CHERAB: Working on behalf of children's speech and language delays and disorders

As far as a therapist in Houston that specializes with apraxia, have you checked with ASHA? We have their link at our site as well. If you still can't find someone, and no one emails you with names, let me know.

Question
5. Are all late talkers apraxic?

You mention that both your sons were "late talkers", but had apraxia. I thought there was a difference, meaning some kids are late talkers, but do not have apraxia. Did I misinterpret?

Answer

Sorry if our story is confusing, but I hope this explanation will clear things up.

The easy answer is yes, a child can be a late talker and not have apraxia. But because you brought up my two "late talking" kids, we go to the tough question! The pediatric neurologist diagnosed our older son, Dakota, with oral apraxia at 2, but Dakota never had oral or verbal apraxia in the way our son Tanner does. Dakota's "apraxia" was used as a symptom (like if you
look up the word apraxia in the dictionary and use it as a definition to describe what is happening. Loss of ability to...) The word apraxia was used for Tanner as a diagnosis. Tanner has oral and verbal apraxia.

There are so many names for apraxia - the neurological based disorder we are talking about when we say "Children's Apraxia Network" for example, names such as dyspraxia, verbal apraxia, oral apraxia, developmental apraxia, global apraxia, limb apraxia, oral motor disorder,
etc. and because the speech and medical community are not always on the same page, names are used by professionals that are very confusing, or that even conflict, at times. Some neurologists are knowledgeable about apraxia, and some are not, some are knowledgeable about apraxia, but use other names to describe it. I'll explain.

Tanner was diagnosed as havinig severe oral and verbal apraxic by various SLPs and by Dr. Marilyn Agin. However, the same pediatric neurologist who wrote in an evaluation that Dakota has "oral apraxia," diagnosed Tanner as having a "phonological motor processing disorder which effects motor planning and speech." You see, this neurologist used the term "apraxia" as a symptom rather than a diagnosis since in his medical opinion the diagnosis "apraxia" was not clear. "Apraxia of what? The limbs, the eyes, it's to vague a term!" is what he said to me in a frustrated way. "I don't like this name apraxia, it's to vague!," he also said. So even though this neurologist knew Tanner was diagnosed as having oral and verbal apraxia by many other speech professionals, and by a medical professional, and even though he understood what apraxia was, he still did not want to use the term "apraxia" to diagnose Tanner. He preferred the diagnosis "phonological motor processing disorder." But if you run that past some SLPs, some will say that means something different than apraxia!

Since Dakota, our older son had "facial palsy" from crushed facial nerves, among other things, from a traumatic delivery, it created "oral apraxia" but this was describing the action of the nerve damage, not diagnosing him as being oral apraxic. It's complicated, but yes, even though both our sons had oral apraxia, only Tanner has apraxia, the neurologically based speech disorder of unknown origin. So for all of you with one child with apraxia trying to explain this to family and friends, imagine us! Thank God that Dakota today is mainstreamed and getting top grades in school! We just can't wait until Tanner makes it out of the woods, as well, at some point.

Once again though, our situation is unique and isn't the best example of two typical "late talkers." One was a late talker from birth trauma, and one was a late talker from apraxia, but they both were described as having apraxia. The average late talker does NOT have apraxia. Apraxia is not rare, but it's not that common, either.

Question

6. Is there an association between apraxia and mental retardation?

"Hi! My name is Candace and my three year old son has apraxia. I have a few questions for anyone who is familiar with this language disorder. First, is there an association with apraxia and mental retardation? I asked a professional what they did 25 years or so ago with children who were late talkers and she said a lot of them were labeled mentally retarded. Also, she said that an IQ test is based heavily on language development. What are your thoughts? Second, people say that when my son does use his words (which is approx. of 20) that he sounds like a deaf child. Although my son had a lot of sinus infections, he did pass a hearing test. He has no high and low pitches to his voice and he mostly picks up the vowels. Is this typical with kids with apraxia? Third question, my son also babbles like a baby at times. When we are out in public, people tend to look at him. What do I do?"

Answer

I'm sure you will receive many responses to your excellent questions, but I wanted to address some of your questions right away, those that I have the ability to answer, even though I'm a parent, not a professional. (This is because of my e-degree and life degree in apraxia research!)

Children with apraxia have been MISdiagnosed as mentally retarded and autistic for far too long.

A child can have apraxia and have normal or brilliant intelligence; from what I've read, seen, and heard, most do. Just so you know however, a child COULD have apraxia and other issues, such as apraxia and mental retardation, or apraxia and autism, or apraxia and cerebral palsy, or apraxia and downs, etc. (Just like they could have a broken leg and autism.) This is why it's so important to bring your child to developmental pediatricians and/or neurologists who are knowledgeable about apraxia as well as other issues. Don't let anyone treat or educate your child as having cognitive challenges unless you know for a fact he does. And don't leave it up to your child's school to "find out" and classify him or her as mentally retarded. Find out by having your child privately evaluated by a medical authority (or two) that you respect, and who has experience and knowledge of apraxia and other issues.

Be careful of "receptive" language evaluations on written reports. Your child can have a severe expressive delay, but if they write a "severe expressive and receptive delay," it means something different. That's a red flag that there could be cognitive challenges going on. It translates (in parent language) to "You're talking to this child, but there is nobody home." If that's the case, again, see a medical professional, but if that's not the case, if your child does understand and can follow simple commands, these are the first baby steps to misclassifying apraxic children. Take it seriously and find out privately.

Don't just depend on one diagnosis, especially since many apraxic children have been misclassified or misdiagnosed. This is one of the reasons we so highly recommend Dr. Marilyn Agin, because she has the background of an SLP, but is now a developmental pediatrician who specializes in autism and apraxia. She gives lectures to medical and other professional communities about these issues and others, and tries to raise awareness so that apraxic children will no longer be misdiagnosed, and will receive the appropriate therapy and early intervention. On top of that, Dr. Agin is the Medical Director for Early Intervention for New York City, the largest of it's kind in the USA. Dr. Agin states that since so many apraxic children are intelligent and know they aren't being understood, some tend to withdraw, and be misdiagnosed as autistic. Her information is at our website under Ask The Doctor.

Again, apraxic children can be brilliant and misdiagnosed or misclassified. What's fortunate is that, because of the Internet, you can prove this point by speaking with the children who have grown up with apraxia or their parents.

The way apraxic children speak varies. You can listen to various apraxic children at The Talking Page. Our son Tanner used to sound deaf when he spoke, but what's funny is that now that he goes to a school for the hearing impaired and deaf, he no longer sounds like he's deaf, and he has many inflections when he talks or sings! Lori Roth, who has worked with both deaf and apraxic children, believes that they both may learn to speak in similar ways, which is why so many apraxic children have done well in schools for the deaf or hearing impaired. It's something to look into anyway. Dr. Agin can explain why apraxic children sometimes sound deaf from a medical aspect as well.

As far as people looking at your son when he babbles, I know how you feel! Tanner is a big kid, so even when he was only 3 he looked 4, and now at 4 and a half he looks like he's at least 5 or 6. At three he had only a few simple sounds or words. He went through the "babbling" stage after three too. His SLPs say that is typical, and a good thing, since it's an important stage in language development that our apraxic children either miss, or don't fully go through when younger. Apraxic children typically go through most of the "normal" stages of language development if they are getting appropriate therapy, but just LOTS slower and later than a typical "late talker" that is not apraxic. Today Tanner talks "like a baby" using 3 to 5 word sentences, and not only are we all proud of him, but he's proud of himself! We don't want to lose that healthy self confidence, so if he doesn't notice any strange looks cast his way, I ignore them. But if these people say anything, or Tanner notices them staring at him, I use my now classic, "He's learning to talk, and he's doing great!" Works like a charm! Also read What's wrong with him? It's pretty funny.