Q: We have a 7-year-old son who has a diagnosis of moderate autism. About a year ago it was suggested that he has apraxia as well. He is completely nonverbal. We have read Becoming Verbal with Childhood Apraxia. Using some of your suggestions, he now imitates about four sounds. It is so frustrating because as soon as we get him to imitate a sound, he loses mastery of an old one – one step forward, one step back. He attends a private school that does ABA. Can you give us some guidance.

A child like yours is one of the most difficult in terms of developing verbal speech. I do not want to discourage you, but children on the autism spectrum are some of the most problematic when it comes to developing verbal speech. Some develop no speech whatsoever. Others become highly verbal. Only time, treatment and education will tell.

• Have you heard of PROMPT? It is a technique that works very well with many different children. It may work for your child. It is a systematized way of cueing children to produce speech sounds.
• You should be reading in the area of autism and talking with more autism experts. Someone with expertise on getting kids to talk like me can take you so far. You really need a broad understanding of the learning style of your child.
• It sounds like your boy can read. If so, and even if he can’t, you can use written words and pictures for a long time as a means of communicating. I always recommend building a 3-ring binder speech book that contains pictures and words about the child’s life.
• For example, let’s say you make a page about getting ready for school in the morning. On the page you would draw stick figures of your son, clothes, breakfast, the school bus, etc. Write key words like “bus” “milk” “socks” “shoes” etc. And phrases like “eat breakfast” “brush my teeth” “get dressed.” That page then is used to “talk about” getting ready for school. He points and you talk. Many pages are created that represent many activities during his typical week.
• This becomes a communication tool he can use to “talk” to many people – mom, dad, grandma, teacher, etc. It becomes what all children want – a means to talk about themselves. This is much more important to them than learning to say phonemes. It should be used as well as pointing to pictures of things he wants.
• And finally, I would not think that “time is slipping away.” These kids need time. They tend to become gradually more verbal with time, with some not really talking much until much older. This may take the pressure off. Think about what you want him to be able to do by the time he is 21. Focus more on what he can do and is doing. Build up those areas while continuing to stimulate verbal speech.

Additional materials that may help with understanding his progress as baby steps, and to help with imitation and moving from non-verbal to verbal include:

• The Four Stages of Imitation: Facilitating Sound and Word Production in Young Children Who Are Non-Verbal — In this hour-long lecture, I describe the four stages of imitation development as defined by Jean Piaget, focusing on how the stages can be used as a basis for developing sound and word imitation in young children who are non-verbal or nearly non-vocal. Much of this lecture is derived from Becoming Verbal With Childhood Apraxia but is digested into a straightforward timeline to follow, with audio examples of speech etc. that can be helpful.
• Apraxia Uncovered: The Seven Stages of Phoneme Development — Using a month-by-month developmental framework, I describe how to nurture sound development in children who have great difficulty learning to make sounds and speech. This book/lecture integrates information from articulation, phonology, oral-motor, and infant vocal development into a comprehensive plan of treatment and will help you understand how to help the child make a wider variety of consonants, vowels, syllables and words, and to become more intelligible. There is also a helpful poster available.
• Leslie Lindsey’s book Speaking of Apraxia is another great book for parents (and therapists) as a guide to understanding childhood apraxia of speech.
• You may also find my free cues for vowels and consonants videos of great help while helping guide his speech learning.

I hope this helps!