Expert: Christine D. DeLoatch, MA CCC-SLP - 8/6/2007

Question
HI, I was wondering what information you had to share about apraxia?  How often do you see apraxic children with learning disabilities?  What do you look for in a young child (school age)?

Background:  My daughter, 6, diagnosed with pure oral and verbal apraxia @ 21 months old.  I was warned about her being learning disabled and/or dyslexic.  I see no signs of either.  She is two years ahead and gifted in science, social studies and writing.  She also was diagnosed ADHD at 4.  She responds well to meds.

My son 5.  Took him to ped. for kindergarten shots.  Voiced some concerns about gross motor activities, ie. throwing a ball, catching a ball, running.  He is vey ackward, but a big kid.  I also notice problems with word recall.  He can't come up with the name of things.  He also has a very difficult time with remembering the names of letters.  He can give you every cue he has ever learned, T:  the sound, toy, turle, but can't tell you it is called a T to save his life.  He is like that after being taught the letters for two years. He knows almost all sounds 23/26.  But 9/26 on names.  He voices a lot of frustration and says he doesn't like school.  He doesn't like the reading and the writing, mind you he hasn't even started kindergarten.  

I am an intervention specialist with 10 years exp.  My mommy hat and teacher hat say to worry so...

After I shared with the ped. these things she wanted to do a speech eval. for possible apraxia.  This ped. was new in the practice and did not know our history.  I almost fell over when she said apraxia.  I have been a bit concerned, but everyone tells me, "it's a boy thing."  When is that no longer the case?  He is on a waiting list for the speech eval.  I am thinking verbal and motor apraxia.  He goes for a PT eval. tomorrow.  I just wanted to pick your brain on what you might know about either of these.

Answer
Dear Bre,

Thanks for asking me your question.  I'm glad your daughter is doing so well.  

I'm surprised and a little saddened that someone didn't explain the exact nature of dyspraxia.  While any of the childhood disorders can co-exist there is not a specific correlation between dyspraxia (oral and verbal) and dyslexia.  There is sometimes a concern with learning disabilities in the area of reading because when children have a hard time pronouncing a word or sound they may spell it wrong because they don't hear the correct sound when they say it to themselves.  

About 40% of individuals with ADHD also have learning disabilities.  But about 40% of individuals with ADHD can also have anxiety.  I don't know if anyone can tell you that you'll have one or the other or any other co-existing condition either.  

It's like me.  I have diabetes (type 2).  I don't have high blood pressure.  I do have Grave's disease (thyroid disorder).  The first 2 are often seen together.  I also have ADHD.  I also am very near-sighted.  I don't know if there is any true relation to the combination of conditions I have.  I'm not sure there is any value in really knowing - except in the case to monitor children for developmental issues.  

Now about your son.  I do think that the physical therapy eval was a good idea.  I also think that an occupational therapy eval should be completed if he is resistant to writing.  He may have some motor dyspraxia.  I also think that he is showing some signs of some word-retrieval issues.  The speech evaluation is a good step, but you need to be aware that word-retrieval issues can require on-going treatment.  You may be given some strategies to help that combine working on the motor and the letter recognition.  Jumping on letters and saying their names. Some times we also work on ways to get the same result to help a child compensate if they continue to show weaknesses.  

I recommend you look into a book called A Mind at a Time by Mel Levine.  He's been on the Oprah show and is very well known.  He specifically talks about how the brain works in terms of memory. There is sequential memory like the ABC's (can he sing the song?), and counting. Then there is visual memory like recognizing the letters and numbers in isolation.  Then there is motor memory like knowing you have to bend your knees before you jump or step down.  You could pin-point the area of weakness then see what strategies might help.  You may also want to see about a video or DVD called the Letter Factory by Leap Frog.  If your son is going well with the sounds, this DVD combines the sounds with the letter name in a song format.  A say ah, B says buh, C says... etc.  You could also use the DVD in a fill-in-the-blank way.  What say ah, What say buh, etc.

Mel Levine also has a website called "All Kinds of Minds."  I'm sure you can type that into any search engine with his name and it will come up.  

All of this information may be valuable for you as a teacher as well.  There is also a site called Apraxia Kids that is very good and might give your some additional information.  

Try to remember that dsypraxia means (dys) a disorder or dysfunction + (praxis)  movement.  It is simply a disorder in movement or motor planning.  It often occurs in children of normal development otherwise.  Dyspraxia in itself is not an indicator of anything else.  

I hope I have been both informative and helpful.

Good Luck to you and many Blessings.

Christine