SLP Mommy of Apraxia

Category: learning disability

  • Disabilities, extraordinary abilities, and lessons in neurodiversity

    Disabilities, extraordinary abilities, and lessons in neurodiversity

    Neurodiversity and learning disability were never in my vocabulary before I had my daughter.

    I had never been exposed to learning disabilities of any kind really, and I had no idea the extraordinary gifts those who are neurodiverse had to offer this world.

    No, when I was in second grade, I was in my egocentric world and our teacher had us write “a book.”  It was a short story and we were to write on the typical school paper that has a box at the top to draw an illustration and then lines at the bottom to write the story.  Writing was always my thing.  Art….was……not.  I usually skipped the picture and went straight to writing.  In my defense though, I never technically had an art teacher.  However, even if I had, I’m sure I would have still been that defiant snotty little girl who turned up her nose at art.

    During one edit, the teacher told me the book was great but I needed illustrations.  I argued with her.  Her job wasn’t to teach me how to draw, her job was to teach me how to write.  Drawing was for the kids who didn’t know how to write and I knew how, so what did it matter anymore?  Did I mention I also went to a Catholic school, so I was marked down automatically for being sassy?  I never pulled that again, but it didn’t stop me from internally rebelling against drawing.

    “When will I EVER need to know how to draw as an adult?” I indignantly exclaimed to my mom.

    My Catholic school teacher had the last laugh though when I became a speech/language pathologist and discovered I needed to know something I didn’t know how to do.  You guessed it.  Draw.

    “What is that?  Is that a dinosaur?” one kid would ask of my drawing of a horse.

    “That’s supposed to be a bird?” another asked of my drawing of an airplane.

    Yes friends.  That sassy, know it all second grade girl started wishing she had paid more attention to art.

    Fast forward 30 years and I have a little past second grade daughter myself.  She has a laundry list of learning disabilities, many stemming from an etiology in motor planning and cerebral palsy.  Everything for Ashlynn seems hard.  She has had to fight and claw her way to learn anything through hours and hours of therapy.  I’m not kidding.  In Elementary school, she started coming home with art pieces from art class that were nothing short of amazing.  They were so amazing, it was sadly hard for me to believe that she did them without help.  However, her art teacher maintained she taught all the kids in a very structured way, giving them multiple opportunities for practice (think motor planning) before completing the final piece. This was Ashlynn’s best one from last year.

    Despite this, Ashlynn had never demonstrated to me independently she could draw even remotely close to this on her own.

    That was, until tonight.

    “Mommy, do you know how to draw a fox?” Ashlynn asked me tonight at dinner.

    “Oh baby, I don’t really know how to draw much of anything,” I answered while my husband snorted his drink out his nose in laughter before adding,

    “That much is true!  Mommy is not an artist.”

    I shot him an evil glare but unfortunately there was no denying the truth.

    “Can I teach you how mommy?  I learned how to draw a fox in art?” Ashlynn offered.

    I agreed and after dinner she had gathered paper and coloring utencils and set to work.  I really wasn’t sure what to expect.

    “Put your fist in the middle of the paper like this, and now draw a line across the top,” she instructed.

    I complied.

    “Now connect this line to this line and see?  We made an upside-down pizza,” Ashlynn continued.

    I looked at the perfect triangle and my mind raced back to three days earlier at OT where the therapist told me Ashlynn’s hardest shape to draw is a triangle because of the diagnal lines. I stared incredulously again at Ashlynn’s perfect triangle.

    “Mom!  Are you paying attention?”

    She then took me in precise detail through the rest of the picture.

    I was impressed by this.

    “You are such a great teacher Ashlynn,” I said.

    “I know mommy because I want to be a teacher you know that.  A teacher and a dog walker because that’s my deal.”

    I smiled.  She just produced a compound complex sentence.  This girl with apraxia and a language disorder just said that.

    Next was the colors.

    I fought back tears.  This was incredible.  I watched her color the page with her wrist fluidly and precisely moving back and forth and my mind flashed back to when her OT told me that until she is able to isolate her wrist from her arm, she would always have trouble coloring within the lines.  I marveled at her wrist now.  Isn’t that crazy?  What mom would marvel at their child’s wrist and control unless they had witnessed how hard that skill was to master.

    Next was texturing and drawing the trees.

    She used these terms I had never heard like “we have to jump and bump.”  I followed along dutifully.  At the end of her lesson I praised her.  It was incredible.

    “But Mommy, we aren’t done!” she said as she got out two new blank pieces of paper.

    She told me we had to write about them.

    Write?  Like actually write?  This girl with motor planning, dyslexia, and dysgraphia now wanted to write about the fox?  She began writing but immediately messed up her spelling. As she peered over at my page that she had dictated, she decided to just copy my sentence. I watched her form the letters as she had been taught and practiced throughout her years of OT and copy my sentence. There was a time, she couldn’t even copy her name, I thought to myself.

    “Sorry, mommy, ” she said, “I can’t write really good yet.”

    I responded, “That’s okay, because I can’t draw very well.”

    “But I can teach you!” she said happily.

    With tears in my eyes I told her,

    “If you teach me how to draw, I’ll teach you how to write.”

    “DEAL!” was her enthusiastic response.

    So that’s the deal.

    Thirty years later my art teacher was a 9 year old girl with cerebral palsy, severe motor planning deficits and a laundry list of learning disabilities whose greatest wish in the world is to be a teacher.  Little does she know, she already is.

     

  • Thank you for choosing me to be your mom

    Thank you for choosing me to be your mom

    It’s Halloween, 2018.  You are a freshly turned nine-year old.  You are 9 years old. My mind immediately repeats a phrase from my dad,

    “Mr. Baskall, here’s your little baby girl.”

    I remember I would roll my eyes and scoff at him.

    “Ugh dad!” I would lament as he looked at me with eyes brimming with pride.

    I don’t have any words to describe or memorialize your entrance into this world, but I have your pictures.

    Halloween, 2009 was the most magical holiday that I have ever experienced.  It was the first holiday I ever experienced as a mom.  I was a mom.

    I was a mom!!

    On Halloween’s prior, the entire holiday was full of self-entitlement, but the Halloween of 2009 was full of something completely different.  I had given life to the most beautiful angel.

    My normally highlighted hair was brown, which is actually my natural color.  I had diligently not dyed my hair while pregnant with Ashlynn to ensure no harmful chemicals crossed my scalp, into my bloodstream, crossing the placenta and then hurting my baby.  I remember taking every precaution to ensure I had the healthiest baby my body could possibly produce.  An avid craft beer drinker from Colorado, I would refuse to even take a sip while pregnant.  I ate my lunch meat warm to avoid lysteria and eliminated all caffeine so my developing fetus was never exposed to any stimulant in utero.  I wore an industrial style mask when I painted her baby room to ensure she was exposed to no harmful fumes.

    So confident was I in ensuring I had followed every caution and recommendation, the thought never even once crossed my mind I would have a child with any sort of developmental delay.

    Life sure answered back with a big middle finger and boisterous laugh at that one.

    Every Halloween though, I become nostalgic.  I remember that new mom holding that tiny baby in her cute onesie with the pumpkin bum and beaming with pride.  I remember my husband dutifully reporting to work each day, but taking time to hold, hug, kiss and fawn over the tiny human we had somehow created together.

    I remember my heart being so full I thought it could actually burst from the amount of love that it was trying to contain inside.  Every Halloween, ironically, reminds me just what a GIFT life actually is. Yes, this day of the dead reminds me of how lucky any of us are to actually live.  Halloween always reminds me of how blessed I was to have a baby.

    I had no idea then, all the challenges life had in store for Ashlynn.  When I look at that picture, I see the instant connection a mother has to her child.  Our eyes are fixated on each other, and I know she trusted me to be the person to never give up on her.  I remember what an honor it is that Ashlynn chose me to be her mom, and I renew my commitment to never, ever, EVER, give up on her.

    I love you Ashlynn Kay.  Thank you for choosing me to be your mom.  I hope I never let you down.

     

  • A language disorder and my snub to the 30 million word gap

    A language disorder and my snub to the 30 million word gap

    There is a famous study done by Hart & Risley that is infamously named the “30 million word gap.”  SLP’s and educators are all taught about this study because the conclusions were that children in poverty who lacked experiences, access to books, and parents who talked to them using a rich vocabulary were at a significant disadvantage in terms of vocabulary than their peers.

    Never mind the study was culturally and racially biased, it completely undermines the fact that children with a true language disorder, regardless of race, religion, socioeconomic status, access to books, or whatever, will STILL struggle with language and vocabulary acquisition because they have an actual disability.

    It is commonly understood that children’s language is largely influenced by their background experiences. Being a mom to a child that has a language disorder is extremely isolating. I should be more specific.  Being a mother who has her masters degree in speech/language pathology and having a child with a true language disorder has been extremely eye opening and heart breaking.  The amount of judgement I feel from teachers and professionals is so tangible it can bring me to tears.

    In education, and particularly with reading there is this term called “background knowledge.”  Background knowledge refers to the knowledge a child has picked up either explicitly but usually implicitly through real life experiences.  For example, a child living in the arctic reading a book about Caribbean reptiles might have a more difficult time with comprehension on the topic not because they have a comprehension issue, but because they have never been exposed to warm climate reptiles.  Children with less exposure to experiences may lack background knowledge which may contribute to reading comprehension issues.  For example, I have never worked on cars, so if I’m reading a book about mechanics and fixing an engine, I am more likely to struggle with understanding the topic. However, if my dad was a mechanic and I was around cars all day listening to and observing car mechanic terms, a passage on cars will be significantly easier for me to understand because of my inherent “background knowledge” on the topic.

    I tell you all this to explain a “true” language disorder.  My daughter Ashlynn has a true and legit language disorder.  She has been exposed to books, been taught vocabulary both explicitly and implicitly by me, a speech/language pathologist, and she has had more experiences than many, many, MANY kids her age.

    Despite this, she recently took a receptive vocabulary test given by her private SLP and scored well below the average range.  When I expressed my disappointment, her SLP said the concepts are becoming more abstract.  Abstract refers to concepts that aren’t tangible.  In other words, it refers to concepts like “freedom” or “poverty.”  You can’t touch these things like you can a “lamp” “bed” or even a “microscope.”  I reluctantly agreed.  Yes, she’s older.  I can see how the words are becoming more abstract now.

    That is, until I looked at the testing protocol.  Words she missed?  I couldn’t stop shaking my head.

    River

    Ok, that might be a hard word.  She’s a city girl after all and how many times is she by a river?  Unless you count that time two months ago where she went camping by a river bed and went white water rafting in a river.   River?? She missed River?  How was that possible??  We laughed just two months ago about how her puppy Pretzel ran head first into the river.  We walked to the river at LEAST a half dozen times on our camping trip and she missed…. river???

    Okay, maybe that was a fluke,  What’s next.  What else did miss?

    Vase

    Vase? As in the vase her dad just pulled out a week ago to put the flowers he bought me in?  The same vase she was looking at while remarking how beautiful my flowers were in it?  The same vase she helped fill with water so the flowers wouldn’t die? That?? That vase?  She missed VASE???

    Naw, it has to be fluke,  What’s next?

    Heart

    She missed heart???  Heart?? Like the hearts that were placed on her door each day last Valentine’s day with a positive characteristic about who she is and what she does?  Heart, as in the candy hearts she loves to eat and read out of her Valentine bags? Heart, as in the shape that her younger brother Jace learned to draw before her and she lamented over saying she didn’t know how to draw a heart yet?  That same heart right??

    Let’s move on.

    Aquarium

    Aquarium??  As in the Denver Aquarium she’s been to twice and pet the sting rays and taken pictures with the mermaids?  That aquarium?  Or, the multiple aquariums in Vegas where she watched the fish and awed at their majesty?

    Okay next?

    Flaming

    Flaming?  Flaming as in the flames from the fire she has watched at least over 30 times on all the various camping trips she has been on in her nine years? Or maybe the flames the entertainer was spitting from the fire and ice show we attended a year ago?

    Canoe

    Canoe?  As in the canoeing activity she has done now twice at a special needs camp called Adam’s Camp and reported it was one of her favorite activities?  Or the canoe her aunt has that she rode in and watched her Aunt and Uncle ride in on an annual camping trip we take every year?

    She missed…….canoe?

    THAT my friends, is a language disorder. She has not only been exposed to and experienced many of the concept vocabulary she missed, but she has also been taught explicitly this vocabulary by me, a Speech/Language Pathologist.  She has been read a book (at least) every single day of her life.

    Enough with the 30 million word gap.  It doesn’t mean crap when your kid has an actual language disorder.

    Enough with the judgement.

    Enough with the blame.

    Enough with the shame.

    My kid has an actual language disorder.  If my English speaking kid with an SLP as a mom has a language disorder, so can children from other monolingual or bilingual families. Stop the blaming.  Stop the assumptions.

    Let’s get more awareness and compassion and let’s recognize a developmental language disability, aka specific language disability aka mixed expressive/receptive language disability aka specific language impairment as an actual childhood developmental disability and not an environmental disability.

     

  • This school year, teach your children to be kind.

    This school year, teach your children to be kind.

    Fresh backpack, lunchbox, shoes and school outfit are waiting tomorrow for my child’s first day of school.  There is an excitement in the air as we bought school supplies and met her teacher last week.  She picked out her name tag like the other kids and picked her seat.  She flashed a big smile to her new teacher and chattered endlessly about school starting again and how she was excited to go back and to learn.  We went and got a new haircut and she told the stylist how she was starting third grade.

    Tomorrow I will take the historic first day of school picture. I will probably proudly post it on all of my social media accounts.  I will most likely scroll back and look at it a couple of times and wonder where my baby has gone.  I will marvel at how this school aged girl with long legs is standing on my front porch.

    That is where the similarities will end.

    As many parents cheer and are relieved to get back to a routine, I’m left with only nerves and trepidation.  The summers in my house are happy.  My daughter is a child who can explore the outdoors and experience life as a carefree and curious kid.  She plays with neighbor children until bedtime and explores campgrounds on the weekend.  She makes mud pies and collects dirt under her fingernails that need to be clipped and scrubbed frequently.

    Unfortunately school brings other stories.  The child who played carefree until bedtime with neighbors is the same child who is frequently seen sitting with her teacher’s aid (TA) at lunch and playing by herself on the playground.  The fingernails that grew long and collected dirt over the summer are replaced with widdled down nubs during school that are bit, picked and chewed so much that her shirts frequently come home bloodied or on some really bad days, have to be changed completely.

    The girl who chatted endlessly to family and friends is the same girl who is quiet and reserved at school, frequently clamming up when put on the spot or asked a direct question.

    The child who could explore during the summer and jump from varying activities is the same child who frequently loses focus and can’t concentrate on subjects at school.

    My child has invisible learning disabilities.

    Many of them.

    However underneath them, she is still just a kid like your son or your daughter.  She is curious.  She is friendly.  She wants friends.  She craves connections.  She’s excited to learn.

    This year as you talk to you children about their new teacher, new classroom, and new adventures, I beg you to talk to your kids about being kind.  I beg you to explain to your child that children with disabilities are just like them, but it might take a little longer to understand or get to know them.  If nothing else though, please just teach your children to be kind.  Maybe ask about something they did that was kind alongside your questions of who they played with or what they learned.

    Our kids will thank you for it!

    Sincerely,

    A proud mama to a child with hidden disabilities

  • Executive functioning home intervention

    Executive functioning home intervention

    Let’s talk executive functioning.  If you follow my facebook page SLPMommyofApraxia (click here), you already know we are making our house an executive functioning friendly zone and you might have read a prior post I wrote a  “What is Executive Functioning, and Why Do You Need to Know?”

    What does an executive functioning friendly zone mean exactly?  I decided to put all of it into a post so you can see and hopefully help others who may have children with similar issues.

    Before I begin, I just want to say this:

    Children with learning differences, many, many, MANY times benefit from the use of visuals.  There have a been a handful of cases in my career where visual aids actually confused the student more; but for the most part, visual aids benefit everyone.  This visual from northstarpaths really explains why:

    Executive functioning (EF) deficits are a common comorbidity with a variety of conditions including: ADHD, OCD, ID and others just to name a few.

    Visuals are AMAZINGLY helpful for children with EF dysfunction.   The problem is, most teaching involves auditory input.  The teacher (or parent) talks, children listen, and learning takes place.  For kids like my daughter, who have a language processing impairment, the teacher (or parent)  talking is basically the equivalent to the teacher in the Peanuts comic series.  All the children hear are “wah wah, wah wah wah wah.”

    Visuals bridge the gap.  I couldn’t say it better than Benjamin Franklin, who himself had a learning disability when he said,

    Aside from just visuals though, kids with EF dysfunction benefit from organization and time management strategies.  The following is what we currently have implemented in my home.

    Morning Routine

    The most recent example from my personal experience involved the steps to getting ready for school.  If I told Ashlynn what to do, she immediately forgot or I had to go through step by step and tell her, which is not promoting independence.  With the help of her SPED teacher, we made this visual schedule and she was successfully completing all of her steps without our help in about two weeks.

    Restroom steps

    We decided to make a visual schedule for completing bathroom steps.  Let me tell you that we have been working on remembering these for AT LEAST a year.  Last year in 2017, I sent her to Adam’s Camp and remember telling the therapists she can say all the steps but still is not consistent.  After Adam’s Camp she came home being able to sing them as well, and still, we could not get consistency.   So we made a visual schedule a little different than her morning schedule and it looked like this.

    This was NOT successful.  It probably has too many steps and it doesn’t have the nice left to right motion the morning schedule this, so I modified and made this.

     

    I’d be lying if I said this was a complete success right off the bat, but it has worked better than any other strategy to date and now that the summer has hit, we have made sure she has to go back and complete her steps every single time.

    Cleaning her room

    The next step was to tackle completing a basic chore like cleaning her room.  I can’t even begin to explain the difficulty with this.  What I do know, is that many adults with ADHD continue to struggle with disorganization into adulthood.  It behooves us now to help our kids develop strategies that are going to serve them well throughout their lives.

    The first step is to make sure everything has a place.  Classrooms are set up this way for a reason.  There is a specific space for each and every item that is used or played with in a classroom.  If not, things will inevitibely end up in a pile of clutter.  Ashlynn and I went through her room and designated certain drawers and bins for different things.  Everything has a spot.  There is a bookshelf, a lego bin, a writing utencil drawer, a baby clothes bin, you get the idea.

    I then created a visual schedule of each piece of furniture that she could check off as she went about her cleaning routine.

    I know it’s hard to read, but basically each furniture item is listed on the left, with a picture representation on the right of what it looks like done.  The picture on the bottom is a grand finale picture of what the entire room should look like clean after completing all of the steps for one last check.

    Next up was to have bigger picture velcroed to all of the furniture items so she could see as she was cleaning them what they are supposed to look like.  I know it seems redundant, but seriously if you have a child who struggles this, then you will relate when I say that a dresser with closed drawers looks fine with clothes hanging out of it to her.  Same with a picked up hamper.  I even have a picture showing what the closet should like closed and no that doesn’t mean it is closed until it hits the piles of crap.  It means actually closed and looking neat.

     

     

     

     

     

     

     

    I have to add that these helped, but still had to be taught.  In fact, it’s still a work in progress.  Some nights, I am so frustrated and just want to pull my hair my out.  I’m only human after all.  I do though, in those times, try and decompress and remind myself this is not a *fix* but a lesson.  Ashlynn doesn’t learn like other kids and that’s okay.  I have to realize though that all of this will pay off in the long run, and when we start early kids have the best outcomes.

    Homework

    Oh man don’t we hear horror stories about homework from parents of kids with varying learning differences.  Teachers make homework sound so easy.  Ten minutes for every grade you are in, so a first grader shouldn’t be more than 10 minutes a night.

    Say….what???  That assignment just took my kid an hour….and then when we went to second grade, that so called 20 minute assignment just took upwards off and on of two HOURS?  Minutes?  What?

    Know that homework can always be modified, but there are strategies that can be put in place to help with this too. Number one is to just start with a place that is going to make them successful for learning.  If you are like me, my first baby is the one with learning differences so instead of preparing for the ultimate learning environment, we were more focused on transitioning my son from a crib to a toddler bed and spent our money on that.  Needless to say, our kitchen table became her homework place.  Yes, the place that she eats and the chair in which she sits that her feet don’t touch on the ground yet is what we thought would be the perfect location for her to sit down and do that quick assignment in 10 minutes.  I should mention too it’s a thoroughfare in my house, so my kid with ADHD was also constantly distracted by the events taking place all around her.  Can we talk about set up to fail???

    I redid her room and created a homework corner.  I bought her a new desk in which she sat at a 90 degree angle, perpendicular to the floor, and decked it out with strategies from executive functioning queen Sarah Ward from the website Cognitive Connections.

    New desk with feet on the floor

    As you can see, I have her own desk, in a corner of her own room, that is quiet and in which her feet touch the floor!

    Get ready, do, done boards

    The colored board above the desk are suggestions from the cognitive connections website.  In the yellow, we write everything we need to get ready.  It might be as simple as a pencil and it might be more complicated if doing a project.  (To modify for non-readers, you can tape or velcro pictures that you need.).

    The green stands for “doing.” These are the steps you need to do to reach the finished project.  The finished project then is the red board and reflects what the assignment looks like when it is finished.  For lower level, you can put a picture of what a completed assignment looks like, or for readers you can simply write it.  Sarah Ward also recommends to “start with the end in mind,” meaning kid with EF deficits benefit from knowing what the end is supposed to look like and then working backwards. For a more elaborate description, go see Sarah Ward talk.  She’s amazing.

    Calendar

    We have tried a few different things to help Ashlynn learn time, and I’m not just talking time management.  Ashlynn has had a lot of difficulty learning the seasons, days of the weeks, the months, and understanding the difference between yesterday, today, tomorrow, last week, next week etc.

    I decided to buy this peeling dry erase calendar at target.  It’s huge and sits right by her desk.  Every month, she helps me write the month and the days.  We then go through and write her therapy/activity schedule and color code them.  Each activity is written in a different color.  The weekends are shaded on red since she has a difficult time understanding that Saturday and Sunday are one unit (the weekend) when they are split up on a normal calendar.  We then marked an X for each day that had passed and talked about yesterday and tomorrow.  This calendar has been AMAZING.  I might be so bold as to say it almost helped her understand days of the week right away.

    Her school though also hit this hard visually and created the following corner in the SPED room just for her.

    ‘

    This picture is also hard to see, but basically you see the basic calendar color coded by day in the middle.  To the left, each day of the week is color coded.  On the file cabinet on the right, the months are placed and she has to pick out the right month each day for added repetition.  The days are in the second bag, and there are tiles for the season and then arrows to talk about the concepts yesterday and tomorrow.  A normal calendar was provided as a reference to keep track of how her modified calendar related to a typical calendar.

    Timer

    Last to come is the timer I used for all of these tasks!  Time management is another HUGE skill that is difficult for those with EF deficits.

    The timer is from the autism community store here in Denver, but I’m sure you can find them on Amazon or other places.  This timer is amazing!!  The colors stand for different things similar to a stoplight.  Green means go, yellow means caution you are nearing the end, and red means you need to be done or stop NOW. What is best, is that each color is completely customizable by time.  For her morning routine, we usually set it for 3-3-3.  For homework, it might be  2-20-2.  Did I mention it also comes with sound?  So that means every color it changes to also has a sound to go with it, aka, an auditory cue.

    The impact

    I have to admit, there were times that as even I were making all of these materials and buying all these things that I wondered will this really make a difference?  Was all this work really worth it?? My answer came from Ashlynn.  As I was making these visuals, she probably thanked me more than 10 times.  She knows how she learns.  She was just waiting on me to help her.

    Laura Smith is a mom to two children, one of which who has multiple learning differences.  She is also an SLP (speech/language pathologist) specializing in CAS (Childhood Apraxia of Speech), a passion that was fueled by her daughter’s dx in 2012.  To learn more, visit slpmommyofapraxia.

     

     

  • Apraxia as a symptom to a bigger picture

    Apraxia as a symptom to a bigger picture

    When I started out on this journey, having my daughter receive the diagnosis of Childhood Apraxia of Speech was devastating.  Unlike other parents who might have needed it explained or who turned to google and realized it is a lifelong neurological disorder, being an SLP I already knew that.  My mind flashed to two boys I treated prior to Ashlynn when I was a school SLP, who both entered Kindergarten nonverbal and I was terrified.

    After I threw myself a pity party, I picked myself up determined to attack the beast named apraxia.  At the time as we were going through it, I did not fully grasp as I do now, the fact that most kids with apraxia will not only hold that one label.  I did not fully realize that most kids with apraxia, a neurological speech disorder, will also have co-morbid neurological disorders as well.

    As a professional SLP specializing in the field, I have a current private practice caseload of around 35 kids.  There is not one who doesn’t have another co-morbid condition.  Friends, I have to repeat that because it is important.  There is not ONE who only has apraxia.

    I feel now like this is an important topic to discuss because I don’t know about other parents, but for me I would have wanted to know up front that a diagnosis of CAS meant I was going to be dealing with more than CAS for the long haul.

    Why?  What does it matter?  You take each diagnosis day by day right?

    I struggle with this.  Part of me agrees but then part of me just wishes I had known the statistics were as high as they were for the chances that my daughter would have dyslexia, or ADHD, or SPD.  I say this because honestly, had I just known up front all of that was a possibility, I could have:
    1. Been more vigilant and more proactive about potential comorbidities
    2. Not been so devastated each time a new one popped up.

    In the post on ADHD I wrote:

    I know it’s a little too young to diagnose ADD, but I hope to God she doesn’t have that too.  She doesn’t deserve this..any of this.

    In the post on Dyslexia I wrote:

    In that moment, my dear readers, I had the same gut feeling I had when that SLP told me back when Ashlynn was 2:11 “Laura this is apraxia.”  In that moment, that article told me, “Laura, this is dyslexia.”  I started to cry at the end of that article.  Damnit.  I missed it again.  I missed another OBVIOUS dx in my OWN daughter.  Why does this keep happening??  What good was all my training and experience when I’m not applying it to my OWN baby??

    Ashlynn has a slew of other diagnoses as well, and EACH time I went through this process AGAIN.  I had to relive the pain of a diagnosis AGAIN.  I guess I can’t say if the pain would have been any less had I known all of these diagnoses were more of probabilities that possibilities, but I honestly think it wouldn’t have made each new diagnosis as gut wrenching.

    I was talking to Lynn Carahaly the other day, creator of the Speech EZ program for apraxia and apraxia expert out of Arizona,  and she said the following,

    Over my career specializing in the disorder, I definitely feel apraxia is rarely the primary issue, rather a sequela to a bigger picture.  The problem is SLP’s and parents are so focused on the speech and not looking at the big picture in early development.  There is this thinking that if we could just overcome the apraxia, everything will be OK.

    I let out a big sigh after reading that.  Anyone else who felt that way, will you raise your hand with me?  I fell into that category.  I was so convinced if we could just fight and beat this beast called apraxia, everything else was going to be okay, and man I was wrong.  Consequently, each new diagnosis brought this sense of total indignation.  We fought apraxia and WON!!  Why now did she have to deal with something else?

    I take a different approach now with my clients.  I am completely honest and transparent about the potential for co-morbid issues.  In fact, I told one mother the other day,

    Your daughter is at risk for dyslexia.  I recommend that for now we operate under the assumption she might have it and get her started early with pre-literacy and phonemic awareness activities; and if she doesn’t have dyslexia, we celebrate.

    I’m just giving parents, and now all of you, what I personally would have wanted to hear.  Lynn is right, and that’s why her program incorporates so many pre-literacy elements.  Let’s start looking at apraxia as more than just a speech disorder, and let’s celebrate if the child did indeed only have apraxia.   Once I started connecting with parents of kids who have global apraxia, only then did I realize every child with global apraxia had a co-morbid diagnosis of ADHD.  The same was true when I found the apraxia-kids facebook group and realized just how many kids with apraxia also had Sensory Processing Disorder!  Oh, and when I found out that and started talking to my global apraxia friends, just how many kids with global apraxia had a similar and rare presentation of sensory processing disorder in that they had a high tolerance for pain and an “under-responsive” tactile system!

    Parents and professionals, the moral of the story is this.  In most cases, apraxia is just a foreshadowing of additional neurological conditions to come.  There are many, MANY, combinations it would be impossible to predict at that initial CAS dx.  Dr. Ruth Stoeckel did a talk at one apraxia conference titled “Co-Occurring Diagnoses: Other Letters that may go with CAS.”  There are MANY other conditions that can and DO go with CAS.  I think it benefits parents and professionals to know we are dealing with just the beginning of what is probably a very bigger picture.

     

    Resources:

    Duchow, H., Lindsay, A., Roth, K., Schell, S., Allen, D., & Boliek, C. A. (2019). The co-occurrence of possible developmental coordination disorder and suspected childhood apraxia of speech. Canadian Journal of Speech-Language Pathology and Audiology.

    Iuzzini-Seigel, J. (2019). Motor Performance in Children With Childhood Apraxia of Speech and Speech Sound Disorders. Journal of Speech, Language, and Hearing Research, 62(9), 3220-3233.

    Langer, N., Benjamin, C., Becker, B. L., & Gaab, N. (2019). Comorbidity of reading disabilities and ADHD: structural and functional brain characteristics. Human brain mapping, 40(9), 2677-2698.
    Lewis, B. A., Freebairn, L. A., Hansen, A. J., Iyengar, S. K., & Taylor, H. G. (2004). School-age follow-up of children with childhood apraxia of speech. Language, Speech, and Hearing Services in Schools.
    Miller, G. J., Lewis, B., Benchek, P., Freebairn, L., Tag, J., Budge, K., … & Stein, C. (2019). Reading Outcomes for Individuals With Histories of Suspected Childhood Apraxia of Speech. American journal of speech-language pathology, 1-16.
    Teverovsky, E. G., Bickel, J. O., & Feldman, H. M. (2009). Functional characteristics of children diagnosed with childhood apraxia of speech. Disability and Rehabilitation, 31(2), 94-102.

     

    Laura Smith, M.A. CCC-SLP is a 2014 graduate of Apraxia Kids Boot Camp, has completed the PROMPT Level 1 training, and the Kaufman Speech to Language Protocol (K-SLP). She is the author of Overcoming Apraxia and has lectured throughout the United States on CAS and related issues. Currently, Laura is a practicing SLP specializing in apraxia at her clinic A Mile High Speech Therapy in Aurora, Colorado.