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What is Apraxia or DAS

 

Sadie trys in many ways to say....

"Let's Focus ON ME NOW!"

DAS is a speech disorder that interferes with a child's ability to correctly pronounce sounds, syllables and words. It is the loss of ability to consistently position the articulators (face, tongue, lips, jaw) for the production of speech sounds and for sequencing those sounds into syllables or words. The area of the brain that tells the muscles how to move and what to do to make a particular sound or series of sounds is damaged or not fully developed. This makes retrieving the "motor plan" for saying a word difficult.

As a result, even though the child knows what she wants to say, she cannot say it correctly at that particular time. Sometimes she cannot even begin. Either the wrong sound comes out, or many sounds are left out all together. At that particular time, the motor plan is not accessible. These errors are not under the child's voluntary control so she often cannot correct them, even when trying her hardest. Frequently, a child will be able to produce a sound or word at one time and not be able to say is again when she wants to. A parent may hear words when the child is playing alone or when he is angry, but when asked to say the same word, she can't. This can be very frustrating for both the child and the parents.

What Causes DAS?

DAS is a neurologically based speech disorder. It is caused by subtle brain impairment or malfunctioning. No one currently know exactly what this brain impairment is or what causes it. 

What are the main characteristics of DAS?

For a young child with DAS, a limited speech sound repertoire is frequently the main characteristic of her speech. This simply means that the child has very few speech sounds that she can use automatically so she frequently uses a simple syllable (such as da) to stand for almost everything.

If the child has gotten to a level where she can use several different consonants and is actually talking, the main characteristic of the DAS is inconsistency. A child with DAS is likely to have inconsistent speech errors and speech capability. For instance, she may be able to say a /p/ sound at the beginning of words as long as the /p/ is followed by an /o/, yet, she may not be able to say it if followed by an /e/. Or, maybe she can only say a /p/ at the beginning of a word if the word also ends in a /p/ as in pop. Another example could be that the child can say a /p/ word just fine by itself, but if there is a /t/ word in front of it, the /p/ becomes a /t/( so two pan is said two tan).

Perhaps she can say short single words well, but as soon as she uses two or three words in a row, she drops all the ending sounds. These inconsistencies can easily lead to confusion on the part of both the child and the parent. The child learns that she cannot trust himself to communicate her ideas well, and the parent may wonder whether the child is just being careless or lazy.

The length of a phrase as an adverse effect on articulation. Generally, the longer the utterance, the worse the speech accuracy. A child may be able to say syllables and short words fairly well but be impossible to understand in phrases or sentences.

Apraxic children are usually better at imitating speech than at saying words spontaneously. If you ask a child to say a words right after you, she is likely to say it more accurately than if he said it without your model.

Anxiety may affect a child's ability to speak well. For all of us, performing is more difficult than talking. Under stress, the ability to retrieve motor plans becomes more challenging. A child may be able to say a word or phrase well in a relaxed setting but, when he is "put on display" and asked to " Tell Grandma...", the plan for saying that word or phrase is not accessible, and the child fails.

Children with DAS may also lose words. Parents frequently report that the child "used to say that, but doesn't anymore". This is another example of the motor plan for a word or phrase being unavailable to the child.

 

What other areas can be affected by DAS?

Children with DAS not only have difficulty retrieving the motor plans for speech, they also may experience accessing vocabulary. Between the ages of 2 yrs and 5 yrs., the number of words that a child understands increases from about 200 words to over 20,000 words. If the child has not organized these words into a "dictonary", she will have huge problems finding the words he wants to say quickly. This increases the effort of communicating.

In the young child, this problem may show up as a tendency to be aggressive with other children. If the child cannot think of words to use to enter into play with friends, she may choose to push them, hit them, or disrupt their play. In older children, difficulty finding the right words may show up as shyness or a tendency to rely on "I don't know".


Some children may choose one topic to be very good at discussing. If you stay on their topic, they sound fine, however, if you change the topic, you find them quiet and unsure of their ability to communicate.

Many children with DAS also have difficulty learning how to put things in sequence or in the right order and then later remembering what the right order was. They already have trouble putting sounds in the right order for words. This difficulty may also be found later as they learn written language.

Many children with DAS have problems learning to read and spell. Often their difficulty with written language is similar to the problems they had with spoken language. They cannot retrieve the words from their memory and they cannot sequence the letters into words or the words into meaningful sentences. When we work with children with DAS, we need to watch for signs of reading and writing problems and refer the children for help if those problems occur.

In addition, a child may show the same motor planning difficulties with fine motor tasks such as cutting, coloring and writing. An Occupational Therapist can assess motor planning problems that are affecting fine motor skills

What can be done to correct DAS?

A child who has DAS will not simply "grow out of it". Without speech therapy, the child's communication skills may improve as he grows older, but his speech will still be filled with errors and be difficult to understand. Therapy for DAS is generally intensive (2-3 times per week) and is started as soon as the disorder is identified and the child is old enough to participate in therapy (18-30 months). Therapy does not provide a "quick fix". Most apraxic children will be in therapy at least 4 years and sometimes significantly longer. However, all but the most severely Apraxic children who receive intervention will eventually be competent oral communicators. In severe cases, augmentative communication will be needed.

What can you do to help your apraxic child?

Probably the most helpful thing that you can do at home is make your child feel as good as possible about her speech and about herself. Accept whatever your child says and, if it is right, praise her. If it is wrong, do not say "No". The child will think that you are disagreeing with the content of her message rather than the way it was said. It is more positive to say, "Yes, that's right" then restate his message with the correct sounds.

If you occasionally ask her to try to correct a word, accept whatever comes out and praise her for a good try. Remember that she does not have consistent voluntary control over his speech and may not be able to say a word correctly even though he wants to and even though she said it correctly ten minutes ago.

Avoid any power struggle situations in which you are requiring the child to say a words before she can have something she wants. In general, you want to avoid criticizing or correcting your child's speech. You also want to avoid putting the child on display.

Instead, you need to be supportive as possible. This will help create self esteem and a positive atmosphere in which you child can learn to enjoy communication. As people, we are driven to communicate with each other. If a child is unsuccessful in communicating, it can severely undermine his self-esteem. It is our job to help the child feel as successful as possible as soon as possible. If you don't understand your child, have her use gestures or point to what he wants. Don't pretend to understand your child if you don't. She needs to know that her message is important to you.

Will teaching my child sign language or picture communication systems make him not want to talk?

The young child with DAS usually has a good understanding of language even though she does not talk. This is very frustrating for the child. One of our first tasks is to lower that frustration level so that the child can enjoy communication. We all communicate in many ways: body language, facial expression, gesture, sound effects and spoken and written words. If we view sign language as a formal set of gestures, then it is not very different from the communication we use all the time. As people, we are driven to communicate with others through talking, however, when talking is difficult to learn, learning to communicate is also difficult. This is when sign language or picture communication systems can be of great help.

Sign language provides the child a way to show others what he wants and knows. It allows her to learn the value of sharing what she knows with others. It gives her success in an area that has previously been defeating. It provides her with a tool through which to learn the value of communication.

Another way to help the child communicate while she is learning speech is through picture communication systems. This is especially valuable if no one in the family understands the child's spoken language.  Pictures can also be used on electronic communication boards to assist the child while she is learning spoken language.

Whatever communication tool you and decide to use while the child is learning spoken language, rest assured that the child will not want to stop learning to talk. As soon as the child is able to be understood, she will want to stop using the other system. It is much easier and more flexible to use spoken language and the child will choose it above all other means of communication. The important thing for the child to know is that we value what she has to say, no matter how she says it!