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When Silence Isn’t Golden

Gila Arnold

Being unable to express what you’re feeling. Not understanding what your child is struggling to communicate. Apraxia of speech is a challenge for the entire family

Wednesday, February 12, 2014

Shira Berger* was three years old when she got off the school bus in her Israeli yishuv sporting a deep bruise. “It looked like a cigarette burn,” said her horrified mother, Shelley,* who attempted to find out what happened. She spoke to the bus driver and the preschool teachers, but they all claimed it hadn’t happened on their watch. And Shira was unable to help solve the mystery. Now almost six, she’s been suffering from severe apraxia of speech since the age of two, rendering her nearly nonverbal.

This complex condition — also known as dyspraxia, verbal apraxia, developmental apraxia, and childhood apraxia — is as confusing a disorder as its many monikers imply. An apraxia is a motor planning disorder that can occur anywhere in the body. Apraxia of speech, according to the American Speech-Language-Hearing Association, is a motor planning disorder affecting speech production. People with apraxia of speech know the words they want to say and how to string together a grammatical sentence, but they can’t get the words out. The difficulty in speaking stems from poor control of the muscles required to produce the sounds of speech. 

However, apraxia isn’t your typical motor disorder; it isn’t caused by muscle weakness or paralysis. Rather, the breakdown occurs at the planning stage: The brain knows what it wants to say, but has trouble transferring its signals to coordinate the fine motor movements necessary for speech. As an example, a child with a nonspeech oral apraxia can instinctively lick some stray peanut butter off his lips, but tell him to lick his lips, and he’ll stand there groping around unsuccessfully with his tongue.

Most of us take speech for granted, but it’s actually a complex process involving a rapid series of highly coordinated fine motor movements. To learn how to maneuver a stubborn, unwieldy tongue through each movement is a slow and painstaking process.

“Imagine closing your eyes, getting spun around seven times, and then trying to touch your nose right on the tip,” says Uri Schneider, M.A., CCC-SLP. “That’s what a child with apraxia goes through each time he tries to talk.” A speech therapist licensed inNew YorkandIsrael, Uri codirects Schneider Speech, a therapy center founded by his father, Dr. Phil Schneider.


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