Wednesday, May 2, 2012

Let's talk apraxia, part 2

The other day I found a helpful list of characteristics (in bold) of children who have Apraxia of Speech.  I then added specific examples of how that characteristic manifests in Shu's speech. 

Your child may say the same word four different ways. Sound errors are significantly inconsistent!!!
Shu examples:  putting D in front of "up" sometimes, but not every time.  Now he is sometimes able to say UP with the P connected to the word, instead of UH-PUH.  But he'll say UH-PUH 20 times for every 1 time that he says it correctly.  The correct version does not stay embedded in his brain the way it does for typically developing children.  Shu was correctly saying BUBBLE for weeks, even months.  Then all of a sudden he started saying UH-BLE, and could not say bubble correctly unless prompted several times to put the B at the beginning.

Saying things incorrectly but different each time is a classic symptom of apraxia.  Today OPEN came out as OH-DUH, then OH-MUH, then OH-BUH.  That is totally different from a typical toddler learning to speak--they make consistent errors.  Yellow is always "lellow" or they always substitute a D for a G (my son, for many months, went around singing "I Am a Dend of Dod!" [friend of God]), until they learn to do it correctly.  Shu's errors are inconsistent, and even though he's been saying something for months, he will suddenly begin saying it wrong with NO idea that he's doing so.  We literally have to teach him every single vowel sound and every single consonant, and then get him to repeat them a bajillion times over many months in order for them to remain a permanent part of his vocabulary.

Your child adds vowel sounds to the end of words that finish with a consonant (Up-pa).
See previous.  Shu typically says UP-PUH, but if prompted, can say UP.  

Apraxic children may be able to produce sounds in imitation, which they do not use in connected speech.
Shu examples:  Shu may try to say words, in speech therapy for instance (when he's not mad and refusing to comply), but he can use maybe only 1% of those words in spontaneous speech.  He has fewer than 10 spontaneous words, and only a couple of these might actually be intelligible to an outsider.  The rest are missing significant pieces--like one or both consonants, or the correct vowel sound.  By contrast, many typically developing children by the time they turn two can say around 50 words.  Shu can make consonant sounds in isolation (such as T, P, H), but cannot pair them with any other sound. 

Your child tends to mix-up consonants within a word. Sound swapping errors are common (efelant vs elephant).
Shu once tried to say WATER with both syllables.  It came out as "doh-wah."  Today we pulled into the driveway and said loudly, "We're HOME."  Shu said "MO."  When we've worked on "down", saying first "dow" and then, after a long pause "Nuh" (which he can make in isolation), putting them together resulted in "DAH-DOH" and then "DOPE-DUH."  Out of nowhere, he said DOPE-DUH instead of "down" for about two weeks.  Then suddenly DOPE-DUH disappeared and it was back to his regular sound for "down":  DUH, or occasionally DOW.  Attempts to say POWDER come out "dow-uh." 

Your child may drop final consonants in single syllable words (omission errors) simplifying their speech unit to contain consonant-vowel pairs in short strings. “Cat come home” = “Ca co hoe”.
This is all Shu does, except with only word at a time.  Occasionally he can put the P on the end of UP.  That is the only final consonant he can produce so far. 

Your child may use only /b/, /m/, /d/, /g/, /z/ with simple vowels like /uh/, /ah/, /oh/, but not /p/, /t/, /k/, or long vowels /ay/, /ee/, /i/ or /ow/. Voicing errors, nasal resonance errors, and lengthening vowels before omitted consonants are present.
Shu can make the sounds ah, oh, uh, and eye.  He can say BAH (ball) and MAMA and DAH (dog), but he cannot usually say BYE or DIE or MOH.  He can say something that sounds a bit like TEE (for teeth), but cannot put any other consonant in front of the EEE sound.  Cannot say ME, or BEE, or PEE; cannot say AY or OOO at all, let alone paired with anything.  "Happy" comes out as "addy."  "Bee" comes out as "buh" no matter how many times I say it or how closely he watches my mouth.    HI comes out "eye" with no H sound at the beginning. HOT is pronounced "ah" (no H, no T).  EAT is pronounced "ee" (no T).  If I emphasize the T at the end, his vowel sound changes from EE and comes out something like AH-DUH. 

Your child has difficulty repeating two different consonant +  vowel pairs over and over again.

A big discrepancy between the child’s ability to move their lips, tongue and jaw for eating or non-speech activities and the use of these parts during speech on command. 
Shu has no trouble using his mouth to eat, but he is still unable to lick his lips (with any functional purpose), or perhaps is completely unaware of the sensation of food on his lips.  He still drools often and rarely closes his mouth, possibly due to low motor tone in his mouth and/or limited awareness of the sensation of spit running out of his mouth.  He still blows (very weakly) by making a PUH sound, rather than blowing a stream of air out of his mouth. 

Hope all that detail is helpful to a few of you.  It's been really helpful for me to carefully document my son's progress.  He's been in speech therapy only about six weeks, and though apraxia is definitely not a "quick fix" disorder, we're all pleased with the growth in his language in that short time.  And yeah, it's exhausting.  For Shu and for his parents.  We're going to do all we can to help him, and we're also trusting in a great big God who loves to heal and restore.  Nothing is too hard for Him! 


Krissy said...

you just helped write an amazing "present level". nicely documented AND made into pretty easy to understand for those who aren't speech savvy... or maybe I understood it, thats why it was clear... either way, its great to read that no matter how you look at it, there is GROWTH!

D said...

Every word, expression and struggle that you and Shu experience, our God knows, feels and is Himself, "our very present help in time of need". Thanks for drawing back the curtains and letting us all come with you on this journey to wholeness.

Love, prayer and hands, always!

Lesa said...

My daughter was adopted from Korea and had a very traumatic transition emotionally. She was diagnosed with apraxia at age 2.75. Her speech was at an 8 mos. age level at that time. We started speech therapy 2x weekly and expected a very long haul with years of therapy & special education. Shock of our lives but at the 10 mos mark, she began speaking in words & in less than two years she tested out of speech!! She started kinder at 6 and has done fine with no need for special ed/IEP. At the age of 7 she is a happy, loving, secure child who speaks and learns normally. I just wanted to encourage you that with our int'l adoption kiddos things sometimes take a lot longer to develop but progress happens & sometimes it surprises you with how fast things improve. Hugs, Lesa