RE: Apraxia vs. Phonological Disorder

[Guest guest]

Candi wrote:

>

> My son Isaac, 2.5, has received a diagnosis of apraxia from his SLP

> (but not from the neuro. ped. who thinks he is a " late talker " ). In

> the last 5 months of early intervention speech therapy (once a week,

> one hour), he has made 8 months progress in 5 months time. He went

> from saying four words to speaking " functionally " - simples sentences

> like " I miss grandma " or " I want stickers " . He is still not extremely

> " talkative " , but he has a big vocabulary and except for some

> articulation issues, he is fairly understandable except when stringing

> together sentences like most apraxic kids.

It seems like some kids make a big jump from a few words to really

talking but then progress after that point seems slower. Getting from

the talking to an intelligibility level that is appropriate is a big

challenge. My son spoke fairly early but we saw lots of words only once

and then not again he also never got much clearer on pronunciation. He

also had a big vocabulary and pretty average language skills.

> My question is based on a recent workshop we attended at SLU, given by

> Hoffman. She said apraxic kids usually have very slow progress,

> but that kids with a phonological disorder usually made rapid progress

> (more like Isaac). What is the difference between the two? She didn't

> talk about the phonological disorder as much because most parents in

> the room had apraxic/autistic children.

My son's friend has a phonological disorder. He did speech for about 4

months and almost totally cleared up. He had very specific sounds he

couldn't say and always used the same substitutions. He could make the

sound when prompted by the therapist. My son also has sounds he can't

say but he doesn't do the same substitution every time. SOme sounds he

can't say at the beginning of a word but no problem at the end of a

word. Sometimes it even depends on what word he says before a trouble sound.

> We are just wondering if that would be any different, although she did

> say that treating him like an apraxic would do more good than harm, in

> the long run. Of course, we're not ruling out apraxia because of other

> idiosyncrasies (i.e., he still can't jump with two feet off the ground

> or stick his tongue out). I feel like he is making good progress, but

> what is our next step? Thanks in advance.

It is also possible to have a mixture of issues. My 7 year old son is

dyspraxic and has dysarthria (weakness/discoordination of the facial

muscles) and we have just found in the past 6 months with more complete

testing that he also has some phonological processing issues. We are

also seeing some mild concerns with language even though he has

previously tested very well in language. He seems to have issues with

summarizing. I think many kids have a mixture of issues and as they go

through all these stages of development you see them affecting them more

or less. But anyway if the therapy you are doing now seems to really

work for him I wouldn't worry if his diagnosis is exact since the

treatment is working. If you haven't consulted a developmental

pediatrician yet or had a complete evaluation through child find/early

intervention those would be the logical next steps to look at the more

global picture.

http://members.tripod.com/Caroline_Bowen/phonol-and-artic.htmThis

website has a good comparison.

[Guest guest]

Candi,

Here is a link that gives an overview of phonological disorders:

http://www.speech-express.com/diagnosis-destinations/phonological-disorder/p

honological-disorder.html

I would ask your SLP why she thinks he has apraxia and not a phono disorder.

Like they always say, " If it ain't broke, don't fix it! " I would just

continue with the course of action you have been taking with speech since

your child is making great progress. I know that typically children with

apraxia progress slowly but there are some that progress quickly. My son

went from no sounds to being released from speech therapy in about 1 1/2

years. Granted he was also on EFA's and had an awesome SLP ( Hoffmann,

of course). Plus the SLP did a great job of giving us homework and making

sure we were on the same page. So the quick progress that you are seeing

(Hooray!) might not mean your son doesn't have apraxia.

Here are some parent friendly soft signs of apraxia:

http://www.speech-express.com/diagnosis-destinations/apraxia/verbal-apraxia.

html

I am so glad your little one is doing so well!!!!

Tricia Morin

North Carolina

Candi wrote:

My son Isaac, 2.5, has received a diagnosis of apraxia from his SLP (but

not from the neuro. ped. who thinks he is a " late talker " ). In the last 5

months of early intervention speech therapy (once a week, one hour), he has

made 8 months progress in 5 months time. He went from saying four words to

speaking " functionally " - simples sentences like " I miss grandma " or " I want

stickers " . He is still not extremely " talkative " , but he has a big

vocabulary and except for some articulation issues, he is fairly

understandable except when stringing together sentences like most apraxic

kids. My question is based on a recent workshop we attended at SLU, given

by Hoffman. She said apraxic kids usually have very slow progress,

but that kids with a phonological disorder usually made rapid progress (more

like Isaac). What is the difference between the two? She didn't talk about

the phonological disorder as much because most parents in the room had

apraxic/autistic children. We are just wondering if that would be any

different, although she did say that treating him like an apraxic would do

more good than harm, in the long run. Of course, we're not ruling out

apraxia because of other idiosyncrasies (i.e., he still can't jump with two

feet off the ground or stick his tongue out). I feel like he is making good

progress, but what is our next step? Thanks in advance.

[Guest guest]

Hi !

A phonological disorder vs. apraxia? is correct in that it

could be both. The good news is that whatever therapy you are

doing with your child -keep doing it no matter what the 'name'! That's the main

thing -to bring our children a voice, for us as parents -it's not

the " name "

Here are some other ways to possible spot the differences of the two

diagnosis other than what already stated.

Children with phonological disorders typically do not have any other

symptoms other than being a " late talker " Meaning it's typically

not a multifaceted communication impairment such as what we are

seeing on the rise today. It is possible to have a child

with " pure " apraxia -but that is not common. This is why

neurodevelopmental exams are recommended here. You say the

developmental MD diagnosed your son as a " late talker " Did he

confirm or rule out any " soft signs "

http://www.cherab.org/information/speechlanguage/parentfriendlysoftsigns.html

As far as surges -a child on EFAs for example no longer presents as

classic apraxic -but doesn't quite fall into normal development

either. Is your child on EFAs? EFAs alone are not a complete cure -

but I would consider them as close to one as we have at this point -

they appear to accelerate the therapy process in most cases

moderately -and in some cases dramatically. It's rare for them not

to work at all when the " right " dosage is used -and again -results

start in a day to three weeks almost across the board. And no

matter how appropriate and intensive the therapy -and no matter

how " right " the EFAs -apraxia is not at this time 100% curable. One

learns to overcome it -in many cases to the point that most don't

notice it. But like any impairment when one is tired or stressed,

or in this case has to say more complex words or thoughts -they will

still break down from time to time. This, again, is why names such

as " developmental " or " childhood " apraxia " of speech " are so

inappropriate -they add insult to injury as our speech impaired

children grow up -which they do.

Below is some information and archives which may help more.

" Some speech disorders can overlap, or be misdiagnosed. For

example, " Verbal apraxia, a disorder of central nervous system (CNS)

processing, and dysarthria, a disorder of output, are commonly

confused " , says Dr. , chief of child development at the

Chicago College of Medicine. " Experts are able to differentiate

between these two disorders by listening carefully to a child's

speech and by identifying certain physical clues " , says Dr. ,

but adds, " These disorders are poorly understood by physicians and

by a lot of speech therapists as well. " It is possible for

phonological disorders, apraxia and dysarthria to all occur together

in the same child. Speech Language Impairments, which is connected

to language based learning difficulties may also be present. And the

severity of each may vary. "

http://www.cherab.org/information/latetalkerhandout.html

archive:

Hi Gail and welcome!

Based on what you wrote it would be hard to say if your daughter has

apraxia. What are the 5 to 10 words she can say? Believe me, as one

who has been there and done that I look back now at what I

considered " words " when Tanner was three. " Ma ma mommy " was a three

word sentence to me of " Where is Mommy? " And when Tanner " learned "

my sister 's name, Aunt , we were all excited to hear him

call her " Doo doo " (we all laugh at that one today -even Tanner)

You guys that read The Late Talker have my Tanner dictionary that I

gave to the school in there, so you know what I mean!

So, how clear and how complex are the words? Does she say them

consistently the same way each time? How quick did she learn the

word? Did she ever say a word and then 'lose' it, where she

couldn't say it again? Can she imitate various sounds? Different

from needing encouragement -apraxic children want to be able to

repeat -they just can't -it's part of the disorder in that at times

the more they want to say it the more it eludes them. This is why

some will say words while you are playing chase, or while you are

pushing them on a swing -while they are not thinking about it.

Apraxia creates of problem of doing the activity 'on demand' Once a

word like " ma " is in an apraxic child's 'motor memory' they tend to

say it the same each time. It's how they learned those words, and

how complex they are.

You did give one sign of apraxia. The child's receptive ability

being ahead of the expressive ability is just one of the signs of

apraxia. Apraxia is simply a motor planning disorder. In itself

apraxia is not a cognitive or psychological behavior, even though it

can co exist with many disorders. Can a gymnast have apraxia?

Sure. Depending on what type of apraxia a child has, it may or may

not affect the child's motor abilities in movement of the body

outside of speech at all. It's wonderful that your daughter is

excelling at gymnastics because it brings her something to take

pride in that doesn't demand verbal abilities. Other children with

apraxia may enjoy karate, swimming, dance, cooking, art, etc.

I too thought Tanner was 'just' a late talker as you will read

below. We, like most, didn't notice his warning signs that were

there long before the neuroMDs and therapists spotted them. After

all, Tanner passed all his developmental milestones on time or

early. Because most apraxic children have normal receptive ability -

they are aware of what is expected of them and will push themselves

to keep up. This is why most that don't receive early intervention

will have " other symptoms " that pop up down the road when more is

expected of the child and they can't keep up.

http://www.cherab.org/information/speechlanguage/parentfriendlysoftsigns.html

Most children with apraxia today present with a delay in speech,

normal to above average receptive ability, and one or more

neurological " soft signs " such as hypotonia (low tone -weakness of

the muscle for speech or body), sensory integration dysfunction,

and/or mild

motor planning deficits in the body. Some can be so mild that they

are not obvious to most until the child reaches school age and more

is expected of them. This is the reason for a thorough

neurodevelopmental exam, so that if any signs are present you can

begin early interventions...early. If there are soft signs present

they should also be viewed as warning signs of a possible speech

impairment like apraxia. This is because most of the children today

with " multifaceted " impairments of speech like apraxia do not

have " pure " apraxia. Pure apraxia is possible, just not probable.

What is pure apraxia? Archive (of an archive?) answer!

~~~~~~~~~~~~~~~~~~~~~

From: " kiddietalk " <kiddietalk@...>

Date: Wed Mar 17, 2004 4:06 pm

Subject: Re: PURE APRAXIA

Hi AC,

Pure apraxia is possible but rare.

More common would be misdiagnosis of apraxia (the child

really is/was " just " a late talker with a simple delay in speech)

Below is an archive on this subject -and yes it's always been a

popular topic and one with many opinions, even from the experts.

From: " kiddietalk " <kiddietalk@...>

Date: Mon Jan 26, 2004 2:21 pm

Subject: Re: any pure apraxia children?

In response to some of the many posts on this -this group is a

mixture of all types of late talkers ranging from mild " just " late

talkers with simple delays in speech, to those with more complex and

severe impairments that overlap with other conditions. The majority

here do not post and lurk instead, and this includes the majority of

those with " just " late talkers. Some have told me they don't want

to post because they don't believe their child's problems will be

taken seriously in comparison to what others are going through. I

just want to once again say -all are welcome here and all is taken

seriously.

Out of the few that do post, there are a handful that post to reach

out to help others (thank you for all that do this!) and share

updates and we get to know them. Most post when they have a

question or when they are upset about something, but a few come here

to share joys that only we can understand (like being excited about

a 4 year old that says " hi " for the first time)

Pure apraxia is a question that comes up often, and as long ago as

when Tanner was first diagnosed. In fact below are two of my first

ever messages on this where first I question what " pure apraxia " is

a day or so after Tanner was diagnosed -and then another where I

sign next to Tanner's name " pure apraxia " (and yes -I too was wrong)

Interestingly enough in my first messages I describe Tanner's signs

of oral apraxia and sensory problems and hypotonia -but since

nobody including Tanner's pediatrician knew they were warning signs -

none were addressed until after these " soft signs " were diagnosed by

the neurodevelopmental MDs.

I'll put my post below, here is just one of the more recent archives

" From what I've seen personally and in this group, apraxia is

multifaceted in most cases...meaning it's not " just " an

impairment of speech. Bilker is one of the only children I

know who has " pure " apraxia of speech and nothing else.

http://www.debtsmart.com/talk/brandon.html

(even though most of us in the early stages also believe it's " only "

a speech delay as you will even read in my first posts 4 years ago.) "

Most children with apraxia do not have PDD, however it's not

uncommon for children with PDD to have apraxia. Most children with

apraxia do have mild low tone (weakness) and/or mild motor planning

problems in other areas of the body. It's also not uncommon for

a 'typical' apraxic child to have sensory integration dysfunction,

even if it's mild. Through anecdotal reports apraxic children are

also late to potty train and may be prone to constipation. (and if

asked to blow their nose into a tissue they will breath in instead

of blow out!)

Subject:

Thanks for the talking kids page!

Date:

Wed, 10 Mar 1999 11:03:00 -0500

From:

& Glenn <shop-in-service@...>

To:

pressone@...

Hi ,

Our 2 3/4 year old son Tanner was diagnosed yesterday with apraxia.

However, as I'm sure you are well aware, we have been dealing with

his

non speech for much longer. (You may have read my e-mail about

Tanner.) Tanner looks like a cherub-strangers say that all the

time.

So we call him " the cherub boy " .

It was wonderful to hear your adorable sons, and the other children

speak. It really does help. At this point our son sounds the most

like

when the father says " 1, 2, 3, a, b, c, " . Without much

prompting

he is non verbal. Also, most of the time, when my husband and I

try

to ask Tanner questions where he would have to try to answer, my

older

son, who is four, talks for him. Like your son, Tanner looks and

acts

normal. Actually outside of expressive speech, Tanner tests on every

other area above average. This was unfortunately the reason our

pediatrician was never concerned. We had to push to get his hearing

and

speech evaluation.

If you could tell us some background on your son it would be

appreciated. When did he first get diagnosed? How many days of

therapy

a week does he receive? When did you see the greatest improvement?

Like Tanner, was there a time he didn't really talk? What is " pure

apraxia " ? Even though he is a perfect weight now, I have been

concerned with the way he sometimes shoves large amounts of food in

his

mouth. Is apraxia a rare condition? I've spent the morning trying

to

find a local support group where I could receive the answers to some

of

these questions. Even Tanner's speech therapist said there is not

much

known about it because it is pretty rare. I did find a world wide

support group for apraxia in Greenbay Wisconsin called MUMS with 20

to

40 members.

Well again, thanks for putting the talking kids page together. Let

me

know what you need, and my husband and I can send you a tape and

picture

of Tanner.

Best,

[Guest guest]

Sorry guys -the following was the archive I meant to post from when

Tanner was first diagnosed:

(check the dates from this one and those below -and then read

Tanner's story in The LCP Solution http://www.debtsmart.com/talk

(under apraxia)

Subject: Efalex update

Date: Mon, 05 Apr 1999 00:10:09 -0400

From: & Glenn <shop-in-service@...>

" APRAXIA-KIDS@... " <APRAXIA-KIDS@...>

Hi All and Happy Holidays!

Many of you may have read that Tanner, who is 2.9 years old and has

verbal apraxia, has been taking the liquid Efalex for the past 2 and

a half weeks. Other than an expressive language delay, Tanner has no

other issues. A month ago Tanner was evaluated twice to have the

expressive language ability of a 12 month old both by his therapist,

and Early Intervention, who just accepted him in.

Could there be a deficiency in children with apraxia? In layman's

terms, could Efalex to an apraxic child be similar to Vitamin C to

someone with Scurvy? Of course there may not be such a thing as a

" miracle " pill, but we are so convinced that the changes are from the

Efalex, that Glenn and I don't want to try the Flax Seed Oil just

yet, even though we've heard from so many of you how wonderful it is.

Tanner has been in speech therapy twice a week for the past 5

months, and both Glenn and I work with him consistently at home.

However, within the past 2 weeks we have seen such dramatic changes

that we both believe it to be as a result of the Efalex. We don't

know if anyone else experienced the changes as soon as we did with

Tanner. Within 2 weeks he attempted to say I love you, " I, ahh, ooo "

(Before then, most of the time Tanner would say, " mmmm " in the right

tones and point, he didn't attempt speech even with prompting. This

is a child that was saying little more than " Ma Ma " three weeks ago,

and wasn't even able to put the sound " ch " together with the

sound " oo " He wasn't even saying " Da Da " !) The other day, Tanner

pointed to the color yellow without any prompting and

said, " lellow " . Tanner is now saying quite a few more words, and he

is being consistent with what words he learns! He's trying to talk

all the time now, something he wasn't doing at all before. As a

matter of fact, before 3 weeks ago most of the time if

you tried to get Tanner to say a word, he would stamp his foot and

say, " mmm " in the tone of NO! Now, he loves pointing to, and saying

colors. (Purple! Blue! etc.) His therapist is thrilled with his

progress in the past week, it's really been a remarkable improvement!

Coincidence? Maybe, but we are hoping to see more improvements just

as rapidly. (Putting 2 words together, etc.)

Right now, Tanner still is unable to lift his tongue from the bottom

of his mouth except by accident. One thing we try is putting peanut

butter on the on the outside of his mouth on top of his lip and make

a game of it that he has to lick it off. He tries to use his bottom

lip to push his tongue up, but he still can't raise it enough to

lick it off. We are curious to see if that changes soon too. It's

only been two and a half weeks for us, but we have not seen any

negative side effects from giving Tanner the Efalex other than he

still hates the taste. We have found cooking it in his eggs or

letting it soak into his cereal or pancakes is the only way we can

give it to him without any problems. Does anyone know about cooking

with Efalex? Any suggestion on how to have him swallow the pills if

we buy them next?

Just one other note for those of you who asked how to respond to

people that say, " Oh, he'll be talking soon " (We ran into that lots

this weekend with the Holiday, especially because Tanner is starting

to " talk! " ) Maybe it's us, but Glenn and I never get mad at people

for saying this. We feel it's coming from love, not maliciousness. We

usually say, " We really hope that happens, but we are doing whatever

therapy we can just in case. " They usually then say, " Oh, of

course...So what is this called again that he has? " We then give

them a brief description of what Apraxia is and how well Tanner is

doing with therapy.

Anyway, for anyone who cares to know, we give Efalex two thumbs up.

We'll keep you updated with what happens in the weeks ahead!

and Glenn, Parents to Dakota, 4.8 and Tanner 2.9 (apraxia)

~~~~~~~~~~~~~~~~~~~

( " Keep you updated in the weeks ahead " Ha Ha -well I tried for

another few weeks on that grouplist. Because of my " updates " others

got excited about it and tried it, and we started " talking about

this too much " the listowner there wrote -and then in bold letters

[OFF TOPIC]

(remember that whomever was around then?!) appeared in the subject

of our emails (we were then asked to put it there if we talked about

Efalex because it was then and there considered " off topic " if you

can believe

that. Remember what I just said the other day how some of what we

accept today as fact we'll laugh at 50 years later -try less then

five years for this one) We were then asked to " take it elsewhere "

if we wanted to keep talking about this off topic subject. Hence

if any of you wondered why there is a Speech Diet list, now you

know. But I didn't want to talk about just speech diet -hence

CHERAB. I

wanted to talk about EFAs, neurodevelopmental MDs, and schools for

the hearing impaired, and everything and anything that others found

for their communication impaired child that may help. I also

learned what it was like to be attacked for your views, and laughed

at -and thank goodness for many of you -I didn't just go away like

many would when that happens.

=====