Previously, we provided an overview of verbal dyspraxia or childhood apraxia of speech. We hope that you were able to gain some useful information regarding this motor speech concern. If you have missed out our previous post, you can check it out here: http://headstartforlife.com.sg/beyondtherapy/speechtherapy/my-child-has-verbal-dyspraxia-what-does-that-mean/

In this post, we will be discussing about several strategies that are used in intervention for our children. Before we move on, it may be helpful to remember the following matters when working with children exhibiting signs of verbal dyspraxia:

• CONSISTENCY- An hour or two of speech therapy drills wouldn’t be enough, follow-up at home is very important. Consistent follow-up will help the child in absorbing and remembering the word and how to say it (motor).

• PATIENCE- Provide enough time for the child to think of what to say and how to say it. Give your child at least 10 seconds of “thinking time”.

• GENERALIZE- Provide various opportunities to let the child say the word. For example, target the word “help” during meals, bath and play.

Given the complexity of verbal dyspraxia, one can come across numerous approaches on addressing it. The ones we will mention are just some of the various examples. Deciding on its implementation depends on several clinical factors such as the severity, age of the child, response to prompting, evidence-based background of the approach, etc.

Imitation of oral movements. 

There has been different perspectives on administering non-speech motor movements as a way to address verbal dyspraxia. Some raised the concern that it doesn’t translate to speech. Some believe it helps in raising the child’s awareness on the movements related to speech. Deciding on this matter would depend on the child’s level and the clinician’s assessment. Some examples include:

Oral movements/non-speech movements	Rationale
Breathing exercises (blowing bubbles, blowing candles)	To develop awareness of oral airflow which is important since most speech sounds are oral (from the mouth). Nasal sounds are m, n, ng.
Performing actions upon demand (open the mouth, elevate the tongue tip, smile)	To increase his/her ability to execute movements precisely such as opening the mouth may translate into “ah”, elevating the tongue tip for “t, d, l” and smiling in relation to “ee”.

Speech sound development target.

Children with verbal dyspraxia usually exhibit difficulty even with the early developing speech sounds such as vowels, diphthongs (vowels together) and consonants /m, p, b, h/. Oftentimes, it helps to address and refine these early developing sounds then facilitate the difficult speech sounds.

Baseline and Stimulability. 

Considering how children with verbal dyspraxia present varying and inconsistent errors, a developmental approach of choosing speech sounds may not always be the way. At times, some are able to produce the difficult sounds such as “sh”, “r”, “s” during the initial observation. This is when we can decide to start teaching based on the child’s strengths or how well he/she responds to prompts.

Speech hierarchy and syllable structures. 

Once you’ve determined the necessary speech sound/s to teach, it’s time to decide on the hierarchy and syllable shapes. Hierarchy discusses on whether to start in isolation (practicing the speech sound by itself such as “ah”), syllable (“p” + “ah”) or word (“papa”). Syllables come in a variety such as CVCV: consonant + vowel + consonant + vowel (papa), CV: consonant + vowel (me), VC: vowel + consonant (up), CVC: consonant + vowel + consonant (pop), etc. The number of syllables in a word should also be taken into consideration, it is easier to say a word with 1 syllable such as “up” rather than a word with 3-4 syllables such as “television”.

Word list and approximations. 

After identifying the sounds and hierarchy, it’s time to create a word list! This will help in monitoring the progress and managing expectations. When creating a list, it is recommended to begin with functional words. Children with verbal dyspraxia try their best to imitate but fail to do so accurately. Thus, accept verbal approximations as an initial step. Here are some examples of functional words and approximations:

People	mama, papa, I, me, you
Signals	help, no, yes, hi, bye
Actions	eat, wash, bath, play

 

Category	Word	Approximation
People	mama, papa	“muh”, “puh”
Signals	help, bye	“hep”/“ep”, “buh”
Actions	eat, play	“ee”, “pe”/”pey”

Singing and humming.

Some children with verbal dyspraxia may sound monotonous and plain. Engage your child in singing or humming familiar songs (Happy birthday and Twinkle, twinkle little star) in different ways- loud voice, high voice, slow paced or fast manner.

Drills. 

Demanding too many speech sounds and words may be confusing especially for children with motor planning difficulty. Some severe cases entail targeting one goal consecutively within one fun activity. For example, take turns playing on the slide by letting the child say “up” before climbing. Try to keep this engaging drill for at least 10 consecutive times.

Be fun and functional. 

Children feel more encouraged when practice is incorporated in motivating and fun tasks! If drills are always done table top, in structured worksheet form, they might see it as a routine and would not be able to really apply it in actual everyday contexts. Remember, repetitive drills are actually tiring for children. Incorporating fun activities take off the stress in performing repetitive drills. Fun tasks may include playing with toys, playing movement games with another person, preparing a simple meal and usual activities (eating, bathing, washing).

Augmentative/Alternative Communication. 

For some children, speech may take time, too difficult and frustrating. We don’t want these children to feel discouraged and reject the idea of verbalizing. We would want them to continue communicating through verbal attempts and approximations with other modalities such as gesturing, writing, showing pictures and using electronic devices with communicative applications.

 

Conclusion:

The above are just some examples of ways to address verbal dyspraxia and really, there are other ways and there is no one way better than another. It all depends on the individual child and what works. But some parameters will need to remain constant and that is the positive energy, patience and support of all those around.

 

References:

Dauer, K.E., Irwin, S.S., & Schippits, S.R. (1996). Becoming verbal and intelligible: A functional motor programming approach for children with developmental verbal apraxia. Austin, Texas: Pro-        ed.

Kaufman, N.R. (2006). Kaufman speech praxis treatment kit for children manual. Gaylord, Michigan: Northern Speech Services, Inc.

The Nuffield Hearing and Speech Centre. (1985). Dyspraxia Programme. London: The Nuffield Centre.