Question on Apraxia of Speech, August 15, 2008

I'm worried my son might have Apraxia. His speech therapist said it's a little too early to tell, but she would not rule it out. My son is one month shy of his 3rd birthday. He is currently in speech therapy twice a week and also has group therapy twice a week. He also has a child development class once a week for his cognitive delays. He has so many great qualities. He loves when I read to him, playing with Thomas the Train, singing (only saying one word for the whole song), and going to class. He knows his ABC's and can count 1-10 (however he has a hard time saying the numbers), and knows his shapes and primary colors. I'm even teaching him how to read small words like cat and hat. He is a smart boy who is just having a VERY hard time talking. When he first started therapy in March of this year he only had a vocabulary of about 15-20 words. He now has a vocabulary of about 50 words. My son does not put two words together yet. He will not even try. I had his hearing tested and it's fine. His therapist also does not see any signs of autism. However, my gut feeling says it's more than delayed speech. Do you believe he could have Apraxia? I am still very concerned for him. He puts a lot of vowels in his words! Any suggestions would be great. Thank you!

Robert's response:

Apraxia of speech (AOS) is a speech disorder caused by a deficit in motor planning. Children with AOS often sound as if they are "leaving out all the consonants" in their words, and have a hard time imitating speech sounds (especially consonants), syllables, and words. They may be able to produce words or phrases with clear consonant sounds in "automatic" speech, but unable to repeat those same sounds or words on request a few seconds later. Children with AOS often have relatively good comprehension skills.

Of course, I can't say whether or not your son has AOS, since I've never met him. However, some of the things you've described do sound like they could be consistent with AOS; specifically, the predominance of vowels, your characterization of him as smart but having a hard time talking, and the repetition of a single word throughout a song.

There are several things that you are already doing right. Your son is getting individual therapy twice a week, group therapy twice a week, and child development class once a week. That's five treatment sessions a week!

In addition, you've had his hearing checked; you play, read, and sing with him; and you're encouraging his interest in literacy. All of these are things I strongly encourage parents to do, and you're already doing them. Give yourself a pat on the back.

Children typically begin producing two-word phrases around the time that their active, single-word vocabulary reaches 50 words and/or hand signs. If he has just recently reached that mark, I am not surprised that he hasn't started combining words yet, but I would look for that to start fairly soon.

The Kaufman Center is a great resource for children with AOS (and their parents). Their web site has a list of signs and symptoms to watch for in children with AOS; if these seem to describe your son, it may be worth pursuing this possibility. Also, here's a link to a site on childhood AOS written by from the perspective of a mom who has been in your position.

The good news with AOS is that it is treatable; however, traditional therapy programs targeting articulation and phonological awareness are generally not effective since these disorders are due to different neurological issues than those present with AOS. If he has apraxia, he should receive therapy specifically targeting oral motor planning. It's good that you have voiced your concerns to his therapist. Continue to stay in communication with her and to ask what you can be doing at home to supplement what she's doing with him in therapy. As I said, it sounds like you're doing a lot of things right, so keep it up!

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