Verbal dyspraxia starts as a difficulty in saying certain speech sounds despite any muscle weakness. Often just one syllable is chosen to represent a range of possibilities. As the child begins to put sounds together to make words and words together to make sentences some sounds will be omitted or substituted and it can be very hard to understand what the child is trying to say. Longer and more complex phrases are generally more difficult to understand than short direct ones.

The problem is with generating the motor plan for the translation of thoughts into words. They cannot tell the muscles how to move to perform the actions required to make the appropriate sounds in the right sequence. Often the child will be able to repeat a modelled word or phrase much better than if they have to generate it themselves because this requires less processing. Sometimes children will lose words which they used to be able to say. They seem to have lost the motor plan they once had for generating that particular word. In general they know what they want to say, but the sounds don’t come out properly, and some get lost altogether.

The difficulties which underlie verbal dyspraxia often lead to problems acquiring literacy skills. Recalling and sequencing the words and sound correspondences in reading and spelling can be very hard and motor planning difficulties may be evident in their uncertain formation of letters and difficulty in joining them together correctly to make words and sentences.

Children with verbal dyspraxia often have difficulty also with gross or fine motor dyspraxia. This will affect coordinated movement or handwriting and drawing skills and add to their difficulties. They can often become very frustrated at their inability to communicate adequately. Sometimes this will come out as aggression and sometimes they will withdraw.

Oral dyspraxia is a condition in which the child has not managed to develop the ability to control the single or sequential silent movements of the lips, tongue and soft palate on which the development of speech is based, despite adequate muscle tone.

Suggested action

Children with speech dyspraxia are generally given access to speech therapy when they are quite young and speech therapists will assess the child’s receptive and expressive language ability and keep track of progress. It often happens that there are other difficulties affecting their communication skills or schoolwork which are not explained by this testing procedure, so use the website to help provide a thorough overview.

Case Histories

JAMES

Presenting problems

James was five years old and had been diagnosed with speech dyspraxia. He used to omit the final consonant sound in words and had difficulty in forming many individual sounds. Sequencing the sounds in words was a problem, so his speech did not always come out in the way he intended. He had responded well to speech therapy but he still had difficulty with similar sounding words, he had a slight stammer and problems with articulation. He could not always find the word he wanted and he would sometimes jumble phrases. He found it hard to organise language, so explanations were difficult, recalling sentences in context was hard, and he had difficulty in understanding discussions.

James could be clumsy and found dressing difficult but he had managed to learn to swim and ride a bike and coped quite well at tennis. He did not use a pincer grip and had some difficulty with tasks that required him to coordinate the two sides of his body. Posting coins and threading beads was quite hard, he had an immature pencil grip and his handwriting was rather messy. He was a bit of a fidget and could get quite frustrated if things did not go well.

Assessment

James had some tactile sensitivity which was clear in the way he held his pencil, with the thumb tip clear, and he was still sucking his thumb. Discouragement led to him chewing his nails instead. This suggested there was still some immaturity in the trigeminal reflexes which might affect speech production. He had great difficulty with visual tracking and there was a large amount of overflow movement, so he also had difficulty with differentiation which would explain the fidgeting. He also had a very slow speed of visual processing, so his visual system was not yet properly set up for learning to read.

James did not quite manage to score on a reading test but there did not seem to be any problems with comprehension. He had some problems with the formation of his letters and his writing sloped downwards quite significantly, which suggested the spinal neck reflexes had not yet integrated properly. He was at a school where literacy skills were taught quite early, so many of his peers would be moving ahead of him significantly.

James’s biggest problems were with central auditory processing. He was processing incoming auditory information very slowly, he could not discriminate the individual sounds efficiently and his brain was not able to put together the information received by each individual ear quickly enough. This meant that he could not listen to language effectively, so his problems were not confined to motor planning and motor output. James was a very bright little boy, although his processing difficulties and tendency to suck his thumb when overloaded made him appear a little immature. There was a real danger that he would become frustrated and suffer major problems with self-esteem if his underling difficulties were not addressed.

Progress

James progressed very well on his programme over the next two years. Initially improvements in verbal fluency, sentence complexity and reading were evident. Swimming was progressing well and he could for the first time manage his buttons. After a year he was discharged from speech therapy although he still had difficulty explaining something which was long and complex. Six months later his reading and comprehension were ahead of his age and his swimming was excellent. His handwriting was still a bit slow and laborious and there were issues with organisation, sequencing and concentration for long periods.

After just over two years on the programme everything was beginning to come together for James, his parents had noticed a lot of improvements and he was on course to take the entrance exams for a good selective school. His reading was excellent, although he could still sometimes skip words and he was not yet an avid reader. His maths was fine, although he sometimes had difficulty in interpreting written maths questions. Handwriting was no longer a problem and he was coping well with his homework. He was still having some problems stringing complex sentences together which could make him seem a little immature and he could be a bit impulsive. A little more time was needed on the programme to fully develop his language skills and to perfect his visual processing, but he was a very happy little boy now and doing well at school.