HOH & Apraxia

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ryancher

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Can anyone provide me with info on "apraxia" and even better "hoh and apraxia"?

I am exploring this as a "possible" for Tyler. He currently has an OT & SLP working with him. Other than the severe speech delay - we have also noticed a delay in his gross/fine motor skills (drinking from cup, colouring/tracing, etc...). He used to have issues with spoons/forks but he's finally beginning to master that. He has also just figured out how to drink out a straw - but a cup is still an issue (he likes to taste the liquid with his tongue prior to attempting to drink).

I am exploring apraxia... and going to mention to his doctor. I also plan on contacting his SLP to find out about arranging more appointments for therapy.

My older son was diagnosed with mild cp and APD. He didn't start speaking until he was 3 years old and then his vocabulary just exploded. He is doing awesome now!!! I know cp is not genetic but I'm wondering if anything could be related between the boys.

Also... wondering if anyone has any experience with hoh & apraxia... and how were ASL/Oral skills? Tyler is doing great with his ASL - thriving and wanting to learn more. He is still not exhibiting any oral skills yet.
 
I have read several blogs from deaf village concerning this subject but I don't know which as I was just randomly reading them. Maybe these people can help
 
Types of Speech/Language Disorders

Developmental Dyspraxia - Dyspraxia is a neurologically based disorder also known as (Developmental Co-
ordination Disorder, and the Clumsy Child Syndrome) is present from birth. These children have difficulty in motor
planning of movement to achieve a predetermined idea or purpose. It is believed to be an immaturity of parts of the
motor cortex (area of the brain) that prevents messages (ideas) from being properly transmitted to the body, which
may affect any or all areas of development. It is inconsistent, and affects each child in different ways, at different
stages of development and varies in severity.

There are three (3) types of Developmental Dyspraxia. Oral Dyspraxia, Verbal Dyspraxia, and Motor Dyspraxia.

Oral Dyspraxia - children are unable to reproduce mouth movements. Examples of this are the inability to put their
tongue up to the roof of their mouth. A child with oral dyspraxia may not be able to, even though they do this
unconsciously.

Verbal Dyspraxia - children have difficulty pronouncing sounds or saying words. Many words just do not sound
right regardless of how hard they try to produce the sound or word correctly.

Motor Dyspraxia - inhibits an individual from moving as planned and effects their sensory input. Children with motor
difficulties appear to be clumsy, as if out of sync with their environment.
 
Dyspraxia in children, dyspraxia, speech dyspraxia, speech apraxia

Types of Speech/Language Disorders

Developmental Dyspraxia - Dyspraxia is a neurologically based disorder also known as (Developmental Co-
ordination Disorder, and the Clumsy Child Syndrome) is present from birth. These children have difficulty in motor
planning of movement to achieve a predetermined idea or purpose. It is believed to be an immaturity of parts of the
motor cortex (area of the brain) that prevents messages (ideas) from being properly transmitted to the body, which
may affect any or all areas of development. It is inconsistent, and affects each child in different ways, at different
stages of development and varies in severity.

There are three (3) types of Developmental Dyspraxia. Oral Dyspraxia, Verbal Dyspraxia, and Motor Dyspraxia.

Oral Dyspraxia - children are unable to reproduce mouth movements. Examples of this are the inability to put their
tongue up to the roof of their mouth. A child with oral dyspraxia may not be able to, even though they do this
unconsciously.

Verbal Dyspraxia - children have difficulty pronouncing sounds or saying words. Many words just do not sound
right regardless of how hard they try to produce the sound or word correctly.

Motor Dyspraxia - inhibits an individual from moving as planned and effects their sensory input. Children with motor
difficulties appear to be clumsy, as if out of sync with their environment.
Click to expand...

There is lots more information at this link.
 
Bottesini said:
Oral Dyspraxia - children are unable to reproduce mouth movements. Examples of this are the inability to put their
tongue up to the roof of their mouth. A child with oral dyspraxia may not be able to, even though they do this
unconsciously.

Verbal Dyspraxia - children have difficulty pronouncing sounds or saying words. Many words just do not sound
right regardless of how hard they try to produce the sound or word correctly.
Click to expand...

Tyler may fit in to one of these two... I'm thinking verbal but not sure about oral.

I have contacted our SLP to ask her - I know she said he had a Motor Speech Delay - just wondering if that's the same as apraxia??? If so, I want to know what we can do at home and if we can set up more therapy sessions.
 
All of the therapists that my daughter has seen will not diagnosis apraxia in a child who is not well amplified. They say that a hearing loss can mimick all the symptoms and that kids with hearing loss are waaaaaaaaaaaaaayyyyyyyyy over diagnosed with "other issues" that actually directly related to hearing loss.

It is possible that he has apraxia, but it actually much more likely that he does not hear many sounds and therefore can not repeat them.
 
faire_jour said:
All of the therapists that my daughter has seen will not diagnosis apraxia in a child who is not well amplified. They say that a hearing loss can mimick all the symptoms and that kids with hearing loss are waaaaaaaaaaaaaayyyyyyyyy over diagnosed with "other issues" that actually directly related to hearing loss.

It is possible that he has apraxia, but it actually much more likely that he does not hear many sounds and therefore can not repeat them.
Click to expand...

All the the professionals involved (audiologist, SLP, etc...) believe he is amplified correctly for his hearing loss. I can understand not hearing some sounds, especially high frequency sounds... but why can't he even repeat or mimic a sound/letter with a lower or mid range frequency? We say da-da, and Tyler will say va-va. The only 2 consonents I have ever heard him say are "M" and "V". Other than that all vowel sounds.

Here's a website I found with warning signs of apraxia. I included the warning signs below and indicated in red the ones that I believe apply to Tyler.
http://www.oafccd.com/factshee/Apraxia.pdf

What are some Warning Signs?
Some of the more common warning signs of Developmental Apraxia of Speech include:
 little or no babbling during infancy
 difficulty with nursing or feeding during infancy
 few consonants
 slow, effortful or halting speech
 poor speech intelligibility
 difficulty imitating sounds and words
 late onset of first words
 inconsistent or unpredictable speech errors
 groping during speech attempts
 high frequency of vowel and voicing errors
 other “soft” neurological signs, e.g. awkward, sensitive to touch, sensory problems, fine motor
problems
 slow or no progress with traditional speech therapy
 
ryancher said:
All the the professionals involved (audiologist, SLP, etc...) believe he is amplified correctly for his hearing loss. I can understand not hearing some sounds, especially high frequency sounds... but why can't he even repeat or mimic a sound/letter with a lower or mid range frequency? We say da-da, and Tyler will say va-va. The only 2 consonents I have ever heard him say are "M" and "V". Other than that all vowel sounds.

Here's a website I found with warning signs of apraxia. I included the warning signs below and indicated in red the ones that I believe apply to Tyler.
http://www.oafccd.com/factshee/Apraxia.pdf

What are some Warning Signs?
Some of the more common warning signs of Developmental Apraxia of Speech include:
 little or no babbling during infancy
 difficulty with nursing or feeding during infancy
 few consonants
 slow, effortful or halting speech
 poor speech intelligibility
 difficulty imitating sounds and words
 late onset of first words
 inconsistent or unpredictable speech errors
 groping during speech attempts
 high frequency of vowel and voicing errors
 other “soft” neurological signs, e.g. awkward, sensitive to touch, sensory problems, fine motor
problems
 slow or no progress with traditional speech therapy
Click to expand...

He is aided the best he can, it is just impossible for a child with a severe loss to hear most consonants with hearing aids.

Audiogram-with-Speech-Sound.gif


As you can see unless he is aided to around 20 db, most of the sounds would be unintelligible.

All the things you have highlighted can be attributed to not hearing those sounds.
 
I understand that... but then why is he able to listen and understand? His receptive language is only slightly delayed... he's doing awesome receptively. It's his expressive that's he's behind in... but the ASL is helping.
 
faire_jour said:
He is aided the best he can, it is just impossible for a child with a severe loss to hear most consonants with hearing aids.

Audiogram-with-Speech-Sound.gif


As you can see unless he is aided to around 20 db, most of the sounds would be unintelligible.

All the things you have highlighted can be attributed to not hearing those sounds.
Click to expand...

Tyler has a moderate/severe loss in his left ear and a severe loss in his right ear. He's had aided tests done and they appear to show him hearing within appropriate levels including some speech. So, then why is he not getting any consonents?

Also how is it that some people are aided and have more severe losses but have good expressive language? Being aided to 20db is almost impossible with moderate/severe losses and up. Tyler probably falls between 30-35db aided... so I believe he should be getting a few more than 2 consonents.
 
I think apraxia is possibility.

Has anyone ever mentioned hydrocephalus to you? It may be worth asking the doctor about it. If it was very slow progressing it may be a possibility. I am doubtful, but maybe.
 
ryancher said:
Tyler has a moderate/severe loss in his left ear and a severe loss in his right ear. He's had aided tests done and they appear to show him hearing within appropriate levels including some speech. So, then why is he not getting any consonents?

Also how is it that some people are aided and have more severe losses but have good expressive language? Being aided to 20db is almost impossible with moderate/severe losses and up. Tyler probably falls between 30-35db aided... so I believe he should be getting a few more than 2 consonents.
Click to expand...

If he is detecting sound at 30-35 db, it is unlikely he would be able to discriminate sounds until at least 40-45 db, so yeah, there are very few speech sounds above that. He would likely have access to all the vowels and M and R. Everything else would likely be unintelligible.

Yes, it is impossible to aid a severe loss better than 30-35 db, and that is what makes severe loss so hard.

As for what he is getting receptively, check out:
http://www.hearingjourney.com/Listening_Room/Kids/CLIX_for_Kids/index.cfm?langid=1

It is a hierarchy of listening and discrimination. Have him take the placement test and it will tell you specifically what he is and is not able to discriminate.
 
His receptive language is only slightly delayed... he's doing awesome receptively. It's his expressive that's he's behind in... but the ASL is helping.
Click to expand...
Yes. That is basicly what apraxia is. faire jour, if he was under amplfied his receptive language would be really down there.
Also, I might agree with you if he had a global severe loss, but he has a moderate severe loss too. And yes, it's still not too unusual to still see audilogically hoh kids with expressive language delays but definitly not to this severity.

My genetic syndrome has as one of its symptoms severe expressive spoken language delays. We are hoh but tend to have really severe expressive spoken language issues. Unfortunatly I can't help you, since I only dealt with the typical dhh issues.
ryancher, are there any social service organizations for the Dhh in your area? Could you take Tyler to your provinces Deaf School for an evalution? They may have seen hoh kids with severe expressive language delays before.
 
Oh ME DUH!!! I know you're in Canada, but there are a handful of Deaf Schools in the US who work with hoh and hearing kids who have apraxia. You know...you may want to contact any CP organizations in Canada. There are some CP kids who use ASL as a first language due to apraxia...Maybe if there's something like a tracheostomy society you could contact them (some kids with "just trachs" use ASL as a first language).......wait a second.....I don't have to give you the info for the American Deaf School apraxia programs! I thought that there was a program affliated with the Alberta School for the Deaf for kids with severe spoken language issues, that used ASL.. But, although you're not in Alberta I would contact them, and see if they have any advice or resources for you! Alberta School for the Deaf
and Tevie Miller Heritage School
and while I'm here I guess I should give you info on the American Deaf schools that offer apraxia programs.
The Children's Center for Communication and Academics - Language Access Program
and St. Rita School for the Deaf (st Rita's had a Sign and Say program for kids with apraxia)
 
Thanks for the info...

I have contacted Tyler's SLP and suggested apraxia... I have also arranged an appointment with a pediatrician to discuss as well.

What are the treatments for apraxia? Anyone know what I can do at home while waiting for appointments?
 
deafdyke said:
Yes. That is basicly what apraxia is. faire jour, if he was under amplfied his receptive language would be really down there.
Also, I might agree with you if he had a global severe loss, but he has a moderate severe loss too.
Click to expand...

Exactly! I don't understand why he understands so much but yet can't repeat. He tries... but he misses so many consonents.
 
ryancher said:
Exactly! I don't understand why he understands so much but yet can't repeat. He tries... but he misses so many consonents.
Click to expand...

He can see what you say by lipreading. But he can't hear all the consonants.
 
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