What parents can do

The next segment of this video contains a number of questions and answers relating to what parents can do to play a role in their child’s therapy. Well, the fact that you’re watching this video shows that you’ve already taken the first step toward helping your child, because you’re working to understand better what might be happening to impede your child’s ability to acquire speech. I think the most important thing you can do is make sure your child is evaluated by a speech language pathologist, and then follow through with the recommendations that they make for intervention.

It’s certainly not unusual to be uncertain, for a parent, and sometimes even for the speech language pathologist. Our understanding of pediatric motor speech disorders, including childhood apraxia of speech, is still in the early stages, and we have a lot more research to do before we understand this completely. The important thing is that if you as a parent are in doubt about what the speech pathologist is doing, or if the speech pathologist has questions or is uncertain, it’s perfectly appropriate to go somewhere to get a second opinion. Good places for that might be university clinics, or major hospital centers where speech pathologists might have experience in assessing and treating children with childhood apraxia.

I think it’s important that you really understand what the speech pathologist is doing. What are their goals? What activities are they using to reach those goals? And most importantly, talk with your speech pathologist about what you can do to help your child at home. Many children with childhood apraxia of speech need frequent therapy. Sometimes that’s not possible. At that point, it becomes especially important that practice happen at home. Probably on a daily basis, but for very short periods of time. It’s important that as a parent, you feel comfortable in helping your child with that practice. Knowing what to listen for, knowing how to help or cue the child if they’re having some problems. Having the opportunity to observe some of the speech pathology sessions is important. And it’s really OK to ask your speech pathologist if that can happen on occasion, especially if the child isn’t too distracted by your presence. That will make you more confident and comfortable in providing that practice at home.

Well, I always tell parents at first to trust your instincts. If it just doesn’t seem right to you, it’s OK to get a second opinion. But first, I’d talk with your speech pathologist. Ask them why they’re doing whatever it is they’re doing. Make sure you understand that rationale. If you still have questions or you’re just feeling like this doesn’t seem right, then I would encourage you to go and get a second opinion about that.

There are a number of things you might think about. For example, if a child has childhood apraxia of speech, they are not necessarily weak, unless they also have dysarthria. If the speech pathologist is working primarily to help strengthen the tongue or the lips, and you think, they really don’t seem weak, that would be one thing that might cause a red flag and cause you to be concerned. Again, I’d suggest then that you talk to the speech pathologist and ask them why they might be doing that.

For children that actually are weak or have different kinds of neuromuscular impairment, non-speech, oral motor exercises are often included as part of the therapy process, and sometimes can be beneficial. For children with childhood apraxia of speech who don’t have weakness, but have more difficulty planning movement, those non-speech activities are usually less important. There are some non-speech oral motor activities, though, that can be very helpful in getting children to an initial position, for example. A speech pathologist may take a straw, for example, to help the child get lip rounding. But at that point, it’s just to improve that child’s awareness of lip rounding, and we would remove the straw as quickly as possible, and soon go into a speech act using that lip rounding movement. So these non-speech, oral motor kinds of tasks can be used in CAS very effectively. But usually just for phonetic placement, increased proprioceptive awareness, and then are faded out as quickly as possible.