Developmental Verbal Dyspraxia (DVD)
Developmental Verbal Dyspraxia (DVD) also known as “Apraxia” is the difficulty forming sounds into words. It is a motor planning delay, characterized by difficulty carrying out movements that a person is physically able and willing to do such as vocalizing correctly and consistently. The child has difficulty carrying out purposeful voluntary movement sequences for speech, in direct imitation, in the absence of weakness or paralysis of the speech muscles. For example, the child may be able to babble on his/her own volitional accord, but unable to imitate babbling when asked to perform this task.
A child with DVD of speech often has difficulty sequencing the motor movements necessary for speech. Research shows that there is a disconnection between the pre-frontal cortex (Broca’s area), which is responsible for motor planning and executive functioning and the primary articulators (lips, tongue, jaw). Your child can present with both Orofacial Apraxia and Verbal Apraxia as they are not mutually exclusive.
Orofacial Apraxia: The inability of a person to follow through on commands involving the face, tongue, jaw, and lip motions. These activities include coughing, licking the lips, whistling, and winking. It is the impaired ability to, on command, perform non-speech tasks like puffing out cheeks, clicking the tongue, or licking lips. The child’s understanding of language is much better than the child’s expression of ideas. The child substitutes gestures and nonverbal communication for oral communication.
Verbal Apraxia: A condition involving difficulty coordinating mouth and speech movements. A child with developmental apraxia may be unable to say certain words in imitation. Or, the child may say a word correctly once, but be unable to do it again consistently. The child usually understands what others say, but has trouble replying. The child may move the muscles used for speech without making sounds. Typically, the child has more difficulty saying longer words and sentences. The following speech characteristics are typical for a child with Verbal Apraxia (DVD):
- Extremely limited repertoire of consonant and vowel sounds.
- Receptive language is typically much higher than expressive language.
- The child can become easily frustrated because he knows what he wants to say, but has significant difficulty planning, sequencing, coordinating, and executing the sounds correctly for intelligible speech.
- The child does not correctly use the sounds in some words that are produced in other words.
- Consonant errors in conversational speech are highly variable.
- The child typically presents with initial and final consonant deletion, cluster reduction, syllable omissions, and substitutions with no pattern to the errors
- Progress is inconsistent, variable, and unpredictable.
- The longer the word, phrase, or sentence, the more speech errors occur. As words increase in length and complexity (but, butter, butterfly), the child’s intelligibility significantly reduces.
- A child with DVD often demonstrates significant difficulty producing multi-syllabic words such as: “hospital,” “spaghetti,” and “cantaloupe.”
- While repetition of sounds in isolation may be adequate, connected speech is more unintelligible than one would expect on the basis of single-word articulation test results.
Most Frequently Asked Questions:
Q. How do I know that my child has DVD?
A: There is not currently a standardized assessment tool to differentially diagnose DVD from a language delay for young children. A licensed speech and language pathologist will conduct multiple play based observations, an oral motor sensory evaluation, detailed language sampling, and a comprehensive parent interview to determine if your child presents with DVD. For children seven years and older, the SLP can utilize The Jelm’s Analysis of Oral Motor Skills in Imitation and/or The Kauffman Speech Praxis test to validly determine the presence and severity of DVD.
Q: How long will my child need therapy for?
A: A child’s prognosis is typically dependent on the following factors: internal motivation, cognition, stimulability, attention, compliance, concomitant or associated disorders, consistency in attendance, and parental involvement. Progress can often look irregular and variable. However, with a highly trained therapist utilizing intensive, research based treatment programs such as PROMPT and The Kauffman program, prognosis s is typically good. Progress is carefully monitored every session and a progress report is written at six months, to determine if the measurable goals are mastered or emerging. The ultimate goal is to achieve functional, intelligible communication with familiar and unfamiliar adults and peers.
Q: How much therapy will my child need if they have a diagnosis of DVD?
A: The most efficacious treatment program for a child with dyspraxia is increased frequency with reduced duration per session. The recommended type, duration, and frequency of therapy for a child with a diagnosis of DVD is typically four times per week for 20-30 minute sessions each.
Q: Where can I learn more information about DVD?
A. For more information on DVD, please visit www.apraxiakids.org or www.ASHA.org