Apraxia of Speech: Early Indicators and How to Support Speech Development By Janice Mervyn, M.H.Sc., B.Ed., Reg. CASLPO Speech Language Pathologist First Words Preschool Speech and Language Program Sam is a 2 year old boy who enjoys everything about cars. He can quickly give his dad the orange car with the broken wheel when I ask him to. He understands language well for his age, however he says very little. His parents comment that they are uncertain how many words he has as he can use a word once and then not say it again. Words that Sam does attempt to say are unclear and some seem to change each day. Sam uses a lot of vowel sounds and a few “p” and “m” sounds are heard in his words. Parents tell me that Sam rarely babbled as a baby. He was a very calm child however lately they find him showing signs of frustration and temper tantrums are becoming an issue at daycare. What lies ahead for a child like Sam? Is his expressive delay an isolated lag in his development or is his limited output characteristic of a larger problem that will become more apparent with time? Many parents of late talking children share these concerns. Considering that early language abilities are strong predictors of later academic outcome, these are very relevant concerns. Speech and language delays and disorders represent one of the most common developmental problems in young children. When children are struggling to develop their communication a number of possible scenarios exist. Some children are late talkers, others are experiencing language disorder, and others may be showing early signs of a complex motor speech difficulty called apraxia of speech. Children with apraxia of speech may display a number of different speech characteristics however a limited variety of speech sounds and an inability to combine sounds and syllables together to form words are early signs. A limited variety of syllable shapes such as using “ba” for many words might also be seen. Inconsistency further complicates matters as children with motor speech planning difficulties might be able to make a sound or word correctly one time, but not be able to say it another time. This makes the child’s speech very difficult to understand and communication becomes frustrating for both parent and child. Generally children with developmental apraxia of speech understand language much better than they use language. They tend to produce sounds better with imitation than on their own. While it is possible to determine that a child’s speech is not developing in the same way as other children and to suspect apraxia, in very young children it is often difficult to confirm the presence of apraxia until further speech develops. Despite these diagnostic challenges, it is possible to stimulate and support speech development at home when a problem such as apraxia of speech is suspected. What you can do to support your child’s speech: Low Pressure Repetitive Verbal Activities: Use vocal exclamations throughout your day “wow, oh oh, oops, oh no” as well as animal/vehicle sounds “baa, moo, neigh”. You are providing speech opportunities that match an early single syllable speech level. “The Big Book of Exclamations “ – provides a picture book format for using exclamatory speech. Play echo games. You say a sound or word and your child echoes you. This encourages imitation skills and provides opportunities for greatest success as your child will likely do better following a model than on their own. Incorporate repetitive books into your daily reading. These allow your child many opportunities to participate with a set group of words. Some early repetitive books titles: Brown Bear Brown Bear; I Went Walking; Peek A Moo Label instead of counting objects in Counting books (e.g., instead of saying “three ducks” say: “duck, duck, duck"), verbalize repetitive activities (e.g., sorting laundry: the table: “top, top, top”; “sock, sock, sock”) Sing repetitive songs (e.g., Old MacDonald) and finger play songs (e.g.,Wheels on the Bus, Itsy Bitsy Spider, PatA-Cake) Expose your child to other Types of Communication: Use natural gestures (body movements) or introduce early sign language with your child. These gross motor movement patterns will be easier for your child and will provide them a means to send a message to others Introduce some visual pictures of choices in your home (e.g, snacks, and toys). Encourage your child to point to the pictures to make a clear choice. Support Communication through Patience and Acceptance: Show family and friends how to support your child’s speech attempts. Be sure that your child is not pressured to speak. Provide time and patience when your child wants to speak. This will help your child develop positive self esteem and learn to enjoy communication! Many scenarios exist when a child struggles to develop expressive language; apraxia of speech is one of many possibilities. Recognizing speech and language problems early on is the best approach! If you have concerns about your child’s communication develop, it is not a good idea to wait-and-see. Recognizing speech and language problems early on is the best approach! First Words speech and language screening clinics are located throughout Ottawa, they are free and no appointment is needed. For more information, visit our website at www.firstwords.ca or call Ottawa Public Health Information at (613) 580-6744.