Re: Phonological disorder?

[Guest guest]

As far as I know, it is the same thing, though there are different

degrees of verbal apraxia. Soft signs that often accompany this kind of

speech delay (characterized by difficulty with speech sounds but good

comprehension) are fine motor and large motor delays. My son is 2 yrs,

0 mos and has only " ma " and " a " in his speech repertoire, though he can

form the shapes of many letters with his mouth silently. He walked at

22 months, but his fine motor is normal. We don't have a DX yet, but he

is in the system, and the therapist says my concerns about verbal

apraxia are legitimate. The disorder is usually diagnosed closer to

three years. The huge discrepancy in my son's receptive and expressive

language got me into services more quickly than most. We have been

seeing a developmental pediatrician since he was 13 months, but my

concerns began at around 9 months. It is hard to get doctors to take

parents seriously this early, but I was pretty insistant.

>

> How is this different than apraxia?

>

> Because Lucas is so young (2yr 3 mos) and because his speech

> repetoire is so limited his ST's are hesitant to " label " him with

> apraxia (although they're treating him as such) they've begun to

> talk about a phonological disorder.

>

> How is this different, and is the treatment any different? Does

> anyone here know?

>

> Thanks!

> Toni

>

[Guest guest]

You know, I was confused by the definitions I found. The symptoms

are all the same, and a couple of sites I looked at even said that

phonological disorder caused by neuropathy is considered apraxia!

Well, Lucas does have some soft neurological signs, like hypotonia,

low sensory registration, a soft chew, and persistent (according to

his ST) drooling, so who knows! LOL

It seems to me that a phonological disorder also can't be diagnosed

difinitively until age 3 or 4, just like apraxia (verbal, not oral

apraxia).

Thanks for your input!

>

> As far as I know, it is the same thing, though there are different

> degrees of verbal apraxia. Soft signs that often accompany this

kind of

> speech delay (characterized by difficulty with speech sounds but

good

> comprehension) are fine motor and large motor delays. My son is 2

yrs,

> 0 mos and has only " ma " and " a " in his speech repertoire, though

he can

> form the shapes of many letters with his mouth silently. He walked

at

> 22 months, but his fine motor is normal. We don't have a DX yet,

but he

> is in the system, and the therapist says my concerns about verbal

> apraxia are legitimate. The disorder is usually diagnosed closer

to

> three years. The huge discrepancy in my son's receptive and

expressive

> language got me into services more quickly than most. We have been

> seeing a developmental pediatrician since he was 13 months, but my

> concerns began at around 9 months. It is hard to get doctors to

take

> parents seriously this early, but I was pretty insistant.

>

>

> >

> > How is this different than apraxia?

> >

> > Because Lucas is so young (2yr 3 mos) and because his speech

> > repetoire is so limited his ST's are hesitant to " label " him

with

> > apraxia (although they're treating him as such) they've begun to

> > talk about a phonological disorder.

> >

> > How is this different, and is the treatment any different? Does

> > anyone here know?

> >

> > Thanks!

> > Toni

> >

>

[Guest guest]

Oh, and I forgot to mention...Lucas has virtually no delay in

receptive language either. His expressive is pegged at about 9-12

mos (at 26 mos) but his receptive is prolly close to his age.

>

> As far as I know, it is the same thing, though there are different

> degrees of verbal apraxia. Soft signs that often accompany this

kind of

> speech delay (characterized by difficulty with speech sounds but

good

> comprehension) are fine motor and large motor delays. My son is 2

yrs,

> 0 mos and has only " ma " and " a " in his speech repertoire, though

he can

> form the shapes of many letters with his mouth silently. He walked

at

> 22 months, but his fine motor is normal. We don't have a DX yet,

but he

> is in the system, and the therapist says my concerns about verbal

> apraxia are legitimate. The disorder is usually diagnosed closer

to

> three years. The huge discrepancy in my son's receptive and

expressive

> language got me into services more quickly than most. We have been

> seeing a developmental pediatrician since he was 13 months, but my

> concerns began at around 9 months. It is hard to get doctors to

take

> parents seriously this early, but I was pretty insistant.

>

>

> >

> > How is this different than apraxia?

> >

> > Because Lucas is so young (2yr 3 mos) and because his speech

> > repetoire is so limited his ST's are hesitant to " label " him

with

> > apraxia (although they're treating him as such) they've begun to

> > talk about a phonological disorder.

> >

> > How is this different, and is the treatment any different? Does

> > anyone here know?

> >

> > Thanks!

> > Toni

> >

>

[Guest guest]

Verbal apraxia CAN be diagnosed by someone with experience in apraxia by age

2. If your evaluator has told you this can't happen until 3, they do not

have the experience with apraxia that you need to get sound advice about

interventions. Our 1st develop ped told us that we needed to wait until 3,

and never suggested OT. Next...

We got a 2nd opinion from a develop pediatrician (who sees my daughter for

her dyslexia) - but doesn't take insurance, and paid out-of-pocket to see

him. He diagnosed the apraxia and also recommended good OT for his low tone

and coordination issues. I would have gone to him first (since I know he's

great), but when we started on this road I thought my son had some global

developmental delays (since he was behind in both motor and speech), and

figured that going the insurance route would be fine. I knew that getting

the services for dyslexia is often difficult, and getting the right

diagnosis at a young age is also not easy, so we went straight to him for my

daughter's evaluation. Now I know - apraxia is even more difficult to get

evaluated and treated properly. Getting the best advice from the very

beginning will get you on the right road sooner. -

[Guest guest]

My understanding is apraxia is characterized by inconsistent

pronounciation. Children with phonological disorders usually make

consistent mistakes. For example " thank you " would always be " day doo "

whereas for my apraxia son thank you can be " tank oo, " " day doo, " " ta to, "

" tangk, " and others. He makes six consistent (inconsistent?) variations on

thank you and even throws a few in that surprise us from time to

time. Inconsistency in vowels is common with apraxia and less common with

phonological disorders. I have also heard that as children progress in

speech those with phonological disorders generally follow the " normal "

progression but at a slower pace

(http://members.tripod.com/Caroline_Bowen/Table3.htm) whereas apraxic kids

can correctly say sounds that develop later and can't say " easy "

sounds. Looking at that table my son regularly makes errors that usually

are gone by age 3 (he's 4.5) but correctly pronounces things that it is

normal for " typical " children older than him to still struggle with.

Apraxia doesn't always look the same in every child. My son in particular

has problems with sounds produced with the tongue on the palate at the

front of the mouth (but he can do th where it's between the teeth) and

sounds where the lips need to purse or tighten or where the jaw needs to

drop. Those are all things that he has difficultly with voluntarily

doing. Throat sounds (g, k), mmm and smile sounds (s and e - ok I know I

don't have the right terms for these!) are much more consistent.

Treatment for both disorders can look similar. Repetition is key! For my

son Prompt is really helpful because it gives him extra tactile cues on

where to place his tongue, lips and jaw. Prompt can work great for

non-apraxic phonological disorders as well. One thing that needs to be

considered with apraxic kids is since it is a motor planning issue the more

you put the child on the spot the harder it is to access the motor

plan. Therefore more patience can be needed. When my son is pressured to

say something instead of saying it with errors he'll just sit and grope to

say ANYTHING. The kids I know with phonological disorders will just say it

again incorrectly, but they don't seem to lose all ability to use their

mouth if that makes sense. While repetition is important for improvement

for both apraxic kids and those with phonological disorders, an apraxic

child tends to need much MORE therapy to reach the same progress. I've

read at least one study that says a child with apraxic needs 87% more

therapy to reach the same percentage of intelligibility to a stranger as a

child with strictly a phonological disorder.

Oh, and another thing I mentioned in an earlier post is that my apraxic son

with a familiar word IN ISOLATION now sounds more like he has a

phonological disorder. I can use frog as an example. He almost always

says frog as " fwock. " This displays the phonological errors of word final

devoicing (voiced soung g is substituted with devoiced k) and gliding of

liquids (r is replaced with w)

http://members.tripod.com/Caroline_Bowen/Table2.htm shows a list of these

common errors. But when he uses frog in a phrase or short sentence,

particularly in the middle, the word is not longer fwock, it is fog or fock

or wok or any other number of things. When tied together the apraxic child

will often muddle words much more. It is my understanding that the length

of the phrase doesn't influence the pronounciation of a child with strictly

a phonological disorder the way it does an apraxic child.

Now someone please correct me if I'm wrong about all or any of this!

Miche

At 01:53 PM 2/22/2006, you wrote:

>How is this different than apraxia?

>

>Because Lucas is so young (2yr 3 mos) and because his speech

>repetoire is so limited his ST's are hesitant to " label " him with

>apraxia (although they're treating him as such) they've begun to

>talk about a phonological disorder.

>

>How is this different, and is the treatment any different? Does

>anyone here know?

>

>Thanks!

>Toni

>

>

>

>

>

>

>

>

[Guest guest]

Recently my mom took my son to his Prompt session. Since I am pregnant and

I have had now two children with speech delays (older was strictly a late

talker, younger apraxic) my mom asked when we can evaluate and start

treating the baby if it is needed. The answer was there are many signs as

young as 6 months and there are things you can start with then if apraxia

is suspected! Usually you will not diagnose verbal apraxia until the child

has at least some words, but oral signs can be diagnosed and treated early,

and there are even signs of verbal in a 6 mo old (lack of babbling or lack

of variation in babbling sounds for instance.) Someone very trained to

recognize apraxia can pick up on things quite young. Now hopefully this

won't be a concern for us. I'll let you all know in a year!

Miche

At 10:03 AM 2/23/2006, you wrote:

>Verbal apraxia CAN be diagnosed by someone with experience in apraxia by age

>2. If your evaluator has told you this can't happen until 3, they do not

>have the experience with apraxia that you need to get sound advice about

>interventions. Our 1st develop ped told us that we needed to wait until 3,

>and never suggested OT. Next...

>

>We got a 2nd opinion from a develop pediatrician (who sees my daughter for

>her dyslexia) - but doesn't take insurance, and paid out-of-pocket to see

>him. He diagnosed the apraxia and also recommended good OT for his low tone

>and coordination issues. I would have gone to him first (since I know he's

>great), but when we started on this road I thought my son had some global

>developmental delays (since he was behind in both motor and speech), and

>figured that going the insurance route would be fine. I knew that getting

>the services for dyslexia is often difficult, and getting the right

>diagnosis at a young age is also not easy, so we went straight to him for my

>daughter's evaluation. Now I know - apraxia is even more difficult to get

>evaluated and treated properly. Getting the best advice from the very

>beginning will get you on the right road sooner. -

>

>

>

>

>

>

>

[Guest guest]

In my son's case, it's not that they categorically won't diagnose

apraxia in a child his age (because our private ST has) but that his

phonetic repetoire is too limited. My understanding from our two

main ST's is that Lucas is not far enough along on the speech

development tract to say for sure one way or the other. But, even

at 2, if his phonetic repetoire was varied enough to give them more

examples of speech errors they'd feel more comfortable giving the

apraxia diagnosis.

He is being treated by EI and by a private ST under the assumption

that he has apraxia, and I believe that's how the ST coded it for

insurance purposes, but they just didn't want to formally label him

too early. They want him to develop more speech before

they're " sure " of apraxia.

>

> Verbal apraxia CAN be diagnosed by someone with experience in

apraxia by age

> 2. If your evaluator has told you this can't happen until 3, they

do not

> have the experience with apraxia that you need to get sound advice

about

> interventions. Our 1st develop ped told us that we needed to wait

until 3,

> and never suggested OT. Next...

>

> We got a 2nd opinion from a develop pediatrician (who sees my

daughter for

> her dyslexia) - but doesn't take insurance, and paid out-of-pocket

to see

> him. He diagnosed the apraxia and also recommended good OT for his

low tone

> and coordination issues. I would have gone to him first (since I

know he's

> great), but when we started on this road I thought my son had some

global

> developmental delays (since he was behind in both motor and

speech), and

> figured that going the insurance route would be fine. I knew that

getting

> the services for dyslexia is often difficult, and getting the right

> diagnosis at a young age is also not easy, so we went straight to

him for my

> daughter's evaluation. Now I know - apraxia is even more difficult

to get

> evaluated and treated properly. Getting the best advice from the

very

> beginning will get you on the right road sooner. -

>

[Guest guest]

Then that explains why they're hesitant to label it definitively at

this point for Lucas. I guess he's just not saying enough of

ANYTHING to know if his errors are consistent or not.

Thanks so much!

>

>