Question from provider about Apraxia
I read a question about Apraxia from a therapist on one of my Yahoo Groups. I have only worked very little with Apraxia but here is the question and my response:
Question:
I'm a verbal behavior therapist looking for suggestions for eliciting target vocalizations from a student who's profile seems consistent with apraxia. (we are currently using "total communication" with her by combining sign and vocalizations. .. with slow progress.)
1. It seems some speech therapists are reluctant to use the word "apraxia" is this just my experience or is there a clinical reason behind the reluctance? (probably it's just that a formal diagnisis has not been made yet?...)
2. Would it be helpful for the parents to have another formal assessment, if so what type of professional would be best qualified to do it?
Regardless of whether a diagnosis is made, I'd appreciate feedback from anyone who's aware of best practices for a child who
1. has pop outs, and can say a variety of sounds, but infrequently.
2. has a very limited echoic repetoire/seems to have a hard time producing sounds by imitating.
We are currently trying:
1. decrease pressure on her by using a combination of sign and vocal models during manding.
2. Incorporating videos like bee smart baby, baby bumble bee to elicit vocalizations.
3. Using repetition-favorite songs, pausing for fill ins.
4. Some physical oral motor prompting (she does not like).
I'm a verbal behavior therapist looking for suggestions for eliciting target vocalizations from a student who's profile seems consistent with apraxia. (we are currently using "total communication" with her by combining sign and vocalizations. .. with slow progress.)
1. It seems some speech therapists are reluctant to use the word "apraxia" is this just my experience or is there a clinical reason behind the reluctance? (probably it's just that a formal diagnisis has not been made yet?...)
2. Would it be helpful for the parents to have another formal assessment, if so what type of professional would be best qualified to do it?
Regardless of whether a diagnosis is made, I'd appreciate feedback from anyone who's aware of best practices for a child who
1. has pop outs, and can say a variety of sounds, but infrequently.
2. has a very limited echoic repetoire/seems to have a hard time producing sounds by imitating.
We are currently trying:
1. decrease pressure on her by using a combination of sign and vocal models during manding.
2. Incorporating videos like bee smart baby, baby bumble bee to elicit vocalizations.
3. Using repetition-favorite songs, pausing for fill ins.
4. Some physical oral motor prompting (she does not like).
My Response:
I reviewed my notes from a conference I attended and found a presentation on Apraxia. Unfortunately, I did not note who did the presentation. Here are some highlights from the presentation:
1. A speech therapist and BCBA worked together to develop the child's programming. They recommended looking at the SLP and ABA journal online.
2. The child had been receiving services for 2 years: ABA and Speech and only had 4-5 words, less than 10 words a day, using PECS and sign and had a lot of tantrums
3. There is very little behavioral research on apraxia but some methods could be behavioral, look up: PROMPT by Hayden 1984, Kaufman (she has a website it is very good), and oral motor stimulation and exercises
4. The researchers theorized that the child needed to strengthen oral motor weaknesses and or issues of apraxia of speech first.
5. They pointed out the methods for developing language: Behavioral Shaping = echoic training and PROMPT method
6. PROMPT Method = Hayden and Sherman 1982 it is a dynamic tactile method based on touch, pressure, kinesthetic and proprioceptive. Attention and eye contact are key. I also have Bose 2001 written down not sure why
7. Oral motor exercises are used to overcome weaknesses related to speech
8. The child had speech therapy 2 to 3 one hour sessions/week focusing on oral motor, articulation drills with PROMPT and receptive and expressive tasks
9. The child had 3 to 4 two hour sessions of ABA focusing on articulation using visuals and verbal, mand training, tact training, receptive, and intraverbal traiing
10. The BCBA benefited from working with the speech therapist because she learned about the tactile prompts, how to perform oral motor exercises, and knowledge of speech disorders
11. The speech therapist gained knowledge of reinforcement and motivation, dealing with problem behavior, how to present a skill, and data collection
12. The child has 70 words and mands and says about 100 words/ day, he also uses 4 word phrases. They don't have to use tactile prompting now, he spontaneous labels items, and there was a reduction in problem behavior.
The speech therapist in this study was trained in how to do the PROMPT technique. Sorry I do not know how long the child received services before seeing the gains mentioned above. Hope this is helpful ~ Megan
Posted by Megan DeLeon BCBA at 11/14/2009 4:16 PM 
Categories: ABA and Autism
Tags: behavior therapy BCBA autism treatment autism autism services apraxia behavior analysis
Categories: ABA and Autism
Tags: behavior therapy BCBA autism treatment autism autism services apraxia behavior analysis
Prompt: Oral motor stimulation and exercises:
http://promptinstitute.com/
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Kaufman Children's Center:
http://www.kidspeech.com/
Greetings !!! Jaz
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