I primarily serve very young children and specialize in treating children with Autism. My clinical experience has been that about possibly 20% of children with autism who I see also have apraxia of speech. These disorders can occur in isolation or in combination. Physicians and early intervention case coordinators often refer children for speech-language services when they see a child has “autistic tendencies” and often well before a diagnosis has been confirmed.
After 22 years I have noted that there appear to be a group of children who demonstrate autistic tendencies when they are very young but later are instead diagnosed with apraxia of speech. Many of these children have sensory issues and are not very social. (It is difficult to be social when no one understands you!) Some very young children with apraxia can even exhibit some perseverative play behaviors early on, but typically outgrow these pretty quickly. Both disorders are often described as having a neurological basis.
Since I have four children of my own, I know how desperately parents want to know exactly what is going on with their child. It’s terrifying to get either diagnosis for your child, especially when you begin gathering information and hear so many mixed reports of progress and prognosis for improvement. This is true with both Apraxia and Autism. It is very normal to go through a grieving process anytime you are told your child has a disability and I understand the need for parents to progress through the stages of grieving. They need to talk and get support from other people.
Still, when a child is very, very young I do not even discuss a diagnosis and instead choose to focus on identifying and treating current symptoms. My reasoning is that first, diagnosing autism requires a team of professionals with expertise in a variety of areas of development. A speech-language pathologist cannot ethically diagnose autism independently even if she or he were confident about the diagnosis for a particular child. Second, I’ve seen too many children with a diagnosis of autism come into the clinic at two years old and have the diagnosis removed later on. (Please be clear that I mean to indicate the child was incorrectly diagnosed rather than that we “cured” them). I’ve also seen children who have the diagnosis ruled out at two years of age but later autism is confirmed. It’s just not an exact enough science to say with certainty with many young children. The same thing can be said of very young children with apraxia of speech.
I don’t want to appear uncaring or unsupportive of parents when they feel they need me to validate their impressions of their child’s diagnosis. I want parents to be supported and consoled and strongly recommend support groups and counseling if needed. I just feel that my role as the SLP has to focus on helping parents learn how to teach specific skills to their child. We have limited time and must prioritize how we spend it.
We determine the needs of services for each child based on the severity of presenting symptoms. If we see motor planning problems, we address those. If we see sensory problems, we address those. If we see social problems, we address those. It really doesn’t matter what the “reason” is as long as the problem areas are being treated. I think we can waste a great deal of time and energy both as parents and professionals by focusing on specific behaviors to “prove”…. is he or isn’t he?? The true answer will come in time as the child teaches us how he learns best and moves through developmental stages. We can deal with it when the time comes and know that either way, progress will continue. Neither diagnosis gives a picture of what the child will “look like” in twenty years. The best we can do for all the children is to give them the best and most intensive early intervention possible.
We also need to continue to work together as parents and professionals to advocate to our legislators that money be earmarked for intensive early interventions services for all children with significant developmental delays and disorders no matter what the diagnosis. There are many research findings indicating that intensive early intervention provides children with the best possible outcome as well as saving our society millions of dollars over the life of the child.
[Tracy Vail, M.S., CCC-SLP, has been a speech-language pathologist for over 25 years, practicing in both the public school and private clinical settings. She has a specific interest in children with autism and childhood apraxia of speech. She currently owns a private practice, Lets Talk, in Raleigh, NC, where she provides both direct and consultative services. She is also a past president of the North Carolina Speech, Hearing and Language Association. In addition, she has contributed articles for the Apraxia-Kids web site.]