Are you wondering how to help your child with apraxia make progress in speech therapy? Childhood Apraxia of Speech presents unique challenges to communication. Often, parents’ stories reflect delayed diagnosis and a period of time when they were searching for answers about their child’s communication difficulty. In early years, apraxia can sometimes be confused with developmental language delay, and in fact, may co-occur with other communication diagnoses that can make teasing out apraxia symptoms less obvious, even to trained professionals. Once parents find out their child has an apraxia diagnosis, the attention usually shifts to questions like paying for intensive and frequent therapy services and helping kids with apraxia make progress.
This article focuses on the second question by covering some fundamentals of apraxia treatment, as well as some information about what we know about speech therapy help for kids with apraxia. If you’d like to read some basic information about Apraxia, you can check out the American Speech Language Hearing Association website for a comprehensive overview. Or, click here to learn more about Verboso’s solutions for Apraxia therapy.
Why do Different Therapy Approaches Help Kids with Apraxia Make Progress?
When a child has an apraxia diagnosis, it means that they struggle with coordinating the necessary motor plan to sequence speech sounds for coordinated speech production. Their challenge lies in sending the signal from their brain to their articulators and as a result, speech sound errors are present. Toddlers with apraxia may present as if they have a reduced vocabulary or language delay because their intelligible speech can be severely limited, making it hard to know if they’re trying to say specific words or not. However, this underlying cause of difficulty is different from other causes, and so a few key differences are present in our treatment approach to help kids make progress.
Treatment improving sequencing of sounds and movements helps kids with apraxia
Apraxia treatment requires lots of opportunities for practicing movement between different sounds. This is different from other types of speech therapy, for example, phonological therapy, which helps kids learn the rules of the sound system. In this therapy, when we teach distinctions between two different sounds, it can help to spark improvement. For example, a common developmental type of speech error is a /b/ for /f/ substitution. In a phonological therapy approach, the child sees pairs of words like “bear” and “fair” and has to learn that they sound different to express a different meaning. Often, if the child learns this rule, they carry over the skill to other sets of /b/ and /f/ examples and can progress through therapy pretty quickly.
Compare this example to a child with apraxia. While some kids with apraxia may also have phonological learning challenges, the motor planning difficulty will prevent them from easily carrying the rule from one pair of words to many. Instead, the fact that words like “fair,” “fear,” “fine,” “fib” and so forth all have different vowels following the /f/ will likely present new challenges. The child with apraxia struggles with the coordination needed to sequence multiple sounds together to make all the different words they want to say throughout the day. So, therapy will teach these transitions across sounds and syllables to build increasingly complicated word structures for the child. Some kids with apraxia may also need practice sequencing and maintaining accuracy across words in phrases and sentences. Others may struggle with coordination pitch and intonation changes to help signal meaning, such as a rising inflection at a sentence end to mark a question.
Treatment needs to be a maximum level of intensity and frequency to see progress
Because kids with apraxia need to practice so many different types of contexts for speech, it’s typically the case that they need frequent services with a high number of practice opportunities each session. While every child’s needs are different, as a general rule of thumb, the more severe the initial presentation is, the more frequent the services should be. Below, we’ll talk about some considerations for treatment frequency and intensity.
Frequency: How often do services happen?
The frequency of speech therapy sessions basically refers to how many days a week the sessions occur. Your child will likely also have a recommended frequency of home practice. Frequency of therapy is usually constrained by practicality. Because life is busy, it’s not usually reasonable to attend therapy every day of the week. However, some kids are able to meet this frequency with a combination of school and private therapy. For example, if a child receives an hour of speech therapy through school, spread across two 30 minute sessions, then on days they don’t have school speech, perhaps they can supplement with private speech therapy.
Intensity: How many repetitions fit into speech sessions?
Intensity often refers to how many practice opportunities a child has for their targets in a given therapy session or home practice session. A typical intensity session will have about 100 repetition opportunities across 45 to 60 minutes, a low intensity session may have more like 25 to 50. A very high intensity session may be upwards of 400 repetitions. Some of the variation may stem from how much practice that particular child can tolerate. Some goals, like language goals, may lend themselves more to low intensity practice and teaching. Apraxia therapy and other motor speech therapy needs to aim for high intensity treatment to help build new motor plans and muscle memory for those motor plans. One of the signs of a great speech-language pathologist is their ability to get in a lot of quality practice and make it fun! Kids with apraxia tend to benefit from higher intensity speech practice sessions.
Kids with Apraxia may benefit from unique teaching methods to help them make progress
In addition to the need for high frequency and high intensity treatment, sometimes the types of techniques a therapist uses for kids with Apraxia may be a little different than those used in other speech sound disorder treatment sessions.
Dynamic Tactile Temporal Cueing is a therapy approach that incorporates a number of different types of cuing into the child’s treatment program. It’s dynamic, in the sense that the amount of cuing changes over time, starting with more support and fading away to more independence for the child. It incorporates tactile cues, meaning touch support for the child as needed, and also includes support like simultaneous production of the movement patterns with the clinician. After simultaneous production, the child moves to direct imitation, then no imitation. The therapist may also use cues like slowing rate to allow for more sequencing and planning time. Focus on vowels and pitch and intonation are included in these therapy plans.
ReST is another treatment program designed for Apraxia therapy. The name is short for Rapid Syllables Transition Training. In this treatment approach, there is a heavy focus on using nonsense syllables to help improve speech skills of transition across syllable types and contexts.
It’s important to remember with all of these approaches that a skilled clinician will combine a variety of methods to suit your individual child. There is no one size fits all approach to any kind of speech-language therapy. The overall goal is to improve accuracy of sounds the child can make, and then improve ability of the child to move between sounds they can make to produce increasingly complex words with correct stress and intonation. Therapists treating a child with apraxia will use a variety of methods that aim to meet these goals, with enough frequency and intensity of practice to create functional progress. Because kids with apraxia may also have co-occurring language or phonological difficulty, the treatment plan may need to include a broad range of goals that also address these areas.
Will Using an AAC Device Help Progress for Kids with Apraxia?
Some kids with apraxia will benefit from using an Alternative or Augmentative Communication device or system to support their communication. This is because, in moderate to severe cases of Apraxia, kids may be experiencing a good deal of communication frustration or inability to express their wants and needs. In addition, kids with apraxia may have language difficulties as well. Having an AAC device, or using a functional vocabulary approach with pictures of core words, can help give kids relief from their difficulty with spoken communication. It can also help boost their language skills, both receptive and expressively. This in turn can actually help boost attempts at spoken language.
How Do I Know if my Child with Apraxia is Making Enough Progress?
Progress with speech therapy can be a process. Sometimes it takes awhile before you may see definite changes in day to day function, particularly if a child is working on foundational skills like learning the mouth movements for a new sound. The best way to know if progress is expected is to talk to the therapist treating them. They can let you know if they have any concerns about the rate of improvement.
We do always expect to see upwards progress to some degree. How fast that progress is can vary a lot across kids. However, if you notice that your child is not improving on the goals they’re working on, or you notice a decrease in skills, talk with your therapist about your concerns. It may be the case that the treatment methods, intensity, or frequency, need to be tweaked to help your child improve.
If you’re interested in talking with a Verboso speech-language pathologist about your concerns, learn about how Verboso’s solutions can work for kids with apraxia.