DAS is one of the motor speech disorders, that is, a speech disorder with a neurologic base. Speech is produced when nerve impulses from the brain are transmitted via the nervous system to the muscles and structures of the mechanisms of speech. These include the lungs, vocal folds, soft palate, jaw, tongue, and lips. In motor speech disorders, the planning, coordination, and timing of execution of speech movements are impaired.

Apraxia occurs despite normal muscle tone, adequate muscle strength, and full range of motion of the lips, tongue, and soft palate. The child with DAS is able to organize non-speech movements, but has difficulty organizing speech movements in time and space. That is, he has difficulty sequencing speech movement (time) involving transitions in varying planes (e.g. vertical-horizontal or anterior-posterior). In order to diagnose DAS, deviations of muscle tone and imbalance and global neurological involvement must be ruled out.

According to Strand (2003), young children with DAS show five key characteristics:

1. Limited repertoire of consonant and vowel sounds.
2. Presence of vowel distortions.
3. Use of simple syllable shapes.
4. Difficulty in producing and reproducing the postures necessary to make a specific sound.
5. Ability to produce specific speech sounds in simple contexts combined with difficulty producing the same sound in a longer context.

However, the first four characteristics are often seen in other speech disorders and “Apraxia is a term that is frequently used too broadly to describe children with severe speech production difficulties” (Deborah Hayden, co-author of the Verbal Motor Production Assessment for Children, and the foremost authority on developmental motor speech disorders). “There is a great concern among speech-language pathologists and others regarding the overdiagnosis or misdiagnosis of childhood apraxia of speech” (Sharon Getz, in an article reviewed by members of the Childhood Apraxia of Speech Association Professional Advisory Board).

Developmental Dysarthria

Dysarthria is a motor disorder resulting from impairments in muscle tone, strength, or imbalance. When speech muscles are hypotonic (too little tone), they will lack the physical ability to make the rapid movements required for normal, easily understood speech and the strength to make precise contacts between the tongue and palate. Thus, vowels may be distorted, consonants requiring strength will not be present, and more complex syllable shapes will not be possible. Note that these are the first three of Strand’s five key characteristics for the diagnosis of DAS. They make it hard for some clinicians to differentiate between the two disorders. When speech muscles are hypertonic (too much tone), they have severely restricted range of movement resulting in speech that is very difficult to understand. Very often children with developmental dysarthria have a history of drooling and some have difficulty chewing and swallowing. At Let’s Talk Kids, Inc., we have evaluated several children who had been previously diagnosed as having DAS when they actually had developmental dysarthria.

Accurate differential diagnosis between the motor speech disorders is extremely important because they require radically different types of treatment. Children with dysarthria benefit from oral-motor exercises to muscle tone alteration to improvement of muscle strength to improvement of range of movement. Such exercises are of no benefit to children with DAS because these children have no underlying muscle imbalance. In this case, the use of oral-motor exercises may impede progress because they take up valuable therapy time. When children do have impairments in muscle tone, it is critical to choose facilitory techniques which do not worsen muscle tone. For example, stretching of muscles is used to reduce tone and allow hypertonic muscles more range of motion. At Let’s Talk Kids, Inc., we have seen far too many hypotonic children whose cheek muscles were being stretched thus making their condition worse.

The clinicians at Let’s Talk Kids, Inc are skilled in the differential diagnosis of motor speech disorders in toddlers, preschoolers, and older children. When needed our evaluation includes video tapped administration of the Verbal Motor Production Assessment for Children, an exhaustive oral-motor assessment by two of the foremost authorities in childhood apraxia. We are very proud of the fact that each child’s therapy program is individually designed to treat the specific features of that child’s disorder. As a result, we often achieve rapid, exceptional results.

Testimonials

My daughter was 4 1/2 years old when she began working with Lesley. She was completely non-verbal due to severe verbal apraxia, despite four years of treatment by four different SLPs. After receiving therapy for a year in a center that specialized treatment of apraxic children, we were told that my child would never speak. At that time, we began seeing Lesley. I am thrilled to say that my daughter has made remarkable progress. Within 6 months, she had been surprising me daily with new abilities in vocalizing and verbalizing. After 10 months of treatment, she had a vocabulary of several hundred words and was beginning to put words together in phrases. Currently, she uses complete sentences and "talks up a storm.” Lesley takes control of the therapy sessions, at the same time makes the exercises fun and exciting. My daughter now looks forward to her therapy session. I am continually impressed and amazed with the freshness of Lesley's approach and her ability to make therapy new for a child who had received therapy all her life. I only wish I had found Lesley sooner.
Margaret, mother of a severely apraxic child

My son has hypotonia (muscle weakness) due to a congenital condition. As a result, he exhibited drooling, tongue protrusion, poor speech intelligibility, and feeding difficulty. My son had Beckman oral-motor therapy through Early On, but the drooping of his lower lip kept getting worse. When he was two and ¾, we went to Let’s Talk for summer therapy. Lesley immediately told us to stop the stretching exercises we had been doing as these were making his muscles weaker and his lip droop more. She taught us exercises to improve his muscle tone, teach him to pull his tongue back into his mouth, and improve sensory awareness of saliva in his mouth.

Lesley has an amazing ability to keep my son focused during sessions (no easy task). She has a wealth of knowledge in this field – it is impressive to watch her work. My son is currently almost 3 and ½ and has made tremendous progress. His drooling is all but gone. His speech is becoming much clearer. He is finally chewing food and swallowing more efficiently.
Jennifer, mother of a child with developmental dysarthria

I have an eight-year-old boy named TJ who has autism and speech apraxia. Over the course of a few years, we had him evaluated by various speech therapists and communication disorder centers, none of which could provide me with a plan other than to “try to get him to say some words.” When TJ was about six and a half, I was lucky enough to find Lesley through another mom. With some trepidation, I took TJ for yet another evaluation. At that time, he had a total vocabulary of approximately six words and used pointing and sign language as his primary forms of communication. After meeting with my son and I and conducting various tests, Lesley sat down with me and outlined a program that she thought might help my son. Nineteen months later, I have been amazed every day at the progress that TJ has made. He has gone from saying a handful of words to speaking in multiple word phrases, reading aloud, and singing songs. Although he still finds it hard to understand at times and there are still some sounds that he cannot make, he continues to add new words and phrases to his vocabulary every day and now uses speech as his primary form of communication.

As a mom with a child who has special needs, I have to be especially cautious about the types of situations that my son is exposed to. When we met Lesley for the very first time, she looked at TJ not as a speech problem to be corrected, but as a child who needed help. The program she developed takes into account TJ’s autism and the various sensory and attention difficulties that go along with it. My son loves going to see the “talking doctor” and even practices the exercises Lesley has taught him without any prompting or reminders from me. Over the course of the last year and a half, I have gone from thinking that perhaps my child will never speak, to thinking that perhaps he might never be a great speaker, to believing that although he may always have a speech impediment, he will be able to be verbally communicate and be understood."

I am forever thankful to the mom who put me in touch with Lesley and to Lesley and the staff members at Let’s Talk who have dedicated their lives to helping children whom everyone else thought couldn’t be helped.
Susan, mother of a boy with autism & verbal apraxia