Early Intervention for Apraxia

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Young children are building a foundation for the learning that they will continue for the rest of their lives. Much of this learning is done through the medium of language: either the child is learning from what someone else says, or he/she is testing his/her knowledge out on others by talking. Thus, early deficits in language can have a profound impact on the child's ability to learn many things -- way beyond language -- from his or her environment and the people in it. More specifically, the foundation that a child builds by hearing and saying the sounds and sound combinations of the language is critical to the child's later ability to learn to read without a problem. Many studies have demonstrated that children who have speech disorders early in life are at higher risk for literacy problems later on. They have an inadequate understanding of the sounds of the language, so they have difficulty learning the relationships between spoken and written sounds. Thus, it is important to help them to build these foundations as strongly and as soon as possible, before expecting weak foundations to support new structures. This is the whole philosophy behind early intervention: to intervene early, to address problems or even potential problems (e.g., risk factors) as soon as possible, so that they interfere as little as possible with the child's overall development.

Although studies have not been done to prove this point, specialists in apraxia generally agree that therapy should occur in very frequent, short sessions. Speaking on demand can be exhausting for a young child with apraxia, so he or she may not be able to tolerate a whole hour of therapy at a time. For this reason, as well as the nature of the disorder, therapy needs to be frequent -- ideally, every day for 1/2 hour for a child with moderate-severe apraxia. This treatment does not have to be drill work; that's not appropriate for a child of this age. Therapy can be incorporated into play and book-reading routines. It is very helpful for parents and other caregivers to engage the child in some carry-over activities in between sessions, but it is also very important for a child with apraxia to have some communication partners with whom communication is relaxing and fun instead of hard work. Therefore, it's not appropriate for parents to do the majority of the therapy (e.g., for an SLP to come once a month and provide activities for the parents to do the rest of the time).

Shelley L. Velleman is an assistant professor of Communication Disorders at the University of Massachusetts at Amherst. She is the author of many articles about normal and disordered phonological development (including childhood apraxia of speech), and also of "Making phonology functional" (Butterworth-Heinemann,1998) and the "Childhood apraxia of speech resource guide" (Delmar/Thomson, 2003).