If he isn't talking yet, you can begin with apraxia
strategies like oral motor sequences with a favorite adult in the
mirror, sensory stimulation to the oral area with tooth brushing,
eating etc. and help him develop some awareness of what mouths do. Add voice when you can for fun and with non-word utterances at first (especially if there is a real psychological factor here). Enjoy sound sequences that can be shaped into words when he is ready.
Some of these little ones also respond well to supplimenting utterances with simple words in sign as they speak. It seems to help them sequence where words go and takes the "talk right" pressure off, because they can vocalize with the sign and be understood. As the speech develops, the sign naturally drops. We have had kids in a birth to three program who got verbal words much more quickly when they could sign "more" then "more milk", always with the expectation and model that voice goes with signs. The adults have to use it consistently too. If they have complex things to relate, use a photograph of the book, play center, etc. that they want. Again you expect and praise any vocalization that goes with the picture pointing. If you get only an "uh", model something simple but appropriate to say as you "repeat his pointed utterance". The words, being more efficient, usually come quickly with bright kids. And these activities even seem to help process the oral motor sequences somehow. Brains of little ones are so plastic and wonderful.
Posted to communicative@listbot.com on April 24, 1999 by Suzanne Rao, M.Sc., B.Sc.(C.D.), S-LP(C) Reg. Speech-Language Pathologist ACHIEVE Speech, Language & Learning
Clinic B.C., Canada
The treatment program for children with speech apraxia must be individualized and flexible. Here are some general strategies I have used effectively over the past 15 years for children with developmental speech apraxia and normal hearing. I hope these ideas will be of some help to you.
- Frequency, type and consistency of intervention are important.
To treat speech apraxia, the speech-language pathologist needs to
provide intensive direct therapy. The child's caregivers/assistants
need to participate by doing daily follow-up activities with the child
at home/school.
- Divide the larger (longterm) goals into smaller (short-term) steps which are concrete and measurable, so that the child and caregivers can see progress. This maintains their motivation for doing home follow-up/practice activities. If the steps
are too longterm, the family may feel frustrated because they do not
perceive the more subtle (but still meaningful) changes in the child's
speech.
- Help the child develop a positive self-image of
himself/herself as a communicator.
- If the apraxia is severe to
profound and intelligibility is poor, introduce augmentative
communication (e.g. sign language, communication boards) as a bridge to
oral communication, while still working on oral speech. This way, the
child can continue to develop linguistic and social interaction skills,
which would otherwise be held back by the articulation impairment.
When selecting a sign language, keep in mind that the idea is to
integrate the child into their English-speaking environment, not into
deaf culture (if the child is also hearing impaired/deaf, then you have
other considerations as well). Choose an English-based sign language
(e.g. Signing Exact English or Signed English). Use "universal"
gestures instead of signs wherever possible, e.g. nod head to mean
"yes" rather than doing the hand sign for "yes", because "naive"
(untrained) communicative partners in the child's environment will all understand nodding.
- Teach pacing: a slower and more rhythmic
rate of speech
- Teach early developing and frequently occurring
consonants first.
- Teach oral-motor awareness.
- Associate tactile and visual symbols with sounds. I have
developed a set of phoneme-grapheme association picture symbols which have been effective for both speech training and literacy training. If the child does not have limb apraxia or motor planning problems, sign language and gestures also provide effective associations. An example of a simple gesture is running the index finger of one hand down the opposite forearm, to represent continuity of a sound (e.g. for fricatives).
- Practice the sounds in the context of frequently
occurring words and vocabulary relevant to the child's daily life.
Progress from individual consonants (e.g. "p") to nonsense syllables
(e.g. "po") to single syllable words (e.g. "pop", "pee", "up").
- Multisyllabic words need to be taught separately, using pacing and tactile cues. The biggest challenge for people with apraxia is
coordinating articulatory movements during quick movement sequences, e.g. diphthongs, consonant blends, progressions between syllables and in conversation.
Beyond Speech Therapy provides information and therapy materials for neurological speech and swallowing disorders including Aphasia, Dysphagia, Apraxia and Dysarthria.
Time to Sing is a specially-designed, slow-paced CD of children's favorite music
here
last modified April 1, 2002
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