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childhood apraxia

Childhood Apraxia: The Facts

Childhood Apraxia of Speech (CAS)

Childhood apraxia of speech (CAS) is a neurologically-based motor speech disorder. Children with CASChildhood Apraxia: The Facts have difficulty producing speech sounds in the absence of muscle weakness or paralysis. Though a child with CAS knows what he/she wants to say, impairments in planning and/or coordinating lip, tongue, and jaw movement results in speech sound errors and differences in prosody (patterns of stress and intonation).

CAS is uncommon, occurring in 1-2 children per 1,000. It affects more boys than girls and occurs more frequently in children with galactosemia, fragile X syndrome, and Down Syndrome.

Acquired Apraxia of Speech versus CAS

There are two main types of apraxia of speech: acquired and developmental. Acquired apraxia of speech (AoS) is caused by damage to the parts of the brain involved in speech production and involves loss or impairment of existing speech skills. Causes of AoS include stroke, head injury, tumor, or illnesses affecting the brain. This disorder may occur with muscle weakness affecting speech production or language difficulties caused by brain damage. In contrast, CAS is present from birth and occurs in the absence of any muscle weakness or paralysis.

Cause of CAS

The cause of CAS is yet unknown. While some researchers believe that CAS is a disorder related to overall language development, others believe it is neurologically based and that it disrupts the brain’s ability to send signals to move muscles involved in speech production. Recent research also suggests a genetic component to this disorder, as children with CAS often have family members with a history of communication disorders or learning disabilities.

Diagnosing CAS

There is no universally agreed-upon list of diagnostic features that differentiates CAS from other childhood speech sound disorders such as phonological disorders or dysarthria. However, three characteristics of CAS are generally accepted by researchers and speech-language professionals:

  1. Inconsistent speech sound errors on consonants and vowels across repeated productions of syllables or words. While a child with an phonological or articulation disorder may make the same error each time he/she says a particular word, a child with CAS will not demonstrate a consistent pattern in his/her errors, even when repeating the same word.
  1. Longer and disrupted coarticulatory transitions between sounds and syllables. Children with CAS have difficulty combining sounds to form a word and may produce long pauses between sounds.
  1. Differences in prosody. Children with CAS produce speech that sounds choppy or monotonous, with stress on the wrong syllables.

Other Possible Signs/Characteristics of CAS

Young Children:

  • No cooing or babbling as an infant
  • Late development of first words
  • Production of limited set of consonant and vowel sounds

Older Children:

  • Numerous substitutions, deletions, and distortions of sounds
  • Understands language significantly more than can speak
  • Difficulty imitating speech, but imitated speech is more clear than spontaneous speech
  • Groping behavior when attempting to produce sounds
  • Saying longer words or phrases are more difficult to produce than shorter ones
  • Difficult for listeners to understand speech
  • Speech sounds choppy or monotonous or the wrong syllables are stressed
  • Distorted or inconsistent vowels

Possible Concomitant Conditions:

  • Language delay
  • Word finding or word order difficulties
  • Fine motor coordination difficulties
  • Oral hypersensitivity
  • Difficulty learning to read, spell, and write

Treatment of CAS:

Children with CAS receive frequent and intensive one-on-one therapy, tailored to their specific speech and language needs. Treatment focuses on improving speech imitation skills, speech-based motor sequences, length and complexity of producible syllable patterns, teaching rules of speech sound patterns, and, in severe cases, using augmentative communication systems (e.g., picture exchange communication system).

If you believe that your child shows signs of CAS or another speech sound disorder, do not hesitate to consult with a speech-language pathologist.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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help your child learn to listen

Help Your Child Learn to Listen

If you spend a frequent amount of time with a young child, you know that one of the most common directions you find yourself saying is, “LISTEN!” Telling a child to listen seems like an easy enough request, right? When in actuality, listening is a skill that children have to develop and improve upon as they age.

When a child carries out a direction incorrectly there are many different factors that could be preventinglearn to listen his or her ability to be successful. Successful listening requires adequate attention and motivation to the current situation. If those components are not present, comprehension or retention of what is said will not be optimal. The best way to help a child be more successful is to teach them how to attend to what is being said. If your child is struggling to follow directions at home or at school, use the following four strategies to help them attend to the information that is being presented to him and her, which will ultimately help them become more skilled listeners and be more successful.

Strategies to help your child attend/listen:

  1. Look at the speaker – Make eye contact with the person who is talking.
  2. Quiet body – Keep your mouth, hands and feet quiet or still.
  3. Think about what is being said – Echo the directions in your mind or out loud. Repeating directions is a good strategy as it increases the retention of the presented information.
  4. Ask if you don’t understand – It’s important for children to develop self-advocacy skills and to feel confident when asking for clarification or extra help.

Use the visual aid to the right as a remainder for kids to use their listening strategies. This can be printed off and taped on his or her desk or hung on the refrigerator. The more the strategies are referenced, the more a child will become familiar with them and start to use them.

It is possible that there may be an underlying issue behind a child’s poor listening skills, such as language comprehension deficits, an auditory processing disorder or even an undiagnosed hearing loss. Consult with your child’s speech-language pathologist if a child continues to struggle with following directions or listening in the classroom.


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NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

The Basics About Down Syndrome

 

 

 

Down syndrome is thought to be the most common genetic causes of cognitive impairment.  This condition has been found to occur in approximately 1 in 800 live births.  Down syndrome results from an extra copy of chromosome 21.

Children with Down syndrome often exhibit issues with their learning and processing of information.  Specific concerns that are often seen in individuals with a diagnosis of Down syndrome include:girl with down syndrome

  • Moderate cognitive impairment
  • Weakness with grammatical aspects of language
  • Impairments with verbal short term memory
  • Weakness with daily living skills

Children with the syndrome do show areas of relative strength and it is important to utilize these areas to help develop additional skills and compensate for areas of concern.  Domains that are often seen as a relative strengths include:

  • Spatial reasoning tasks
  • Visual memory
  • Social skills

There have been numerous studies which indicate a multi-tiered treatment approach can be beneficial to help children with a diagnosis of Down syndrome, including:

  • Speech and language therapy with possibly teaching sign language
  • Use of a visually based intervention teaching reading and vocabulary skills
  • Emphasis on the development of phonological awareness to improve reading
  • Use of rehearsal and repetition to enhance memory skills.
  • Occupational therapy for sensory integration and motor development
  • Parent training to emphasize the use of structure and planning

 

Hunter, S & Donders, J., eds. (2007)  Pediatric Neuropsychological Intervention








 

 

Is Your Baby’s Drooling Normal or Excessive?

Parents often wonder if it’s normal for their child to drool. You might notice your child’s toys are covered with saliva after playing, or you may notice a soaked shirt-collar throughout the day. The short answer to the question “is drooling normal?” is “sometimes.” At certain points in your child’s development, drooling is completely typical. At other points in his development, it is atypical and may require further intervention.

Developmental stages of drooling:

According to Morris & Klein in Pre-Feeding Skills, Second Edition, the following stages of drooling can be expected as your child develops:

  • One – three months: From one to three months of age, drooling is rare when your child is in a supine or reclining position (lying face-up), although some drooling may be noted when he is in a prone or a supported sitting position.
  • Six months: By six months of age, drooling is more controlled when your child is in supine, prone or seated. You may notice drooling as your child babbles or uses his hands to play, point or reach for objects. Drooling may also be noted as your child is teething or in response to eating particular foods.
  • Nine months: By nine months of age, drooling rarely occurs during gross motor activities, such as crawling or rolling. You may still notice drool in response to teething.
  • Fifteen months: By fifteen months of age, drooling rarely occurs during gross motor activities, such as walking and running, although you may notice some drooling during fine motor tasks, such as stacking blocks or manipulating objects. It may also continue in response to teething.
  • Eighteen months: By eighteen months of age, your child no longer drools when attempting fine motor tasks. Drooling may occur during feeding, dressing, play, or teething.
  • Twenty-four months: By twenty-four months of age, noted drooling is minimal.

Why children drool:

Saliva serves many necessary functions. It helps bind food together as we eat, which is important for safe swallowing. Saliva also aids in the digestion of food and helps keeps our oral cavity clean.  For the average child, unnecessary loss of saliva stops around age 4. For other children, however, it can be excessive.

According to Morris & Klein in Pre-Feeding Skills, Second Edition, the following possible causes of excess drooling might include:

  • Teething, which results in more saliva production.
  • Poor oral sensory awareness, resulting in decreased triggering of swallowing. If a child’s face is constantly wet, he may be less responsive to sensory cues that signal a need to swallow.
  • A constant open-mouth posture, which prevents saliva from building up and triggering swallowing as needed.
  • Difficulty swallowing efficiently, which may be due to poor head and trunk control, poor jaw stability, or increased or decreased muscle tone in the lips.
  • A response to certain foods.
  • A response to motor activities that require balance.
  • A possible side effect from specific medications.

How to help your child if he is drooling excessively:

If you feel concerned about the frequency and amount of drool, seek help from a licensed speech-language pathologist, feeding therapist, or occupational therapist. Your child’s therapist will help you determine the underlying cause of your child’s drooling and specific interventions.

Therapeutic interventions might include the following:

  • Increasing oral-sensory awareness to help your child better assess when his face or mouth is wet.
  • Improving head and trunk control to achieve better control of efficient swallowing.
  • Improving oral-motor control (i.e. lips, cheeks, jaw) to better manage saliva and efficient swallowing.
  • Helping your child achieve a closed mouth posture.
  • Improving your child’s ability to swallow.
  • Teaching your child about concepts such as “wet” and “dry.”

By working with a licensed professional, you can eliminate the uncertainty you might be feeling and find answers to your questions.  Most importantly, your child will receive the help he needs to better manage how much he drools.

Sources:

Morris & Klein. (2000). Pre-Feeding Skills, Second Edition.  Austin, Texas: Pro-Ed.

NSPT offers services in BucktownEvanstonDeerfieldLincolnwoodGlenviewLake BluffDes PlainesHinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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Learning Through Play Time with Your Toddler

Play time provides a natural context for early language learning and is also important for the development of social communication skills. Childrentoddler playing learn through play and often practice newly acquired language skills and words during play time.

There are three stages of play development:

  1. The first stage is referred to as “self-related” symbolic play. This type of play can be observed between 12-18 months. This type of pretend play mimics daily activities using real objects. A child at this stage of developmental play typically plays alone. For example, a child will pick up a cup and pretend to drink.
  2. From 18-24 months, a toddlers’ play progresses to “other-related” symbolic play. The child is still using real objects, but will perform the action on multiple play toys. For example, the child will use the cup to give a drink to a doll, offer a sip to the bear, and finally have a drink herself.
  3. The final stage of play development is “planned” symbolic play. This stage of developmental play emerges between 24-30 months of age. Play behaviors include using one object to represent another, such as using a stick for a spoon. At this stage, the child has also begun to plan out play sequences by gathering all necessary props prior to engaging in a play routine. She might use a doll or other play toys as the agents of the play action. For example, the child will have the doll give the bear a drink.

Suggestions for Toys:

  • 12-18 monthstoy kitchen set, toy garage set, zoo animals. All of these toys provide multiple opportunities for parents to sequence a variety of play time routines for the child to imitate. This is where we as parents and caregivers must dive into our inner child and start using our imagination!!
  • 18-24 monthspuzzles, farm set, pretend painter’s/doctor set. These toys provide the child with multiple opportunities to start acting out and initiating their own play routines and to use their own imagination, as well as allowing for multiple play partners and toys to be used. Be prepared to clean up a big mess!

Following these guidelines should  help you use age-appropriate play with your child. Developing play skills will expand your child’s language and social communication.

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Navigating Early Speech & Language Milestones: What to expect between age 1 and 2

Parents often wonder if their child’s skills are developing typically.  Between gross motor skills, fine motor skills, speech-language skills, social-emotional functioning, and overall growth, there’s a lot to keep track of!  In fact, it might feel overwhelming.  Mother communicating with infantIt’s important for parents to remember that every child develops at their own rate, with some skills emerging faster, and other skills taking more time.  When considering your child’s development, referring to developmental milestones can be an excellent guide.  In Part 1 of this blog, we reviewed speech and language milestones to expect during the first year of your baby’s life.  In Part 2, we’ll review communication milestones you might expect to see between age 1 and 2.  If you begin to feel concerned regarding your child’s development, seek help from a licensed professional right away.  A trained therapist will give you accurate information, ease your worries, and if needed, give your child any help they might need.

Speech & Language Skills Emerging Between 1 and 2 Years

1 – 1½ years

Your child might:

  • easily understand his own speech
  • use a variety of words (between about 3-20) to communicate
  • understand between 50-75 words to communicate
  • be able to point to various objects or body parts as you say them
  • be able to follow simple 1-step directions
  • use words that contain a consonant + vowel (e.g. “bo” for boat)
  • be eager to imitate words they hear others say
  • use some jargon when they’re communicating
  • request things by pointing or vocalizing
  • let you know what they don’t want, by shaking their head “no” or pushing objects away

1½ – 2 years

Your child might:

  • be likely using more true words, and less jargon to communicate
  • be asking questions by using a rising intonation
  • begin to include sounds at the end of their words (e.g. hot)
  • use more than 50 words to communicate
  • understand about 300 words to communicate
  • begin to combine words into simple phrases
  • be able to follow 2-step related directions (e.g. “open the box and give me the bear.”)
  • begin to respond to yes/no questions
  • understand location concepts “in” and “on”
  • begin using words to tell you when they don’t want something (e.g. “no bed”)

For more information about speech and language development in childhood, visit the American Speech-Language-Hearing Association at http://www.asha.org/public/speech/development/.

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5 Activities to Promote Language Use in the Car

Are we there yet? Are we there yet? How much longer? Are these commonly heard phrases in your car? It’s summertime and a road trip is just around the corner.

Learn 5 activities for car rides that are not only fun, but a great way to encourage language skills on the go!

  1. I Spy: “I spy with my little eye…” Use this game to target the following skills:
    • Articulation: See if you can find objects, restaurants, stores, etc. that begin with the sound your child is working on in speech therapy.
    • Receptive language: Ask your child to find 5 items outside the car that belong to a certain category. For example, “Can you find 5 different animals?”
  2. Story Time: Making up silly stories can make for a fun ride! Ask your child to make up a story using ideas, activities, or characters he sees out the window. Be sure the story follows an appropriate sequence of events. This activity can also be a team game. Each person in the family takes turns adding a sentence to the story!
  3. Camping Trip: This is a game to get the whole family involved in your child’s language development. The game begins with one person saying, “I went on a camping trip and I brought…” The frist person states an item that begins with the letter A (apple). The following family member repeats the phrase and adds his own item beginning with the letter B (“I went on a camping trip and I brought an apple and a bouncy ball”). See how far down the alphabet you can get while you target auditory memory, attention, and phonemic awareness!
  4. Clue: This game is great for targeting receptive and expressive language!
    • Receptive Language: Tell your child you are thinking of an object. Provide “clues” (function of the object, category, attributes, etc.) to help them figure it out!
    • Expressive Language: Now it is your child’s turn! Let your child provide you with clues and see if you can figure out what object he is thinking of.
  5. Rhyme: It is rhyme time! Take turns picking a word. Work together or make it a race to see who can find the most objects outside the car that rhyme with the chosen word!

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5 Board Games That Promote Speech-Language Skills

 Any board game can be turned into a language and social learning time, but here are a few NSPT favorites:

5 Board Games To Promote Speech In Children:

  1. Cariboo, a creative game made by Cranium, promotes turn-taking, requesting, and conceptual skills. Personal pronouns can be targeted by asking, “Whose turn is it?” while requesting skills can be targeted by having your child ask for game materials such as a card or key. After requesting a playing card, you and the child can discuss colors, shapes, letters, and numbers (for example, “Wow, this door has 4 yellow butterflies on it!”). Cariboo can be played individually, but it is highly recommended to play it with friends!Board games
  2. S’Matchencourages the development of conceptual skills, such as similarity, colors, and numbers.  When your child flips over two cards, phrase your questions so that you provide choices.  For example, “Are blue and green the same or different colors?” or, “Do cows belong with animals or transportation?” Like Cariboo, S’Match also practices requesting and turn-taking skills by encouraging your child to ask for game pieces and declare each partner’s turn.
  3. Guess Whois a classic game that promotes grammar (e.g., do/does, has/have) and syntax (word order) skills by asking questions.  If your child has a difficult time phrasing a question, you can model the question first and have him/her repeat it (e.g., Does your person have facial hair?). While Guess Who is designed for ages 6+, younger children can play this game too. Guess Who is fun to play with teams of partners!
  4. Zingo brings a new spin to BINGO.  While you and your child take turns matching tiles to the board, encourage your child to name distinctive features of the pictures (for example, “Look, you matched a sun.  Where do you find the sun? What color is the sun?  How is the sun different from the moon?”).  Zingo can be played independently, but it is more fun when you and your child play together.
  5. Scattergoriesis designed for adolescents and adults, and promotes vocabulary, word retrieval, and organizational skills. For example, name something you can find at a beach that starts with the letter /s/, such as “swimming suit.”  If your child is having word retrieval difficulties, use strategies such as identifying the category/function, describing what it looks like, or drawing a picture.

All these games can be found at:

  1. Target
  2.  www.hasbro.com
  3.  www.amazon.com

These games are so fun that your child will not even be aware that they are learning!  The list of language learning games is endless, so if  you have any games that you would like to share with our North Shore Pediatric Therapy families, please share and comment below.

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