Dyspraxia

– Compiled by Nicole Curtayne

Introduction

Developmental Verbal Dyspraxia (DVD) has many different names that might be confusing to parents:

• motor planning speech disorder
• apraxia
• dyspraxia
• apraxia of speech
• sequencing disorder of speech

 

Causes

We do not really know what causes dyspraxia. There are several risk factors that doctors or other professionals may ask about as they have been linked to dyspraxia:

• a lack of oxygen at birth
• prematurity
• dyspraxia
• sensory integration problems
• a genetic link

 

Features/symptoms

Typical/age appropriate or much better understanding of language than output indicates.
History of no or very limited verbal output including limited or no babbling as a baby.

Inconsistent errors

• Vowel distortions
• Produces a word one day but not again.
• Poor carryover to other situations.
• Poor sound sequencing so that, one word represents lots of things, only cv or vc words are produced spontaneously. Although the sound repertoire improves with age the child still struggles with long/multisyllabic words.
• Difficulty in extending the speech sequences into sentences and speech clarity deteriorates when the child uses longer utterances.
• Delayed expressive grammar, including the use of pronouns (he, she), prepositions, morphology (word endings that show number or tense, such as past, present or future).
• Groping which can be visual, such as lip/tongue movement, or may appear quite similar to stuttering as the child produdes repetitions and prolongations.
• Prosodic difficulties: loud, fast, strange pitch, robotic sounding
• Oral nasal confusion (eg: /b/ sounds like /m/ and vice verse)
• Word finding difficulties – often helps when first part of the word is given.
• Social emotional difficulties: high frustration, poor self-confidence which both result to very reactive behaviour in new or challenging environments, poor problem solving, inappropriate ways of communicating or reduced communicative intent
• ADHD often co-occurs with dyspraxia
• Sensory integration problems. Produces a word one day but not again.
• Auditory discrimination and memory difficulties
• A lot of children with dyspraxia also have reduced oral strength /or range of movement which, combined with poor sensory integration, affects eating.

 

Therapy

We follow a hierarchy system where we start where the child is at and introduce sounds, cvcv (mama) then vc/cv words(on/moo). From there we move onto c1v1c1v2 (puppy) and then c1v1c2v2 (runny) words and finally multisyllabic cvcvcv (banana) words. At each level the child is encouraged to then produce the word with a carrier phrase, eg: I want/ I got… We use auditory, visual, tactile and movement strategies where necessary to help the child develop speech sounds. Simultaneously, the child’s expressive language is worked on as speech sounds are meaningless without the context of language. Simple words, that are in the child’s speech repertoire are used. As the child’s speech improves, the complexity of the words in therapy increases.

What you can do at home?

• Reduce verbal pressure on the child. History of no or very limited verbal output including limited or no babbling as a baby.
• Encourage songs with repetitive verses, as singing helps with verbal rhythm.
• Do not talk for your child, but help them with cues, for example giving the initial sound or giving them an option, such as “Do you want the jersey or the hat?”
• Allow the child space to produce spontaneous language, encourage whatever language they use without expecting them to imitate longer sentences.
• Allow your child the use of conversational alternatives to spoken language, such as gesture and body language.
• It’s important to give your child a break from speech work when they need it.
• Address sequencing skills by playing games and singing songs that relate to the more global sequences of seasons, months of the year, days of the week and day and night cycles.
• Try to have fun when helping your child, for example musical instruments help to develop pitch, speed and volume and a drum can be used for rhythm and for slowing down multisyllabic words.
• Most importantly your job is not to be the therapist and so incorporate what you can where you can, but don’t make speech clarity your focus when interacting with your child.
• Good eating and sleeping routines as well as a healthy diet.

 

Difficulties for schooling

Children with dyspraxia of speech are at high risk for literacy problems, such as, phonological awareness, reading, spelling, maths and written expression, especially if their speech problems persist after 5 years. Comprehension and overall language processing can also be affected, which in turn can affect narrative skills and social and pragmatic language skills. Children with DVD participate less in conversation because of their poor speech and expressive language and so don‘t develop these skills.

The academic problems in children with DVD can be understood when considering that typically developing children use this speech processing system to develop speech to develop phonological awareness, where the child learns to manipulate the sound structure of a word separate from its meaning. You use your phonological awareness skills to play sound and rhyme games eg: I spy and rhymes. Children who find this difficult can have problems with cracking the alphabetic code of language.

Cracking the code is what children do when they sound out letters of a written word and then blend them together to read/pronounce it, or when spelling they take a word, sound it out and write letters that fit the sounds. Cracking the code required children recognise the sequence of sounds in a word, pan = p – a- n. This phonological awareness requires accurate repetition of words. Children with speech difficulties often need specific help not only with learning letter sounds and names but also with how these are combined in words through graded phonological awareness activities.

Furthermore, clear and consistent speech production is very important for spelling (and when learning new vocabulary). Typically, when asked how many syllables there are in a word children count the claps while saying the word. If they can’t say the right number of syllables or even say the word in the same way then they won‘t be able to spell it (or remember it).

Work on all aspects of his speech processing system with phonological awareness and letter knowledge training is very important to develop a consistent approach to spelling. Speech therapy my therefore be necessary for a long time for children with significant dyspraxia and it may well continue into the school years where the focus may shift to teaching strategies for phonological awareness, reading and spelling.

Prognosis

It is difficult to predict the level of intelligibility and the specific difficulties with literacy that individual children with DVD may develop, but there are certain elements that will work in the child’s favour or against them. These include

• Early intervention
• The severity of the child’s CAS
• The child’s initial progress in intervention
• The presence and severity of co-occurring symptoms, such as, language impairment, cognitive impairment, and non-verbal and/or limb apraxia.

 

Children with DVD can and do make significant progress with speech and language intervention, especially early intervention but this does not mean to say that they won‘t need therapy during their school years or that they won‘t need remedial schooling or help at some point. We often recommend remedial schooling for the foundation stage of schooling so that children with DVD can learn the fundamental literacy skills in a small, supportive and non-threatening environment.

References:
Grizzel, B & Taneyhill, M (1998), Stomp like a dinosaur & jump like a frog.
Addy, L. (2004) How to understand and support children with dyspraxia.
Lancaster, G & Pope, L (1989) Working with children’s phonology.
Stordy & Nicholl (2002) The remarkable nutritional treatment for children with ADHD, dyslexia and dyspraxia.
www.apraxia-kids.org