Speech Apraxia

Article excerpt

Q My daughter is seven years old and has been diagnosed with encephalopathy--a degenerative brain disease--that is now static; ihat is, it is not getting any worse. She has developmental delays and mild cerebral palsy, mostly affecting her left arm and leg. She can walk and feed herself. She is in special education classes but will be mainstreamed into a few typical classes soon.

Her most significant problem is an almost total lack of intelligible speech. She tries to talk but can't seem to form the words. However, she seems to understand what people say to her.

Her speech problems are so frustrating for her--and the rest of the family--because she tries so hard and gets upset when she cannot express her thoughts. Her father and I are concerned that she will just give up and not want to talk at all. Do you have any suggestions? I have heard that some medications may be useful for this problem.

A Most of us never really think about the complexity of everyday communication. For example, the brain's ability to comprehend speech (receptive language) involves hearing sounds, segmenting those sounds properly as words, and then matching those words with their appropriate meanings. The ability to use speech to express thoughts and ideas (expressive language) is controlled by a different part of the brain. This is one reason receptive and expressive language may develop at different rates. This is also why individuals like your daughter may be able to understand spoken language without having expressive language skills.

Your daughter seems to have what is called speech apraxia. (An apraxia is a loss of the ability to carry out familiar, purposeful movements or activities in the absence of motor or sensory impairments.) Unfortunately, speech apraxia in a child is often more of a problem than in an adult (who might have lost the ability to speak because of a stroke, for example). This is because young children with speech apraxia usually do not have an already-developed language base, as would be the case with an adult who developed this condition.

I know how frustrated your daughter must be; I have seen similar frustration in some of my own patients. It sometimes seems that the harder a child tries to overcome this type of apraxia, the more difficult it becomes to speak. And research has shown that after eight years of age, it becomes less likely that a child will show any significant improvement with this type of speech difficulty.

There have been reports of certain drugs having a positive effect--antihistamines in some cases, and a medication known as Levodopa in others-in rare cases where the speech apraxia was actually caused by a type of dystonia (abnormal movements or coordination due to disordered muscle tone). …