Part Two: What is Apraxia???
Imagine you are driving to a familiar place. A place that you have driven to many times before. Maybe your work or your school. Someplace that you drive to often. Now – think about how much thought you put into your trip to get there. It is surprising how little we actually have to think about trips like these. In fact – there have been many times that I got in my car, began driving, and next thing I knew I was home. And I wondered – how did I even get here – I don’t really remember the drive. I am sure you have experienced this same feeling. Our bodies and our brains kind of go into autopilot mode when doing things we are familiar with.
Now imagine you are driving to a completely new place. A place you have never been before. When making a trip like this – a map or directions become crucial. There is almost no way you will get where you want to go without them. The map or directions tell you which direction to head in and they tell you where to turn. They give you a guide and a plan as to what to do. You have to be thinking about and focusing on the plan in order to follow it correctly. And as time goes on, the more a destination is traveled to, the less attention and focus is needed because the route is familiar and well know.
Now compare these two scenarios to speech. When typically developing children are exposed to speech their brains start to create a bunch of maps. These maps store the traveling information required for speech. These maps tell the articulators how and when to move to convey specific messages. They show the movement patterns necessary to travel from one speech sound to another. And as time goes on, the more a speech movement pattern is practiced/used, the less attention and focus is needed to produce it correctly.
Now compare this to children with Apraxia. I have learned after working with many apraxic children that they are simply missing their maps. They know what they want to say or where they want to go – but they don’t know how to get there. Speech for them is like hopping in a car and traveling to a destination they have never been before without any map or directions. You can see how frustrating this would be. They may even know where to begin, and where they want to end, but they have no idea how to get from point A to point B. To them, speech seems like an endless amount of unknown endpoints and they are left driving around lost and discouraged. Often times it seems like they jump in their car and start driving around any road they can find – any road that seems familiar and it is just pure luck if they find the right route to take. This is what groping looks like. These kids are searching with their articulators to find the correct points of contact and are trying to move correctly from one sound to the next. Once they find a route (or movement pattern) that is successful – it needs to be practiced and repeated so many times that they can find it again when they need it – through memory instead of a map.
So – you can see how overwhelming and discouraging this journey would be. Most of the time, when I meet kiddos like this, they are ready to give up on verbal communication. It is way too much work with very little success. I would probably feel like giving up too. So the real question is how can we help them? Where do we start?
***Remember to FOLLOW ME along my 7 post journey in which I will describe my systematic approach to viewing and treating apraxia of speech in great detail. Don’t forget to add your comments and feedback and together we can conquer apraxia of speech.
I am having trouble determining if a child I just started seeing has CAS or is just severely delayed in speech and language. I have only seen him once thus far. He is 3 but is communicating in 1 word/approximations of words, with good intonation that models conversational interactions. His articulation errors appeared to be consistent, but he does presented with vowel distortions and is especially hard to understand in multi-syllabic words and words containing later developing sounds. He is great at imitating and his production of words, although at times unintelligible are consistently (e.g. “pow” for push consistently after modeled). Any thoughts on this? After reading your posts, I am thinking, CAS or not the method of sustained phonation of CV patterns could be a good route for this child, due too the amount of sounds (consonants and vowels) he is lacking in his phonemic inventory. Have you used this method before with kids that are not clear cut CAS? If so, would you suggest starting with sounds he already has (b,p,m) or ones that can be sustained like you said (fricatives)? Thank you!