Tuesday, November 27, 2012

update on gretchen's speech

Gretchen and I had speech therapy yesterday and it was her best day yet. She was very receptive and worked really hard. I can see that therapy and my work at home with her is helping, slowly, but helping. She has new words like Buzz, Bee, and Baby.

Our therapist is Chris. Chris mentioned something about Apraxia and I finally asked if this is a sort-of diagnosis. She said at first she didn't want to give Gretchen a label until she knew her better and had the opportunity to work with her but after this many sessions she now believes that Gretchen has Apraxia. What does this mean? Much more therapy and work at home, that's for sure!

What is childhood apraxia of speech?

Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words. 

What are some signs or symptoms of childhood apraxia of speech?

Not all children with CAS are the same. All of the signs and symptoms listed below may not be present in every child. General things to look for include the following: (Note: I've listed the ones that I've noticed with Gretchen.)

A Very Young Child

  • First words are late, and they may be missing sounds 
  • Only a few different consonant and vowel sounds
  • Problems combining sounds; may show long pauses between sounds 
  • Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)

An Older Child

  • Makes inconsistent sound errors that are not the result of immaturity
  • Can understand language much better than he or she can talk
  • Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech 
  • May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
  • Has more difficulty saying longer words or phrases clearly than shorter ones
  • Appears to have more difficulty when he or she is anxious
  • Is hard to understand, especially for an unfamiliar listener
  • Sounds choppy, monotonous, or stresses the wrong syllable or word 

Potential Other Problems

  • Over sensitive (hypersensitive) or under sensitive (hyposensitive) in their mouths (e.g., may not like toothbrushing or crunchy foods, may not be able to identify an object in their mouth through touch) - This we've noticed is HUGE with Gretchen. She has an oral 'thing' where she constantly needs to have something in her mouth at all times, chewing, etc. She has oral tools to chew on but still puts inappropriate objects in her mouth.
  • Children with CAS or other speech problems may have problems when learning to read, spell, and write 
What treatments are available for children with apraxia of speech?

Research shows the children with CAS have more success when they receive frequent (3-5 times per week) and intensive treatment. As the child improves, they may need treatment less often. (I'll be finding out if more therapy is needed at this point. We currently go 1x week.)
To improve speech, the child must practice speech. However, getting feedback from a number of senses, such as tactile "touch" cues and visual cues (e.g., watching him/herself in the mirror) as well as auditory feedback, is often helpful. With this multi-sensory feedback, the child can more readily repeat syllables, words, sentences and longer utterances to improve muscle coordination and sequencing for speech.
The focus of intervention for CAS is on improving the planning, sequencing, and coordination of muscle movements for speech production. 
Some clients may be taught to use sign language if the apraxia makes speaking very difficult (sign language is working well here but we don't want to foster sign language if she is capable of saying a word, i.e. juice.) Once speech production is improved, the need for these systems may lessen, but they can be used to support speech or move the child more quickly to higher levels of language complexity.
Practice at home is very important. Families will often be given assignments to help the child progress and allow the child to use new strategies outside of the treatment room, and to assure optimal progress in therapy.
One of the most important things for the family to remember is that treatment of apraxia of speech takes time and commitment. Children with CAS need a supportive environment that helps them feel successful with communication. 
So, that's Gretchen in a nut shell right now....

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