Hearing Loss and Apraxia

By Julia Janka, Co-Director, Georgia Hands & Voices

I remember the speech pathologist telling me that my daughter, Carrie-Min, should be able to communicate orally given her level of hearing loss and the effectiveness of her bilateral amplification. So we were concerned and disappointed when she could not speak even after months of intense therapy. It was then that the same speech pathologist informed us that our daughter has Childhood Apraxia of Speech (CAS). The news of another diagnosis and another roadblock to our child’s oral language success sent us reeling. We felt like we had just gotten the whole hearing thing under control-- now we had to learn to deal with something called CAS? What on earth was CAS??

Of course, I went home that night and looked up the definition online. I thought one of the best explanations came from the Apraxia-Kids website (www.apraxia-kids.org):

“Childhood Apraxia of Speech is a motor speech disorder. For reasons not yet fully understood, children with apraxia of speech have great difficulty planning and producing the precise, highly refined and specific series of movements of the tongue, lips, jaw and palate that are necessary for intelligible speech. Apraxia of speech is sometimes called verbal apraxia, developmental apraxia of speech, or verbal dyspraxia. No matter what name is used, the most important concept is the root word “praxis.” Praxis means planned movement. To some degree or another, a child with the diagnosis of apraxia of speech has difficulty programming and planning speech movements. Apraxia of speech is a specific speech disorder.”

As we know, d/hh children often struggle with enunciation and oral language because of their hearing loss. CAS complicates the situation by adding another component to the process of producing speech. The child has to work to hear the sounds of language correctly and then has to concentrate and learn to think through trying to repeat those sounds. They must remember to move their tongue and lips and inhale/exhale in a complicated series of steps that is not second nature to them. They literally have to train their brain to train the muscles in their mouth to replicate each speech sound.

Although there is limited research regarding the dual diagnoses of Hearing Loss and CAS, I was blessed this July by the wonderful information shared at the 2008 National Conference of Childhood Apraxia of Speech in Williamsburg, VA. There are very specific recommendations for speech therapists when treating hearing loss and there are very specific recommendations for treating CAS. Some of the treatment plans overlap and some are poles apart. For instance, some parents may choose not to teach their d/hh child sign language and therapists would not necessarily have a professional opinion about that choice; however, sign language is highly encouraged with kids who have apraxia in order to give the child a means of communication until therapy and brain training click in for oral speech. In addition, a child’s hearing loss is often assumed to be the child’s primary and/or sole problem, so a diagnosis of apraxia is often overlooked. Without taking into consideration the possibility of CAS, therapy may never address the “how to’s” needed to produce clear speech. These undiagnosed children may also encounter difficulties with certain academic subjects, such as reading and math word problems.

The good news is that there seems to be a growing awareness among researchers about the need for more information on children with hearing loss and apraxia. While at the conference, I had the opportunity to meet Dr. Ruth Stoeckel, a highly regarded speech pathologist at the Mayo Clinic with whom I was able to discuss my daughter’s dual diagnoses. Her specialty happens to be deaf and hard of hearing children with apraxia.

Dr. Stoeckel was very interested in what Hands & Voices provides to families. She mentioned that she would be willing to entertain developing a study of families with children who have the dual diagnoses in order to start to develop more effective treatment plans for therapists and parents to use. If you are willing to participate in such an endeavor, please send me an email at Jjanka2000@gmail.com by the end of 2008 and I will forward your information to Dr. Stoeckel to be included in a survey.

The diagnosis of CAS along with hearing loss does not have to be an oral language roadblock. Getting an understanding of CAS creates a better opportunity for our children to learn to communicate. It may require changing your approach, your preference, maybe even a bias if you have one. This survey presents a tremendous opportunity for parents to participate in the search for answers and research-based treatments for our children. I’m grateful to Hands & Voices for offering to put the word out through this article both through their amazing parent network and on the website, www.handsandvoices.org. I look forward to hearing from many of you soon!   ~