When one of my kids was about 6 or 7, a friend of hers who I hadn’t met thanks to the COVID restrictions of the previous year or two, had some time off school for something unrelated to their health. When they came back to school my child was elated. They called out to each other from opposite sides of the road and waved. My kiddo ran through the school gate happily, to see her friend again. I still didn’t get to meet them!
However, I recognised their mum standing outside the school gate. So I went and introduced myself, and shared how much their child had been missed. She responded with what I came to know was her usual warmth and enthusiasm for life. But also with a degree of relief, saying she often wonders how much her child got to connect with their peers due to their “speech condition”. I stood there a little stupidly for a moment then said, “Speech…?”
She looked baffled, and told me their child had Apraxia of Speech and couldn’t really talk yet*.
I laughed. Then realised that probably seemed rude. Then explained to her that my child, having spoken so highly of this kiddo for around a year, had never mentioned it. My kid had mentioned their sense of humour. Their kindness. How fun they are. That they share. And that they make them feel included and wanted and awesome. That they couldn’t speak easily? Didn’t get a look in.
*The fact this mum, in explaining her child’s neurodivergence, used the word “yet” without any pause or thought landed her in a very special place in my heart immediately. She just gets it. She knows a difference is just a difference, that we fix the tricky bits that the child wants or needs to fix if the outcome is going to be a good one, that we aspire to things and assume the best, and that we love, love, love wherever the journey of “fixing” ends and the continuation of accepting takes over.
My daughter has taught me that the only disability in life is a bad attitude, and that regardless of any challenge, we should wake up each day with a smile and be happy to be alive
Laura Baskall Smith, Overcoming Apraxia
Apraxia of Speech
Apraxia of Speech occurs in approximately 1 in every 1,000 children. It is considered a neurodivergence as it occurs due to differences in the brain. Apraxia is a disorder of motor planning. Apraxia of Speech is a speech condition in which the brain experiences difficulties communicating clearly and consistently with the muscles required for speech in the mouth, lips, jaw, and tongue. This means kids with Apraxia of Speech can be difficult to understand, or even unable to communicate using speech.
Often referred to specifically as Childhood Apraxia of Speech, it can continue on into adulthood. Acquired Apraxia of Speech can begin during adult life due to a brain injury.
How Is It Different to Other Speech Difficulties?
When a child experiences a developmental speech delay they generally hit the same milestones, but at a later stage than expected. Sometimes this occurs with assistance from a speech therapist, etc.
Speech impediments often occur when children produce sounds incorrectly, substituting the correct phoneme with another consistently. For example, kids with a lisp use a /th/ phoneme instead of a /s/.
A child with dysarthria has speech difficulties due to muscular weakness and control. This usually presents as slurred or slow speech.
Childhood Apraxia of Speech, however, presents as inconsistent muscle control and therefore sound production. Words often aren’t consistently mispronounced in the same way, making it increasingly difficult for these kids to make themselves understood. As such, they can’t always rely on their family and peers learning their way of pronouncing words, because they frequently change. Some speech errors are consistent, however.
How Apraxia of Speech Presents
Traits of Apraxia of Speech can include:
- Distorted vowel usage, for example saying “dug” when meaning to say “dog”
- Applying stresses to the incorrect syllable in a multisyllabic word, or applying equal emphasis to all syllables
- Pausing between syllables in a way that makes it sound like separate words
- Difficulty smoothly transitioning from sounds, syllables, or words, to the next
- Making groping movements with the jaw, tongue, or lips, when attempting to produce correct sounds
- Inconsistently making errors, for example trying to say “Bat”, but saying “Pat”, then “Mat”, then “Gat”, when attempting
Babies with Apraxia of Speech may also babble less, have feeding problems, and use a limited range of sounds when beginning to speak.
Neuroaffirming Approach
One of the things we shout loudest at More Than Quirky is that all approaches including therapies need to be neuroaffirming. This frequently implies a degree of radical acceptance of differences. When it comes to Childhood Apraxia of Speech, the feeling is often that if it’s possible to enable to a child to speak and therefore be able to communicate with the greater world more readily, it should be done. So how do you actively try to change a child without challenging neuroaffirmation?
Being neuroaffirming around Childhood Apraxia of Speech is about:
- accepting your child’s differences, in terms of loving them as they are in any particular moment or phase
- not speaking of their speech differences with criticism, pity, concern, fear, or any other negative approach
- focusing on achievements and praise, rather than discussing what needs to be “fixed”
- being mindful when setting goals – both long- and short-term – that they are realistic, wanted, fair, kind, and include your child
- paying attention when your child says they’ve had enough of therapies, or need a break
- not expecting your child to end up with perfect speech. Acknowledging when it might be time for radical acceptance opposed to another round of therapy
Therapy for apraxia can help other speech disorders; however, approaches that do not target the underlying speech motor difficulty are not likely to be effective for apraxia.
Laura Baskall Smith, Overcoming Apraxia
Therapy Types
As Apraxia of Speech is due to motor planning issues in the corpus callosum or the posterior parietal cortex, it can be treated in a similar way to brain injuries. This includes improving synapse connections, creating muscle memory, and strengthening communication inside the brain to improve spoken communication outside the brain. Using approaches used for speech impediments or speech delays, generally will not work. If your speechie is sticking to these methods, seek a new therapist with specific awareness of Apraxia of Speech opposed to developmental speech delays.
There are many formal approaches to improving speech quality for children with Apraxia of Speech, including:
- Rapid Syllable Transition Treatment (ReST)
- Nuffield Dyspraxia Programme (NDP3)
- Dynamic Temporal and Tactile Cuing (DTTC)
- Integrated Phonological Awareness (IPA)
- And biofeedback.
These therapies work differently with children of differing abilities and ages, and frequently work in blocks of time. For example, a child doing ReST will often need to do one hour per day, four days per week, for a few weeks at a time.
How You Can Help
While kids with Apraxia of Speech can, of course, have other conditions that do impact on their intellectual abilities, AOS itself has no relation to intelligence. However your child communicates, what’s going on in their thoughts is likely much the same as any other child their age! They can still understand just as well. Their sense of humour can still be just as hilarious or cheeky. They can still have the same concerns, stresses, and anxieties.
Possibly most importantly, they can understand everything you’re saying about them when they hear it, they can interpret your tone of voice just as well, and they know if they’re being treated differently.
Treat your child with Childhood Apraxia of Speech precisely the same way you would feel was the right way to treat any other child, with the exception of:
- Being more patient when listening
- Adopting strategies to support understanding, such as Augmentative and Alternative Communication (AAC) devices, picture boards, or sign language
- Using these means of communication alongside your speech to demonstrate to your child how the two integrate and substitute, but primarily focus – particularly once your child is an AAC expert (as they rapidly become!) – on speaking to them as you would speak to anyone else, and receiving their preferred means of communication as you would listen to speech
- Finding an excellent neuroaffirming speech therapist, and working diligently, lovingly, and supportively with your child on daily exercises
- Ensuring school is supportive, accommodating, and engaged with the use of AAC or other supports as entirely acceptable forms of communication
- Keeping school up to date on approaches, whether you’re in a phase of actively encouraging mouth-speaking as preferably over AAC, or if you’re taking a pause in therapies and school is to follow your child’s lead
- Advocating, advocating, and advocating some more
- Asking for help when you’re unsure