Gifted Issues Discussion homepage Forums Twice Exceptional Suggestion of apraxia diagnosis

Hello to all --

My first post to these forums, and I hope to find perspectives and perhaps some encouragement from all of you who've walked this path before me.

My son is 27 months old, and has shown signs of being advanced practically since birth (motor development, ability to focus for extended periods, rapid learning of new skills, large receptive vocabulary and beginning to read letters). No testing to officially declare gifteness yet. I was a highly gifted kid, so the same is possible for him.

Here's the reason for my post: he's not talking. No other delays, he's just a man of few words. We've been in speech therapy for about six weeks and are making progress quickly -- he's now attempting all kinds of sounds, he vocalizes constantly, and has a small number of words that anyone could understand (and a few more that only the 'insiders' can understand). This is great, and this rapid learning curve is consistent with everything I've seen from my son since birth.

Yesterday, our SLP mentioned in passing she thinks he has apraxia of speech. I promptly did some searching online, which yielded great information, but of course without any context to my son's situation. Things that scared me included that he'd need years of therapy and still may not speak well, and that this could impact his education.

We're having a second speech eval done tomorrow (long story, but it has to do with limited insurance coverage), and I will be interested in this second party's opinions. She may have already seen apraxia in our current SLP's notes, but I have not yet mentioned it to her -- in a perfect world, these evals would be done truly independently to avoid coloring judgment unnecessarily.

For those of you who have kiddos with apraxia, I'd appreciate feedback regarding the duration and success of speech therapy, and how they've done in school since then. Did you struggle with your school not seeing beyond the label of apraxia -- that your child also happened to have quite a brain in that little head?

Thank you in advance,

Maria

I'm curious, did she explain at all why she thinks he has speech apraxia, given that he's only just turned 2, and is making progress in speech therapy?

Ah -- an excellent question. She sees that he has a hard time coordinating his face and mouth muscles to make sounds and words. Initially she saw him "groping" with his face and mouth before making any sounds or words, but that happens very infrequently now that we're six weeks into therapy.

His current obstacle is adding a consonant on the end of a vowel (e.g., in, up, on, open). His motor skills are otherwise quite good (he walked at 9.5 months), including fine motor skills using hands and even feet. It's daunting how much coordination he has, even with chubby little two-year-old fingers!

Thank you for the question!

Ah, I understand. Well hopefully with the early help you are getting him he'll work through it quickly.

I will post tonight or tomorrow.

I sent you the info in a PM. :-)

I appreciate both of you taking time to respond (special thanks to quaz for the PM!).

An update after this morning's eval by a different SLP...

My son offered quite a few different sounds and words (his versions of them, anyway) to the SLP. I was pretty impressed. At the end of the eval, she and I spoke for a few minutes (in a level of language we did not think he'd understand). She was also pleased with where we are today as compared to our first eval in mid-September. Lots of good progress.

I then asked her about apraxia. One thing I feel important to highlight: I would not ask one SLP to critique another SLP's methods, opinions or perspectives. That's an incredibly difficult (and unfair) position in which to put someone. With that said, I told her that apraxia had been mentioned, and that I was having some difficulty absorbing this diagnosis. Her response was that apraxia is usually not a diagnosis that can be made until age three. A child can display apraxic (sp?) symptoms when they are speech delayed because they're struggling to make their mouth work properly, but not necessarily be apraxic. Because what she saw today was such a leap over the initial eval, she was not necessarily hurrying to concur with a diagnosis of apraxia.

She said that such a diagnosis CAN help with insurance coverage. Since that is one of the things we're wrangling with now, it is possible our current SLP is using apraxia in her letter of medical necessity in hopes our insurance plan will waive their annual visit maximum.

I realize that this second SLP only had 45 minutes of observing my son, and in a limited amount of time it's hard to gather all information -- our current SLP has had the benefit of six weeks with my little guy! So if she spent more time with him, perhaps she'd observe the same things as has our current SLP. But, it was reassuring to have someone else say he's making good progress. I will take wins where I can get them! We'll take each day as it comes.

Thank you to all! Have a great weekend!

Yes, I thought the progress was very good considering the short term duration, and is the one item that makes me wonder about the initial diagnosis.

Apraxia I feel is a tricky diagnosis. You saw in my PM, how we went years without a diagnosis. I even had one SLP via the school tell me there was no such thing as apraxia! There are many views of it and misconceptions. Yes, some say it shouldn't be diagnosed until 3, and some say 2. I think because there is SUCH a big change from 2-3, that many SLPs do go with 3. It is also something that can be overdiagnosed.


When we did get the diagnosis, it was via a place that dealt with apraxia. I did question the diagnosis, because there were aspects that just did not fit. (like the fact my child was talking). I think the best input I got was to think of Apraxia as a spectrum disorder. That really made sense to me.

I think at this phase, for your case, the apraxia diagnosis is a good thing.

I think that is far better to have that as the initial diagnosis, and then later have to back off of it if it is determined it isn't apraxia, than to be in the position we were, with a different diagnosis, only to find out much later that it was apraxia. That impacts early years of therapy.

Because apraxia is a neurological speech disorder and is not developmental, yes, it is something that insurance is more apt to cover than not.


This article is alright
http://www.associatedcontent.com/ar...signs_of_apraxia_in_children.html?cat=25

I do like this quick definition of it.
To condense the lengthy medical definitions, apraxia basically is a neurological impairment that involves the planning, executing and sequencing motor movements. Verbal apraxia is a term borrowed from adult victims of accidents that have robbed them of some speech ability; when children are verbally apraxic, it is a neurological problem that affects the rapid sequence of muscle movements needed to make the sounds of speech. Oral apraxia is closely related to verbal apraxia, but includes impairment in non-speech functions, such as blowing, puckering, sucking, or licking lips. Verbal and oral apraxia tend to overlap in diagnosis.


This list on the second page of the article...
Now, if you have a late talker, there isn't necessarily a reason to panic. But, if your two year old isn't talking and also has these symptoms:
*excessive drooling
*inability to lick peanut butter or other foods off lips or from around mouth
*inability to pucker to make a kiss sound
*inability to drink from a straw
*difficulty forming consonant sounds
*has limited facial expressions ("the serious child")

*seems to have difficulty with certain food textures

My child hit 4/7. I think the thing with apraxia, is that there is probably more than just speech. The checklist above shows some of that... but there are things likes
Sensory, low tone, coordination (fine motor), oral apraxia...