By Pam Marshalla
Q: Do you have a list of diagnostic indicators for young children with CAS? The best I have found has been from a seminar I attended by Dr. Barbara Davis in 2010. This is what I put together from her handout: Characteristics of Apraxia Barbara Davis does research in the area of childhood apraxia of speech and she presented a summary of research in this area at a recent seminar (Davis, 2010). She reported that the incidence of apraxia is…
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: Do you know of any good books about remediating speech (not language) in children with Down syndrome? My client is 12 years old and I think it is time to concentrate more on intelligibility after years of language work. I answered this question through a personal exchange with the SLP, however I thought I would say a few things about the topic here on my blog. Always remember that with Down syndrome you always have dysarthria and that means that…
By Pam Marshalla
Q: My two-year-old client with Down syndrome has dysphasia and the classic forward tongue posture. Which of your books will guide me to work on oral-motor skills so I can strengthen the oral structure for swallowing and speech? Therapy is rarely about “strengthening” oral movements. Therapy for developing expressive speech in a toddler with Down syndrome usually includes the following: Activities to encourage a wide variety of oral movement through feeding and oral play activities. Activities to get the…
By Pam Marshalla
Q: How can I get my client with Down syndrome (DS) to keep her tongue inside the mouth during speech? A client with Down syndrome has low tone, dysarthria, and lack of oral stability. The oral mechanism is supposed to be stabilized in a certain way during speech. The jaw should move up-and-down in a very small restricted range that is high, and the tongue should anchor its movements in the back against the back lateral teeth or palate. Children…
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…
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….
By Pam Marshalla
Q: I have heard that we should avoid the topic of tongue-thrust therapy (orofacial myofunctional therapy). I’d like to hear your thoughts on this. In my experience, problems in articulation, orofacial myology, feeding, dysphagia, and motor speech disorders are all the same thing manifested in somewhat different ways and to various degrees. All of these therapies are about facilitating new oral movements and/or fixing incorrect oral movements. I have spent my entire career (since 1975) studying the research, clinical practices,…
By Pam Marshalla
Q: My son has Down syndrome and possible apraxia. Can you give me advice about this? Many therapists today are labeling children with Down syndrome as apraxia, but this is an incorrect diagnosis. The expressive speech and language problems of children with Down syndrome are the result of dysarthria and cognitive deficit. Dysarthria “A generic label for a group of motor speech disorders caused by weakness, paralysis, slowness, incoordination, or sensory loss in the muscle groups responsible for speech” Brookshire, R. H….
By Pam Marshalla
Q: I cannot get my client with Down Syndrome to produce “Long E” (as in the word bee). I have tried using a tongue blade to get his tongue back. Do you have any other suggestions? To produce long E (/i/), the jaw must be high and the tongue must be wide, high, and tense in the back. If you are using a tongue blade to push the tongue back, you have several problems that are working against you. First,…
