Apraxia Therapy: Early Apraxia Therapy (Where to Begin) Part 1

I frequently receive requests for information from parents or therapists of very young children - usually between the ages of 18 and 30 months. The children have very few, if any, words. They make few sounds. They have a history of reduced or absent babbling. They have difficulty imitating and difficulty making volitional utterances. They are beginning to become aware that they are different. They want to communicate and yet struggle. Frustration is increasing on the part of both parents and children. The child may begin to act out in negative ways. What do you do? Where do you start?

You have three immediate goals:

1. Reduce frustration.
2. Establish and increase frequency of volitional utterances.
3. Increase number of daily speech utterances through structured practice.

Early Apraxia Treatment - Reducing frustration.

Both child and parents experience increasing frustration. The child has the cognition and underlying receptive and expressive language skills to want to communicate and yet the child is unable to talk. The child wants to initiate simple requests - they want attention, food, help, an item out of reach, etc. When they are unable to make those requests they are frustrated and act out in frustration. They also resort to grabbing, pulling, pointing, crying, and grunting as they attempt to communicate. You need to reduce all of this frustration to improve the quality of life for the child and everyone around him or her. The child needs to be able to communicate their basic needs. You need to teach temporary ways for the child to communicate effectively.

1. Teach simple signs - Teach the child simple signs such as "no, stop, more, help, eat, drink," etc. Teach the same signs to any adults and other children who regularly spend time with the child. Incorporate the use of these signs into daily routines and encourage the child to use them as well. Adults and other children should pair the use of the sign with the matching spoken word, but do not push the child with apraxia to vocalize. The purpose of using the signs at this point is to allow the child to communicate functionally when their voice fails them. This will result in a happier child who will be able to better understand the underlying give-and-take nature of communication when you are ready to bridge to verbal communication. Here's a visual guide to 21 signs useful with young children.
2. Create communication boards - Create communication boards and post them in key areas of the child's home. Make a simple chart of food and drink items to put on the wall in the kitchen (at a height the child can reach). Post another chart with characters from their favorite TV shows near the television. A third chart might include pictures of the toys they request most often posted near the place toys are put away. This gives the child a way to request specific things without needing to be able to verbalize complex sounds.
   
   Think about the things the child most often struggles to communicate and create boards that feature those things. For more in depth information, read about why and how to make and use communication boards in my Apraxia Therapy: Communication Boards post.

Trying to write this as one continuous post was simply too long. Look for the continuation of this series the rest of the week. In the meantime, if you need more general information about Childhood Apraxia of Speech, the following posts may be useful:

1. What is Childhood Apraxia of Speech and How Is It Diagnosed?
2. What makes Childhood Apraxia of Speech different from other speech disorders?
3. Childhood Apraxia of Speech Therapy Fundamentals: Part 1 - How Much and How Often?
4. Childhood Apraxia of Speech Therapy Fundamentals: Part 2 - Types and Variability of Practice
5. Childhood Apraxia of Speech Therapy Fundamentals: Part 3 - Methods and Content