Speech Apraxia vs Autism: Are they related?
Speech Apraxia vs Autism: Are they related? If a child is speech delayed what can you do? Christina gets helpful information and insight from Kacy Woodson, a speech-language pathologist, in this week’s episode.
Hello and welcome to Just Needs a podcast where we talk about parenting children with disabilities. I’m your host, Christina Kozik, and I’m so excited that you’re here. This podcast is a project of Exceptional Lives, a nonprofit organization that supports families like yours. You can learn more about Exceptional Lives at our website, www.exceptionallives.org.
Hi friends. I’m back this week with another great interview. Today I’m talking with Kacy Woodson. She’s a speech-language pathologist at East Baton Rouge Parish School System, as well as an adjunct professor at Southern University in the speech-language pathology and audiology program. Welcome and thank you for joining me today.
Thanks. I’m really glad to be here.
So I’d love to get started just by learning a little bit about what you do.
What is a speech-language pathologist and how do you help support families?
I love that question. So there’s this Facebook post that always goes around in May when it’s Better Speech And Hearing Month and it’s, “Oh, you’re a speech therapist. You help people with their R’s,” or, “You help people talk,” and it’s so much more than that.
We really do treat beginning to end of the life cycle in terms of working with infants in the NICU, all the way to adult patients that are maybe in a nursing home or things like that. We work with people who have brain injuries, who’ve had strokes, children who have developmental disorders, some reading, some literacy. There’s so many different facets of it, which is what made it very interesting to me that you always can find something new.
But my job specifically working in the school system is really to support students as well as their families and then service providers, educational providers, in making sure that children are successful in the academic environment. So being able to learn.
So whether that’s working on articulation or fluency disorders that are keeping them from being able to communicate clearly or effectively with peers and teachers, whether it’s expressive or receptive language skills. We do sometimes have some students who have some voice disorders, so we work on some things with voice.
We support individuals who have things like autism, developmental delays, and all those kind of areas. And we also help to generate some plans for students who maybe don’t qualify for services but could benefit from a few additional supports or some strategies for teachers to implement in the classroom.
That’s amazing. That is way more than I would’ve ever thought. I have a child who has severe ADHD, and we were very fortunate that he was an early speaker, and so we did things like OT and PT, but we never did any sort of speech therapy, and so I really just had no idea.
And recently I’ve started learning a little bit more about communication styles and the different communication processing. So all of this is very intriguing and interesting to me, as I’m sure it will be to our listeners as well. So thank you for what you do and thank you for being with us today.
So I guess the main topic or what I wanted to touch on today was this thing that I’ve heard called speech apraxia or apraxia of speech, and I just wanted, what is that? Yeah, what is that?
So childhood apraxia of speech, it’s kind of a little bit of a mystery. It can be associated with different disorders like cerebral palsy or something where there is a neurological deficit, but it can also be something that’s called idiopathic.
And there’s not necessarily a rhyme or a reason, but what it basically is this kind of neurodevelopmental disorder where there’s kind of an issue with the programming and planning of speech. It’s not something structural.
So we use a lot of these terms when we’re looking at a child initially, things like range of motion or tone. So there’s not an issue with tone. So they don’t have any muscular weakness. It’s not that their tongue can’t go up, it can’t go left, it can’t go right. There’s not anything when you would look and evaluate the structure of a child where you would say, oh, that’s why they can’t make that sound or that’s why they can’t talk.
It’s something that has to do with sending those brain signals. It’s like, “I have this idea that I want to communicate and then I kind of have put it into the language, like the words, the sentence that I want to speak, but when I send that message to my mouth, it’s not quite coming out. I can’t quite form the words to say.”
And so it’s kind of strange because it’s not something where you can pinpoint, “Oh, this is why the child is struggling,” or, “This is why they have this disorder.” It is kind of mysterious and there’s been a lot of research done.
There’s some studies that look at different things like areas of the brain that are activated that they’re trying to look at to kind of determine maybe some potential indicators that a child may have apraxia of speech, but it’s kind of one of those mysteries that there’s not necessarily a definitive indicator of why this occurs.
So this is just for me because curious, so you mentioned childhood apraxia of speech. Is this something that can happen later in life due to a stroke or dementia or anything like that?
Yes, yes. That’s a great question. Yes. And it’s funny when you look at some of the different treatment options that they’ve come up with or intervention methods for children with apraxia of speech, there’s one in particular, ReST, or now called TEMPO, that was kind of developed based on working with adults who had had strokes and then had apraxia of speech based on some brain damage that was done from the stroke resulting from the stroke.
So childhood apraxia speech, that’s when it occurs in childhood, but then there are also cases of apraxia occurring later and it’s not necessarily from brain injury, but it can be from a significant traumatic event. But that is kind of like with late onset fluency.
Those are things that’s very rare, but there have been a few cases and that’s not really something that we worry about too much. It’s not something that I expect to ever see, but typically we do see the childhood apraxia of speech or the acquired apraxia of speech later due to some sort of brain damage.
Wow, that’s so interesting.
The brain is just an amazing thing. And I’m always intrigued when we talk about any kind of neurological disorder or neurological disability because it’s just so interesting to me and I honestly don’t understand how all of it works, but that’s interesting.
So I also wanted to ask what are some early signs that parents could look for if they have a child who’s maybe not hitting their, I guess, verbal milestones?
That’s another really good question, and that’s one that, and I’ll just say regardless of it’s apraxia or something else, it doesn’t ever hurt to ask questions.
Being a mom myself, that is something that my pediatrician probably is annoyed with me every time. I’m like, “So can we get her evaluated? Can we go…” It was like at six months, she hasn’t said any new… I’m one of those moms that I didn’t think I’d ever be, but now I’m like, “Well, let’s get it checked out.”
So if as a parent you ever think that there is something not right or you’re like, “I’m not sure if they should be doing this,” and they’re not, it doesn’t hurt to ask. I’m definitely pro, “get them evaluated because early intervention never hurt anybody” and it’s better to know, and the worst that’s going to happen is they’re going to say everything is fine and you’re good.
But definitely some things to look for, for any sort of potential delay, levels of frustration.
If your child is trying to communicate something and they cannot effectively communicate and they are clearly frustrated, that’s definitely a sign that you probably want to get something checked out.
I know toddlers, they get frustrated easily because they’re learning and they can’t communicate. And those tantrums, they’re part of the game whether they have a communication disorder or not.
So just because your child is throwing a tantrum and they’re two years old does not mean… I’m not saying that means they have a delay, but if they’re trying to play with friends or other peers and they can’t quite make that connection because they can’t communicate with peers, that’s an indicator. If they’re having trouble with familiar adults, so adults who have kind of picked up on some of their patterns. If they avoid speaking. So those are some things to look for.
Something called groping. So if it looks like they’re trying to make sounds, but it’s like they’re kind of doing these things with their mouth, they’re trying to figure out how to make their mouth, that’s kind of an indicator.
That’s something we look for when we’re doing kind of some differential diagnosis, trying to determine whether a child may have apraxia or whether it’s just a phonological or speech sound disorder.
Things like inconsistent errors. So I use this example with my students. If you take for example, the word baby. So if they say the word baby a bunch of different ways, maybe they say baby, beby, beni, and it’s not always consistent, that may be something where I’d say that may be something to look at.
Because for example, if I said the sentence, “The wed wibbon,” you probably can guess what I mean. And so those are some of those typical errors. And even if it’s not a typical error, children who have speech sound disorders usually make consistent errors. So they may say it incorrectly, but they’ll say it the same way incorrectly each time.
And children with apraxia of speech will be very inconsistent. So they will say the same word many different ways. And so when you can’t pick up on patterns and things like that because they don’t necessarily have a pattern, that to me is an indicator that there could be something more going on there.
And also, especially young kids, oral apraxia, which is apraxia of just oral motor movements, so not related to speech can co-occur or it can occur without the speech portion. So if they have difficulty with things like feeding, that’s definitely something to consider and to get evaluated. And they may not have issues with speech, but they can have oral apraxia without that speech component. So that’s always really important to look at as well.
Well, I just learned something completely new. I didn’t even know that there was oral apraxia. So yeah, thank you for bringing that up. And again, I didn’t know, I didn’t really know anything about speech apraxia. And so I assumed there’s a lack of communication, like, a child may present as nonverbal. But it sounds like they may have some language, but like you’re saying, they’re making errors or they’re having trouble putting those sounds together to make the words. Is that correct?
It can be both, and it kind of depends on that level of severity. So some children who have severe speech apraxia and may present as nonverbal because they’re just trying to avoid speaking completely or they may not be able to put things together.
And then you may have some that either with therapy or just over time or may have a milder case may try to engage and speak and they just really have trouble putting sounds together or they have a very limited phonetic inventory, and so there’s only a limited number of sounds they can produce.
Okay, that’s good to know. And so another question that I saw around when I was doing some very basic research around speech apraxia, because I wanted to come into this conversation with you with just some basic information.
One of the big things I saw was a lot of articles said something along the lines of apraxia versus autism. Are they related? And so I pose that question to you, are they related or is it just something where they may be comorbidities and kind of coexist?
There’s been a lot of controversial research. I don’t want to call it controversial, I guess contradictory would be a better word.
Back in 2011, there was a study that said there isn’t necessarily a higher correlation between the two. And then there’s some more recent research that shows that there could be.
There is a more recent study that was done I think in 2020 where they’re looking at white matter and gray matter and cortex levels comparing children with autism to typically developing as well as children with apraxia to typically developing. And they have found that some of that brain structure may be similar, but I think it really kind of depends.
I think too, sometimes it’s hard to determine because children with autism, they do have those co-occurring speech and language disorders, and so it’s kind of like where does one start and one end? So I think it really kind of depends on what research you’re looking at, but I’m also kind of that school of thought that I don’t treat the disorder, I treat the presenting symptoms.
So if you come to me and you have a laundry list of diagnoses or you come to me and you have zero, I’m going to look at level of functioning and then level of need.
Where do we need to fill in those gaps? Where is the child frustrated? What do they need to be successful? And that’s what I’m going to look at.
But it is definitely something very interesting to look at. There are some syndromes that do have a higher occurrence of apraxia, and that would be cerebral palsy. A lot of children with cerebral palsy, because of course there is that brain component.
Right. That makes sense.
And then also Fragile X and Rett syndrome, there tends to be a higher incidence of apraxia in those populations.
So with autism, there could be a higher correlation, it could be a comorbidity. I think we still have quite a bit of research to do before we can definitively say, but a lot of those symptoms that you see that decreased or limited verbal and some of those groping behaviors, because there is that neurological component, there may be some overlap.
Okay. Well that’s good to know. Like I said, I didn’t want to dive too deep into anything. I said, “I’m going to save my questions and I’m going to ask Kacy.”
And so that’s good to know. And it was just very interesting because I’m sure if I dived into some more of the research around speech apraxia, I would’ve seen things like cerebral palsy and Fragile X, but they didn’t pop up like the autism correlation questioned it.
And so I said, well, let me definitely ask that because I’m sure if we have a parent or a family who’s maybe kind of new to having a child and they think something might be different or something like that, and they start searching for these things, if those things pop up, we want to make sure we give them as much information as we can so they can make informed decisions.
Now with that being said, if a parent suspects that there may be a language delay or they might need some more support around language, where should they start? And I know it’s going to be different if they’re under three versus if they’re over three, but where should a parent start?
Well, I’m glad you touched on that. So before three, Early Steps would be your place to go. You can go to the website and find your point of contact for your area and reach out pediatrician.
It’s always good to check with them to see if they have any specific referrals. That’s always another resource that you can use.
If a child is over three, one really good thing to do is to touch base with Pupil Appraisal Services for your school district. And I didn’t realize until I started working in the school district how much I didn’t know about services that could be offered.
So currently, well, I work for East Baton Rouge Parish School Systems, but I was housed at a school, a couple of different schools, but then I also started doing itinerant services, so I would go into daycares and provide services. So these are students that are… Some have rolled over from Early Steps, some never were in Early Steps, but they’re not in an East Baton Rouge Parish school yet.
But they went to Pupil Appraisal and they received an evaluation through the school system. So the school system still provides those itinerant services to the child even though they’re not enrolled in school. So that would always be a really great place to start because it’s free.
It does not happen overnight. I will say, unfortunately, it’s a process. You can’t call today and they’ll come out and do an evaluation tomorrow. There is a timeline, unfortunately, but a lot of outpatient clinics and stuff, if you go there for an evaluation, you may have a six-month, 12-month waitlist to get an evaluation and then start services.
So, unfortunately, that’s kind of par for the course. But the school system, if you go to Pupil Appraisal, you can still get services even if a child is not in the school system. And if you think, “My kid’s going to go to a private school,” or whatever, it still doesn’t hurt to go and get the evaluation and get whatever services you can.
I have worked with a child before that he was going to a private Mother’s day out type program. We cannot go there because it’s kind of a conflict of interest. But because he was evaluated through the school system, mom was willing to bring him to a public library and we could provide services at the public library, so there’s still options.
That’s good to know.
It’s not limited to you being enrolled in a public school. So I think that’s always a really good resource and it’s one that not enough parents realize is available. I didn’t realize it was available.
I mean, that’s part of our family story is my son didn’t start showing behaviors until after he was three. And so we spent about 18 months just floundering and surviving because we didn’t know that
In my parish where I’m at, it’s called Child Search, but we didn’t know that that was an option until somebody said, “Hey, why don’t you call Child Search?” And we started that process, and like you said, there is a process. It was not overnight. We were fortunate that because when we contacted them, we had a very short wait time. For us was only three to four weeks versus the six weeks, but we were able to start getting him help and support through that.
And so I am a huge proponent of telling families all about Child Search or Pupil Appraisal. And for those of our listeners who are not in the state of Louisiana, these are services that are offered federally. It’s all covered under IDEA, which is the federal law that protects students with disabilities.
And so in your area, it might be called something a little different. It might be called Early Intervention if they’re under three or it might have a slightly different name, but you can always either look up Early Intervention in your town or your city name, or you can go to your school board, your school systems’ website and type in students with disabilities or students with exceptionalities. And you can generally find at least a contact number to call and say, “Hey, this is what I think is going on. I’d like to get an evaluation.”
And so for those of our listeners that are in Louisiana, we have Early Steps program. And then depending on your parish, it’s usually called Child Find, Child Search, or Pupil Appraisal.
Kacy, I mean, thank you so much. You’ve given us a lot of great information and some things to look for, and hopefully, this can help some families who maybe aren’t sure, and now they have some more information and a direction to go in if they think that they need some more support. But before we wrap up, I mean, is there anything else that you’d like to share with us?
I just, I’ve really enjoyed being on this. I was really nervous, but I really, really enjoy this. And apraxia or just speech and language in general as a speech pathologist is something I’m passionate about.
But, ask questions. I think that’s my biggest takeaway.
If you’re a parent or you think something’s wrong, you have some concerns, ask questions. The worst that’s going to happen is someone will say, “You’re fretting over nothing and it’s fine.” But it’s better to try to do something and not need it than to later say, “Hey, I wish I had asked questions,” or, “I wish I had done something.”
Getting a little bit of support, extra support with speech and language doesn’t hurt even if your child is typically developing and doesn’t have any issues in that area.
It’s a skill that we all need to be successful, and we use it socially. We use it academically. We use it to get our basic wants and needs met.
So advocating in that area, I’m always going to tell parents, ask questions, get help if you need it. And if not, no harm done.
Well, thank you again and I really appreciate it and yeah.
Thank you for having me.
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