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Apraxia (dyspraxia) - effects on speech

Dyspraxia; apraxia; development; speech; language; stutter; speak; learn; developmental; verbal; clumsy; talking; talk; ;

In this topic we are looking at the effects of apraxia (dyspraxia) on speech. Apraxia causes difficulty in controlling the muscles that are needed for speaking skilfully and quickly. This interferes with a child's ability to correctly pronounce sounds, syllables and words.

  • The word dyspraxia can be used for various difficulties with precise muscle control of the rest of the body, planning and control of movements. Children who are said to have dyspraxia or developmental dyspraxia may have difficulties with:
    • balance
    • fine and gross motor coordination (movement)
    • awareness of where their bodies are in space
    • reading and writing.

Contents of this topic


What is apraxia?

  • Different sounds of speech are made by precisely positioning the lips, tongue, soft palate (the 'roof' of the mouth), teeth and cheeks by rapid movements of small muscles.
  • A person may make up to 15 different sounds per second during normal speech, each of which is formed by moving parts of the face and mouth into exactly the right place.
  • Apraxia is not being able to do this consistently, so that sounds are left out of words or somehow changed when speaking.
  • Not all speech pathologists use the same name for the complicated set of difficulties that are called apraxia here. Apraxia may also be known as 'developmental verbal dyspraxia' or 'developmental apraxia of speech'.

What does apraxia sound like?

  • Children with apraxia have difficulty making some speech sounds when they try to talk at a normal rate. Their speech may be understandable (especially if the listener knows what they are talking about), but it may not always be understandable, particularly if the child is talking fast.
  • They may be able to make a particular sound sometimes (especially if talking slowly) but leave it out at other times, so the sound errors are not always the same.
  • Anxiety or having to say something to someone they don't know usually makes talking even harder.
  • Usually with apraxia, a child's understanding of what others are saying is normal for his age.
  • Also, usually, the language that a child is trying to use is similar to the language that most other children of the same age are using. ('Language' here refers to putting words together to form meaningful sentences, whereas 'speech' is making the sounds of words).
  • If other people cannot understand what they say, it puts children off from trying to talk. Some children with apraxia may say very little, or be silent rather than running the risk of people being critical of how they try to talk.

What causes apraxia?

  • The cause of apraxia is not known, but it is known that it is not caused by 'brain damage'.
  • Apraxia can 'run in families' so in part it may be inherited.
  • It can be associated with other developmental problems such as developmental delay, learning problems or reading difficulties, but many children with dyspraxia have no problems with thinking or understanding.
  • Research suggests that the difficulties have a similar cause to those of stuttering.

Other difficulties linked to apraxia

  • Children who have apraxia are often, but not always, mildly clumsy (they have difficulty with the precise control of many muscles, not just the ones used for speech).
  • Sometimes they have difficulty with learning to read and with spelling.
  • Some children will have had difficulties with feeding when they were babies. They may have had difficulties in managing solids for example (which require different movements of the tongue and palate to breast or bottle feeding).
  • Some children will have drooled (dribbled) for longer than is usual.

Not being able to communicate can sometimes lead to behaviour difficulties. Some children become angry and aggressive when others can't understand them, and other children becoming shy or use a 'standard answer' such as "I don't know" rather than taking the risk of being misunderstood or teased.

Therapy for apraxia

  • Children with apraxia can usually make the sounds needed for speech, but they may take a long time to be able to make the sound easily. This makes it difficult for them to put the sound into speech at the normal speed.
  • Speech pathologists usually follow a 'motor skill training approach' which gets children to practice making sounds quickly and accurately, making it easier to put these into normal speech.
  • It seems also that children with apraxia do not listen carefully to what they are saying, so that they do not realise that they are leaving sounds out, and they need practice with listening to what they say as well as with making the sounds.
  • For children with severe difficulties, using hand signs (signing) may temporarily help a child to communicate.
  • With support most children with apraxia do learn to talk well.
  • If a child is also having difficulties with other activities (such as fine motor tasks like writing, cutting, drawing), an occupational therapist may be able to help.

What you can do

The most important thing at home is to make the child feel as good as possible for trying to talk.

  • If the child says something clearly, tell him so he knows he has done it well.
  • If what your child said was not clear, but you understood, answer what he has said, and then say again what he said with the correct sounds (for example, ''yes, that is dad's car''). There are two reasons for this: you reward the child for trying to talk to you, and you give him the chance to hear the message clearly so he knows how it should sound.
  • Remember that your child does not have full control over the sounds he can make, so he may not be able sometimes to make a sound clearly when he is speaking, even if he could make it clearly a short time ago. He is not trying to be difficult, he just cannot control it all of the time.
  • If you can understand what he is trying to say, but others cannot, act as an interpreter for the child so that frustration does not build up.
  • Do not get into the situation where your child has to say any words clearly before you will answer or give him what he wants (this often leads to frustration and aggression, and does not help a child to learn).
  • Some children need to 'sign' because they cannot yet speak clearly. Recognising and accepting their signs helps them to feel good about being understood. You do not need to sign back, because a child with dyspraxia understands what is said to him.
  • Practise with your child what your speech pathologist has recommended. The practice may not be interesting or much fun to do. Your child will need your enthusiasm and rewards to be willing to keep trying. With young children rewards usually have to be things, such as a special food, but your praise for trying will also be needed.

Resources

Kidsense has information about physical difficulties which are also known as dyspraxia 
http://www.childdevelopment.com.au/sound-awareness/49 and also speech delay/disorder http://www.childdevelopment.com.au/sound-awareness/87 

Better Health Channel https://www.betterhealth.vic.gov.au

References and more to read

Guild A, Vail T "What is Developmental Apraxia of Speech" (written for parents, with some excellent information on supporting children with dyspraxia). http://www.tayloredmktg.com/dyspraxia/das.shtml

The Dyspraxia Association of Ireland:
http://www.dyspraxiaireland.com/ 

American Speech-Language-Hearing Association 
http://www.asha.org/public/speech/disorders/ChildhoodApraxia/ 

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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