By Pam Marshalla
SLPs often overlook the diagnosis of mild dysarthria. This therapist’s letter perfectly describes such a client. My answer below summarizes the problems and offers links to treatment. Q: I was hoping you could provide some guidance for me with a student I am evaluating. She is 11 years old and has been in speech for R, L, S, Th for several years. I met her for the first time this week when I began her re-evaluation. The SLP who has…
By Pam Marshalla
Q: I have a two-year-old client who only says “Mmmm” and “Ahhh.” He won’t do anything for me. How can I get him to talk? First, I would like to refer you to my book called Becoming Verbal with Childhood Apraxia. I am not trying to sell you a book, but I wrote it precisely for this type of case. It will help you understand how to help little kids become more vocal, verbal, interactive, communicative, and imitative. It discusses…
By Pam Marshalla
Q: I am working with an 8-year-old client with severe apraxia who only can produce vowels, M and B. I have tried all the strategies in beginning of your book called Apraxia Uncovered. But this has also not yielded much. Do you have any hints for how to physically prompt other consonants? This child has severe cognitive dysfunction, too. The reason that the information in Apraxia Uncovered was not of much help to you is because although your client may…
By Pam Marshalla
Q: In your presentation called Improving Intelligibility in Apraxia and Dysarthria you mentioned that it is important to practice phonemes that they can do, rather than phonemes they can’t do. Why is that? That’s a good question! Van Riper and other old-time SLPs said that about 75% of every therapy session should be a rehearsal of things the child can do correctly, and about 25% should be material that is new, unfamiliar, and challenging. Most SLPs today spend most…
By Pam Marshalla
Q: My client is a five-year-old with polymicrogyria. He drools severely, eats only purees, basically is non-verbal, and has a non-verbal IQ of about 85. He is labeled as apraxic. Can you give me advice on how to proceed? I had not heard of this disorder, so I Googled it and found quite a bit under “polymicrogyria ” and “children with polymicrogyria.” Apparently it is a developmental malformation of the human brain characterized by an excessive number of small convolutions on the…
By Pam Marshalla
I recently attended a seminar on apraxia taught by David Hammer, SLP. It was fabulous and I highly recommend it to all my readers! David uses a combination of verbal cues, object cues, and gestural cues together in his work with apraxic children. He bases this speech training on the theory that children with apraxia need a multisensory approach that focuses on phoneme sequencing. The verbal cues he uses are names and phrases that describe the outstanding place, manner, and…
By Pam Marshalla
Q: My two-year-old son has Pierre Robin Syndrome and cleft palate. He had oral surgery at 6-days of age, and again at 9 months. He makes a few sounds like “Eh-eh-eh,” “Mmmmm,” “Baba,” and “Papapa.” There has been little if any vocal play until just recently. Receptive skills are good and he signs many words. Can the syndrome be a cause for his delay? I need suggestions. Yes, the syndrome is most assuredly the cause of the delay. Surgeries and…
By Pam Marshalla
Q: Would you agree with the following statement: Children with apraxia will respond to structured production of increasingly difficult syllable shapes, while children with dysarthria need supplementing with oral motor exercises to address muscle weakness. Before I answer your question, let me say a few things about “muscle weakness” and dysarthria because many SLPs––including professors of articulation and phonology––do not seem to understand this area very well. The muscle weakness seen in dysarthria can have many different causes, and the…
By Pam Marshalla
Q: My son is 2 years and 2 months, and he jargons mostly. His therapists can’t seem to figure out if this is apraxia or autism. Why is this? It can be very difficulty to determine if a child has autism or apraxia when they are under three years of age. This is because so many of the problems overlap. Both disorders cause the child to be non-verbal or minimally so. Both cause much refusal to follow directions and answer…
By Pam Marshalla
Q: I have a student with Down syndrome who stutters. Her private SLP has diagnosed her as having apraxia, and insists that the fluency problem is part of the apraxia. Can this be right? Many therapists assign the label of apraxia to children with Down syndrome, but I believe that this is an incorrect diagnosis. Dysarthria should be the assigned disorder. Please note the following definitions: Dysarthria Dysarthria comprises a group of speech disorders resulting from disturbances in muscular control….
