Apraxia and Hearing Loss

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

In my last article, I introduced the diagnosis of Childhood Apraxia of Speech (CAS), (Fall 2008, Volume XII, Issue 1.) This time, I’d like to share more about how CAS is diagnosed. Parents can check out the CASANA website http://www.apraxia-kids.org and see the process detailed under the Family Start Guide’s section. The speech-language pathologist takes the lead in choosing assessments since CAS is a communication disorder. When discussing CAS as a possibility with your treatment team (doctors, schools, support group, etc.) be sure the SLP has a strong foundation in CAS so they can make the appropriate diagnosis. The SLP will take a complete history of the child which includes assessing the following criteria: 

A complete inventory of the sounds, syllable shapes, and words a child can make or attempts to make will be noted, as well as any “mistakes” the child makes when doing so.  Errors and/or distortions of sounds will be compared with what is known about normal speech development to determine if the child’s speech performance is normal or not.

The SLP will try to interact with your child and try to get them to use spoken language in order to see what happens when they are asked to repeat syllables, words, or phrases a number of times. Observations will be made about whether the length or difficulty level of words or phrases makes a differences to the accuracy with which the child says words.

A child’s ability to both use and understand words, phrases, word endings, grammar, etc. will be evaluated and compared to what is typical for their age range.

The child’s oral structures and the oral cavity will be examined to determine that they appear normal and are in good working order for speech. Since most young children do not like strangers peering in their mouths, this part might be a challenge! Some children also might be sensitive to touch around the mouth and this will be noted.

Observations will be made about the child’s respiratory system related to speech including whether they have enough airflow to sustain speech; how they hold their bodies; if they appear to have enough muscle strength and muscle tone for speech; if the quality of their voice seems appropriate; if their face appears symmetrical and if they seem able to move the lips, tongue, jaw and soft palate normally.

The SLP will make note of the child’s intentions to communicate and interact; engage in social interaction; listen; and respond.  They will observe what other forms of communication the child makes such as pointing and gesturing.

This information will be analyzed and used to compare the child to children with typically developing speech, and to determine if a child has a communication delay or a communication disorder.

CAS and the DHH child

Ok, now we know what CAS is and how it is diagnosed, how do we manage CAS in our deaf/hh children? My daughter was diagnosed with CAS almost a year after being diagnosed as hard of hearing. Next came the challenge of managing both diagnoses in school. We had already tried both public and private speech school programs and decided that the best solution would be a public school setting that allowed my daughter to focus both on speaking and signing -- dual methods of communication. 

Our county has a strong Deaf Ed program but the speech language pathologist in that program is not well versed in CAS. My initial reaction was “oh my… how can you treat my child?”  In brainstorming the situation with my daughter’s private SLP, (she receives both school provided and private speech therapy) I decided to approach our county to conduct an in-service. The county was more than willing to bring in an expert to speak. They were able to secure the same doctor/speech pathologist that had made my daughter’s diagnosis to conduct the in-service. We hosted a dual presentation with the clinician presenting for three hours on Apraxia and I gave the parents perspective on living with a child who has a dual diagnosis this past month.  

All of this was possible because I was able to educate myself about my daughter’s needs through both the national Hands & Voices website and the CASANA websites. There is a tremendous amount of information available regarding advocacy in IEP’s and how to approach school districts.

The combination of a dual-diagnosis is a challenge and you need a support team to help manage the process. Treatment is long-term and frustrating; your child will literally have to program his or her brain to speak, something most of us take for granted. My support groups include Georgia Hands & Voices as well as the many practitioners who serve my daughter.  I am confident in time her communication skills will continue to improve, as they have already. We have the proper diagnosis, an appropriate treatment plan, and now we are working our plan. In the past, I was the only one who understood her. Now, with patient listeners, she is able to tell a short story using a combination of signs and oral communication that others can understand.  There is always hope.     ~

Editor’s note: Readers can contact Julie at Jjanka2000@ gmail.com; part one of this article can be found at www.handsandvoices.org