Questions on Apraxia Therapy

I notice that a number of people who come to my site are searching for and interested in information on apraxia and speech therapy for apraxia. Parents want to know when and how it is diagnosed and what kinds of therapy they should be looking for to help their child.

I have blogged on this topic a number of times, often related to my view that children are often diagnosed too early or misdiagnosed in this area. I ran across a helpful interview that addresses this issue as well as appropriate therapy approaches, feedback and practice. In the professional magazine,, blogger and speech language pathologist Stephanie Bruno Dowling, interviews Sharon Gretz, MEd., founder and current executive director of CASANA, the Childhood Apraxia of Speech Association of North America. Her interview is very informative and helpful to parents as well as therapists. Several points are emphasized that I agree with:

  • Effective apraxia therapy must be approached from a motor planning and programming approach, understanding that children with CAS practice movements that lead to permanent change in their motor system.
  • Effective therapy is delivered individually and in short, frequent sessions. I have had parents call me, telling me that their child was diagnosed with Childhood Apraxia of Speech and they were getting therapy in a group, once or twice a week for an hour. Therapy needs to be very specific for a child and include repeated execution of motor movements which is not conducive to group therapy. Several shorter sessions per week have been found to be more effective. In fact, the American Speech and Hearing Association recommends therapy 3-5 times per week for children who are diagnosed with severe to moderate CAS.
  • Effective practice by the therapist and parents as well as feedback is important for progress with CAS
  • Effective speech therapy for apraxia appears “to include multi-sensory feedback in the form of visual, verbal, or even tactile/touch cues to help guide the child’s speech movements.” Unfortunately  there isn’t one method that is right for each child so it is necessary to try different approaches that involve strengthening the child’s internal sensory systems, while giving feedback for correct motor movements. I have blogged in the past about success I have found in using the Kauffman approach as well as PROMPT.
In the final part of the interview, Ms Gretz addresses the issue of what to do when therapy isn’t working. What is considered adequate progress? She shares some realistic questions to ask that can help move therapy forward regarding is the type, frequency, practice and intensity of therapy adequate?
Especially if you are a parent with a child newly diagnosed with CAS, read the full interview for a good understanding of apraxia and how to deal with it.
Posted in 3-6 year-olds, 6-8 year-olds, Apraxia, Birth-3 year-olds, Elementary School Age, Speech and Language Delay, Strategies to Encourange Language Development | Tagged | Leave a comment

Free Downloads for Valentines Day Speech Activities

We are always looking for fun free downloads to use for speech therapy activities. has been a great source for free valentines and this year they posted several options for free vintage and retro valentines for kids.

Use them for a reinforcing activity for articulation or incorporate them into a language lesson on spacial concepts, descriptions, sequencing or other goals.

Other options for fun free printable valentines are linked on the site as well. So get out your scissors and glue and have some fun this week!

Posted in 3-6 year-olds, 6-8 year-olds, Articulation, Elementary School Age, Language, Speech and Language Delay | Leave a comment

Using a Game to Help Word-Finding in Speech

Today I worked with a little girl who has a word-finding problem. She has difficulty naming words in categories and even understanding categories.

I brought out the “Mystery Garden” game by Ravensburger. The game board is a luscious painting of a path through a garden filled with flowers, animals, a lake, park, farm and so on. A player selects on of the 50 picture cards that are an exact picture of something on the board. The other player has to ask yes-no  questions to guess what is on the card. This game of deductive reasoning, vocabulary, association and categories helps build language skills.

It took less time than I thought to teach my 5 year-old client to start with “bigger” questions that were more general dealing with categories. By playing the game, she finally learned what a category was, which was a concept that had been difficult for her to master. I drew big circles on a piece of paper and wrote “toys,” “animals,” “plants” and so on. She quickly understood the group of categories to form a question about in her first line of questions: “Is it a toy?” “Is it an animal?” If she started too specific, I would use the words, “Give me a bigger question.”  We followed our questioning with where it was, “Is it in the sky?” “Is it on land?”

Then I needed to show her the next level of questioning based on the category. If I was holding an animal card the options were about attributes: “Does it have four legs?” “Is it furry?” “Is it smooth?” or “Is it big?” She quickly lost the temptation to ask if it was a specific object.

I was amazed at how easily this little girl started to see the hierarchy of questioning based on going from the more general to specific and being able to question according to attributes.

I knew the game was a hit when I found her making up her own cards for guessing when it was time for me to leave. She wanted to continue with Mom!

Posted in 3-6 year-olds, 6-8 year-olds, Elementary School Age, Language, play, Speech and Language Delay, Strategies to Encourange Language Development, Word Finding | Leave a comment

Articulation Carryover Ideas

I work with several children with articulation goals–aged 3-7. Lately, several of them are at the same stage of trying to carry over the correct production of their sounds. They are able to produce the sounds correctly in sentences but when we move to conversation or during an activity, they are not as accurate. I start with increasing their auditory discrimination of correct and incorrect sounds in my speech and move to recognition in their speech. I ask them to give me a thumbs up if I said it a good or bad way. They have fun with that. Then we focus attention of listening to them.

The other day, a five-year-old girl taught me a great strategy. She said a word incorrectly while she was talking, then looked up at me and said, “I will fix that,” and proceeded to correct herself! I saw two more children that day in a similar stage in therapy and tried that same line. “Can you fix that?” Somehow the kids loved the idea of them fixing their speech, not me!

Another little boy corrected himself, seemed surprised, looked at me and said, “I fixed that!” It is a wonderful way to teach kids to be responsible for their speech carryover as well as build auditory awareness and discrimination skills.

Try this out and let me know what ideas you use to effect carryover of sounds you are working on.

Posted in 3-6 year-olds, 6-8 year-olds, Articulation, Preschool, Speech and Language Delay, Strategies to Encourange Language Development | Leave a comment

Valentines Day Picture Books for Speech Therapy

Here are some more Valentines Day books to use in speech therapy to liven up your sessions:

Love, Splat by Scotton

Splat has made a special valentine for his secret crush, Kitten. A little bashful about giving it to her, he also discovers that his rival, Spike, has eyes for Kitten too. In fact, Spike has a bigger valentine for her than Splat. Losing his nerve, Splat drops his valentine for Kitten in the trash. Turns out that Kitten finds it, and prefers Spat over Spike inspite of his rumbling stomach and bendy tail.

  • A cute story to use to re-tell, talk about the beginning, middle and end, as well as the problem and solution.
  • Extend the story to talk about how kids treat you at school. What makes a friend? What do they appreciate in you?
Happy Valentine’s Day, Mouse by Numeroff and Bond
Mouse is making valentines for his friends and each one celebrates what she likes in that friend–pig is a good dancer and moose is such a good artist.
  • Make some valentines for friends. Talk about what you appreciate in each one and dictate or write a message telling them that.
  • Talk about the difference between being good at something like soccer or drawing versus a character trait like generous, kind or helper
I Love You More by Duksta
This clever book is divided in half, with one side devoted to a mother telling her son how much she loves him, while you flip the book over and read the other half where the boy declares his love for his mother.
  • Talk about the comparatives, “I love you higher than the highest bird ever flew,” or taller than the tallest tree.” Encourage the student to make their own comparatives: bigger than…., wider than……happier than….. and illustrate your words.
Mama, Will You Hold My Hand? by Pignataro
Mama promises to hold her little Bear’s hand “to the ends of the earth.” They pass through beautifully water colored landscapes as they hold on to each others hands.
  • Point out the descriptive words, “swirly skies,” “sneaky shadows” or “wavy waters.” Collect pictures or objects around the room and add a descriptive word to the noun. See how many you can brainstorm.
  • Talk about places your student has gone, and add a descriptive word to it.
Posted in 3-6 year-olds, Birth-3 year-olds, Books, Elementary School, Language, Preschool, Speech and Language Delay, Strategies to Encourange Language Development, Uncategorized | 2 Comments

Speech Problems with Apple’s iPad Name

How funny that speech and language difficulties can even be involved in the naming of Apple’s new release, the iPad Tablet. According to the New York Times yesterday, in their article, “iPad Name Conjures Up More Than Intended,” the pronunciation of the /a/ sound in the iPad is too similar to the /o./ in iPod for people from Boston to Ireland to easily hear a distinction. Who didn’t check that out???  A good speech pathologist trained in foreign dialect could have advised Apple on the confusion.

The language piece that gets confusing is, that according to the article, some women are upset because of the awkward association between the name and feminine products. Naming consultants get paid a lot of money to come up with names that conjure up just the right associations. In this case, who would have thought?

Anyways, I think the iPad is a cool product and as soon as I get to know my precious iphone a little better, I will be ready to take on the iPad, controversy or not.

Posted in Uncategorized | 1 Comment

The Financial Burden of Autism

In today’s New York Times, the article, “Dealing with the Financial Burden of Autism,” offers a look into the financial side of providing the best program for a child on the autism spectrum. Konrad’s article gives several practical suggestions for navigating the insurance obstacles while pushing for the best program for your child.

According to the article, direct medical and non-medical costs for a child with autism can cost between $67,000 and $72,000 a year. Parents already deal with the challenge of finding the right set of therapies to benefit their child since the treatments aren’t one size fits all. Since many therapies are given several hours a week, the cost adds up.

The article gives some practical advice for seeking financial reimbursement and assistance. The father highlighted in the story obtained financial assistance through a special part of the Medicaid program. He talked about planning therapy deliveries according to caps you might have in your insurance program, coordinating with services covered by the schools, and utilizing resources such as community chapters of the Autism Society of America or Autism Speaks for help with practical advice.

Let me know what has been helpful in your journey with trying to get services covered for your child with autism. Use the comments below.

Posted in 3-6 year-olds, 6-8 year-olds, Autism, Birth-3 year-olds, Speech and Language Delay | Leave a comment

Getting Ready for The International Toy Fair in New York City

rocking horseI am excited about the upcoming International Toy Fair in New York City, February 14-17. Just walking through the Javits Center, one feels surrounded by innovative, creative people. Inventors of children’s toys and games have to be incredibly intelligent but also have a child’s whimsy to relate to their market.

Yesterday I was in a wonderful toy and hobby shop in Fairfield, Connecticut, Hobbytown. I explained to Celeste, the knowledgeable employee, that I reviewed children’s media for its language value and asked her about some of the products that I liked–if they sold well and just what was popular among parents who selected toys and games for their kids.I had specifically pointed out International Playthings’ Playdate puppet show. She said that it was a popular item because it met the criteria she sees parents using in selecting toys for their kids:

  1. Kids play independently with the toy.
  2. They can finish the game or pretend play and have a sense of pride in completing something.
  3. The toy or game is interesting to play with over and over as they play with it in a new way.
I will be on the look-out for new games and toys to share with you that meet the above criteria and also build language and pretend play. Get ready for my list!
Posted in 3-6 year-olds, 6-8 year-olds, Birth-3 year-olds, play, Toys | Leave a comment

When Brothers Become Parents

kids and parents on slideOne of the joys of motherhood is to see your children become parents. You get to re-live their child-like attributes as you see them come out as parents.

Last weekend two of my sons and their families met for a family get together in North Carolina. They ventured off to a new indoor playground, “Plaza Fiesta.” which they described as “like a McDonalds Play Land times 10 with several stories of padded ramps, tunnels and swirling slides,
and an immense amount of static electricity snapping and popping all over the place.” The oldest had been there before with his daughter and even planned his attire for minimal static electricity! They apparently wore themselves out, going up and down the four story slides and topped off the experience with authentic Mexican food.

The adult child who loved to draw, has art time with his 1 1/2 year-old,  spreading crayons and paint out for experimenting and the one who taught himself to play the guitar, is patiently teaching his 3 year-old.

I didn’t realize how much fun it would be to see their childhood played out again in a new little body!

Posted in play | 1 Comment

Valentines Day Books for Speech Therapy

It’s time to talk about love, hugs and kisses and use some fun stories to work on children’s speech and language goals. More books are included in last year’s blogs.

Here are some fun books for preschoolers and early elementary aged students to encourage language:

Max’s Valentine by Rosemary Wells

Max of course wants to sabotage Ruby’s activity making valentines by eating the candy, yum yum glitter and all. Finally Max gets his own valentine delivered from Grandma, full of chocolate ants!

  • Use the story to talk about sequence–making valentines, mail them, receive them.
  • Create your own valentines with lots of options for fun candies to glue on the hearts
  • Practice sounds and language structures as the child re-tells the story.
The Giant Hug by Hornug
Owen wants to send his granny a big hug for her birthday. A picture of a hug won’t do so he starts with the first step–he gives a big hug to Mr. Nevin, working the counter at the post office, and asks him to pass it on to his granny. Each step of the way, the hug is passed on until granny is found in her garden and receives her gift.
  • Re-tell the story using drawings, or objects representing the different steps a letter or package goes through to get to its recipient–letter sorter, truck driver, airplane captain, mail truck driver and mailman.
  • Change the story with each child offering what gesture or words they would like to “send” through the mail.
Won’t You Be My Kissaroo? by Ryder and Sweet
Equally loved as Won’t You Be My Hugaroo? this book is great for a toddler but can start a good language discussion for an older child. Each kiss illustrated has its own adjectives–“a morning kiss is full of sun and wishes for the day to come.” A breakfast kiss can be sticky or a good-bye kiss can be safe. The author cleverly adds upon each kiss until there is a surprise kiss with all the animals gathered for a birthday party.
  • Talk about the words that describe each kiss. Add more thoughts or adjectives to each one–a breakfast kiss could be slurpy, buttery or tasty.
  • Draw and cut out pictures of different lips to represent each kiss, add your own and write out the words that describe the kiss.
Posted in 3-6 year-olds, Articulation, Birth-3 year-olds, Books, Language, Preschool, Speech and Language Delay, Strategies to Encourange Language Development | Leave a comment