My Experience working with my son’s verbal/global apraxia issues. (Updated 4/40/0 
I decided to put in another page here, because this is another thing we deal with on a daily basis. My son has apraxia. I’d never heard of it when the diagnosis was given, but since then I’ve tried to learn what I can about it. My son is developmentally delayed, and has dealt with many issues since birth. We had no idea that apraxia was at the root of some of it. Looking back, I now know that his original diagnosis of Childhood Apraxia of Speech was only a partial one. He also has Global Apraxia.
Let me clarify. Here’s what Wikipedia says about it:
“Apraxia
From Wikipedia, the free encyclopedia
Apraxia
Apraxia is a neurological disorder characterized by loss of the ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements. It is a disorder of motor planning which may be acquired or developmental, but may not be caused by incoordination, sensory loss, or failure to comprehend simple commands (which can be tested by asking the person tested to recognize the correct movement from a series).
The root word of Apraxia is praxis which is Greek for an act, work, or deed. It is preceded by a privative a, meaning without.”
In layman’s terms, people with apraxia are unable to coordinate their muscles to do the things that we don’t even have to think about, such as swallow saliva when we talk, or even TALK for that matter! Babies learn early on that by babbling babababa, mamama, things get done. This is how they learn to communicate–to talk.
D1’s Story
A baby with apraxia may not be able to create that tongue-jaw-voicebox-swallow muscle routine that allows them to babble. D1 didn’t. He could laugh, cry, squeal and scream. He could not create sounds using his mouth or lips. Nothing. At one year, we began to teach him sign language. It was so obvious that he understood everything, but could communicate nothing verbally. I got a book called Signing Exact English, and I taught him some signs. He learned and faithfully used the signs for: eat, drink, milk, water, please, thank you, more, all done, book, apple, orange, juice, tired, up, and I love you. It wasn’t much, but it was enough.
Those First Sounds & Therapy
When he was 2, and still unable to even say Momma, I took him to the doctor. The doctor referred us to an ENT specialist for a hearing test, which went just fine. His hearing was normal. The next referral was for a speech evaluation. That went as we figured: he needed speech therapy desperately. We began speech for one hour, once a week. It took two months before he could begin to make those sweet baby babble sounds. Babababa, mamama, dadadada, papapapa…. those were his first sounds (and his first two words ended up being dada and mama, as they came to him developmentally). He made leaps and bounds of improvement after the first sounds finally came. His therapist had him working at sucking applesauce and pudding through straws, and licking peanut butter off of popsicle sticks and spoons, to build up his muscle strength in his lips and tongue. He blew whistles and bubbles. I know eating pudding doesn’t SOUND theraputic, but when you’ve got a kiddo who can’t get his tongue to touch the outside corners of his mouth, giving him something chocolatey to lick off of there makes it much more motivating! It was a really long road before words started to come.
The first stage after the babbling came (and praise God that it did! Music to my ears!!), he began to learn words. Lots and lots of words! This didn’t mean he was intelligible, though. D1 could not create consonant sounds at the beginning or ends of words! All of his words were really only fragments. “Mom, come here and see what I made!” sounded like “o u ea a ee u I a!” Gradually over a year, he began to get the middle consonants, and some ending sounds. He dropped off the first sound from his words until he was five years old. “Om, um ere an ee ut I ade!” It was an improvement, anyway. And this was JUST the speech area of the apraxia. We didn’t realize it until we began to explore further, that his motor skills and toilet training were also heavily affected by apraxia.
Toileting
Since apraxia is a lack of muscle control, it only makes sense that toilet training would be affected. We didn’t anticipate this, and no one told us that toileting could be a serious issue as he got older. I can say that while it DID take YEARS to train him to use the toilet, he is 7 now and only has accidents once in a GREAT while. He wasn’t what I would call potty trained until he was 5 1/2. Yes, they make Pull-ups that big, although really he thought they were the same as diapers, and since Mom changed his diapers he didn’t have any problem at all using the Pull-ups instead of the toilet. He couldn’t sense that feeling of needing to go, and once he DID feel it, it was already too late because he couldn’t hold back. My saving grace was the triple-thick training underwear with the plastic on the outside (kinda of like the old rubber pants with underwear on the inside.) These can be found at WalMart for around $7 for a two-pack. I bought a couple packages there, picked up some at yard sales and secondhand shops, and where ever else I could find them. I got a big bucket with a lid (the kind that dishwasher detergent comes in from Costco is perfect), filled it with water & 1/2 cup of bleach, and kept it, sealed, in the cupboard next to the toilet. If he had an accident, the underwear went straight in the bucket. I know that without those training pants he’d probably STILL be wearing pullups. I ended up with about ten pair of them, and when we first began using them, he’d go through all ten in a day. As time went on, he got better. It’s just like potty training your two year old, except much bigger and older! *grin* Don’t worry Mom, this too shall pass!!
Other Muscle issues
As a baby, he had very low muscle tone in his trunk. We had an occupational therapist that would come out to our house twice a week and work with him. The biggest issue then (birth to 9 mos.) was that he could not bear weight on his arms. I could lay him on his tummy on the carpet, and there he’d lay, face down, frustrated and crying. He couldn’t get his arms under him to hold him in the crawl position. He could get his knees under him, but not the arms. His goal at that time was to crawl. He was actually standing, cruising furniture before he could CRAWL! About a full week, in fact. Once he crawled, his OT discharged him. He crawled for 6 months, before he learned to walk. We thought that was the end of his needing OT.
He hadn’t had a full developmental evaluation since 6 mos., so when he was 3 I had another one done. This eval. showed some lack of coordination, and some sensory seeking/movement seeking behaviors. (This was also when the official Apraxia diagnosis was made. He was once again approved for OT. He was placed into a speech/OT group for an hour once a week. It was D1 and five other little boys, with an OT and and SLP. They ran it like a mini-preschool, where they used a calendar and checked the weather, hopscotched and climbed, crashed, and rolled clay, etc. All things that helped to strengthen his fingers and his muscles. He was in that group for a year, up until he started develpmental preschool through our school district.
April 2007
Now he is 6. I asked for another OT evaluation a few months ago, and OT was recommended. Presently (04/07) he is receiving an hour a week of OT. This is D1’s THIRD go-round with OT. By God’s amazing grace, his OT is the same one he had (at another facility) when he was in the speech/OT group! 
This thrills me to no end, because she KNOWS how far he has come!
April 2008:
Currently D1 is doing very well. His speech articulation is almost 100% perfect. He is currently working on language goals: Irregular verbs and irregular nouns (run/ran, man/men, etc) and a lot of thought process things related to language. Retelling something he read or that has been read to him (a’la Charlotte Mason), getting ideas from reading, and other skills which are necessary for writing and reading fluency. Many of his current goals are more related to his developmental delays than dyspraxia, but at this point it all kind of runs together anyway. He was discharged from OT again in January, so for now we are trying to continue using the “How Fast Does Your Engine Run?” program parts that the OT taught us, and it does help. He is still somewhat clumsy, as muscle coordination isn’t the best, but he is one of the most active kids I know when it comes to physical activity. He isn’t in organized sports, but we aren’t ruling that out! Anything that has a ball is something he would like to play.
He still waits until the very last minute to run to the bathroom, but I think at this point it is more of a busy boy thing than an apraxia issue.
Above all, you have to be vigilant if your child has apraxia issues. They make headway, and they plateau. During the plateaus you have to watch that it doesn’t go on too long. Sometimes asking the therapist to change up the treatment a bit (if they really NEED to be asked!) can make all the difference. Don’t be afraid to ask for services AGAIN, even if they were discharged previously. You have to just watch to see how the child is doing developmentally and then act. ASK for what your child needs.
Stumble It!
June 4, 2007 at 3:33 am
Thanks so much for your note. I just started toilet training our 3 1/2 year old boy who has been diagnosed w/ oral/verbal apraxia and other sensory integration issues. He doesn’t seem to know how to tell his brain how to pee/poop in the toilet, although he is able to tell us after the fact (”leaking” or “poopy”). Although I don’t like hearing that the process is long — it’s encouraging to me that at least they CAN and do learn. Thanks.
June 6, 2007 at 12:41 pm
My 9 year old son that was diagnosed with apraxia of speech at the age of 3. Many therapists and doctors later, a number of opinions have been expressed as to the cause of his speech/language, motor, social, maturity, and behavior problems. This summer we will begin to homeschool him. Do you recommend any language arts curriculums that are great for boys with verbal apraxia? He will be starting 4th grade level.
June 6, 2007 at 8:10 pm
So the diagnosis is apraxia, and he’s 9 now? Has he received services? (Speech/language, OT?) How is that going? Has there been improvement? Is he reading, and how well? There are lots of things to consider when searching for curriculum. One thing that is a good idea is to read his IEP. There are goals on the IEP that will give you a good place to start. Talk to his speech therapist, ask what she sees he needs to work on. Most likely there will be some articulation, but probably more language-related skills. For example, my son has trouble understanding “why” questions. He’ll give inappropriate answers to why questions…. “Why is the coat on the floor?” Answer: “That’s my blue coat.” or “It’s on the floor.” He’ll answer it with a what or a where answer. That’s a language skill that is included in his IEP as: “D will answer why questions 5 out of 5 tries with no prompting.” Reading comprehension comes into play once they are reading. Concepts like giving attributes (color, size, position) of an object, answering the what/where/when/why/how questions, and prepositions (above, around, under, beside, behind, below, through). Your son may have already passed these things, but I’m just giving you an idea of what we’ve been working on.
If sentence formation is difficult, I found an ESL curriculum (English as a Second Language) by Evan Moor called Look, Listen & Speak that is really neat. You can see it here and look through the individual titles: http://www.evan-moor.com/catalog/series.asp?SID=81
You can choose certain topics which would also tie in really great for a unit study. The one we used was on Farms and farm animals. I can’t think of the exact title right off the top of my head. There is a CD included with some interactive language exercises on it too. Since kids with apraxia are essentially just learning English, using ESL curriculum makes sense. Definitely talk with any therapists he’s been working with, and see what they say. It will give you a good jumping off point. The very BEST thing about homeschooling is that you can work WITH your son, right where he’s at. If he’s a fourth grader but reading at a second grade level, you can start there and work up. With one on one teaching, you can accomplish much more than he will get done in a classroom of 23 students!
July 2, 2007 at 12:44 pm
Hey, MommaKnows. I’m so glad you found my homeschool blog (St. Andrew’s Homeschool) Thanks for commenting. AND . . . I’m so glad I came over here to “meet” you. This page has brought me to tears. Why? Because I have a 5 year old (she’ll be six in one month) who has Cerebral Palsy and Auditory Processing Disorder. It’s a long story that I’ve only just begun to write about at my personal blog (the SmockLady). I’ll answer the questions you asked me on my blog after breakfast and a cup o’ joe. Again, thanks for visiting me.
July 9, 2007 at 1:59 am
I have a son with Apraxia too and he is 8 now and speaking very good! Don’t give up! Fight, Fight, Fight! Most importantly in the first years, we only used sign language to help him because he still opened his mouth and signed, we tried the augmentum device and he didn’t try to talk at all. He wouldn’t open his mouth. I am so glad we didn’t use it. I think if we would of back then, he wouldn’t be talking now. The speech therapist was upset with us for not having him use the device..so I guess my biggest advice is trust your mother instincts when it comes to your child. God gives us them for a reason. If you have any questions, just leave them for me on my BLOG.
July 17, 2007 at 3:41 am
My son also has verbal apraxia, and global dyspraxia.. we have had a lot of the same challenges !
September 18, 2007 at 12:36 am
My son has apraxia of speech and here’s some info that might help. We tried traditional speech for years (he’s 9 now) and only once we tried the Talk Tools program and working with an oralfacial myologist did we see any real improvement. Here are some sites that may help:
1. Talk Tools - http://www.talktools.net/site/web-content/index.htm
I would be happy to email anyone a copy of our regimen that we use. The Talk Tools program has a program using whistles and straws that really helps. We were not making much progress until we found this program.
2. Myo Munchie - go to http://teethperfect.com/ this oral facial myology therapy tool is a mouth guard that works on trying to realign any physical structures so that the child can physically make the sounds while working on the neurological part.
3. Good apraxia site: http://www.apraxia-kids.org/
4. PixWriter Computer Program. For children with difficulties this is a good program becuase it has a nice audio piece that accompanies the words. My son has fine motor skill issues so they were trying to teach the kid with CP how to type when typical kids can barely type. Anyway, came across this. It allows you to type in whatever lesson plan you are teaching in about 2 secs then your child can use the mouse to click on the words (versus typing letters) to compose words & thoughts.
http://www.slatersoftware.com/
You can customize the graphics using photos (e.g. to teach family names, places, etc.)
Anyway, cheers to all of you for working so hard. Your child is blessed to have you!
September 20, 2007 at 9:23 am
Hi , My almost five year old has apraxia too, also some hearing loss, and some muscle contractions,mainly now tight fingers.Its hard, he is in kindergarten now but much delayed in speech, and not all the kids are kind.We are privately teaching him to read, and hoping it might help his speech..Speech therapy has been a long slow process.He was late potty training.His brother had night time bed wetting,and we used a Malem Ultimate alarm to wake him up.We used it in the end for potty training during the day for my son with apraxia too, as otherwise he did not seem to know when he went, and this thing alarmed every time he started to go potty. .It helped and he was potty trained just before kindergarten, thank heaven: almost no accidents now!Its nice to knwo sometimes that we are not alone! Thank you for your website.
October 24, 2007 at 6:17 am
I am so thankful to find your little blog here on your D1’s apraxia. My dd is 4 1/2 and has been in early intervention for one year. I see a little bit of improvment, but….
She is still not potty trained either, which I haven’t read anywhere else about there being a connection. I’ve tried everything and now we’re back in pull-ups. I believe she has global apraxia, but I have no definate diagnosis as they told me she was too young to diagnose. We are going to be looking into private sector help to suppliment. She is suppost to start Kindergarden next year, but as of right now I can only understand less that 50% of what she is saying myself and I know an overcrowded classroom is no place for a teacher to deal with the special attention my dd needs. Sometimes I feel really alone and unequiped to help her.
December 2, 2007 at 9:23 pm
Raya: I would encourage you to seek testing with the school district, to get your daughter an IEP. She could then get into an integrated class, where she may spend part of the day in a self-contained classroom and get ongoing help with her IEP goals, as well as regular ed classroom time AND she’d have the assistance of an aid. This is what we did with D1 and it was wonderful. There were only 7 kids in his K-I class and only 16 in the regular ed kindergarten class, because they reserve spots for the other 7 from the K-I. It works out for better teacher/student ratios AND more attention for each student. Also, as part of the special education K-I class, they worked with his potty training!!! By February ALL of the kids were potty trained, partially due to having a bathroom schedule, and partially due to a little positive peer pressure, which is NOT a bad thing.
March 23, 2008 at 4:59 am
Thank You for sharing your journey.
April 12, 2008 at 11:57 pm
Potty Training and other skills - What I did with my son that really helped is I made a lot of visual aids to help him remember what to do. For the potty training, I first let him run around all summer in his underwear so that he had to do very little to go to the bathroom (we used little trainer potty outside and bushes… sorry but we were desparate). Then once he realized the sensation, we made a simple chart of what steps he needed to do in the bathroom. I took photos of the door (and wrote close door underneath), then took a pictur of a potty with the seat lifted), then a photo of the handle (with “FLUSH” written under it), then picture of him washing his hands. I downloaded the photos then cut and paste them onto an 8 1/2″ card stock sheet landscape (cut it in half lengthwise) and pasted it above each toilet he uses. Everytime he does all the steps, he gets an immediate treat (e.g. read books, paint, play ball outside, etc.) so that he gets a good reward each time he does his business correctly. I have found the use of visual aids to be huge for my son. He nows makes his bed, brushes his teeth and gets dressed for school without a battle. I simply have a little checklist I made on a whiteboard using permanent marker and then using velcro I bought at the 99cent store, I have a little photo of him he moves across as he completes his tasks. (I also have a little line above each task where he can simply check off the task if he wants!) If he does all his tasks, he gets to listen to his CD player during breakfast or play on the computer. If we don’t have time before school, I simply give him a “ticket” with the reward on it so that he can cash in his ticket for the activity when he gets home.
We pick out the rewards each night so that he looks forward to it at home. Pick things that do not cost anything so that you don’t go bankrupt!
April 29, 2008 at 2:35 pm
I have a son who is nearly 4 and is in speech therapy for apraxia, although she is not positive it is apraxia.
He says plenty single words, but very few sentences. He is a cautious walker and has recently started running. He rides a bike like a pro, but potty training is a nightmare.
I have been training him for so long. He will go for anyone but me. I am going to be trying out the cloth training pants with plastic pants over them as my mother has been pressing me to do. They are expensive, but in the long run it will cost us less than the pull-ups.
I will also try the visual aid thing. He rarely needs reminding, his memory is immaculate, but I think he will enjoy it.
Thanks to all who shared.
May 16, 2008 at 5:16 am
It’s great to find you guys! I have felt very alone in my journey into apraxia! My first son is 3 and a half and starting to group 2 and 3 words together. Yahooo! Thank goodness for Early Intervention and Developemental Preschool.
As many have said, potty-training is proving difficult, but I am excited to try much of what I’ve read here.
My son has had a lot of tactile and textural issues in addition to the apraxia which totally complicates everything. He’s terrified to try new things, and then when they don’t go smoothly because of the apraxia, he gets very discouraged. Eating is a joke. If it weren’t for Pediasure, he’d starve to death. Any advice?
My 11 month old is looking very apraxic too. He’s only just barely rolling around and not speaking much at all. (He does babble ma-ma-ma and da-da-da for a day or two and then nothing for weeks on end) Does this run in families a lot?
May 16, 2008 at 2:30 pm
Welcome W and H’s Mom! As you can see in the comments above, you are not alone. Parenting a child with apraxia is a different type of parenting, I believe. One thing you didn’t mention is whether or not you have had full developmental assessments done on your children. Early intervention really IS key, and they should have a full developmental eval. every one to two years. If you have already done that, what did the results show? It may even be more than just apraxia too. Thankfully my son didn’t have any feeding issues–definitely NOT. This kid can still out-eat our older teens, and he is only 7! (And he does not have a weight problem, either!) As far as tactile issues, you may very well be looking at sensory integration issues. That would also explain the problems with eating. If I were you I would have developmental eval’s done on both kids and then go from there. If your older child needs more, I’d look for a developmental pediatrician too. Stay on top of it– it is worth the effort!
May 21, 2008 at 11:49 pm
Sorry about taking so long to get back. We’ve had a round of strep-throat at my house. Ick! But I think we’re going to live. That’s great to hear that your son eats so well! He must have an unbelievable metabolism. Too bad groceries keep going up in price!
What do you mean by a full developmental evaluation? After meeting with my older son, a speech pathologist diagnosed him with Apraxia of Speech, and a child psychologist diagnosed him with “a touch” of Autism. I’m assuming that’s where the tactile and sensory issues stem from. My younger son has only been through the typical Early Intervention intake. He hasn’t met with any specialized professionals about his developmental delays yet. At the moment we are seeing a pediatric endocrinologist because he hasn’t gained any height or weight since he was 3 months old. (Bleh, I get so tired of all this stuff!) So I’m holding off on the pathologist and psychologist because after all the testing, ect., I don’t want to torture him beyond what he can handle. It’s probably a little early for them anyway.
May 22, 2008 at 5:37 am
Hi. I just wanted to say thanks for posting your stories on the web. I have a little girl who will be 3 in July and I am pretty sure she has verbal apraxia. The only things she says on a regular basis are mama and ba and ge. I have heard her say several other words but she only says them one time and then never again. SHe is set up to go to a SLP on June 3 so hopefully I will get some answers then. She had gone to a SLP once before about a yr ago but they could never even get her to verbalize any sounds without bringing my older son (1 yr older than her) to play with her and at that point the DR was over an hour away and I made the decision that if that was all they were going to do then we so that all day long at home. Now looking back on it , it was probably a real bad decision to stop that therapy but all I can do now is move forward from here. My daughter was 3 mo preemie and has always been about 4-5 mo delayed in all skills. I was wondering if anyone else’s child was a preemie? She also still puts EVERYTHING in her mouth and I constantly have to be careful that she isn’t eating something she shouldn’t be (ie the other day she took a big bite out of a bar of soap and swallowed it! yuk) That behavior leads me to think she may also have some oral sensory issues. She also isn’t able to play patty cake or things like that. She can clap her hands but not in any rythm or trying to clap them back to my hands. I think she may need a developmental evaluation but can anyone tell me how to get one? Does her pediatrician do this or is it from a place like headstart? Up to this point she has never gone to school or daycare but I am working on getting her enrolled in the local headstart program because from what some people have told me it seems that would be very good for her and help her to get the services she needs. Any suggestions or advice would be greatly appreciated.
Thanks again for sharing your stories of your wonderful little ones!
May 30, 2008 at 6:31 am
I could really use some more advice about potty-training my son. I’ve written about it in detail on my blog. If you have a minute, stop by and help me out.
And to Jessica, my kids weren’t preemies, but they are both really oral. My son had trouble with patty cake and the like also. He eventually got it after tons of repetition. Ask your pediatrician and/or school district about Early Intervention and developmental preschools. EI only goes until they are 3 yrs old, but they could at least evaluate your child for you. My pediatrician also recommended a speech pathologist that evaluated my son and diagnosed him with Verbal Apraxia.
May 30, 2008 at 6:32 am
Sorry, my blog is at myinstructionmanual.blogspot.com
May 31, 2008 at 12:42 am
Mamma Knows you are an angel! Thanks for visiting and offering such good advice! I like the run around naked idea. My yard isn’t very secluded, but maybe we’ll just live at Grandma’s this summer. My son is actaully only 3 1/2, but I’m not as patient as I should be. Anyway, thanks for your help!
May 31, 2008 at 6:08 am
The long T-shirt idea is brilliant! I’m totally going to do that. Thanks so much!
July 15, 2008 at 11:48 pm
I am thrilled to find a blog that also mentiones Apraxia! I am a mother of 8, and the 7th child has global apraxia. It is a daily struggle and sometimes I feel very alone. I just wanted to say thanks for taking the time share a bit of your life.
July 19, 2008 at 5:17 am
Thanks so much for sharing your story about D1. My son is 5 yrs old. and has received many of the same therapies your son has had. He currently has an IEP and will be starting public school kindergarden in September. Did you use/find any printing/writing program particularly helpful when your son was learning to write letters?
God bless.