12 September 2010

Eleven Criteria for Apraxia of Speech

Many people have reached out to me asking about the "signs" of apraxia I mentioned in my last post. My time is still being ruled by the two men of the house, so I thought that the least I could do is slap up the 11 criteria for apraxia until I have more time to post about Sheridan specifically...  

You all know I'm not a speech language pathologist (I don't even play one on TV), so keep reading with that in mind. Seek out a professional who knows apraxia if some of this raises an eyebrow for you.

Sheridan's SLP used the Differential Diagnosis for Childhood Apraxia of Speech assessment (adopted from Ruth Stoeckel, MA, CCC-SLP and David Hammer, MA, CCC-SLP, members of the Childhood Apraxia of Speech Association Professional Advisory Board - by the way, I found their Family Start Guide to be a useful overview). 

Here are the 11 criteria, in no particular order of importance... 
  1. limited phonemic repertoire (e.g., limited vowel and consonant sounds)
  2. frequent omission errors
  3. predominant use of simple syllable shapes (e.g., “buh buh”)
  4. reduced expressive language (speech) compared to receptive language (comprehension)
  5. high incidence of vowel errors
  6. increased errors on longer units of speech output
  7. difficulty imitating words or phrases correctly
  8. altered suprasegmental characteristics (A.K.A. prosody, or the patterns of stress and intonation in language)
  9. impaired volitional movements
  10. inconsistent speech errors (e.g., may be able to produce accurately a sound/word in one context but is unable to produce the same sound/word in a different context)
  11. reduced/irregular diadochokintic rates (a person's ability to make rapid speech movements using different parts of the mouth; ability to accurately produce a series of alternating sounds)
Other signs often go with the diagnosis (but aren't enough to actually distinguish those who have apraxia from those who don't). One example is a loss of previously spoken words (e.g., used to say "baby" consistently but no longer says the word).

The Childhood Apraxia of Speech Association noted that SLPs do not demonstrate consistency in which characteristics they place more weight on than others in a diagnosis (so are some of the 11 criteria more indicative of apraxia than others?).  It is not clear which or how many characteristics must be present for the diagnosis (I've seen a few sources say a child must clinically meet at least 8 of the criteria, but other sources say 7 or 9). Also, many of the cites I found indicated that children must have a decent repertoire of words before a diagnosis can be attempted (in other words, they have to have enough speech sounds and words in order to detect these errors).

I'll be posting more as we learn more... from what I have gleaned so far, oral motor and PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) are important and critical therapies, especially when used together. And other strategies can be helpful, as well. Most important is that apraxia requires intensive one-on-one speech therapy.

Anyway, we're still learning and we're grateful for any lessons learned you can share. We'll certainly be sharing what we learn :)


  1. Lisa, I am just catching up with you! I am shocked!!!! I'm so sad to hear/read all you have been through! Of course, I had no idea about Gary and I am stunned! I can't imagine what the last 3 weeks have been like for you. I wondered why you didn't post on Sheridan's Birthday. I was waiting to read (and see) all the fun we missed. I'm thinking of you.....xoxo

  2. According to the American Speech-Hearing Association (National org. for speech-language pathologists) Integral Stimulation Therapy is the only approach clinically proven to work for Apraxia. See Guildersleeve-Neuman and/or Edythe Strand on CASANA website.

  3. Sorry that's Guildersleeve Neumann with 2 ns. You can also search Integral Stimulation Therapy on CASANA (Apraxia Kids) website. ASHA's 2007 technical report on CAS singled out this approach as the only one reporting efficacy data (data that proves it works) since 1995.