Monday, May 14, 2012

Leslie Lindsay, R.N., B.S.N.

Today we share an article from guest blogger
Leslie Lindsay, R.N, B.S.N.

Welcome to May! While it’s a busy month full of end-of-the-school year activities, it’s also “Better Speech and Hearing Month!” I am honored to be a guest blogger on PHA so that I may share with you our experience with childhood apraxia of speech (CAS), a complex neurologically-based motor speech disorder. Here goes:

 As first-time parents, we didn’t want to appear “delinquent,” so when Kate was 15 months old, exactly, we headed to the doctor (the same one who delivered her) for her scheduled well-child check-up. I say “we,” because both doting parents were off work for the occasion. We came armed with our wiggly daughter; along with thoughts, questions, and toddler antics to relate to our doctor.

Kate was meeting all of her developmental milestones right on target. Except one: talking. She had only one word, “Hi.”

After Dr. Baumgartner whirled into the exam room, plopped down and smiled at us, she asked a series of questions . . . was Kate doing this, doing that? Yes, yes, and yes, we nodded and smiled proudly. “Is she saying ‘mama’ and ‘dada’ and a few other words?” Nope. We held our breath, awaiting her response.

Sure, I was slightly concerned. After all, I had friends from childbirth class whose toddlers were jabbering up a storm. As a first-timer, however, I didn’t want to jump the gun. Kate was only 15 months old after all. She still wore diapers, took a pacifier when distressed, and was rocked to sleep. In many ways she was still a baby, and babies don’t talk, do they? Plus, I knew kids—through my years as baby-sitter and as a child psych nurse.

We told our doctor that all Kate was saying was “hi,” and that she started saying that around 13 months. Wasn’t that good enough? Our caring doctor probed a little further and eventually referred us to a local speech-language pathologist (SLP). “You can do it now, if you want to be aggressive, or wait until she is 18 months, if you want to take a conservative approach.”

I took the conservative approach. I finally made the call at 18 months. Kate still wasn’t saying “momma” and I wanted to hear my little girl call my name, instead of grunting when she needed me.
 I’ll admit, I was totally skeptical of the capabilities of a speech-language pathologist at first. But we stayed the course—taking Kate to speech therapy weekly after the SLP determined there was a “delay.” When she was 28 months old, she was diagnosed with childhood apraxia of speech (CAS), which is a neurologically-based motor-speech disorder. In plain language, this equates to, “She knows what she wants to say, yet she just can’t coordinate the complex movements from her brain to her mouth in an intelligible manner.” We saw a lot of grunting, gesturing, and similarly, frustration—for all of us.

Childhood apraxia of speech (CAS) typically affects more boys than girls. However, prevalence is a tricky thing. The answer may surprise you. Let me explain: there are a good many of over-lapping symptoms and co-occurring conditions (having more than one concern/disorder at the same time) that may blur even the best-trained clinician’s eye. If you are looking for some numbers, it’s difficult to determine. Some studies indicate that CAS occurs in 1-2 children per 1,000, yet another study indicates somewhere between 1-10 per 1,000 children. If you suspect CAS in your child, it’s best to get him to qualified speech-language pathologist (SLP) for a full evaluation (which is based on a variety of behavioral checklists, observation of the child’s speech, and family history review). However, give your child some time. If you detect a speech problem early on, don’t assume its CAS. Most SLPs won’t give your child the CAS diagnosis until he is about three years old, unless it is very clear that CAS is the issue at hand.

Once your child is diagnosed with CAS, the real work begins. The American Speech-language Association (ASHA) recommends “frequent and intense speech therapy,” which could mean two-three 60-minute sessions of motor-based speech therapy each week over the course of several years. Some professionals recommend breaking speech therapy time into smaller, more manageable chunks of 30 minutes more times per week. This is dependent on your child’s attention span, and your schedule availability.

Here’s a quick check-list of behavioral symptoms associated with CAS*:

 • Decreased cooing or babbling as a baby; “quiet baby.”

• May have feeding difficulties as a baby/toddler (overstuffing, “pocketing,” hyper- or hypo-sensitivity to foods)

• Your baby’s first words appear “late” (after 14 months) or not at all

• Understands most of what is said, yet can’t repeat/verbalize well (large gap between receptive and expressive language)

• Cannot correctly use sounds

• Difficulty imitating words and phrases

• May have developed an elaborate system of gesturing

• Searching or “gropes” for words

• Leaves sounds off of words

• *This list is not exhaustive, nor diagnostic.

I am happy to share that Kate is now a busy, creative, and bright 7-year old wrapping up a successful first-grade year. She is no longer in speech therapy, and sometimes we have to ask her to be quiet!

If you are interested in more information about apraxia, you’re in luck! The first-ever non-academic book exclusively on childhood apraxia of speech was recently released by Woodbine House, Inc. in March 2012, Speaking of Apraxia: A Parent’s Guide to Childhood Apraxia of Speech. Written in a sympathetic, yet down-to-earth manner, you will find this book covers it all from diagnosis to treatment to family coping and lifestyle. It’s a great resource for parents, pediatricians, SLPs, and more. Speaking of Apraxia is available thru Amazon and Barnes & Noble. In addition, I urge you to look to Apraxia-KIDS/CASANA (, CHERAB Organization ( and the Windy City Apraxia Network (contact for more information) where you can find in-person meetings the first Thursday evening of the month. Follow my blog on apraxia, child development, parenting, etc. at ….Practical Parenting with a Twist!

Leslie Lindsay is a suma cum laude graduate of the Sinclair School of Nursing at the University of Missouri-Columbia. She practiced nursing at the Mayo Clinic in child/adolescent psychiatry for 5 years before choosing to stay home with her two daughters, where she writes full-time. She lives in suburban Chicago.

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