A prognosis is, at best, an estimate of how your child’s speech skills will improve with therapy. An exact outcome is impossible for any SLP to predict. There are several reasons why a child’s treatment outcome is very difficult to predict.
To begin with, developmental verbal apraxia is a spectrum disorder. What this means is that there are no definite behaviors that identify its presence. Instead, a child is identified as having apraxia if he/she exhibits a number of characteristics that are believed to be highly indicative of apraxia. Because of this, no two children with apraxia are alike.
Additionally, although many hypotheses have been proposed for the etiology (cause) of apraxia, in reality, apraxia has a number of etiologies. Some of them are: genetic predisposition to motor sequencing disorders (family history), problems prenatally or at birth, differences in the rate of development or quality of myelination (covering or sheath for the nerve cells in the brain, which increases dramatically in the preschool years), neurological disorders, developmental delay, etc.
Finally, there are many features/traits in a child’s life that will differ with each child, that have a great deal of influence in terms of the outcome for a child with apraxia.
Factors Which Effect Long-term Outcome in Apraxia:
Etiology of the Child’s Apraxia
Is the cause of the child’s oral motor deficits primarily motor, linguistic, or phonological in nature? Because the cause of apraxia varies, so will the prognosis. Two children with similar presenting symptoms initially, may have different outcomes because one child’s etiology may allow for new motor skill development more readily than the other child’s etiology. The difficulty for the clinician lies in the fact that only rarely do we know the etiology (cause) of a child’s apraxia.
When other family members have a similar speech history, it is reasonable to conclude that the child’s long term outcome may be similar to that family member’s (providing, of course, that their etiologies are truly the same).
Severity of Apraxia
In general, the more severe the child’s apraxia, the longer they will need to receive treatment.
Presence of Oral as well as Verbal Apraxia
Children who exhibit an oral apraxia as well as a verbal apraxia often require treatment longer than those children who exhibit only a verbal apraxia.
Children whose overall health is good are more accessible to learning of all kinds than children who have periods of time when they are less “learning available” because of illness (middle ear infections, upper respiratory infections, etc.).
Children with measured learning potentials in the average to above average range have a more favorable prognosis than children with cognitive delays.
Attention/Ability to Focus
Children with attentional issues will often require intervention for longer periods than children with average to above average attentional skills. This is because the SLP can focus on the child’s productions rather than on maintaining their attention, and because children with attentional issues tend to have more difficulty monitoring their own speech (which is very important for “carry-over” of skills to the conversational level).
Child’s Reaction to Their Intelligibility Deficit
Children who are seemingly unaware of, or unbothered by the difficulty other people have understanding them often require longer treatment.
Ability to Self-Monitor
Children who have average to above average abilities to monitor their own speech productions tend to make progress more quickly than children who are unable to “self-monitor” and continue to need the SLP or others to give them feedback regarding their productions. Self-monitoring is an important skill for children with apraxia to learn. This is the process by which they take skills learned in therapy and begin to use them in their spontaneous speech. The only way this can occur is for the child to begin to “hear” his/her own productions and “edit” them. If a child cannot perceive an error, it will be impossible for him/her to correct it.
Age at Which Intervention Begins
The younger the child is when treatment begins, the better his/her long term prognosis.
Appropriateness of Therapy
Because children with apraxia are different in terms of the etiology of the apraxia, the therapeutic approach utilized in their treatment needs to be tailored to their individual needs. A “one-size-fits-all” approach does not work for children with apraxia. Knowledge of the current approaches to the management of apraxia is necessary for the SLP to adjust sessions according to the child’s needs.
Frequency of Therapy
The more frequently the child receives appropriate therapy, the better his/her long term prognosis.
The presence of other disorders with apraxia (such as hearing loss, dysarthria, etc.) will generally indicate a poorer prognosis than when apraxia presents as the only disorder/delay for a child. A “pure apraxia,” however, is not the norm. When a child is neurologically different in one way, it often means they will exhibit learning/motor/behavior issues in other areas of their development. Additionally, children with apraxia do not have the opportunity to interact with peers and adults in a typical way, and so are at greater risk for developing/exhibiting social, behavioral, language, etc. delays and disorders because of the apraxia.
A child who has a positive response to working with a therapist on increasing his/her speech intelligibility has a better prognosis than the child who is resistant or ambivalent towards his/her therapy.
Parent Involvement, Education, Support
A parent’s knowledge/understanding of their child’s apraxia increases their ability to respond in ways that encourage the child’s communication skills. They are also much better equipped to advocate in effective ways for the child with other people in the child’s life.
Parents should be wary of any prognostic statement which is absolute in either direction. It is not possible for a clinician to say with absolute certainty that a child will completely recover; conversely, he/she will not be able to tell you that your child will never talk.
To date, there are no definitive studies of the outcome of children with apraxia. This is due to the lack of agreement/identification of this group of children, and also due to the fact that there are no two children with apraxia who are exactly alike in terms of their apraxic characteristics, so establishing a control group to determine efficacy and results of long-term therapy is very difficult.
The studies that have been completed on the various therapeutic techniques for the treatment of apraxia in children are limited.