Tuesday, May 29, 2012

Speech Apraxia: am I signing loud enough?

So after months and months of intensive speech therapy, Jack still struggles to get his words out.  Am I missing something here?  Yesterday we were playing "horsie" in the backyard.  The rope tied loosely around Jack's waist, I called out "giddy-up horse, neigh, neigh".  A clear and precise "neigh, neigh" escaped from Jack's mouth in return with no effort.  You see the harder he tries to say something, the less likely it is to come out at all.  He signs more than 150 signs now and one of the research documents I have consulted has warned that speech production is priority now, let the signing diminish.  But try as we might, Jack's brain cannot send the sounds and words to his mouth.  It is not an oral motor issue.  He can blow bubbles and pucker like the best of them.  It is a brain issue.  Can you work hard to train the brain like you can a muscle?  It seems a little daunting to me at this point.

Here is an excerpt from an article called You said it yesterday, why not now?  After seeing that Jack's speech challenges reflect most of the items on the list of symptoms...I am thinking we need a new strategy here.  Any ideas?

Developmental apraxia of speech (DAS) is defined as a cluster of characteristics of speech.  The most frequently reported symptoms of DAS are:

  • Struggling or groping when speaking or trying to speak.  He seems to be working hard to talk, but the correct sounds are not coming out.
  • Inconsistency in sound and speech production.  One time, he can say a sound or a word clearly, but at other times he has great difficulty with the same sound or word.
  • A limited repertoire of phonemes.  He tends to use a small number of sounds.  More vowels are used without consonants attached, which makes the speech hard to understand.
  • Automatic phrases and movements may be clear, but his intelligibility is worse during spontaneous speech.  He may say "I don't care" or "I don't know" very clearly but have great difficulty in spontaneous conversation or when asked for a specific answer to a question.
  • Difficulty combining and sequencing phonemes.  He maybe able to imitate or produce individual sounds but when he tries to combine them into words, he has difficulty, especially as the words get s longer or more complex.  He can say "ham", but when he says "hamburger" it may come out as "hangurber".  "Banana" may be "nabana". Sounds and syllables are frequently reversed.
  • Decrease in intelligibility as utterance length increases.  He has more difficulty with longer words and phrases.  So, he may say "key"  easily, but have difficulty with "monkey" or "monkey bars".
  • Prosodic or rhythm difficulties.  He may talk slowly or rapidly or have and uneven pace.

Also according to the article we should have a daily repetition and drill, continuted signing, and play slower versions of songs for Jack to be able to attempt to sing along with amongst other strategies.  Maybe we will be adding another signing time series to our well loved library after all.

A nosy lady with an iphone catches Jack reading...my iphone is, of course, way more interesting.

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