The components of any speech-language treatment program will vary depending on the individual child. But there are a number of general guidelines that should help parents know if their child is getting appropriate services. Before going into the general guidelines it is important that the diagnosis is checked for accuracy. Many clinicians in the schools (and for that matter anywhere) do not have a lot of experience with children with apraxia of speech. Therefore, getting a second opinion is important. Childhood Apraxia of Speech is often misdiagnosed. In fact, when I am asked to provide second opinions, it is not uncommon that the diagnosis is something other than apraxia of speech. Once one is sure that the child has apraxia of speech then the following guidelines will help.
- Make sure the clinician working with the child has experience with childhood apraxia or at least an appropriate background. This may not be as simple to find as one might imagine. However, ask the clinician how many children with apraxia have been on their caseloads and over how many years. Second, make sure they have had appropriate coursework in apraxia and more importantly, have taken workshops in childhood apraxia to continue their education in this area.
- Make sure that the child gets a full speech, language, and cognitive evaluation. Most children with apraxia are at risk for concomitant (co-occurring) problems such as specific language impairments, reading problems and even some difficulty with social skill development. Treatment plans (IEPs) should be structured to meet all of the childs needs, not just the apraxia.
- Treatment should be provided on as intensive a basis as possible when the childs speech is affected severely or when they first start treatment. While this of course varies depending on the age of the child, the concomitant problems, and the severity of the apraxia, we recommend individual pullout treatment 5 days a week for at least 40 minutes a day. This level of treatment may continue for many years or may be reduced as the child gets older and improvements in speech are made. Also, it is important for school personnel to realize that most children with apraxia of speech can improve if given appropriate services and over time will most likely require less intense speech services.
- The two main ways in which the motor skills are learned are through practice and by getting feedback on performance. Any treatment program of a child with apraxia should include lots of practice. There is a need for a much greater amount of practice than can be offered in school, so this means that parents need to get involved in the treatment process (see 6 below). Another help is to have a speech aide work with the child after school to get more practice time. In therapy, clinicians should be working on fewer sounds (we recommend starting with 3 or 4 sounds) and practicing them more as opposed to working on many sounds and getting less practice on each of them. We recommend at least 50 trials per session of each target sound during therapy.
- Make sure that a means of communication is targeted from the start of treatment. We strongly recommend that alternative-assistive communication devices be used from the outset of therapy (when the child is as young as possible). There is no evidence to suggest that alternative communicative means such as computer based devices or gestures handicap the development of speech, but rather the opposite appears to be the case. More importantly, young children need to communicate to develop language and cognitive skills and the failure to provide a child with a means of communication often results in unnecessary delays in language and cognitive milestones.
- Parents should be involved in the treatment plan. Importantly, I recommend that they receive training from the clinician working with their child as to what to do when they help their child practice speech sounds. In our clinic, we let parents watch treatment, be part of the treatment session on occasion, and we even let them work with their child and provide feedback to assist them when they are working on speech homework.
- We do not recommend oral motor exercises with the child with apraxia. Indeed, I have frequently observed clinicians who do warm-up exercises. Such exercises in my opinion are a waste of time (and there are data in the motor learning literature that speak clearly to this issue). In fact, we target speech from the outset of treatment and try to avoid any oral motor movement drills if possible.
- The speech-language pathologist should work with the teacher to provide assistance in how to best help the child with apraxia in the classroom.
- We also advocate the inclusion of summer therapy as part of the treatment plan. Indeed, many children with apraxia regress if they do not get some treatment over the summer.
- Finally, your child should be evaluated at least two times a year and the IEP modified appropriately. I view the treatment process as dynamic and ever changing and frequent updates of the IEP are needed. Make sure that as a parent, you are involved in all IEP meetings. I view the child and parents as critical members of any team working on speech and language skills. The teacher should be present at IEP meetings as well to provide input and get recommendations from the team on how to structure classroom activities to the benefit of all.
While these are not all of the guidelines, they are some of the more general ones we recommend with each child with apraxia. If you have questions about your child, contact one of the experts in your area or around the country. The advise of an expert is often well worth the time and expense to make sure you child is on the right track. If you are unsure of whom the experts are, contact the Childhood Apraxia of Speech Association (CASANA/Apraxia-Kids), the American Speech-Language and Hearing Association (ASHA), or a nearby University that has a Speech-Language Pathology program.
[Donald A. Robin, Ph.D., BC-NCD, is a Professor, Department of Communicative Disorders, at San Diego State University and the Joint Doctoral Program in Language and Communicative Disorders, San Diego State University/University of California, San Diego. Dr. Robin has worked with and studied children with childhood apraxia (motor speech disorders) for almost 25 years. He has published over 70 papers, co-authored textbooks, and presented workshops on motor speech disorders in adults and children. Dr. Robin has recently retired as the Editor of the American Journal of Speech-Language Pathology. He is a coauthor of the popular text on childhood apraxia, Developmental Apraxia of Speech: Theory to Clinical Practice. Dr. Robin is a member of CASANA’s Professional Advisory Board.]