By Pam Marshalla
Q: I work in a school and I have an autistic student 4;0 with limited verbalizations. She also sees a private therapist who keeps telling the parents that my methodology isn’t right, and that is why the girl isn’t making progress. She says that apraxia therapy has to be done a certain way. The child actually is making progress but limited, and the parents are saying that the progress is due to the child’s own development and not because of…
By Pam Marshalla
Q: My male client is six and he has had phonological therapy for three years with another therapist. He was switched to me because he was going nowhere, and now he is going nowhere with me. I think he needs a motor approach but I have no idea how to begin. Can you guide me? Yours is a very common dilemma: You have tried basic phonological therapy that is auditory/cognitive/linguistic in nature and found that your client is not doing…
By Pam Marshalla
Q: I received a referral for a 15-month-old diagnosed by a private SLP with apraxia. The child has excellent receptive language and produces 10-15 words. I was told that the child was an “automatic qualifier” coming in with the diagnosis of apraxia. I have huge reservations with this and do not feel as if the diagnosis was made appropriately in just in one session and not over time. There are no indications of motor difficulties elsewhere. Am I out in…
By Pam Marshalla
Q: My male client is age 6. He has average intelligence, CP, and cleft palate. He was pre-mature and is non-verbal. He has been using an iPad with communication app “Words for Life” very successfully. He drools, can’t blow, barely moves his mouth, etc. He makes random vocalizations. Any ideas? This child represents some of the most severe we see. This is severe apraxia and dysarthria, with cleft palate thrown in just to make it interesting. Let us state bluntly…
By Pam Marshalla
Q: I have a 5-year-old child with PDD, NOS (autism spectrum disorder). Her language comprehension is very good. She makes sounds and she babbles, but she produces no words. She is social and definitely has communicative interest and intent. Based on your experience, would the techniques in your book and CD called Apraxia Uncovered be of potential benefit to my daughter to help her speak words (even though she does not carry a diagnosis of Apraxia, per se). Thank you…
By Pam Marshalla
Q: Everyone seems to say that kids with Down Syndrome have apraxia. Is this right? Shouldn’t it be dysarthria? Any client with a speech problem and neuromuscular disorder has dysarthria. Period. That is the very definition of dysarthria. Dysarthria is a non-linguistic, neuromuscular disorder of expressive speech, characterized by impaired capacity to execute speech movements. Dysarthria defines a group of motor speech disorders that includes clients with muscle tone disturbance–– Low tone, high tone, mixed tone, fluctuating tone; It includes…
By Pam Marshalla
Q: My client had a xyanotic episode at 4-days of age. She had no verbal language until about 24 months. She is now 33 months and is talking quite a bit with delay. But what is throwing me for a loop is that she has changed “mommy” from “Mee-mee” to “Mah-mee” and now to “Hah-mee.” She also substitutes H for other M words. I’ve never seen this. Can you explain it? I don’t have all the info I would need…
By Pam Marshalla
Q: I am very frustrated working in the public school. I am forced to see very low functioning children 2-4 times per week, and even with this much therapy they are not progressing in vocabulary, phonemes, nothing. Am I doing something wrong? Let me be very blunt here. Warning! Those of you who don’t know me need to be warned that I do not speak with political correctness. I find it to be an imposition on our freedom of speech…
By Pam Marshalla
Q: I have heard you complain about research in the area of apraxia. Why do you think it is so poor? Think about this: APRAXIA occurs in the ABSENCE of neuromuscular disorder while DYSARTHRIA occurs in the PRESENCE of neuromuscular disorder. Now think about this: ALL the research in speech that has been done on apraxic kids since the beginning of time has been done without any assessment of their muscle tone. Researchers have just been assuming that tone is…
By Pam Marshalla
Q: What would to do in an evaluation to differentiate between CAS and dysarthia? Specifically would you rule out muscle weakness? The definitions of apraxia and dysarthria speak for themselves–– APRAXIA is a motor speech disorder that occurs in the ABSENCE of neuromuscular problems. It is a problem in the perception of movement, and therefore it causes problems in planning movement. The result is severe articulation and phonological deficit. DYSARTHRIA is a motor speech disorder that occurs in the PRESENCE…
