I discovered that I was bad at numeracy, PE and holding my pencil - but I did much better with literacy tasks. Later in life, I encountered more jarring problems, such as severe procrastination with homework and deadlines. I struggled with carrying out instructions without supervision, time management and tidying. Coupled with long-standing mental health issues, these challenges made my life a living hell. Until very recently, I had no idea that any of these issues were remotely connected to a condition most people assume you grow out of.
Earlier this year, as I was shown a list of symptoms online, my jaw dropped. Everything I was upset by, but couldn't make sense of before, suddenly hit me. Doctors often refer to dyspraxia as a 'diagnosis of exclusion'. Difficulties with gross motor co-ordination skills large movements and fine motor co-ordination skills small movements are the core features of the condition.
Unfortunately, there isn't a specific test for dyspraxia. Chances are it's dyspraxia, DCD. It can be even harder for adults to get a diagnosis if dyspraxia went unnoticed as a child because you would have to provide new primary evidence.
According to Payne, to obtain a clear diagnosis of dyspraxia, a doctor must consider four major factors:. A GP will look at all the evidence and advise on the best course of action. Children with dyspraxia are often referred to specialists such as paediatricians and physiotherapists who will make a further assessment. The non-motor symptoms can be quite similar to those of dyslexia and ADHD, which can leave GPs unsure of the most appropriate diagnosis.
Behaviours such as clumsiness and overreacting to situations may be passed off as normal for young children and teenagers. However, it can be hard for the patient to 'prove' how problematic these issues are for day-to-day life. Before I understood that dyspraxia was more than 'clumsy child syndrome', I would get incredibly upset with myself over minor discrepancies, such as misplacing an item of clothing or being late to an appointment.
I would be frequently late for lectures at university, and for meeting up with friends, and I even lost jobs because of tardiness. It was soul-crushing as I convinced myself I would be known as someone who was intentionally lazy. This was not the case with my son. He started to babble at the same time as his peers did. But then he turned 1, and there was no first word. He still bubbled a lot though.
And then, 15 m, and 18 m and still no first word. Of course well-meaning friends, and just about anyone else I met were telling me how, he is a boy, and boys tend to be late talkers. Also my baby is bilingual. So that came into play as well, as I read and heard about how multilingual babies often start to speak later. Even at our 18 m Dr. We have decided to involve EI when he was about 20 m. At 20 month he was still only pointing and granting. Not a single word.
They evaluated him and concluded that he is eligible for 1 h per week of speech therapy. He has no other developmental delays. So far we have had 7 weeks of speech therapy and one week the appointment was missed, so 6 appointments total. There is no improvement. He still does not say a word. Like I said he used to bubble a lot as an infant.
Now he actually bubbles much less. And since she believes that he cannot really say words that have meaning , it causes him to remain quite most of the time.
He is still bubbling once in a while, and we can definitely solicit bubbling. But most of the times he just points and grunts. Sometimes it sounds like he is talking inside of his head. Same when we are going for a walk. He understands a lot. And he knows quite a few alphabet letters. He can point almost all the animals in a book. He definitely knows a lot of words but does not say out loud any. He just tries; I am praising him on whatever comes out. He also uses vowels a lot.
And his consonant repertoire is pretty limited. Even though lately I did hear him trying to imitate. I have also noticed that he watches my mouth very closely when I pronounce certain words or sounds. But he never tries to imitate it. My son will turn 2 in less than a months. I realize that he is still too small to be given a definite diagnosis. I understand that a lot may change between the ages of 2 and 3. He also did not really make that much of an attempt to speak as of now — so it can only be suspected that motor planning is an issue for him at this time.
So at this point I am concerned that with the therapy we are having today we are just loosing time so to speak. Our SLP has mentioned that there will be some period during which she will only work on her relationship with our son, and that before he warms up to her, there is really not much she can do.
It takes my son some time to warm up to strangers. And quite frankly she only sees him once a week for 1 h, and some times even less than that if there are holidays in the middle and by the time she comes back he pretty much treats her as a new person again. During the therapy sessions she is pretty much just playing with him with different toys and showing him different signs while saying words out loud.
I am teaching him signs too. He is now signing consistently, but needless to say he has never attempted to repeat a word during a therapy or otherwise. Are we not wasting time at this point? But does it mean that SLP that is not certified in the above techniques will not be effective in treating CAS and we are just wasting time at this point? And most importantly in the later case should we still keep seeing our current SLP, or having 2 different SLPs can actually do more harm due to a potential inconsistency in their treatment.
From reading your blog I can tell, that your feedback is sincere. What would you do if you were in my shoes? Hi, This article and links have been extremely helpful. My baby is 3. We are now suspecting CAS due to drooling, low oral muscle tone, loss of words… She only has about 2O words 10 signs and those words arent that clear… It is evident she needs more therapy, can you help me find out how to get insurance to cover more than 20 visits a year???
My speech path is telling me appeal is futile!! Hi Micki, You are right that she definitely needs more therapy. Unfortunately I do not have any helpful hints in dealing with insurance. We choose not to take insurance here because it is difficult to get them to cover speech therapy. I would suggest having your therapist write a letter of necessity to your insurance company. It may work and it may not work. Sorry I could not be of more assistance to you.
Gabriela, While it is impossible to diagnose CAS without seeing your child it definitely sounds as if he has a significant speech and language delay. I would recommend a high quality evaluation by a licensed speech language pathologist who has knowledge and experience with CAS. From your description I would recommend at least 2 weekly therapy sessions as well.
Hi Crystal, Has your daughter ever been seen by a pediatric neurologist? If not I would make this a priority. I agree with you that any regression in children is worrisome.
A pediatric Neurologist could rule out any other neurological conditions. It is possible that your daughter has CAS however it is not possible to make a diagnosis without seeing her. Do you have a child development team in any of the hospitals or universities near you? If so I would recommend getting a thorough evaluation from a full team of therapists.
Hi ggKate, If I was in your shoes I would do my own research and find out who is the best pediatric speech language pathologist in my area and if she treats children with CAS.
If so I would find a way to see her. If not I would ask her for a referral and go from there. The state programs could be great but they could also be terrible and I would not want to take that chance with my child. Without knowing him I would not be able to give you any tips on how to work with him. However his SLP should be able to help you. Most likely he will need daily practice on his target words and phrases which she should be able to generate and you can do at home. You might even want to practice a couple times a day for maybe 15 minutes each time.
Your SLP should be able to help you know what is appropriate and when to move on. Choosing the right goals and lots of repetition is the key when working with children who have CAS.
I would love any feedback you may have after I tell you a bit about my son. He will be 19 months on the 8th of January. We have never been concerned about any developmental delays until recently. I am a psychologist and work with infants and toddlers, which has made it somewhat difficult to not overly scrutinize every developmental stage. He seems to always fall on the later side of milestones walked at 15 months , but it is almost like he sits back and takes it all in and then takes off.
He has been gesturing and communicating nonverbally for months and his receptive language skills are very strong. He follows two step directions and has learned the few signs that I have taught him.
I have never observed any oral motor difficulties. When he started gesturing to get his needs met he was also vocalizing.
At around a year we felt like he had a few words and at that time he started responding yes when asked a question.
We have noticed his babbling has increased over recent months, but up until a month ago everything was really dadadadada. We have heard other sounds, but not regularly. In the last month we have really worked on trying to get him to imitate p, b, and m and we now hear him using b, d, and m sounds spontaneously.
With lots of work and prompting we can now get him to make a p sound, but it seems to take a ton of prompting. I want to get the proper support if necessary, but am also afraid that having worked with so many non-typically developing children it is sometimes hard to know what the true range for typical development is.
How do I find out who is the best? It seems like there is no way to find out how knowledgeable one is with K-SLP as there is no real certification path there. And I live in a large metropolitan area. One more question. As I am in process of searching for SLP for my son, which proved to be extremely tedious process, I am getting more and more anxious with regards to the fact that he is bi-lingual.
I would love my son to speak two language he currently understands equally well. This being said, considering the fact that we are living in US, I do not believe speaking only English will seriously degrade his quality of life. On the other hand not being able to speak any language properly, because the speech therapy was not very effective and because we were desperately trying to get him to speak 2 languages may pose quite a challenge.
What is you opinion on the bi-bilingualism and children with CAS? Provided he has CAS of course, who knows? In fact even if there was a SLP who was the best rated, she might not be the best fit for your child. My suggestion is to ask as many people as possible if they have a SLP to recommend. I would ask my doctors, friends, acquaintances and parents of other children with special needs.
I would talk to each therapist and get a feel for their personality, knowledge and experience. I would also suggest meeting with several therapists until you find the one that really clicks. You will know when it does by watching her with your son. You will also likely see some immediate progress. Again, I would suggest meeting with them before making a final decision. The level of certification does not necessarily correlate to quality of therapy.
When it comes to the issue of bilingualism and CAS it does get a bit complicated. I would recommend making sure the languages are really separated, meaning that he will hear English at certain times and a second language at a different time.
I would never recommend mixing the 2 languages. However with that being said, if it is not that important to you, stick with English, as long as you are a competent English speaker, which it appears you are. Hi Sam, From the description of your son it is clear that he is a Late Talker. At this point there is no way of knowing whether or not there is anything else going on.
Some may label a non-verbal 19 month old with suspected CAS. However, the truth is that it is not possible to diagnose him this early. With that being said, I would recommend Speech and Language therapy at least 2 times weekly. The sessions should be short in duration, possibly 30 minutes and you should be very involved.
While I have never met your son I am always concerned when a child is over 18 months and non verbal. You may see an explosion of language in a short period of time and then you can stop the therapy.
With regards to the bi-bilingualism, my son does not have any other developmental delays at this time. We do try to separate the 2 languages as much as possible. I appreciate your advice regarding this. I am currently considering switching to English only. We live in Philadelphia. We have been taking our daughter to a Pediatric Neurologist since she was 2 months old because of the many developmental delays she has had.
We have also gotten involved with a county program that brings teams of therapists of all sorts: OT, PT, SLP, and Special Education Teachers into the childs home for a more comfortable and continuous evaluation. I feel like we are doing everything in our power to help her, but we are unfortunatly at the mercy of the physicians at this point.
Her regression has been attributed to a growth spurt. She has also been having difficulty staying upright when sitting unless someone or something is behind her. Again, this has been attributed to a growth spurt and her being tired. Does that make sense???? Hi ggKate, Unfortunately, I do not know any therapists in the Philadelphia area. Hi Crystal, I would recommend getting a second opinion. When it comes to speech and language a growth spurt would not cause regression.
Hi Micki, If she is in a quality school program I would say the 4 speech sessions and the 5 half day preschool would be great. It would be helpful if her Speech Language Pathologist connects with her classroom teachers and talks to them about what they can do to help carry over her speech goals. Please let me know how she does.
Two issues to consider. Insurance Companies will not accept an apraxia diagnosis from a speech pathologist as it is a medical diagnosis. Second many insurance companies will not pay for a developmental speech delay, but will pay for an apraxia speech issue referring ti speech therapy services. Quite often insurance companies do not cover services for children with CAS regardless of who makes the diagnosis.
They most often only cover services that are due to accident, injury or congenital anomaly and they do not feel that CAS is any of these three.
We speak Spanish at home and the therapy is in English…One of the therapis is from the school and encourage us to keep speaking in Spanish…the other is private practice and asked to speak in English the whole time…What is your oppinion? Claudia, If your primary language is Spanish and it is the language you speak fluently then you should definitely speak Spanish.
You can try ASHA. That is our national organization and they have a database of therapists and their areas of expertise. Isa, Our daughter is 4 years old and was diagnosed with apraxia of speech 1 year ago.
She is now receiving private speech therapy and ST at school, but her school ST feels she has a phonological disorder and not apraxia of speech. What exactly is the difference? Are they treated the same? Hi, my daughter…2 year 4 months was just tested for speech…. From everything I have been reading, it seems like it may be accurate. They say she is fine cognitively….. I am really wondering what her outcome may be….
She has not started speech therapy yet but they suggested times a week. They child connections said they will contact the speech therapist that typically works with children who have verbal apraxia. Please, any comments or experiences are welcomed. Dylan, There is so much confusion around Childhood Apraxia of Speech. It is rare for a child to have only CAS as they often have other phonological sound errors as well.
So it is likely they are both right! Reyna, Without meeting your daughter it would be impossible to give any sort of prognosis. In fact I usually like to work with a child for a while before giving my opinion of what the future may hold.
I do recommend that the speech be provided at least 2 times a week. One session per week is just not enough. Also, if she is only 2 and not talking yet, I would not be comfortable with a diagnosis of Childhood Apraxia of Speech.
Right away she was visited 2 home up to 3 times a wk. She goes to speech school 3 to 5 days a wk. I have to say the sooner the speech therapy is started the better, im gratefull for everyone that help her talk. It was such a beautiful song when I heard her talk for the 1st time……. Take advantage of everything thats offered for ur kid.
It might seem like a though road, but its just a breeze…….. Since my last post, my daughter has started speech at home and I took her to get an outside evaluation done as well. I have spoken to a few speech therapists and they said to KEEP speaking in both languages of course try not to mix the two- as with any child but not to be surprised if your child speaks in English quicker than Spanish because many Spanish words have more syllables than English words Pelota, ball…arriba, up ….
Hope this helps! My son, Michael, just turned 4 years old. He was diagnosed by his Speech therapist Early Intervention at 3 years old. At 3 he transitioned to the Public School…. Currently, he is receiving speech services thru the public school system, twice a week. And in addition, he receives private speech once a week, for a total of 3 sessions each week.
Yet, he is still not speaking. Thank goodness Michael fully understands when you speak to him and he is always able to get his needs met he is very stubborn! My concerns are…so many….. Will he ever really speak using more than one or two words the two words have started recently. She thinks it may be something else…. But, she was the only one to say it. Also, when he was younger, he spoke words — duck, quack, and even said caterpillar.
My mother was sitting across the table from him so I have a witness. Most people do not believe that he actually said it but, I had him repeat it and he did. And it was clear when he spoke. So, now, at four years old, I am totally lost at what to do for him — Did we miss something?
Where do I go from here? What else could he be suffering from? And, how do I help him? Also, he was a twin but the twin passed at around 12 weeks but I carried it the entire pregnancy. He was a full term c-section. I do not know his birth scores but have always wondered if something happened during his birth to cause this? Hi, my son is a non-verbal 2 year old. He had fluid in his ears- we have no idea for how long and he got tubes in Feb. Since Feb, we still have no speech. My neurologist says we can no longer use his hearing loss as an excuse for not talking.
Because of this he is now being labeled as suspected autism spectrum and suspected apraxia. How important is this? My son is 32months almost 3 and he has a very limited vocabulary. Only recently has he been saying more words. He is making more sounds and saying things in context. He is enrolled in the CT birth to three and we have requested more speech hours but according to them CT only allows 1hour a week per child.
If this is what he needs and it seems to be working I cant imagine we would be denied. Catarina, Unfortunately state early intervention programs have limited funds and are not always able to provide the frequency of services that are most beneficial. I would recommend 2 weekly sessions as a minimum. If you have the ability I would recommend supplementing his services outside of early intervention with some private speech therapy.
My son has been getting speech therapy Early Steps since he was 2. She was convinced that it was strictly articulatioin. The reason we had to dismiss the successful SLP is because after 8 months my son became completly not interested in his sessions any more and more time was spent in trying to get his attention than on therapy. We are at odds on who to trust and are looking for a third SLP in our area that can test him.
The first two knew each other and never got along, so the difference of opinion, I believe, stems from them not liking each other. If you can, please recommend someone in the Lafayette LA area. Erin, It is not possible at this point to confirm a diagnosis of Apraxia; however finding a really strong therapist is key. Finding a good match is the most important. What area of NJ are you in? I do know some therapists in that area. Brenda, My assumption as to why he did well with this particular therapist is that they were a really good match.
Not every therapist is right for every child. In regards to the diagnosis I would assume that the therapist who made all the progress had the right diagnosis. Being that they were such a good fit I would reconsider letting her go. Maybe a short break would help. Maybe a change in location if she comes to your home or maybe the therapist needs to change her approach slightly to regain his attention.
Maybe lessen the pressure to reengage him. In therapy with such young children we often see ups and downs with interest and behavior. I would not give up on her so fast. Hi Beth, I am so sorry I missed your message and I took so long to respond. I can imagine it must be so difficult to wit this long for your little guy to talk. Since he has been making progress you should continue to expect him to make more progress.
The progress is slow and will continue to be slow however there is progress. If possible I would increase the private speech to 2 times a week. It is difficult to make significant progress with a child who is only seen once a week by a particular therapist.
It seems as if you have ruled out any neurological conditions when you saw a neurologist you can always get a second opinion. It might also be helpful to see a developmental pediatrician. Lastly, I would talk more with his new SLP about what she thinks is going on. It is your child and she should feel comfortable to express her thoughts to you. Please keep in touch and let me know how he progresses. I am about to begin my 2nd year at my current school and have a 4th grade child with a diagnosis of CAS on my caseload.
Consistency is lacking to say the least. Co-articulators are helping him produce the sound…sometimes. Parents are frustrated, child is seemingly oblivious to the errors and I am at a loss. He is a very social, well-liked, popular young man. Works very hard in all areas. Hi Sue, Are there any other language learning or attention issues? Are the parents working with him at home on a daily basis? Hi Isa, He does have difficulty with reading but not too far off grade level.
Family is very involved but not confident they are working every day on correct sound production especially over the summer. Isa, He is a little behind in reading but still within grade-level. No attention issues. Parents are very involved but do not practice on a daily basis. Sue, Sorry for the delay in responding.
I do agree that sending home artic. I would recommend having the family come in for a few of your sessions and hear what the sound sounds like when he gets it right. And talk with them about how to reinforce it at home.
I would also work closely with the home based therapist. She could be the connection for you with the family. My son just turned two in August and has about 40 words. As I understand this is on the low side. He does not string words together and by no means uses all of these words regularly.
These are words I have heard him say and most of the time feel comfortable to repeat them. He gets very frustrated. He has an older who asks him lots of yes and no questions and I am guilty of the same. I talked to his pedi who said I need to wait until 2. Many times I will say to him say nose….
I would think that would be easy as he say no to me all day, yet instead of trying to talk he just points to his nose. Same with many things I ask him to say, he just points. He also says rock rock when on the rocking horse but outside we see a rock and i tell him then ask him to say it and he just says aaaaa…yet i know he can form the word in another context. I feel there is a connection missing.? And everything with wheels is either a room room or a choo choo. I am in the SF bay area. Thank you for any advice.
Catherine, I would not recommend waiting if you are concerned. The worst thing best thing that could happen is that the therapist you see will tell you that there is nothing to be concerned about. Hello, My daughter will be 2 next month and has been receiving speech therapy for almost 6 months. In that time she has only learned 1 word Ut-Oh, She was already saying Mama witch she calls everyone and Dada witch is just for daddy.
She has had a therapist through EI once a week, has had an autism screening, goes to a playgroup through EI once a week for 2 hours, and just today they added another speech pathologist once a week for an hour. I know every child is different and you can not diagnose a child under 3 or who you have not met, but my question is should she be talking more by now? Or should I be looking into a different group? During her Autism Screening they said shes too receptive to be autistic, but she does lack Social Emotional skills as well.
Shes been in the play group for over a month and still will not interact with any of the other children and is quickly becoming MORE frustrated with herself everyday. They told me I should make picture strips and put them around the house so she can point to things she may want.
I came across this site while trying to find materials like this. Do you know where I could find picture strips of sorts to communicate better with her? She does sign simple words please, open, more, bye, no, yes, eat, drink.
I want to learn more myself so I can teach her, but again I find myself lost in an ocean of information called the internet! My son has just turned 3. He has been in early intervention for just under a year.
I am not being given any direction as to what is causing his speech delay. I just want to help him but it seems that the specialists will not commit to a diagnosis or even an area. Please let me know if you know of a speech pathologist in the rockland county NY area. I will be willing to travel for help. Hi Dana, We are across the bridge in Westchester County. I would be happy to see him and give you my opinion. Charity, I am always so sorry to hear from parents in such distress with no one to guide them.
It is impossible for me to say whether or not your daughter is in the right program or with the right therapist. Sometimes progress can be extremely slow when they are so young. I am sure she is changing in many ways and it would be your therapists role to point out all the good things she is doing.
If you are questioning your services I would recommend getting a second opinion. As far as picture strips I would recommend photos because she is so young. Take pictures yourself of things you want her to communicate and put them around the house. You can also make a book for her to look that has all her favorite things in it. He did learn to sign more, give me, again, etc but his words are still very limited. In the recent weeks I hear more vowels, a, e, i, and the word HI but randomly he does say mamma, and daddy.
Or other things. Do you know of anyone that can help diagnois his speech impediment or a speech pathologist in the Westchester NY or fairfield County area? I feel he may need more one on one time than what he has been receiving. Thanks Catarina. Charity- does your daughter interact with other kids when NOT at the play group?
Also, what did they people who screened her say about her cognitive level? She has gone from saying about 3 words to three and four word sentences. She sees her speech therapist once a week and attends a play group once a week. One thing I did notice at the play group is that she does not interact with other kids but she will interact with other kids at the mall, at the playground, and in her dance class.
Hopefully this made sense. Just sharing my story because sometimes hearing similar stories will help you figure things out. BTW, my daughter was super frustrated before and this has lessened with the more she is able to speak. The speech therapist put together a book of pictures of our family actual pictures and that helped her learn and practice what to call everyone.
Hi Catarina, My practice is actually in Westchester County. We would love to see your son. Feel free to call me Hello, I have a 31 month old son who has been speech delayed since birth. He rarely cooed, never babbled, and when he was 12 months finally the doctor agreed he needed to be evaluated.
Around 20 months he started to babble the same sound over and over. He never changed them. That is because most children under age two do not have the ability to understand specific directions for tasks that would be critical to making the diagnosis. Or the child may be unable to cooperate or pay attention to the extent that they would need to do so in order for a differential diagnosis. Children between ages 2 — 3 may also be difficult to firmly diagnose with CAS.
Some can and some cannot. There is no strict age as to when a child can be diagnosed with CAS.
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