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Developmental verbal dyspraxia

Developmental verbal dyspraxia also known as Childhood apraxia of speech or dysapraxia is a conditioned where the child has difficulty in controlled production of speech. The first symtom of it would be lack of expressive vocabulary despite normal hearing and adequate comprehension skills. In childhood apraxia of speech, children produce speech sounds of with enormous variability in terms of phonemes, loudness and related features. The inconsistencies in their production make interpretation more challenging. They have difficulty in varying stress and intonation patterns. They have enormous difficulty in producing even two word phrases.can be defined as a severe and persistent phonological disorder coupled with an expressive syntactic disorder with variable neurological and articulatory findings.” (Aram 1984)

Incidence/Prevalence

DVD is low incidence with perhaps 1 – 10 in 1000 children affected or 3 – 5 % of speech-impaired preschoolers.

Etiology
Demographics

  • 86% of kids with DVD have @ least one family member w/ speech-languagedisorders
  • 59% have @ least one affected parent
  • Higher rates of family history than for other speech-sound disorders: suggestsgenetic basis in at least some cases (Lewis et al. 2003
  • FOXP2  Translocation on chromosome 7q31:A few individuals (e.g., the “KE” family) with this genetic difference have the symptomsof oral and verbal apraxia.  However, they also have oral-facial anomalies and non-verbaldeficits.  Thus, FOX-P2 may be the cause of some cases of CAS, but certainly not all of them.

Symptoms.
Symptoms of DVD:

Not all children with DVD are the same. All of the signs and symptoms listed below may not be present in every child. It is important to have your child evaluated by a speech-language pathologist (SLP) who has knowledge of DVD to rule out other causes of speech problems

  • Receptive-expressive gap
  • Delayed or deviant syllable and word structures: Errors increase with length or complexity of utterances, such as in multi-syllabic or phonetically challenging words.
  • Sequencing: Depending on level of severity, child may be able to produce accurately the target utterance in one context but is unable to produce the same target accurately in a different context.
  • More difficulty with volitional, self-initiated utterances as compared to over-    learned, automatic, or modeled utterances
  • Vowel deviations:Limited repertoire of vowels; less differentiation between vowel productions; and vowel errors, especially distortions
  • Prosody differences, especially lexical stress: Overall slow rate; timing deficits in duration of sounds and pauses between and within syllables contributing to the perception of excess and/or equal stress, “choppy” and monotone speech.
  • Impaired rate/accuracy on diodochokinetic tasks (Alternating movement accuracy or maximum repetition rate of same sequences such as /pa/, /pa/, /pa/  and multiple phoneme sequences such as  /pa/ /ta/ /ka/ )
  • At some point in time, groping or observable physical struggle for articulatory position may be observed .

Prognosis:

Factors that are likely to influence progress for children with DVD.

  • the severity of the problem
  • The existence or co-occurrence of other disorders or problems, such as other speech or language diagnoses, poor health, attention issues, cognitive problems, etc.
  • the age at which the child began appropriate intervention
  • the child’s ability or opportunity to practice outside of therapy time
  • the child’s intent and willingness to make speech attempts and communicate

No one can totally predict the child’s ultimate success at becoming a verbal communicator.  Thus, be wary if you are told that your child will never learn to speak or conversely that it won’t be long until your child is speaking perfectly

Treatment:
Automaticity vs. Flexibility

The two primary goals in all therapy with children with DVD are the following:

  1. Increase the child’s repertoire automatic speech acts to increase communicative efficacy: Old forms with old functions. For young children, this will include animal and other environmental sounds, and simple words to express basic needs.  For older children, this will include communicative sentence frames. Over-learning (drill) of specific words and sentences alone is not an adequate remediation program.
  2. Increase the child’s oral-motor flexibility. Challenging the system — very gradually and systematically — to produce varying sequences of syllables, words, and sentences expands the child’s oral-motor organizational capability

Parental Intervention:

The  principles needed for speech therapy for children with DVD are called the principles of motor learning.

  1. Frequency and intensity of practice opportunities. Skilled motor activity is acquired through repetitive practice. Observation of therapy sessions by parents is key!  This is how they will know when to try to elicit a speech production from their child, how to get multiple repetitions, and when to back off.
  2.  Type of practice. Children with severe apraxia of speech would start with a small set of core functional words.  When the child practices their set of words, randomly, over and over this is called distributed practice and overall this is felt to lead to the best generalization of motor skill. So children severely impaired would benefit from both types of practice.
  3. Type, amount, and schedule of feedback.
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