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Helping Children with Apraxia Become ‘Risk-takers’ with Their Speech and Communication

Deborah Hayden, M.S., CCC-SLP

For most of us, and especially for children with severe speech production disorders, risk taking requires trusting that the situation or person to whom we are communicating is safe and predictable. It also generally requires that the effort be worth the risk. If these conditions are met most children will attempt to use what speech or communication they have to interact. The major issue, however, is how to create this environment? One proposition is the creation of boundaries. Boundaries, in this context, refer to the physical, mental, and emotional conditions that surround the child and are based upon realistic expectations for performance.

As a parent, it is difficult to always recognize that providing consistent boundaries and expectations for our child is a “good” thing to do. Especially for children with limited or unintelligible speech, we often feel the need to protect them from becoming frustrated. Often for parents, feelings of responsibility for the childs disability make them want to “do” for the child and keep them safe. Unfortunately, in order to take risks in oral communication, the child must venture out, must experience “controlled” frustration, and must realize that when communicating there are “rules and consequences.” It is reasonable to expect that a child use what they can produce in oral communication interactions. Even if this means using a vowel sound to get attention or to answer a simple question such as “Do you want this?” Simple speech productions can be used and shaped very effectively to interact or respond. The following ideas are presented to stimulate thinking and discussion of boundaries. The use of boundaries should be considered positive and, when implemented with a full understanding of the childs ability levels, provide a safe way to begin risk-taking.

A parent, caregiver or clinician may begin to create realistic boundaries by helping the child:

Learn that daily life routines have predictable sequences, and that these sequences, have outcomes or results. For example, something as simple as putting on a shoe has a sequence and within the sequence the child may need the parents help. If the parent does not put on the shoe, but waits until the child looks at them and then asks the child if they want help, there is an opportunity created for the child to use even a simple vowel /a/ for acknowledgement or to use the syllable /ya/. If the child does not immediately answer, the parent may tell them to say /a/ or yes and then proceed to put on the shoe. This way the child is learning that, in order to get something they want, they must interact and use something they have.

Learn what behaviors, within these events; will lead to successful outcomes or interactions. As stated above, using their voice or what speech they have, will lead to a successful outcome, e.g., getting the shoe put on. However, as children acquire more accurate speech-motor skill, they need to be asked for longer productions. For example, where a simple /ya/ may have sufficed before, now “more shoe”, “shoe on”, “mom shoe on”, or “put my shoe on” would be expected. The child, depending on their ability level, should be slightly challenged.

Understand what unsuccessful actions will lead to, in other words, results that do not produce the intended outcome that the child desires. Here, the child would learn that they would not get the help they wanted or that the shoe did not get put on. Obviously parents must make decisions about what aspects of a childs behavior they can use for these purposes. If, for example, the child does not like having their shoes on, then not getting help will not be reinforcing. They may be quite happy not using any speech because they are already getting what they want. It is important that the parent recognize what events are essential and reinforcing to the child and use these especially when beginning.

In order to reinforce these realistic boundaries and provide the support that will lead to trust and risk-taking the parent or caregiver should:

  • Determine (with their speech and language clinician) what speech productions are usable and how these can be combined to produce the most functional and interactive communication.
  • Choose routines, or activities of daily living (as above) or games that will allow the child to interact using these sounds, syllables or words.
  • Determine the rules to be followed (or the number or steps) within the activities, routines or games that are expected from the child. In other words, set a limit on the number of things the child must do to complete the task. Make sure they know how many turns or words they have to say before the task is over. In younger children, or with more severe speech disorders, make the number of turns or responses few.
  • Create situations in the home (or school) environment that provide the child with multiple opportunities to use their sounds, syllables or words with familiar and unfamiliar people for communication, e.g., asking for something, saying no or yes to something, saying hello to someone, calling attention to themselves, etc.
  • Provide positive reinforcement when the child uses their speech to interact. Again, make sure that the consequences, for the child using speech, are rewarding and actually lead to something the child considers fun or important.

Finally the main goal of oral communication should always be to increase the childs competence and feelings of self-worth. When the above steps are considered and implemented the child will find safety in clear expectations and a reason to communicate that is well worth the effort.

[Deborah Hayden, M.A., CCC-SLP, SL-P(C), Reg. CASLPO, is the Founder and Executive Director of The PROMPT Institute ( and an Adjunct Specialist in the Department of Audiology and Speech Sciences at Michigan State University. Her research has been in the field of childhood and adult speech production disorders; phonology, hearing impairment, dysarthria and apraxia. She founded the PROMPT Institute for the purposes of treatment, training and research in speech production disorders. Her current research efforts have been directed towards norming and publishing the VMPAC (Verbal Motor Production Assessment for Children), now available through The Psychological Corporation, and VMPAA (Verbal Motor Production Assessment for Adults) with colleague Dr. Paula Square. She is also a co-author of the EMCS (Early Motor Control Scales). Deborah has published extensively and has presented internationally at workshops and conferences both in United States, Canada, Australia, and Hong Kong. In addition, she is a member of CASANA’s Professional Advisory Board.]

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