Developmental Apraxia of SpeechExcerpted in part from Briggs and Associates Newsletter, Spring 2004What is it? Developmental Apraxia of Speech (DAOS) (also referred to as apraxia, developmental verbal dyspraxia [DVD], dyspraxia, or childhood apraxia of speech) is a problem in the planning and execution of voluntary movements for speech. This disorder is assumed to be neurological in nature, although there may be no readily apparent neurological signs. At times there may be “soft neurological signs” of clumsiness or awkwardness. With DAOS there is no paralysis or weakness of the muscles used for speech. The problem is in programming and coordinating the complex movement of the muscles to produce clear sounds, words, and sentences. At Briggs and Associates we are experts in young children with a variety of oral-motor difficulties. DAOS is just one type of difficulty. Together with parents, pediatricians, and other professionals we are able to effectively diagnose and treat DAOS. Praxis The ability to select, plan, organize, initiate, and sequence motor patterns. Involves the following:
How do you recognize it? Some of the signs or symptoms in young children are:
Can it be recognized early? There has been some concern about making a diagnosis prematurely. However, many of the signs and symptoms just discussed are apparent in infancy and toddlerhood. Frequently, the best way to proceed is to begin treatment with a child who is speech delayed. Then we and the family can continue to assess to make a more definitive diagnosis. This process is called “diagnostic therapy.” It should also be noted that many speech and language disorders have an hereditary factor. We often assess and treat younger siblings of children who have been diagnosed and treated for DAOS. The severity of the disorder often varies, but siblings may share similar speech traits. Due to family involvement in the sessions, parents often notice “red flags” in their younger children much earlier and can begin to address difficulties that reduce future speech delays. What causes it? The bottom line is… we don’t know. There are two prevailing theories, though, that continue to be investigated. The first theory is that there is a primary problem in the areas of the brain that control voluntary motor movements. Speech is an extremely complex motor act that requires careful planning, organizing, and coordinating within the central nervous system milliseconds before the speech structures and muscles produce what we recognize as sounds, syllables, words, and sentences. The second theory argues that the problem is in learning the rules of language. Producing sounds and combining them to form words is one aspect of language. According to this theory, children who have difficulty producing sounds don’t have a motor problem; they simply haven’t yet learned all the rules of language. Although neither of these theories has been “proven”, they both have very different methods of assessment and treatment recommendations. What do we do? We believe in the first theory—that there is a motor planning problem at the core. We also strongly believe in early identification and intervention—the sooner the better. As part of our play-based approach where families are partners with us in assessment, planning, and treatment, we have developed a number of techniques that work:
Progress is often referred to as “stair-step.” This term is used because often children progress in spurts, making progress and then reaching plateaus for a bit. There may even be an appearance of regression. Typically what happens during this pause in progress or plateau is that the child is integrating new skills before putting them into place to produce new sound patterns or words. Resources Ask any member of our team for help or further information. We maintain a library of resources on this and many other topics. If you would like to read more, go to:
© M. H. Briggs, PhD, 10/05 |