Q: I recently heard the term “pop out words” accredited to you and used to describe words a child may say once but then not repeat.  Can you explain this phenomenon to me, why it happens, and why I should be concerned about it.

I use the term “pop-out words” to refer to the way children produce a clear word occasionally but who cannot say the word on demand.  For example, one essentially non-verbal child called out “Turkey” on Thanksgiving Day. His production was as clear as a bell to the family.

In my experience, typically developing children do this for a short time, perhaps during their first ten words. But children with severe expressive speech problems do it for a longer period of time, perhaps for their first 25-100 words, especially in the case of apraxia.  Children with apraxia often can say words spontaneously––the words just pop out.  But then they don’t seem able to say these words again on demand.  They cannot repeat them for us, and they cannot repeat them to themselves when alone.

A typical child will repeat words over and over to himself for play and self-entertainment.  For example, I was watching a two-year-old boy at a playground the other day, and he was saying “gummy bear” over and over to himself.  He must have said it at least 50 times while he was playing with a truck in the sand.  Why was he saying it?  He was not saying it to anyone, and I rather doubt he was even aware he was saying it.  This is just the way a typical child learns to master the things he can do.  Just like filling a toy truck with sand and dumping it over and over again, so too does the average child say words repeatedly.

I believe that it is this inability to rehearse words that contributes to the apraxic child’s severe speech delay. Without the ability to practice words repeatedly, the child cannot “play” with his words, and he cannot take control of them the way a typical child can.  Pop-out words occur before this rehearsal process takes over.

The reason that children with apraxia over-use pop out words, and under-use the rehearsal process is still a mystery, I suppose.

In the sensorimotor integrative perspective proposed by Ayres (1980), apraxia is a deficiency in the ability to organize incoming tactile, vestibular, and proprioceptive sensation.  The child moves (or speaks) but he does not perceive these movements well.  The maps, or schemas, he is building of his movements is faulty.  Therefore, when he goes to speak the same thing again, he has incomplete data upon which to plan his actions. Thus he does not know how to go about saying the same word again.  He cannot, or does not, rehearse his words.  He becomes increasingly less proficient, and ever more delayed, in speech skill building as a result.

I write about how to stimulate for better rehearsal of speech in my book called Becoming Verbal with Childhood Apraxia.

Reference

• Ayres, A. J. (1980) Sensory Integration and the Child. Los Angeles: Western Psychological.
• [Newer Resource] Kranowitz, C. S. (2005) The Out-of-Sync Child. NY: Penguin.