecting for play dates or support groups, hook us up!
  • We have a lot of other concerns.  It may be that we have to take off work early—or stop working altogether to make sure our child gets to speech therapy.  Money may be tight.  Our insurance may be giving us a hard time.  The demands of raising a family, running a household, and dealing with apraxia may have taken a toll on our relationships. 
  • We have a full, busy life.  Apraxia and speech therapy is a part of our life, but we are many things to many people.  Please respect our time. 
  • Deep down, we just want to have a “normal” kid.  When we overhear a precocious 3-year old chatting with his mommy or daddy at the local park or coffee shop, our heart breaks.  “Why can’t that be my kid?!”
  • We worry.  Will this ever get better?  Will my child be able to talk—when?  What do I need to do? 
  • We want to help.  Let us into your speech-pathology world.  You don’t have to give away all of the secrets to the trade, but let us be your partner. 

As a professional SLP, here’s what you can do to help smooth our path: Graduate student working with a child(image source: http://splh.ku.edu/ipcd/)

  • Give us homework, tips, ideas, and more information on childhood apraxia.  Some folks may request this, others might not know what they need or want.  Feel us out.  If you come across something in your professional life you think will help, but all means, pass it on. 
  • Treat us with respect and compassion.  We know a lot about our children and we want to help them. 
  • But don’t tiptoe around our feelings. Go ahead, lay it on me.  Tell me that CAS is serious and complex and can take years to remediate.  Tell me, too that you will do all you can to help my child learn to speak verbally and that we are in this together.  I need that right now. 
  • Ask us about our home life.  We may have some inside tips to help you with our child in therapy.  For example, she really does get scared of bubbles; please do not blow them with her.  She can’t go anywhere without her favorite stuffed puppy.  Let her bring him to therapy and perhaps incorporate him into your activities. 

You see, as a former R.N. who worked with children day and night in an inpatient child psychiatry program at the Mayo Clinic, I know that children and their families matter.  We are not simply a diagnosis who needs treatment.  We are real people, with real feelings and real lives. 

It is because of my daughter Kate that I wrote the first book designed for parents on this complex neurologically-based motor speech disorder.  SPEAKING OF APRAXIA: A PARENT’S GUIDE TO CHILDHOOD APRAXIA OF SPEECH(Woodbine House, 2012) is as much as labor of love as it is a resource to help others along their apraxia journey.

The book is comprised of over 300 pages of tips, ideas, research, and more on various topics related—not just to CAS—but other speech disorders from suspecting a problem to getting treatment (what that treatment consists of), school challenges, what you can do at home, family coping, child coping, networking, advocating, and co-morbid conditions.  Sprinkled throughout are quotes from parents speaking out about apraxia—what helped, what mattered, and what challenged them. 

Speaking of Apraxia is a must-have for every practicing pediatric SLP.  Read what others are saying:

” I was so excited to open up my Advancefor SLPs magazine today and see your book advertised! Your ‘baby’ is out there. I wish you lots and lots of success with it!”–R.W.

An SLP in Missouri shares this: “I already have a couple of families in mind that I am excited to tell about Speaking of Apraxia. What a great resource!”

“I could feel your blood, sweat and tears as I flipped through the pages (wiping my eyes).Outstanding!  I just shook my head in amazement…I am in awe and I am still kind of speechless…really! This book will be just one of your legacies…well done!!”

–T.K.P., CCC-SLP in Minnesota

And remember, our kids need your special touch.  For without the “magic” of dedicated SLPs, our children with apraxia wouldn’t be able to make the gains they do.  Thank you. 

[this article was written for, and first appeared on The Future SLPs Blog, ,http://www.futureslps.com/1/post/2012/08/future-slps-our-children-with-cas-need-your-tlc.html)

 Bio:  Leslie Lindsay is former child/adolescent psych R.N. at the Mayo Clinic-Rochester. She is the mother of two school-aged daughters and a basset hound, named Sally. Lindsay and her family reside in the Chicago suburbs where she writes full-time. She is the author of “Speaking of Apraxia: A Parents’ Guide to Childhood Apraxia of Speech” (Woodbine House, March 2012). Read more on her blog, “Practical Parenting…with a Twist” where she writes about apraxia, parenting, education, and more 5 days a week, www.leslie4kids.wordpress.com


Apraxia Monday: A Gossip Columnist Shares “Speaking of Apraxia”

By Leslie Lindsay

(image source: http://socialtimes.com/another-online-newspaper-ventures-into-socal-shopping_b43352)

Talk of the Town: Gossip Queen & Child Development Expert Answers your Most Pressing Questions.

Today’s Topic: Childhood Apraxia of Speech (CAS)

Saturday, September 24, 2012

Dear Miss Talks-a-Lot: 

Argh!  I am so frustrated.  My 3 year old son has so much difficulty talking.  It’s like he knows what he wants to say, but he can’t quite get the words out. Everything else [developmentally] seems to be right on target, yet he just jibbers and gestures.  What could be going on? 

–Frustrated in ColoradoRocky Mountains(image source: http://www.destination360.com/north-america/us/wyoming/rocky-mountains)

The Rocky Mountains plus the rugged beauty of Wyoming add up to

Dear Frustrated in Colorado:

It sounds like your son may be suffering from Childhood Apraxia of Speech (CAS), this neurologically based motor speech disorder is characterized by the inability to connect thoughts with verbal output.  It’s as though the child knows what he wants to say, he just cannot coordinate the muscles of articulation with his brain. Often, kids with CAS will gesture or create their own words and phrases to get their needs met.  Your best bet would be to have him evaluated by a qualified speech-language pathologist(SLP) who has a background in childhood apraxia of speech. From there, you will receive an official diagnosis, a treatment plan, and suggestions for next steps.

Dear Miss Talks-A-Lot:

I have heard of this new book, SPEAKING OF APRAXIA and wonder what your thoughts are? 

–Curious Mom in Missouri

Dear Curious:                       

So glad you asked! SPEAKING OF APRAXIA was recently published by Woodbine House, a leader in producing quality special needs books for parents, professionals, and caregivers since 1985.  It is my understanding that it is the first non-academic book designed exclusively on the subject of CAS. Written by mom and former child/adolescent psychiatric RN from the Mayo Clinic, this book embodies everything the author, Leslie Lindsay thought about, worried about, and learned about during her course of raising a daughter with CAS. She wanted a book when her daughter was diagnosed, but was disappointed in the options available.  Plus, she wanted to help others walking the same path.  SPEAKING OF APRAXIA truly is a labor of love. It has received national and international recognition from SLPs, parents, and educators. A Georgia-based parent says: 

“A comprehensive encyclopedia on childhood apraxia of speech (CAS) & self-help book for both parent and child. In addition to having over 400 pages full of facts, Leslie chronicles bits & pieces of her own daughter’s journey with apraxia.”

Anita, a speech-pathologist in Sao Paulo, Brazil shares, “Few professionals know Apraxia. Many children are without diagnosis, teachers and educators and parents completely unaware. I bought your book and loved it, it is very practical and thorough and sure I can use with parents of my patients….surely, it will be very useful for all children with Apraxia.”

Dear Ms. Talks-a-Lot:

All this talk about SPEAKING OF APRAXIA—why should I read this book over others that are available on late-talking children? 

–Wondering Why in Wyoming

Dear Wondering:

SPEAKING OF APRAXIA (Woodbine House, 2012) is the most comprehensive book available on the subject of childhood apraxia of speech (CAS), hands down! The author, Leslie Lindsay not only lived apraxia for over 4 years, but she read, researched, and facilitated her own support/education groups with parents of children with CAS.  Extracting from her life experiences and weaving in research, expert opinion, charts, and other graphics, she takes readers from suspecting a problem to family and child coping, advocating/networking, and beyond.  There is an appendix that covers co-morbid conditions such as autism, Down syndrome, ADHD, and more.  You’ll also find information on navigating the educational systems, how to help your child at home and so much more.  Truly a book that should be on every parent—and SLP’s bookshelf, as parent in Kentucky shares, “I REALLY really enjoyed the book. [Ms. Lindsay] went above and beyond, really. …I sincerely believe this is MUST READ for so many!” –Parent in Kentucky.

An SLP in Chicago,“I have read the book & I love it! [Ms. Lindsay] did a great job writing as an informed parent. I just adore [Lindsay’s] writing style and point of view. I’m confident that it will be a resource for parents nationwide.”–Amy, CCC-SLP

[this is a mock newspaper article written by the author of SPEAKING OF APRAXIA: A Parent’s Guide to Childhood Apraxia of Speech, Woodbine House, 2012.  The quotes are real, but names have been changed to protect privacy.  SPEAKING OF APRAXIA is available through the publisher’s website, www.woodbinehouse.com, Amazon, and Barnes & Noble (in-store and on-line).] 

Bio:  Leslie Lindsay is a mom and writer.  She lives in suburban Chicago with her children, husband, and basset hound.  She is at work on her next book, a novel.  You can follow Leslie on Twitter, @Leslie1, read her blog, “Practical Parenting with a Twist,” www.leslie4kids.wordpress.com, and visit her Facebook Page at https://www.facebook.com/pages/Speaking-of-Apraxia-A-Parents-Guide-to-Childhood-Apraxia-of-Speech/235772599837084?ref=hl


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

Apraxia Monday: Word Study

By Leslie Lindsay

Each day, I am reminded that my daughter has apraxia.  It’s not so apparent anymore.  Her speech has really developed since she was diagnosed way back when (she’s 6 now), her vocabulary is huge–even if she doesn’t articulate so well.  But, there was a time when I knew absolutely nothing about speech pathology.  Nothing.

Fast-forward 4 1/2 years and I know waaay more about speech pathology than I ever, in my wildest dreams imagined. 

In elementary school, there were “speech teachers,” whom some of my classmates would see on occassion.  Later, I learned these folks were actually speech-language pathologists (SLPs) and I really had no idea they worked anywhere but within schools.

Entering High School, there were “speech teachers,” but of a different sort.  These speech  teachers taught speech & debate, improvisational theater, radio & television broadcast…all of which I was involved with when I was a student.

And then, I had a baby (some years later).  And this baby grew to become a non-verbal toddler.  And she was diagnosed with speech apraxia (CAS).  And my eyes were wide-open.

Generally speaking, parents will do just about anything for their kiddos.  So, schlepping my daughter to and from the local speech clinic didn’t seem all that bothersome, with the exception that I hardly knew what they would do for my little pumpkin.  I had no background experience to draw from, I knew virtually nothing about the assessment process or even how to read that darn report!

Drawing on my medical background, I was able to punt my way through.  Assessment and diagnosis…treatment (plan)…intervention…prognosis…all of which are common medical terminology.  I had a pretty good understanding of some latin word roots, and knew that apraxia basically meant, “without motor speech,” yet I didn’t really know what more to make of the diagnosis.

Let’s start with that report you’re likely to receive from an SLP.  It’s filled with all kinds of words.  Big words, little words…and you may not know what they all mean.  Don’t lose heart!  If you don’t know something, please ask–it’s better than wondering and waiting if you aren’t sure.

For example, here’s a list of terminology I wasn’t so familiar with:

  • Pragmatics:  The practical aspects of speech–how  your child uses language to communicate with others in her environment. Examples
    include: responding to other’s vocalizations, point to/show/give objects, making eye contact, responding to greetings, and
    controlling behavior
  • Receptive Language:  The words and phrases one receives.  Listening is part of receptive language.
  • Expressive Language:  The words and phrases one says.  Speaking is part of expressive language.
  • Articulation:  How clearly something is said.  Can you distinctly hear the sounds of each letter as your child says them?
  • Prosody:  The flow or rhythm of speech; does your child sound “smooth,” or “choppy?”
  • Groping:  Searching for the right word.  Sometimes, with apraxia in particular, you can almost “see” your child mentally searching (something struggling) to find the right word.

Okay–I know there are more, so many more but this will be enough to whet your appetite for next week.  Until then, I leave you with a few apraxia-world updates:

  • Sign up for an Apraxia Walk near you!  Visit the CASANA website, www.apraxia-KIDS.org and see what might work for you.  Our family is registered for the Chicagoland Walk on Saturday, October 15th
  • Windy City Apraxia is planning it’s next drop-in meeting for this Friday, September 16th at 7pm.  Email Holly at chicagoapraxia@comcast.com for more information.  This is a FREE event.
  • Small Talk: All About Apraxia is a FREE 5-week session of all you ever wanted to know about apraxia held in Naperville, IL beginning Thursday, September 22 thru Thursday, October 20th.  Email Leslie leslie_lindsay@hotmail.com to reserve your spot.

My book, Speaking of Apraxia: A Parent’s Guide to Understanding and Coping with Childhood Apraxia of Speech is due out in early 2012 by Woodbine House.  Keep your eyes peeled!