Childhood Apraxia: Understanding It and Treating It

Childhood Apraxia of Speech (CAS) is a specific speech disorder which involves a difficulty in planning and consistently producing sequences of speech using the tongue, lips, jaw and palates. This difficulty can prevent a child from producing intelligible speech. It is not a weakness of these structures that produces this difficult; rather, the difficulty originates in the brain. A child with CAS has trouble putting these structures to use properly in order to form comprehensive statements or sounds.

When we communicate, an idea first forms in our brain as to what we want to say. Our brain thinks about the words it needs to recall and produce as well as the order in which these words should be produced to correctly verbalize our ideas. This information than translates into highly coordinated movements of the tongue, lips, jaw and soft palate, AKA the "articulators". The brain tells the muscles that control articulators the exact order and timing of movements to produce intelligible speech. Children with CAS may not be able to accurately and consistently produce these plans, due to neurological impairments or developmental disabilities.

When a child receives a diagnosis of CAS, he/she needs to begin speech therapy. This type of therapy varies for children according to the severity of their diagnosis. Experienced therapists may attempt different therapies, since there is no "one-size-fits-all" approach to treatment and all children are motivated differently. They may need frequent one-on-one therapy, lots of repetitive practice with sounds, sequences, and movement patterns in order to be able to automatically incorporate them into their speech normally and intelligibly. Overcoming apraxia of speech can be tedious, but it is well worth it. Practicing at home is crucial in just about any speech and language program; this one especially.

Many therapist recommend the use of sign language, picture communication systems, and other augmentative or alternative communications. Combined therapies (sign and vocal word attempt) may enhance the chance that the listener will be able to understand the child. This will help with their self-esteem, which will help with their motivation in speech therapy and overcoming apraxia.

Young children recognize their speech difficulties, and any successful communication experience will encourage them to work harder. This is why various therapies and a continuous aim is highly encouraged by therapists. For some children, visual cues (ie. pointing to lips to insinuate a "b" sound) can aid in learning to use their articulators to produce a desired word. When a word and sign are consistent, children begin to associate the visual image of the sign with the placement of the articulators.  It's a very complex form of treatment for a very complicated disorder, but it works if a child works it.

If you notice speech delays or difficulties with your child's production or problems with his/her communication skills, please contact your physician or consult a speech-language pathologist in your area.

Resources

Spivey, Becky, M.ED. Super Duper Handy Handouts (2001):  Tongue Thrust, Dental Problems and Lisps

P.R.O.M.P.T. Therapy: Who, What, & Why?

PROMPT stands for Prompts for Restructuring Oral-Muscular Phonetic Targets. The technique utilizes tactile-kinesthetic (a fancy word for "learning through doing") articulatory cues on one's jaw, face, and under the chin to develop OR restructure speech production.
Many therapists at Suffolk Center for Speech are trained in PROMPT therapy, versed in manually guiding children in articulating specific sounds or words. PROMPT, for many children, can be boring and unengaging. But we know how to make it fun. Our therapeutic platform for children is heavily focused on motivating and rewarding. Many parents of patients tell us their children "can't wait for speech."

During PROMPT, a clinician will use their hands to cue and stimulate articulatory movement in the patient's mouth area, and simultaneously, discourage unnecassary movements to eliminate them. This type of therapy addresses cognitive, social, pragmatic, behavioral, sensory motor and physical domains. Each individual is evaluated for his/her strengths and weaknesses. Strengths are utilized to improve the clients communication skills with a focus on dimishing weaknesses. PROMPT therapy may be different for individual patients in terms of how a clinican helps the patient improve motor control, cognitive skills, and social interactions. At Suffolk Center for Speech, our main objective in PROMPT therapy is to improve functional, interactive, and verbal communication of young ones. PROMPT therapy is not for everybody.

Who Can Benefit?

Children and adults who suffer from Apraxia of Speech, Developmental Delays, Dysarthria, Phonological Disorders, Autism Spectrum Disorders, and Hearing Impairments can all benefit from PROMPT therapy.



What Does A PROMPT Session With A Child Involve?

A therapist will initially evaluate a child's degree of focus during the communication process. If a child is having difficulty paying attention to the therapist, maintaining eye contact, and/or generally focusing, a therapist will implement strategies to help the child "be present". The therapist may attempt to slow down the child's rate of speech, and prompt the child to use vowel sounds. Once the child begins to imitate or initiate vowel sounds for the purpose of communication, Parameter PROMPTS (processes that facilitate jaw/facial control and a degree of articulatory movements) are provided. These will shape speech production for a child in need. It won't happen overnight, but PROMPT is an extremely effective approach to teaching a child to proper communication skills(physically and verbally). Therapy structure will shift from focus and attention to functional speech exercises.
 

Can Parents Carryover PROMPT Therapy Goals At Home? 

They sure can. In fact, parental involvement is critical to the success of PROMPT therapy. Parents are NOT encouraged to attempt to imitate PROMPT training. PROMPT therapy is a specialty that requires in-depth training, and incorrect emulation can interfere with PROMPT therapy goals. Parents are encouraged to talk with their children about what he/she did during therapy: to ask them questions about it. This will help the child remember what he/she has learned during therapy (how to articulate certain sounds or vowels, or how not to). Parents are also encouraged to read stories that contains words that force out the articulators the child is finding difficulty with in a fun and engaging environment (particular to the child). If the child is still pronouncing sounds wrongly, inform them subtly. Make it fun for the child to learn correct pronunciations by playing games that include well rehearsed words or phrases. A fun and natural environment is important for the child to rehearse pronunciation; otherwise, they may not bring what they've learned at Speech Therapy home or to school. It's extremely important that parents acquire a solid rapport with their child's speech-language pathologist, so that strengths and weaknesses can be discussed as well as ways to foster successful therapy (homework, if you will). A skilled therapist will give ideas to a parent regarding situations and scenarios where a child may experience most effective practice.
 

PROMPT Trained and PROMPT Certified:
What's the Difference? 

A PROMPT-trained therapist is allowed to practice PROMPT therapy on patients in need, and are completely qualified as well. The only difference between a PROMPT-trained therapist and a PROMPT-certified therapist is a video project, which is extremely costly to the therapist. Other than that, there is no difference.