Dyspraxia / Apraxia
Speech and language disorders refer to problems in communication and related areas such as oral motor function.
These delays and disorders range from simple sound imitations to the inability to understand or use language or use
the oral-motor process for functional speech and feeding. Some causes of speech and language disorders include
hearing loss, neurological disorders, brain injury, mental retardation, drug abuse (during pregnancy), physical
impairments such as cleft lip or  palate, and vocal misuse. Often the cause is unknown.

Speech Delay

A child's communication is considered delayed when the child is noticeably behind compared to others of the same
age,  in the acquisition of speech and/or language skills. Sometimes a child will have greater receptive (understanding)
than expressive (speaking) language skills, but this is not always the case.

Speech disorders are difficulty  producing speech sounds or problems with voice quality. They might be characterized
by a break  in the flow or rhythm of speech, such as stuttering. Speech disorders may be problems with the way
sounds are formed, called articulation or phonological disorders, or they may be difficulties with the pitch, volume or
quality of the voice.
There may be a combination of several problems. Children with speech disorders have trouble using some speech
sounds, which can also be a symptom of a delay. They may have difficulty pronouncing sounds like “L”, “R”, or
“SH”.  Listeners may have trouble understanding what the child with a speech disorder is trying to say. A child with
voice disorders may have trouble with the way their voices sound.

Language Disorder

A language disorder is an impairment in the ability to understand and/or use words in context, both verbally and
nonverbally. Signs of language disorders include improper use of words and their meanings, inability to express ideas,
inappropriate grammar, reduced vocabulary and inability to follow directions. One or a combination of these
characteristics may occur in children who are affected by language learning disabilities or developmental language
delay. Children may hear or see a word but not be able to understand its meaning. They may have trouble getting
others to understand what they are trying to say.

Types of Speech/Language Disorders

Developmental Dyspraxia - Dyspraxia is a neurologically based disorder also known as (Developmental Co-
ordination Disorder, and the Clumsy Child Syndrome) is present from birth. These children have difficulty in  motor
planning of movement to achieve a predetermined idea or purpose.  It is believed to be an immaturity of parts of the
motor cortex (area of the brain) that prevents messages (ideas) from being properly transmitted to the body, which
may affect any or all areas of development. It is inconsistent, and affects each child in different ways, at different
stages of development and varies in severity.

There are three (3) types of Developmental Dyspraxia. Oral Dyspraxia, Verbal Dyspraxia, and Motor Dyspraxia.

Oral Dyspraxia - children are unable to reproduce mouth movements. Examples of this are the inability to put their
tongue up to the roof of their mouth. A child with oral dyspraxia may not be able to, even though they do this
unconsciously.

Verbal Dyspraxia - children have difficulty pronouncing  sounds or saying words. Many words just do not sound
right regardless of how hard they try to produce the sound or word correctly.

Motor Dyspraxia - inhibits an individual from moving as planned and effects their sensory input. Children with
motor difficulties appear to be clumsy, as if out of sync with their environment.

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Somewhere between sensory information gathering and storing, ideation, motor planning, and action, the messages
are not getting through clearly causing them not to produce correct action. The following is an insight of difficulties a
child with dyspraxia faces.

Ideas - When babies explore a new activity like a set of blocks, for the first time they gather sensory information
about the object. How it feels, tastes, looks and smells, and their shape. How much space that shape takes up, what
the weight feels like, are they hard or soft, strong enough to support each other, do they stay put or roll, balance etc.

Motor Planning - The motor planning area of the brain has received the idea, now it must work out and plan the
positions of the body, which arm and leg muscles must contract or relax, in what sequence and how much, how
delicately the finger muscles must move and in which direction. To work this out it needs to recall sensory
information from past experiences. It also has to plan the sequence in which the muscles are to work, how still the
rest of the body must stay, etc. When this plan is made, messages are sent out for action.

Action - Muscles can only contract or relax, and for each muscle messages from the brain are telling it what to do,
for how long, and in what sequence, and sending sensory information, requesting action. When the motor plan has
been made, messages are sent first to each part of the brain, and then to all the muscles to tell them what to do to
carry out the actions.

Characteristics of Dyspraxia

Symptoms vary and may include:

•        Poor balance and coordination,

•        Clumsiness,

•        Vision problems,

•        Perception difficulties,

•        Emotional and behavioral problems,

•        Difficulty with reading, writing, and speaking,

•        Poor social skills,

•        Poor posture, and

•        Poor short-term memory.

Although individuals with the disorder may be of average or above average intelligence, they may behave immaturely.
It takes longer for them to learn new skills and absorb what has been learned.

Dyspraxia may affect various  motor functions (e.g., fine motor control, gross motor planning) and other language
functions (e.g., learning grammatical function words like "the, "is"and "or"). Other learning difficulties are spelling;
putting words together into a sentence or sentences into a paragraph.

Dyspraxia  affects up to one in 20 children, with boys identified four times more frequently than girls. 50% of these
children exhibit emotional and or behavior problems. Children with Dyspraxia may appear no different from their
peers, until new skills are tried or attained skills are taken out of known environment, is when difficulties may become
apparent. Therefore diagnosis, naming the disorder, is often very difficult. It is only those children whose disorder  
markedly impairs their learning and development who stand a chance of having their difficulties recognized,
diagnosed, and treated.

Childhood Apraxia of Speech

Apraxia is a disorder of the nervous system, described by an inability to perform determined movements, but not
accompanied by a loss of sensory function or paralysis. Apraxia is a motor speech disorder which affects voluntary
or learned motor performance it can be oral, verbal, or developmental. Children with apraxia have problems saying
sounds, syllables, and words. In apraxia 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. Apraxia is caused by an injury or accident to the area of the
brain responsible for performing these acts, apraxia may or may not exist with a language disorder and can affect any
part of the body.

In oral apraxia the individual has difficulty performing non verbal tasks with muscles in the larynx (vocal cords),
pharynx (the canal that connects the mouth and nasal passages with the esophagus), tongue, or cheeks. Reflexive or
automatic function is intact, but the person is usually unable to carry out specific directions when asked. For example
the child may open his mouth when asked to close his/her eyes or say the word "blow" when asked to blow out a
match. It is not unusual for a person with apraxia to insist he/she has achieved the correct movement when no
movement has been performed at all. Many of the responses can be considered peculiar, while the person may be
completely unaware of any irregularity.

Verbal apraxia is defined as difficulty executing the appropriate movements for speech when paralysis, weakness, or
incoordination exists. Consequently, individuals may have extreme difficulty making speech movements. Such
impairments may lead to the lack, alteration, or substitute of certain sounds. Mistakes seem to increase as the length
of the word or sound become difficult, and initiating speech can be almost impossible. Repetition of phrases may be
inconsistent and overall quality of sound may be poor. Debate regarding the cause of apraxia continues. It is generally
accepted however, that the lesion causing apraxia is most likely deep within the left frontal lobe.

Symptoms may include difficulty initiating speech, difficulty sequencing speech sounds, and oral struggle behaviors.
Children with developmental apraxia 2 may not show evidence of a brain lesion, while adults always do.

It is important to have your child evaluated by a speech-language pathologist (SLP) who has knowledge of apraxia to
rule out other causes of speech problems.  General things to look for include the following:

Signs of Apraxia

In Very Young Children

•        Lack of cooing or babbling as an infant, first words may not appear at all, pointing and "grunting" may be way
of expression.

•        Produces first words after some delay, but these words are missing sounds.

•        Single words may be articulated well, but attempts of sentences becomes unintelligible.

•        A whole phrase may be clearly said and never heard again, or cannot be repeated.

•         Fine-motor problems may be present (using pincer grasp).

•        Produces only a few different consonant sounds many of which are b, m, p, t, d, or h.

•         Words may be simplified by deleting consonants or vowels, and/or replacing difficult phonemes with easier
ones. A syllable is favored, and used for all words.

•        May have feeding problems

An Older Child

•        Makes inconsistent sound errors that are not the result of immaturity

•        Can understand language much better than he or she can speak

•        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

•        Weakness of the lips, jaw, and/or tongue

•        Delayed language development

•        Other expressive language problems like word order confusions and word recall  

•        Difficulties with fine motor movement/coordination

•        Over sensitive (hypersensitive) or under sensitive (hyposensitive) in their mouths (e.g., may not like tooth
brushing or crunchy foods, may not be able to identify an object in their mouth through touch)

•        Children with apraxia or other speech problems may have problems when learning to read, spell, and write

Speech / Language Therapy

Speech-language pathologists assist children who have communication disorders in various ways. They provide
individual therapy for the child; consult with the child’s teacher about the most effective ways to facilitate the child’s
communication in the class setting; and work closely with the family to develop goals and techniques for effective
therapy in class and at home. The speech-language pathologist may assist teachers in establishing communication
goals related therapy  experiences of students and suggest strategies that are effective for proper development.

Vocabulary and concept growth continues during the years children are in school. Reading and writing are taught and,
as students get older, the understanding and use of language becomes more complex. Communication skills are the
root of the education experience. Speech and/or language therapy may continue throughout a student’s school years.
Occupational therapy, physical therapy, and learning disabilities assistance are often helpful.

Intervention

All communication disorders have the potential to isolate children from their social and educational surroundings, it is
important to seek appropriate intervention. While many speech and language patterns can be called "baby talk" and are
part of a young child's normal development, they can become problems if they are not outgrown as expected. In this
way an initial delay in speech and language or an initial speech pattern can become a disorder which can cause
difficulties in learning. Because of the way the brain develops, it is easier to learn language and communication skills
before the age of 5. When children have muscular disorders, hearing problems or developmental delays, their
acquisition of speech, language and related skills is often affected.

More than one million of the students served in the public schools’ special education programs in the 2000-2001
school year were categorized as having a speech or language impairment. This estimate does not include children who
have speech/language problems secondary to other conditions such as deafness, or language disorders related to other
disabilities such as mental retardation, autism, or cerebral palsy. It is estimated that communication disorders
(including speech, language, and hearing disorders) affect one of every 10 people in the United States.
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