Developmental Apraxia or "Delayed Speech" "He just can't seem to make sounds". "He doesn't talk much but he sure seems to understand and he knows what he wants". These are some of the comments from parents and others who work with children with the speech problem called developmental apraxia. Developmental apraxia has been defined in so many ways and many of the experts disagree on the definition of developmental apraxia. There is not one acceptable definition. The experts do agree that developmental apraxia exists in children and that it is a problem producing sounds. Most experts agree that developmental apraxia involves the planning and making of physical movements of the lips and tongue to make speech sounds. Children with developmental apraxia have difficulty planning and/or making sounds and moving from one sound to another in a word and in whole sentences. The making of sounds (motor movements) is disrupted and the sounds may not be produced at all. Another sound may be made or sounds may be produced in a slightly different way. Developmental apraxia can be a mild problem making sounds but it can be so severe that a child may not talk at all or their speech may sound like nonsense words. Often children with developmental apraxia talk later and use fewer words than most other children. Speech pathologists generally agree that a diagnosis of developmental apraxia is often difficult to make and should be made with much consideration. Testing should include speech, mouth movement, language, and some experts say, speech pattern and motor tests. Differentiating between developmental apraxia and another articulation disorder is sometimes difficult. Many children have trouble producing some sounds but do not have motor planning or motor problems found in developmental apraxia. How to diagnose developmental apraxia is disputed even more than the definition of developmental apraxia. After the evaluation, the speech pathologist creates a plan to treat the problem. With developmental apraxia, many new ideas and methods are being used. Practice in moving from one sound to another sound is an approach that we have used. Words with similar tongue movements are tried The child practices moving from one sound to another (i.e., wagon, wagging, and wicker). Another approach emphasizes visual help. Touch cues for each sound has been found effective. This may involve watching the tongue movement of the speech pathologist and the speech pathologist touching over the child's lips or under the child's tongue. The use of melody and rhythm has also been found beneficial in acquiring speech. A familiar phrase is used in a sing-song or emphasized manner (i.e., "I want"). Improving the articulation of words that are important to the child can be very powerful. For example, the child may say "ga-ga" for "grandma". If grandma understands that "ga-ga" means grandma and responds to it, it can be very rewarding. Making words and sentences with sounds that a child has or sounds a child is learning is an important tool a child can use to make his speech understood by others. Language in Action Children learn best and are more interested when play and repetition are used. Making speech and language stimulation fun is especially important for children with developmental apraxia because it provides natural motivation to make speaking attempts and avoid the great potential for frustration. The following guidelines are intended to provide ways to encourage speech and language development without power struggles. Be sure to modify ideas and length of play time to your child's speaking level and needs. 1. Provide many opportunities to make sounds, words or word combinations through repetitive turn taking games: When cleaning up use the same word or phrase while dropping a story in a container, (i.e., "Boom", "go in", "bye-bye ___"). Play peek-a-boo using the same word or phrase. Encourage your child to take a turn popping out with same verbalization    or to say a specific word/phrase to get you to pop out. Match words to actions, (i.e., jump around and say "hop, hop, hop" or "up", "go up", while climbing stairs). 2. Let your child see how you say a sound, word, or phrase: Get down to your child's visual level when playing and talking. Hold objects and pictures by your face while saying the word or phrase. Use novel positions to get your child to look, (i.e., play peek-a-boo while laying on the ground, or looking up.) Use a mirror to play face making games. Moving toys across the surface can facilitate looking. A portable/shatterproof    mirror can make mirror play more convenient. 3. Use rhythm, music, and familiar stories to encourage repetitive practice that is fun and meaningful. Use finger songs and word games such as "I know an old woman who swallowed a fly", "Going on a bear hunt", "Wheels on    the bus", and "This is the way we wash our clothes". Encourage pairing body movements with sounds, words, and phrases, (i.e. tapping, clapping, and squeezing a ball.) 4. Use books to stimulate skills. Take turns identifying pictures "I see a ____." When telling a familiar story have the child finish the repetitive phrase (i.e., Three Little Pigs, "And I'll huff and ____.") As    the child becomes more familiar leave more of the phrase off for the child to finish. Encourage your child to read aloud with you. Seeing the sound, word, or phrase with the printed page may help with    speech and language production. 5. Assist your child to communicate better. Commonly used phrases can be produced more clearly with practice (i.e. "I want ____," "hello", "my turn", and family    names.) Although the ultimate goal is speech production, the use of signs/gestures can be helpful in meeting current wants/needs,    avoiding frustration, and can facilitate speech due to the pairing movement with speech. Respond to the meaning expressed by your child rather than how it is spoken. Modeling correct productions or adding on    to your child's utterance will provide a learning opportunity without frustration.    These suggestions can be used with any child. Discuss which activities would best benefit your child with    your speech pathologist. Ask The Professional What causes developmental apraxia? Developmental apraxia is felt to be a "soft" sign of an inadequate functioning in the brain that affects speech production. The area of    this subtle brain malfunction has not been identified even with neurological tests.. Theories    accounting for this difficulty include: ·    The brain impairment is so small that it cannot be detected. ·    The impairment is so broad or spread out that it cannot be located (i.e., the "wiring" is different). In addition, there is no known specific cause that has been linked to this subtle brain malfunction even in the child's birth and prenatal history. Finally, although developmental apraxia is felt to be neurologically based, intelligence is not necessarily affected. In fact, many children identified with developmental apraxia are of normal or above normal intelligence. Will my child ever speak? This is a hard question to answer due to the range of mild to severe degrees of developmental apraxia. Usually the more severe, the more difficult it is for a child to develop speech and the slower the improvement. The average treatment time can be two years or longer for children with developmental apraxia. Perfecting later developing sounds (i.e., /s/, /r/, /th/) may also be difficult and take some time to improve. Overall, with carefully structured programs which focus on a child's level and needs, improvement should result. In some cases use of alternative methods may be needed to aid communication (i.e., gestures, communication board.), but speech is always encouraged (i.e., syllable sounds, words,). What are some of the behavioral characteristics of a child with developmental apraxia? Every child is different and as a result, their reaction/behavior will vary. The following list are general behaviors seen in children with developmental apraxia, based on an article entitled Speech Apraxia by Kathleen A. Bykowski, M.A., CCC-SLP, Michele M. Dorenkamp, M.S., CCC-SLP, of the Child Development and Learning Disorders Program of Park Nicollet Medical Center. Every child is different as a result the reaction/behavior will vary. The following list are behaviors seen in children with developmental apraxia: Little or no interest in babbling or vocal play. Delayed onset of babbling, first word and jargon. Suddenly stops building expressive sounds or words. Refusal to verbally imitate. At age two years, does not have an adequate expressive vocabulary. Frustration when asked to speak. Possible behavioral difficulties due to communication problems. Keep in mind that this list is not complete because every child behaves differently in response to a speech difficulty, particularly, developmental apraxia. In addition, your child may display some of these characteristics and not have developmental apraxia which indicates again how difficult it is to distinguish between developmental apraxia and another speech disorder. Discuss your child's individual needs with your therapist if you have questions or concerns.