Friday, November 12, 2010
Little Man asked me why Peanut has to have speech therapy every week. I explained that Peanut needs help learning words and how to make his mouth work and Little Man looked at me with a doubtful look on his face and told me in no uncertain terms that he thought his brothers mouth worked just fine. But the truth is that he does need the help. I have had a lot of questions from friends and family about Peanut's speech delay and motor planning disorder so I thought I would put together a post to help explain.
What is Apraxia?
Peanut has apraxia which is a neurological motor speech impairment. That means that there is a breakdown in the transmission of messages from the brain to the muscles in his jaw, cheeks, lips, tongue and palate. There is no obvious weakness in these muscles just in the communication from brain to muscles. Due to his apraxia, Peanut knows what he wants to say but there is a roadblock obstructing the signal from his brain to his mouth. His brain says "speak" but his muscles can't or don't "hear" it.
How did you know he had a speech delay?
For the first 12 months of life, children use their entire brain for speech and after 12 months speech begins to shift to the left hemisphere of the brain. When Peanut was 12 months he could say 4 words which is average for that age and nothing to be concerned about. However, once his speech center began to shift to his left hemisphere of his brain he lost the ability to say those words and went silent. By 15 months he stopped talking completely and didn't babble, imitate or make any sounds while playing. This triggered alarm bells for me and we started talking to his doctor and started the process for getting him evaluated for speech disorders. We are really lucky to have amazing resources available to us because this early intervention has been crucial in his success in overcoming his apraxia.
What is it like to live with apraxia for Peanut?
Peanut gets frustrated at times not being able to communicate with us in the way he wants to. Sometimes he can say more difficult words and gets excited about it and then he can't say them again for weeks. Sometimes he adds vowels to the ends of words or drops sounds from the ends of words. Down becomes "dow" and up is "uppa". We use prompting (a form of therapy where we touch and help his mouth form the movements required to make a sound) to help him learn how to make sounds and sometimes he learns how and then weeks later his muscles forget. He has a hard time transitioning from sounds that require his mouth to open wide to softer sounds and doesn't grade his mouth appropriately. He also has a hard time knowing when to voice a sound and when not to. Like b and p are the same sound, just one is voiced and the other isn't.
How is he doing?
None of this is to say that Peanut isn't doing fantastic. He is so quick and so bright that he surprises me each day. Early intervention has been key in his success. Up until a few weeks or so ago, we literally had to teach his muscles, jaw, mouth how to make the movements and translate the messages from his brain. None of the words he could say were spontaneously learned through imitation or hearing a word the way speech is typically learned by children. But a few weeks ago in the car he said "baby" clear as day and just last week he learned "bye" in that spontaneous way. So we are making progress and quickly. His speech therapist won't speculate on the future, but I think that by the time he is 3 or 4 we won't even know he ever needed this intervention. He went from 0 words at 15 months to 17 words by 19 months. Right now we are focusing on certain sounds like the "o" sounds because he has difficulty forming the rounded lip that he needs for that sound. My bottom line for Peanut is that he is happy and playful, excited to have his baby sister here and loving to his big brother. Peanut doesn't know he has apraxia, he doesn't even know that he gets special time with us to practice talking and playing. He just knows he is loved so throughly by all members of our family and that his only job in life is to play and be happy.