Q: My preschool client with apraxia can only say “K” when he bobs his head around. Should I ignore this as part of the learning process?

Some clients seem to need extraneous movement to initiate a phoneme’s movements, but they do not need them for long.  I see them as gross movements that will become more refined with time.

I usually let my clients do all this extra movement at first, and I even emphasize it by imitating it back to him.  We “play” with all this extra movement for a little while––especially with a preschooler.

But after a while you can expect it to tone down on it’s own.  Van Riper said never to fear exaggerated movements because they usually go away on their own.

If all the extra movement doesn’t slip away naturally, however, I usually begin to talk about it with the kids, and I begin to tell them they don’t need it.

I say something like this— “You made that sound with your head! Oh, that big head is moving. We don’t need to move our heads to make that sound. Only the tongue needs to do the work.”

As you probably know, the jaw, lips, and tongue need to work differentially for mature speech to emerge.  This means that they work independently from one another and from the rest of the body’s movements.  A client who moves his head when he is trying to move his lips or tongue is demonstrating that he has poor differentiation of movement.

Fixing this is a matter of stabilizing the extra movement.  Your client literally may have to hold his head still with his hands (or with your hands) as he learns to do the work only with his tongue.

I usually tap on the head, massage the neck a little, and literally move the head around with my heads to help him perceive his extra gross head movements.