Apraxia of Speech

Early Signs and Symptoms

• Limited or little babbling as an infant (void of many consonants). First words may not appear at all, pointing and "grunting" may be all that is heard.
• The child is able to open and close mouth, lick lips, protrude, retract and lateralize tongue while eating, but may not be able to when directed to do so.
• First word approximations occuring beyond the age of 18 months, without developing into understandable simple vocabulary words by age two.
• Continuous grunting and pointing beyond age two.
• Lack of a significant consonant repertoire: child may only use /b, m, p, t, d, h/
• All phonemes (consonants and vowels) may be imitated well in isolation, but any attempts to combine phonemes are unsuccessful.
• Prosody is unusual, there is equal stress and sometimes a monotone quality.
• Speech may change or disintegrate with many repetitions.
• Words may be simplified by deleting consonants or vowels, and/or replacing difficult phonemes (consonants and vowels) with easier ones.
• Single words may be articulated well, but attempts at further sentence length become unintelligible.
• Receptive language (comprehension) appears to be better than attempts at expressive language (verbal output).
• One syllable or word is favored and used to convey all or many words beyond age two.
• The child speaks mostly in vowels.
• Verbal perseveration: getting "stuck" on a previously uttered word, or bringing oral motor elements from a previous word into the next word uttered.
• Oral groping may occur when attempting oral motor movements or consonant/vowel production.
• Struggle behavior may occur when attempting to imitate or to speak (without dysfluency or stuttering).
• Deletions or replacements of consonants, vowels or syllables may occur at the end of a word, phrase or connected word levels.
• Vowel distortions or replacements occur which are not due to oral motor weakness.
• The ability to blurt out clear whole words, phrases or sentences may occur though there is difficulty imitating these same words "on command" or upon imitation.
• Difficulty with maintaining clarity with extended word length or complexity.
• Phonological processes are employed to simplify motor speech output.
• Late talking with above characteristics or errors may be present.
• Other fine motor challenges may be present.
• Echolalic utterances (the automatic repetition of words, phrases or sentences often without comprehension) might be perfectly articulated but novel attempts at words or combinations might be more effortful.

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