What is childhood apraxia of speech (CAS)?
Children with CAS have a speech disorder that affects how they plan the movements required for speech. What appears to be an easy task for most kids can be impossible for others. Children with CAS need practice combining sounds to say words and phrases.
As a speech-language pathologist who worked with very young children for years, diagnosing apraxia with children who are not yet speaking can be difficult. There can be so many possible reasons why a child is not speaking. I hesitate attaching the label of apraxia of speech to children who are not imitating or who cannot use words to communicate. But there are some children attempting to imitate who struggle to produce vowel sounds and vowel combinations and to move from vowels to consonants, consonants to vowels, all with the purpose of shaping words. Motor planning is affected. Even if a diagnosis of apraxia is not given, these suggestions can he helpful for you.
How can I help my child with apraxia of speech?
Your child will benefit from lots of verbal practice. I’m guessing that you have tried many things, but getting a child to practice something that is difficult is often easier said than done. Speech and language therapy will be helpful, and I encourage you to locate a speech-language pathologist in your area who can guide you.
From the research I have read and from experience, I have created a little poem of important components to speech and language therapy for children with apraxia.
Keep sounds moving.
Keep them slow with
Intonation and rhythmic flow.
Core words, Cues to
Feel and see.
Repetition, Chains of three.
Keep sounds moving.
This is a key component to therapy for apraxia. When a child can say a sound, helping him or her move to another sound is crucial. When you think of words, they are simply a group of vowels and consonants combined together. Moving from vowel to vowel can create a word like, “ow,” (ah – oo) and can be incredibly powerful in a child’s world of owies, bumps, and scrapes. Learning to combine a consonant with a vowel as in the word, “go,” takes a lot of coordination, movement of the tongue, lips, and palate, and control of the mechanisms for voicing and breathing. When you think how complex the art of speaking is, you begin to be amazed how children are able to figure it out.
Something that may help you in this process is my Blast Off Board Sound Sequencing Set. Go to my Blast Off Board Sound Sequencing Set shop to read more about it. You can also view this video to see how I use the Blast Off Board for not only children with apraxia, but any child who needs drill and practice of a variety of skills.
Free Checklists to see what your child is able to produce and the progress he or she is making
Go to Blast Off Board Downloads to print out a variety of checklists of the sound combinations, words, and phrases covered in our Blast Off Board sets. This will guide you in what sound combinations are difficult for your child. The will also help you know which sound sequences to practice and in what order.
Keep them slow.
In general, extending sounds and slowing them down will help a child get ready for the next sound in the word he or she is trying to say. For example, when a child wants to say, “me,” it may help to extend the mmmm to give your child time to motor plan the movements needed to say “ee.” Give your child the feeling that he doesn’t need to be in a hurry to say what he wants to say. Slowing down your own rate of speech can be helpful as well. Keep the flow of your speech normal, but just speak a bit more slowly to give your child the comfort of knowing that there is no pressure to communicate.
With intonation and rhythmic flow.
There are many ways to create a joy for vocalizing, but one excellent tool for children is music. Practicing intonation and rhythm will help a child understand the normal inflectional flow of speech. Our Talk It Rock It songs can be helpful for verbal practice that is enjoyable and that focuses on sound blending from vowels and vowel combinations to consonant-vowels (CV), CVCV structures, words, and phrases. You can listen to song samples, see the visuals that illustrate the songs, and watch a video that describes our songs. Go to our songs to find out more. Our songs are great, but there are many other ways to incorporate music into your day.
- Sing your own songs throughout the day.
More than anything, we encourage you to make a song out of every moment. We believe that “Every moment is a note, every situation is a song, and every person is a player.” When you go to the park, drive in the car, go to the store, tuck your child in at night, eat together, etc., sing about what you are doing. Sing at the level your child can understand and handle verbally. When a child is actively involved in music, it activates his/her whole brain. You will do nothing but good things for a child if you present things musically.
- When you sing songs, sing them in a manner that is within your child’s verbal ability.
You may want to sing vowel sounds, consonant-vowels like “ba ba ba,” or “na na na” to typical children’s songs like The Wheels on the Bus. Classical pieces like Vivaldi’s Four Seasons or Handel’s Water Music are also excellent. Or perhaps try our instrumental-only tracks on our song sets. Sing whatever sounds your child.
- Make noises!
Your child may benefit from hearing you make noises like sneezing, coughing, and kissing as modeled in our song, Noisy, Noisy, Noisy (Imitation Exploration Set 1). Animal noises such as the songs, Puppy, Puppy, Puppy, Animals (Imitation Exploration Set 1), Yee Haw (Imitation Exploration Set 1), or many of the animal sound songs in Animals Movin’ and Groovin’ Set 5 are also great to practice. You could also use our Animal Faces to encourage your child to imitate animal sounds. You can watch a video and read descriptions of the animal faces at our Animal Faces shop.
- Be a rock star!
If your child is able to produce some simple consonant-vowel sounds such as mama, dada, or baba, you may want to lose yourself in singing some Beach Boy songs, pretending you are the background singer. Those songs are filled with vowels and consonant-vowel structures. We have used this concept of consonant-vowel practice and our songs are packed with them. Some examples are The New BMW, Tongue Tip Time,(Imitation Exploration Set 1), I Dressed Myself (Rock & Roll with a Language Goal Set 2), Singing a Song (Rock & Roll with a Language Goal Set 2), and many of the songs in Drills for Sounds Set 3.
If your child is able to say any sounds, begin to use those sounds to shape words. For example, the vowel, uh, can be used for the word, “up.” When you are walking up the steps, he/she could say “uh” for each step. You can say the word “up” for each step as well to give him the model of the correct production. But any attempt your child says for a word should be accepted and welcomed.
Think of all the activities that your child loves to do or what he/she does consistently each day. Whether it be eating, getting dressed, or playing with toys, think of the words that would be most important for him/her to learn in those situations. For example, during eating, a child may need to learn “eat,” “more,” “water,” or “peas.” A child who can say, “ee” can certainly use that to ask for something to eat. “Muh” can be more, “wa” can be water, or “pee” can be peas. Accuracy isn’t essential when children are just learning to communicate. Try to think of core words that you can encourage throughout your child’s day.
As you think about what core words are important in your child’s world, please look at the book, Talk With Me. This children’s book is also a parent training book on helping children interact with a book and imitate noises, sounds, gestures, and words while looking at a book.
Talk With Me$16.95
Cues to feel and see
Tactile cue – There are many techniques that are used with children with apraxia. Some training programs such as Prompt Therapy have been found very helpful for sound sequencing. It is a cuing system that many speech-language pathologists use, and it involves touch cues to a child’s face including his jaw, lips, and tongue. These cues help shape the muscles required to shape words. Speech-language pathologists who are trained in Prompt have used Talk It Rock It songs and the Blast Off Board Sound Sequencing Set as an extension to speech and language therapy.
Signs and gestures – In addition to tactile cues like Prompt, signing is another cueing system that can help children with apraxia. Signs as well as gestures can enhance verbal skills, not hold them back. Use signs and gestures in combination with verbalizations to give your child the ability to communicate with your child’s hands even if he/she cannot yet say the words. Using signs and gestures is a motor planning skill just like speech, so practicing movement of any kind is excellent for a child with apraxia.
Using visuals – We believe strongly in the use of visuals in combination with speech, tactile cues, and music. Our Blast Off Board Sound Sequencing Set Level 1 contains pictures with a hierarchy of speech sound sequences beginning with vowels and vowel combinations, consonant-vowels (CV), CVCV structures, VC, VCV, two word phrases, and final consonants. Go to our Blast Off Board page for specifics. I can assure you that using our magnetized pictures and overlays will give you a motivating and fun way to practice speech.
In addition to the Blast Off Board, our songs are also illustrated. You can print out the pictures and printed words to follow along as you practice singing the words to our songs.
When is your child the most vocal? Is it while you are in the park, playing rough-and-tumble games, swinging in a swing? Watch carefully and wonder about how to keep that vocalizing going. Wherever or whenever it is, participate in the game with your child, imitate him/her and occasionally make other sounds that your child does not say. Do not expect any imitation. Just enjoy the moment and the interaction. Take advantage of times when you can laugh and squeal with delight together. Keep doing it. It can be contagious, and it is during those times that you can create the model of the sounds that your child needs to practice. Repetition is key. Any activities where your child can practice vocalizing and repeat the same sounds and words many times is so helpful.
Sometimes, when children have severe speech and language problems, we become so focused on getting them to practice certain speech sounds that we forget about just having incredible VOCAL FUN! Verbalizing is hard work for children, so our job as parents, therapists, and teachers is to find ways to make the practice less of a chore and more of a sheer delight that will provide confidence in kids and empower them to initiate practice on their own. That seems so simple in theory but may be difficult to put into practice.
Our songs feature repetition that are excellent for children who need sound sequencing practice. For example, the word, bye, is repeated 73 times in the Bye Song. Repetition is essential to progress, and songs can give children a fun way to practice.
Chains of three
Because we know that moving from sound to sound is crucial in therapy for children with apraxia, we also incorporate “chains of 3” in our songs. Many of our songs will blend sounds or words 3 times sequentially to give children additional practice moving from sound to sound. For children who say some single words but are not able to use phrases, we find that saying a single word in a chain of 3 helps children get ready for phrases. With chains of 3, children can practice the motor sequence of many syllables without the grammatic complexity that a phrase presents. Chains of 3 is simply a step between single word productions and phrases.
Best wishes in your journey with childhood apraxia of speech. We hope that our products give you the speech and language practice that helps your child along the way.
Rachel Arntson, M.S., CCC-SLP
Owner of Talk It Rock it