Childhood Apraxia of Speech or Developmental Verbal Apraxia?
Oral Apraxia and/or Verbal (Speech) Apraxia?
Volitional? What does it Mean?
“Pure” Apraxia of Speech
Childhood Apraxia of Speech or Developmental Verbal Dyspraxia?
These two terms are generally synonymous. Developmental verbal dyspraxia is often shortened to “DVD” and childhood apraxia of speech to “CAS”. The “a” in “apraxia” stands for absence and “dys” in dyspraxia stands for partial. Thus, apraxia is absence of speech and dyspraxia is used by some to indicate some speech ability. “Praxis” indicates difficulty executing skilled movements. Thus, both terms focus on the core challenges of the child who has difficulty with speech motor planning and programming. However, more recently Childhood Apraxia of Speech is the preferred term for describing apraxia of speech in children. It is the preferred term because it encompasses all children who show symptoms of the disorder, including those who acquire it in childhood through illness, injury or accident. Additionally, nonspeech professionals often interpret the word “developmental” as meaning the child is capable of outgrowing it. That is not the case for children who have speech difficulty due to apraxia. They do not outgrow the problem without specific, targeted speech therapy help.
Oral Apraxia and/or Verbal Apraxia?
Oral apraxia indicates that the child has difficulty with volitional control of nonspeech movement. For instance, perhaps the child will have difficulty sticking out and wagging their tongue when requested to do so. Or the child may have difficulty sequencing movements for the command, “Show me how you kiss, now smile, now blow”. Verbal apraxia indicates that the child has difficulty with volitional movement for the production of speech. This can be at the level of sounds, syllables, words, or even phrases (connected speech). The motor struggle is most typically seen with sounds sequencing.
Often oral apraxia accompanies verbal apraxia, but that is not always the case. Speech and language pathologists have mentioned that it is very rare and fairly unheard of for a child to have oral apraxia without verbal apraxia/dyspraxia.
Volitional — What does it Mean?
In the course of discussing apraxia, as we have above, you will note the use of the word “volitional”. The meaning of this word in relationship to apraxia/dyspraxia of speech means that the child is experiencing the difficulty in nonspeech and speech movement when they are very consciously aware of trying to make movements or they are attempting movements when requested by others. Those same movements, sounds, etc. may be heard while the child is busy playing or he/she just seems to blurt out when no one is really paying attention or trying too hard. As an example, the child may be playing happily and parents may hear sounds being made – almost without thought – “ma, ma, ba, ma,da”. However, when the parents attempt to get the child to use those sounds – “Say Mama!”- the child is unable to do so. In many cases one can see the struggle on the child’s face. They may grope with their lips or silently posture their lips as if searching for the position they need. One minute they could do it (when not thinking about it or attempting the task) and the next minute it is an intense struggle (they are now aware of the request and are trying to will their mouths to make those movements – volitional control).
“Pure” Apraxia of Speech
What is meant by “pure” apraxia of speech is that no other speech, language, cognitive, or sensory issues coexist with the deficit of impaired sequencing for volitional speech (apraxia). The professional literature tells us that “pure” apraxia of speech in children is rare, that most often apraxia is associated with other speech, language, cognitive, and/or sensory issues. Paula Square states that,
“In its purest form, acquired apraxia of speech does not coexist with language impairments, auditory processing deficits, or cognitive deficits. Nonetheless, ‘pure’ apraxia of speech rarely occurs. Coexisting deficits for expressive language, psychoacoustic processing, and motor execution are likely to occur in both acquired apraxia of speech and DAS (developmental apraxia of speech) because of the proximity of the neural structures underlying each of these processes to those that generate programs for praxis. A review of the literature suggests that co-occurence of language impairment with both acquired apraxia of speech and DAS is frequent…”
Associated issues might not be apparent in a young child. This is especially true in children who are young preschoolers. For instance, these children may not have any apparent problem with receptive language according to traditional and typical assessment. However, the child may begin to experience difficulty when entering kindergarten, when the language processing demands of the setting are heightened. It would not be unusual to then identify higher level language processing problems. Parents and professionals will do well to be vigilant about the child’s total development to insure that, should an associated area of difficulty arise, help for the child will be readily available.