Apraxia & Motor Planning Difficulties

I've been corresponding with a mom (His Steph, if you are reading this ;)) about her son's speech delays and concerns about Apraxia. The first email I wrote her was quite lengthy, since I covered a lot of subjects and I figured this may be of help to some others. So, with a bit of change to the email, I've put it here.

Starting with our background and where Osiyyah is at: Osiyyah can say quite a few words, and quite a few variations of words. A lot of people cannot understand everything he says, but he has a handful of words where people outside of our family can clearly understand him (like his name, Mom, Me, Yeah, and a few more).

Osiyyah has a hard time getting the final consonant sound on at the end of words. Like he can say “Bum” (as in a joking "You're a Bum!" type of way), but he can never get that “m” sound on at the end. He will miss sounds (consonant or vowel) in the middle or beginning of a word at times. But, mostly it’s at the end.

I do A LOT of oral motor therapy with Osiyyah and have since he was pretty little. Although I wish I knew what I know now when he was a baby, since I am convinced his speech would be MUCH clearer now. He is able to blow horns, bubbles, candles and just about anything. But, we didn’t get him to be able to do all that without a lot of work.

For the longest time, he would be able to blow a horn, but when it came to bubbles, candles or anything . . . blowing without something in his mouth, he just couldn’t do it at all. It took MONTHS of work and now he’s able to do it with no problem. But, there is still work that we need to deal with on his blowing/breath length (which I’ll mention later).

Another area that Osiyyah has had trouble with is actually putting the sound into a word. Like he can say the “L” sound isolated, but when combining it with words, it’s VERY difficult (and with some words impossible) for him to do. In his every day speech, he doesn’t say that sound. It’s only when I have him sitting down and we’re actually concentrating on saying the sound in a word or words. He’s getting better, but I know from working with past sounds, that it will take months.

For years he called his mom “ba”, even though he could say “mmm” and “aaaahhh.” Putting the two sounds together just didn’t work. We worked with him for MONTHS, saying “mmmmaaahhh.” He’d say “mmmmbbbaahh.” It was so frustrating and took tons of patience. Now he can say Mom, mama, etc. But, there’s still a word that he WON’T drop the “ba” sound on and it’ll take a few more months to get him to say “Molly” (one of our puppy’s names) instead of “Bolly.” He did say "Molly" once, but instantly went back to calling "Bolly" . . . sigh . . .

We use some signing with Osiyyah, but we don’t use that much. Because Osiyyah tends to not say the word or even try to say the word when he knows the sign for it. And since we communicate just fine typically without the sign, we haven’t pressed learning it. But, that’s not to say we still don’t use sign, cued speech or PROMPT with him. We still use it all when we are working on how to say a sound or word. And it works very well. It’s the only way he’s been able to learn how to say some sounds and words because he is VERY visually oriented. Now, that's not to say using sign language will hinder other children, since I know there are lot of kids who are greatly helped by being able to fluently use sign language. Just for us, it's not the best choice to use it in every circumstance.

I think that’s a pretty good description of Osiyyah’s speech situation. I’ve gone back and forth on him having Apraxia for over a year. I must say many of his symptoms of Apraxia stopped or at least greatly diminished when we started giving him Longvida Curcumin back in May ’09. His speech JUMPED so, so much since starting that. But, he still struggles with it.

Some of the symptoms of Apraxia which still concern me with Osiyyah are his lack of consonant sounds/ending word sounds, his lack of being able to say a sound with a word, and how he can only say certain sounds in certain words, but not in combination with other words (like how he can say Mom, but not Molly). But, there is still so much that doesn’t make him out right Apraxic, so what he at least has, is Motor Planning difficulties.

I think this is why it can be really hard to decipher or diagnosis Apraxia in children with DS. Due to their lack of muscle tone that can create speech delays and then also Motor Planning problems which can greatly represent Apraxia.

With Osiyyah and also a lot of kids with DS, visual cues and repetition help them tremendously. For kids with Apraxia that is the way to treat it – lots of repetition with sounds and then working up to sounds with word combinations and also visual cues, like PROMPT.

We use PROMPT, Cued Speech, some sign language, written words and oral motor therapy all in combination in Osiyyah’s speech therapy. I can’t stress enough how important PROMPT has been in helping Osiyyah learn how to say (and properly say) certain sounds. Even though he doesn’t technically have Apraxia, PROMPT has greatly helped him.

And even if we were to find out sometime that he truly does have Apraxia and not just Motor Planning problems, everything we are doing is what would be done in a child with Apraxia, so we have our bases covered. We wouldn’t have missed out on anything as far as therapy goes.

The written words I mentioned . . . I write out on a piece of paper a word we are working on, then show Osiyyah and break down each letter and sound combination for him to say and then say the word in full. This has helped TONS. If he sees the words & sounds, it helps him tremendously say it all correctly.

On blowing again . . . It took us a long time to get him to blow without something in his mouth. Months of practice and repetition (repetition is what makes perfect here, haha!). But, part of his speech problem is also due to lack of being able to keep a real long breath. His breathes are typically fairly short, so if you talk on short breathes, you’re not going to talk that great. We are working on that with blowing steady, prolonged blows with the bubbles and some horns. We’re making progress, slowly but surely.

If a child can’t blow bubbles or horns, or some other certain jaw/mouth muscles strengths, that is where I would start first . . . at the oral muscles. Trying to get a child to say certain sounds and words without proper jaw strength and correct oral muscles, you're not going to get very far.

About a year ago, we realized how incredibly weak Osiyyah’s jaw was (after I read Talk Tools Jaw book – best speech read ever!). He could not even bite on a bite block. It was like he was clueless that it was in his mouth. Ever since we have started working on that we have seen lots of improvement. He can know hold a bite block in his mouth for 20 seconds per side 6-8 times per side. It’s amazing.

If there is no strength in the jaw, teaching the tongue and lips to do stuff isn’t going to work very well and won’t get you very far. If you teach the jaw first and then subsequently start working on the lips and tongue, it will all start to fall into place. The jaw is the foundation of the oral motor area and it is soooo essential. Many people don’t realize how important it is, yet it is so fundamental.

Now, I know I've said some of this on my blog already, but I thought it would be good to have this all in one concise, space. And of course, you can always look back through the blog to see more detailed speech therapy posts!