Apraxia of Speech or a Phonological Disorder?

Childhood Apraxia of Speech (CAS) is a motor speech disorder that is not due to muscle weakness. The brain has difficulty planning the movements that need to be executed by the mouth structures to result in speech. This results in difficulty with making voluntary speech sounds and sequencing or stringing them together in the correct order to make words. The child knows what he/she wants to say, but his/her brain has problems with coordinating the muscle movements necessary to produce those words.

Characteristics of CAS include:

Early Development

·         slow and late development of speech skills

·         limited early sound development; most vocal communication is in vowels only

·         limited ability to imitate speech

·         frustration with communication skills

·         use of grunting and pointing as a main mode of communication beyond 18 months of age

·         words used a few times and then never heard again

     Speech Characteristics

·         unintelligible speech

·         difficulty positioning the mouth structures for speech sound production (“groping”)

·         inconsistency of speech productions

·         difficulty speaking “on demand”

·         unusual and atypical error patterns

Phonological Disorders:

A phonological disorder is difficulty with the patterns for combining sounds clearly into speech. Find a description of phonological processes here.

Important Differences

1.    Language Skills

Although their receptive language or understanding is generally intact, children with apraxia usually have delayed expressive language skills. Children with phonological disorders may have expressive language skills closer to or within the normal range. While their speech is mostly unintelligible, they use lots of words and try to combine them into phrases and sentences.

2.    Copying Abilities

Children with apraxia usually have severe difficulties imitating speech sounds or mouth movements, while children with phonological disorders can copy movements, sounds or words, although their words might not be produced accurately.

3.    Consistency of Errors

Children with phonological disorders are generally consistent with their errors and exhibit patterns of errors, while children with apraxia are very inconsistent. They could say a word correctly once and then incorrectly a short while after.

4.    Vowel Sounds

Both children with phonological disorders and apraxia have difficulties with consonant sounds, but children with apraxia also substitute or sometimes omit vowel sounds too.

5.    Groping

Children with apraxia often look like they are searching for the correct way to position their mouths to form speech sounds.

It is important to contact a speech- and language therapist if you are at all concerned about your child’s speech development and –intelligibility.

For more information check out the following links:

The Source for Childhood Apraxia of Speech (LinguiSystems)

http://www.asha.org/public/speech/disorders/childhoodapraxia.htm

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Childhood_apraxia_of_speech

http://www.pammarshalla.com/blog/2011/08/differentiating-between-apraxia-and-severe-phonological-deficit/

http://teachmetotalk.com/2008/03/16/is-it-apraxia-or-a-phonological-processing-disorder-sorting-out-the-differences-in-toddlers-preschoolers-2/

http://testyyettrying.blogspot.com/2011/04/what-is-childhood-apraxia-of-speech-and.html

http://www.webmd.com/brain/apraxia-symptoms-causes-tests-treatments

Post by Elmien Truter

What are Phonological Processes?

What are Phonological Processes?

Phonological processes are the patterns of sound errors that typically developing young children use to simplify adult speech as they are learning to talk. All children use these processes while their speech and language are developing.

Young children do not yet have the ability to coordinate all the mouth structures such as the lips and tongue for clear speech, so they simplify complex words in predictable ways until they develop the coordination needed for clear articulation.

As children get older, their speech matures and they stop using these patterns to simplify words, which results in more understandable, adult-like speech. As every child is unique, each child will develop their phonology skills differently, but there are ages when it is expected that a child should stop using different phonological processes.

Below is a table describing the different phonological processes and the age by which they should likely disappear:

Substitution Processes

Phonological Process	Description	Examples	Gone by Approximately
Fronting	A sound produced in the back of the mouth, e.g. /k/ or /sh/, is replaced by a sound produced in the front of the mouth, e.g. /t/ or /s/.	car → tar sheep → seep	3:6 yrs
Backing	A sound produced in the front of the mouth, e.g. /t/ or /d/, is replaced by a sound produced in the back of the mouth, e.g. /k/ or /g/.	tap → cap duck → guck	Usually seen in more severe phonological delays.
Stopping	A fricative sound (e.g. /f/, /s/ or /sh/) or affricate sound (e.g. /ch/ or /j/) is replaced by a plosive/stop sound (e.g. /p/, /t/, /d/).	fish → pish sun → tun shoe → too thin → tin	3 yrs = /f/, /s/ 3:6 yrs = /v/, /z/ 4:6 yrs = ‘sh’, ‘ch’, ‘j’ 5 yrs = ‘th’
Deaffrication	An affricate (e.g. ‘ch’ or ‘j’), is replaced with a fricative or stop sound (e.g. ‘sh’ or ‘d’).	chips →  ships jump → dump	4 years
Gliding	Liquid sounds (/l/, /r/) are replaced by glide sounds (/y/, /w/).	leg → yeg ring → wing	5 yrs

Syllable Structure Processes

Phonological Process	Description	Examples	Gone by Approximately
Final consonant deletion	The final consonant in a word is deleted.	soap → sew dog → dah	3:3 yrs
Weak syllable deletion	The unstressed syllable in a word is deleted.	telephone →tephone banana → nana	4 yrs
Cluster reduction	A consonant cluster (two consonants next to one another) is reduced to a single consonant.	spoon → poon truck → tuck	4 yrs

Assimilation Processes

Phonological Process	Description	Examples	Gone by Approximately
Pre-vocalic voicing	An voiceless sound at the beginning of a word, e.g. /p/ or /k/, is replaced by a voiced sound, e.g. /b/ or /g/.	pig → big key → gey	3 yrs
Word final devoicing	A final voiced sound, e.g. /d/ or /g/, is replaced by a voiceless sound, e.g. /t/ or /k/.	bed → bet bag → bak	3 yrs
Consonant harmony	A sound starts to sound like another sound in the word.	bus → bub cat → tat	3:9 yrs

Click here to download the PDF version of this table.

A phonological delay is when a child continues to use these processes beyond the age when most typically developing children have stopped using them.

It is important to consider contacting a speech- and language therapist for an evaluation if you are concerned regarding your child’s speech intelligibility and/or suspect a phonological delay.

Information for this post was gathered from these sources:

1. http://mommyspeechtherapy.com/?p=2158
2. http://www.playingwithwords365.com/2011/09/phonological-processes-and-phonological-delay/
3. http://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=30:table2&catid=11:admin&Itemid=117
4. http://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=31:table3&catid=11:admin&Itemid=117

Post Submitted by Elmien Truter

Happy Holidays

If you are like me (and most women in general) then you too peruse the malls for any bargain you can find. One of my favourite elements of retail shopping is looking for new therapy material. There are three toy shops in my area that I frequent, and I have started to consider myself a bit of a collector now. There are also specific brands of toys that I am beginning to prefer.  That’s not what I want to talk about today though. Today I want to bring up those awesome little discoveries that one finds unexpectedly. Actually, I now expect to find these awesome discoveries twice a year, namely at Christmas and Easter time at Woolworths. Their holiday items are becoming more arbitrary but I do find them rather exciting. The most exciting part for therapists and parents is that if you hang on a week or two after said holiday these items are reduced to anything from 25-75%.

A few years ago I found the loveliest farm-animal finger puppets that came with a small Easter egg inside; the year before that it was full sized Winnie-the-Pooh puppets over a giant Easter egg. This year it is little plastic robots and plastic ice-cream cones that open with an explosion of jelly beans. Now what does a robot or ice-cream cone, have to do with Easter you ask? Well if you come up with the answer please let me know too! I’m not complaining though because I am finding some very exciting uses for these in therapy and the jelly beans disappeared amongst our therapy staff very quickly.

I have loved hiding targets for vocabulary and articulation in these little toys and the children I see have loved it too. The element of surprise has been a real help in keeping the attention of otherwise inattentive little kiddos.

The basis of articulation therapy is really to get as many drills of the target sound in the desired word position as many times as you possibly can. Articulation therapy is quite a process and for more detailed information please click here and here. I use pictures to target specific sounds and I often use Black Sheep Press or the lovely articulation sheets from Mommy SpeechTherapy. I then cut them apart and lay each one face down on the table. I have been quite predictable in that I have used the ice-cream cones for the girls (they are in pretty pink and purple colours) and the robots for the boys. I have then either the robot or the ice cream cones out on the table too. The child takes one picture at a time and then says the target word (so we can learn what the pictures are) and then hides the picture in the toy. Once all the words are hidden I then hide the robots/ice cream cones around the therapy room. The child then gets to run around finding them (Like an Easter egg hunt, just to make them relevant). When they find one they have to open it and use their best sound to say the word (voila! spontaneous production!).  

I’m going to enjoy these little gems until the next holiday season comes around.

For more information on what articulation disorders are check this out.

For more resources for articulation therapy ideas go here.

For the love of Pirates

preschoolers.about.com

So this weeks post was a little later in coming out as I have had my fair share of busy-ness but it is a topic that has been on my mind as long as this blog has. Please feel free to comment and add your own ideas!



preschoolers.about.com

I must say that growing up I was a very girly-girl and although I was intrigued by all things “Under the sea” I only ever gave thought to pirates after the appearance of the oh-so-swaggering Captain Jack Sparrow. The Pirates of the Caribbean series seemed to spark a renewed interest in this age-old theme. Until then pirates had a bit of a bad rap and in some cases still do (deservedly- thanks Somalia!). Their value in a therapy session, though, is incalculable. To the 4-8 year old population this topic holds a mystical sense of adventure that I take full advantage of. I’m not alone in this. There are many resources and blogs out there that are also capitalising on this franchise. One of my favourite bloggers, Brea, from ‘Let’s talk SLP’ has come up with a whole pirate package. This is full of fun and useful therapy material that focuses on articulation and language skills. I have acquired some of these and have frustrated my poor husband by spending my evenings cutting, laminating and re-cutting these gorgeous pictures. My favourite one is the pirate barrier game. It is a great way to elicit language and to introduce the rest of the series.  

In my own toy cupboard I have a treasured game: “Pop-up Pirate-Treasure Island”. This is one in a series of Pop-up Pirate games by TOMY®. I am still trying to get hold of the original Pop-up Pirate here in SA but it seems impossible. A former colleague had this version and the kids went mad over it! I had one little boy in particular who was so enthralled by this game that his mom and I both went on a treasure hunt looking for it for him. I eventually found a very cheap Chinese knock-off that did the trick.

 

Now there is actually value in my ramblings. The original Pop-up pirate was not only useful for keeping attention and making therapy fun but I would often use it in auditory processing tasks.  The game includes swords in 4 different colours; the point of the game is to put the swords into a barrel, when you hit the right spot the pirate pops out. It does well in creating suspense and lots of giggles. I would place the swords on my minimal pairs picture when targeting auditory discrimination. The child would be required to pick the sword from the picture he heard. I would also use them in auditory sequencing tasks. For example I would lay out one sword of each colour and then give an instruction like: “take the red one first and then the yellow one” or “take the blue one, then the green one and then the red one”. It was then simple to work out what level we would be working on for auditory memory and sequencing.  These tasks would not form the whole therapy session but form a productive part in the positive reinforcement section of my session.

The Pop-Up Pirate- Treasure Island game is fairly new in my repertoire so I have not yet had the fun of figuring out all its hidden secrets. It can definitely be used for more advanced auditory sequencing tasks as it contains 6 different coloured keys. This week I also had the opportunity to use it with a little articulation guy. He has particular difficulty with the /k/ and /g/ sound as he fronts these to /t/ and /d/ respectively. His attention is very poor so he finds it hard (and boring) to do traditional drills. This game gave us the perfect platform to do lots of repetitions of the target words /key/; /gold/; /coin/; /back/ and /lucky/ as he has had lots of practice with both /k/ and /g/ in all word positions already. I could’ve taken it even further by hiding his other target words under the barrels where the keys get hidden. In fact that is exactly what I’m going to do in our next session. The exciting bit about this game is that you never know when the sneaky pirate is going to pop out of the treasure chest and demand his gold back. I foresee myself using this game for many different language targets (prepositions are easy to elicit with this) and sentence expansion.  I have seen that TOMY® have also come up with a Captain Jack Sparrow Pop-Up Pirate. That may be another acquisition I’ll have to make!

Until next week then! Oh and if you want some more ideas for auditory processing tasks then look at these links:
1. https://pinterest.com/schoolsparks/auditory-processing-activities-for-kids/
2. http://www.speakingofspeech.com/Auditory_Processing.html
3. http://sensoryplanet.com/blog.php?user=BodyLogique&blogentry_id=492