Developmental Verbal Apraxia

Development Apraxia of Speech (DAS)

DAS is a motor speech disorder that affects a child’s ability to plan and sequence speech sounds for clear and intelligible speech. It has also been called Developmental Verbal Apraxia, Dyspraxia, Verbal Apraxia, and Articulatory Apraxia. Children with DAS have difficulty preparing and coordinating their muscles for speech production.

Development apraxia of speech is:

A neurologically based communication disorder that interferes with a child’s ability to correctly pronounce sounds, syllables, and words.
A disruption in the smooth execution of voluntary movements in speech production.
A difficulty with sequencing the complex oral movements involved in speech.
A disruption in retrieving the “motor plan” for saying a word automatically.
Potentially disruptive to typical development of expressive language.
Present from birth.
On a continuum from mild to profound.
An obstacle in the development of intelligible, articulate speech.
Able to be treated.

Development apraxia of speech is not:

A muscle weakness or paralysis problem.
Always accompanied by “oral dyspraxia”, a condition that interferes with use of the tongue, jaw, and lips for non-speech purposes.
A condition that uniformly impacts children’s speech.
The reason behind all, or even most, articulation delays or disorders.
The result of anything the parents did or did not do.
A condition that a child grows out of without therapeutic intervention.
A problem of cognition. Usually children who only have DAS understand language but have trouble expressing themselves.

Typical Speech Characteristics of Children with DAS

Limited speech sound repertoire (very few speech sounds that a child can use automatically).

Omissions of sounds (very common).
Substitutions of one sound for another.
Distortions of sounds.
Additions of sounds.

Difficulties with sound sequencing.
Disturbances in timing of movements and accompanying sounds.
Increased errors as word / sentence length increases.
Inconsistent speech errors, even on repetitions of the same word.
Vowel errors.
Intelligibility of connected speech may be significantly impaired.

Other Effects of DAS

Can lead to behavioral problems due to the frustration of not being understood.
May be sensitive to, crave, or avoid particular sensory inputs (e.g. food textures).
Some children with DAS have difficulty learning to read and spell, and have difficulty retrieving the word from their memory and sequencing the letters into words and the words into sentences.
Some children show motor planning difficulties with fine motor tasks like cutting, writing, etc.

What Can Parents Do to Help?
The following activities can be done in a play context and are an integral component of speech therapy:

Give your child many opportunities to say and repeat a sound / word / phrase (depending on their level).
Repetition helps a child learn how to make a sound / word / phrase become more automatic.
Practice by singing songs and reading books with repetitive lines. This also can help to teach about the rhythm necessary for speech. Common phrases such as “I want” or “I see” can be practiced often so that they become more clearly spoken.
Practice making combinations of sounds.
Children with DAS need to practice “sequencing” sounds. For example, if your child can say “bye,” practice by saying goodbye to the toys that are put away; “bye bee,” “bye ball,” “bye pooh.” Begin with sounds that are easy for your child, whether they be speech sounds, animal sounds, or environmental sounds (e.g. beep, beep).
Have fun! The less pressure there is on the child to speak and imitate sounds, the more successful they will be. You can model sounds repeatedly in play without requiring a response. A child will often produce more sounds when the pressure is reduced.
Show and tell your child how you make sounds (e.g. “I put my lips together to make the “p” sound”). Play in front of a mirror to increase your child’s awareness of his or her mouth. Practice making silly faces and imitating each other’s facial expressions.
If your child can read, show them the printed words for visual help. Allow your child to use signs or gestures alone or in combination with a word. This will allow them to get their idea across more easily, decrease their frustration, and relieve some pressure allowing them more freedom to speak.
Play with whistles, blow toys, bubbles, and musical instruments. Practice blowing in and out can often help improve a child’s coordination and control of the respiratory movements necessary for speech.
Help children feel good about their speech and themselves. Accept what they say, and when it is correct, offer praise. If the speech is incorrect say, “Yes _____” (then restate the message with the correct sounds).

What Can Be Done to Help a Child with DAS?
A child with DAS does not simply “outgrow” the problem. While the child’s communication may improve, their speech will continue to be difficult to understand without speech therapy. Therapy does not provide a “quick fix” and can take at least two years and often significantly longer. Most children, with therapy, will eventually be competent speakers.

Questions?
For more information about DAS, or to schedule an evaluation or therapy, please call the Hearing, Speech & Deafness Center at 206.323.5770 V/TTY or email speech@hsdc.org.