speech evaluations

Childhood Apraxia of Speech

I am thrilled to feature this guest post by Alyssa Gilligan, M.S., CCC-SLP. Alyssa is the founder/owner of Crescendo Speech Therapy in Baltimore, Maryland. She specializes in treating children with autism spectrum disorder and motor speech disorders with a focus on early intervention. She graduated with her masters in speech-language pathology from Towson University and has been a speech-language pathologist for 6 years. www.crescendospeechtherapy.com

May is Apraxia Awareness month! Childhood apraxia of speech (CAS) is a congenital, neurological motor speech disorder that impairs a child’s ability to motor plan the oral movements needed to produce words. Children with CAS typically have a good understanding of language but are not able to express themselves and approximately 1 in 1000 children will be diagnosed with CAS.

The act of speaking is actually quite complicated! It starts with an idea that is formulated into words and/or phrases. Your brain then has to decide what sounds and in what order are needed to say each word. Your brain sends that information to your muscles in your mouth that are needed to move. Then you move your muscles! Children with CAS have difficulty sequencing the sounds in the correct order and then sending that message to their muscles.

Common symptoms of CAS include highly inconsistent speech with frequent vowel errors and will often say the same word many different ways. They may have prolonged pauses between sounds or syllables as well as inappropriate stress on syllables or words. You may also notice “groping” behaviors in which you may notice your child struggle to achieve the correct mouth posture to produce the word. CAS may be diagnosed by a speech-language pathologist that has experience with motor speech disorders. You can find an experienced SLP on the Apraxia-Kids.org website!

CAS requires a special type of speech therapy that is specific to motor speech disorders and often involves multi-sensory cues including touch cues, visual cues, and auditory cues. Additionally, it is recommended that they participate in intensive speech therapy for at least 2-4 days a week.

Interventions specific to CAS include Dynamic, Temporal, and Tactile Cueing (DTTC), Rapid Syllable Transition Training (ReST) and Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) therapy.

With the right speech therapy and the support of the entire community, children with apraxia can and do make amazing progress in the ability to speak!

-Alyssa S. Gilligan, M.S., CCC-SLP

Early Signs of Autism: A Different Perspective

I am thrilled to feature this guest post by Megan Myatt, M.S., CCC-SLP, speech-language pathologist and owner of a speech-language pathologist and owner of Growing Together: Speech-Language Therapy. She provides speech-language evaluations and therapeutic supports for young children and their families in Carroll County, Maryland. www.growtogetherslp.com

In honor of Autism Acceptance Month, and in anticipation of Better Language and Communication Month, I’d like to talk about the benefits of early identification (and resulting therapeutic supports) of autism. But first, let’s go over a few definitions...

What is autism? 

The DSM-5 defines autism as “persistent deficits in social communication and social interaction” paired with “restricted, repetitive patterns of behavior, interests, or activities” that cannot be better explained by other disorders/disabilities (e.g., intellectual disability).  

While this definition provides specific insight into the social and behavioral presentation of autism, I find it to be somewhat negative. It implies that autistic individuals have “deficits” or “atypical behaviors,” when really, they’re just wired differently. 

Over the years, I’ve noticed that some parents (definitely not all) avoid early identification, or quickly seek to change their child’s “deficits,” in fear of what they perceive autism to be. 

As a parent of an autistic child, I completely understand this fear. Our society has long supported the notion that autism is a bad thing. The media presents only the best and worst parts of autism. Parents want the best for their children- whether that be love, acceptance, happiness, you name it, and autism may be viewed as a barrier to those experiences. 

So let’s talk about another definition: 

What is ableism? 

Ableism is defined as the “discrimination and social prejudice against people with disabilities and/or people who are perceived to be disabled. Ableism characterizes people who are defined by their disabilities as inferior to the non-disabled.”

The diagnostic criteria for autism is clearly written from an ableist perspective. And it’s time to shift our language and views to celebrate and embrace the differences that autistic individuals have to offer. This change is not going to happen overnight, but I believe it starts with the early identification/diagnostic process. 

I propose the idea of using different, strengths-based language to talk about autism. Limiting words like “deficits,” “impairments,” “atypical,” or “odd.” As professionals and/or parents, we can still acknowledge our child’s social, communication, and behavioral challenges, and leave out the ableist terminology. 

So- back to the main topic: are you concerned about your child’s development? Do you notice differences in their communication, social interaction, play, and behavior? Here are some early characteristics or traits of autism (Please note- this is not an all-inclusive list, and not all traits are necessary for an autism diagnosis): 

  • Differences in language and communication

    • May demonstrate challenges with verbal communication (e.g., may not use words, or may repeat phrases)

    • May prefers physical communication (e.g., pulling/guiding)

    • May use fewer communicative gestures (e.g., pointing)

    • May not always respond to their name

  • Differences in social communication

  • May prefer to be the leader in their own play (i.e., may play next to other children rather than with them)

  • May show differences in social reciprocity (e.g., may not understand the social expectation of responding to hello/goodbye)

  • May demonstrate differences in gaze/eye contact and facial expressions (e.g., may not give everyone eye contact)

  • May not show and share interests as expected (e.g., pointing out interesting toys, sharing objects for play)

  • Differences in play and behavior

  • May find different ways to play/use objects (e.g., aligning toys)

  • May be detail-oriented (e.g., notices blemishes on preferred toys)

  • May prefer repetition and routine

  • May demonstrate special interests in certain topics or objects 

  • May have different sensory experiences (e.g., sensitive to lights or loud noises) 

  • May express emotions in physical ways (e.g., flapping hands)

So, what’s the benefit of early identification/diagnosis?

Early identification leads to early intervention, which can provide your child with the opportunity to build engagement and connections with others, grow their communication skills to advocate for their wants, needs, and interests, and begin to learn how to regulate their emotions and sensory experiences in this world. 

It also provides answers- for parents, families, etc. Early identification may lead to a greater understanding of autism- helping parents to understand their child, communicate with them, understand their behaviors and meet their sensory/emotional needs, and connect on a deeper level.  

The risk of “wait and see” and/or the fear of diagnosis plays into the ableist perspective. It may also prolong communication challenges for autistic children- particularly in a world that wasn’t designed for them (at present time). Autism does not have to be negative, and it does not need to be “fixed.” Early interventionists can identify and foster your child’s strengths, and support your family in meaningful ways. 

If you’ve noticed any of the above signs/traits of autism, reach out to your local early intervention program or related professionals. And remember, acceptance starts with you. Neurodiversity is beautiful. 

Book-Linked Play: The Why and The How!

Before we get started… Ascend Speech Therapy has moved! We are thrilled to be offering services in Ocean County, New Jersey and Monmouth County, New Jersey. We will continue to offer teletherapy to all of Maryland and New Jersey area! Now, let’s get to it!

It is well known that reading to your children from birth (and even before!) can help to develop early literacy and language skills. Adding in toys that match characters or objects within your book is a great way to take the language concepts from the story and bring it to life! Allowing your child to have this multi-sensory experience while hearing the vocabulary that matched what they are experiencing is a perfect recipe for language learning and generalization (taking a skill from one context, and applying it in another!) It’s also an excellent way to model and practice pretend play, another big player in language learning and development!

You’d be surprised at how many items you have around the house already that will be helpful to use when reading a book! For example, if you’re reading a book with a Lion, look around for a lion toy or figurine. If you’re reading a book about fruit, grab a real apple or a toy apple! As you read each page, model the words and actions from the book with your toy (“the lion is jumping! jump, jump, jump!” “the lion is sleeping, shhh!” “He is eating the apple!” ) Remember to keep your language concrete (“jump, jump, jump!” vs. “honey, look over here at the lion jumping so high!”) Encourage your child to play along, and enjoy this new twist to your story time!

Jackie Anderson, MS CCC-SLP is a certified speech-language pathologist, and owner of Ascend Speech Therapy, LLC.
Ascend Speech Therapy offers in-home and community based pediatric speech therapy and evaluations in Ocean County, NJ and Monmouth County, NJ,
in addition to teletherapy services for all of New Jersey and Maryland.