Elizabeth Ho, M.H.Sc., CCC-SLP
Alexia Mazzone, M.S., CCC-SLP
What is communication?
Meaningful, effective, and efficient communication is an essential part of life for both children and adults. Communication allows us to express our ideas, make our basic wants and needs known, and connect with the world around us.
When people think of communication, the first thing that comes to mind is the production of sounds and words to share a message with others. This is referred to as verbal communication, or communication that involves intentionally producing specific sounds to make words. For most children, verbal speech emerges naturally and appears easy and effortless—an automatic motor plan that ensures correct production of each sound and combination. When development is not typical, however, producing the sounds that make up speech can be difficult. For many children with Autism Spectrum Disorders, for example, combining sounds into words and sentences can be very challenging. These challenges can make it difficult to communicate basic wants and needs, leading to frustration for both the parent and child.
What is Motor Planning and what are the symptoms of difficulties in Motor Speech?
Motor planning is the ability to coordinate and execute all types of movements in our everyday lives. As we perform the same movement over and over again (e.g., keeping our balance while sitting up), our brain learns what movements are needed to perform that action. The brain stores this information as a motor plan so that every time we need to do that action we can use the plan instead of figuring it out from scratch. Motor plans allow us to perform complicated movements quickly and automatically. As children grow and learn, they develop motor plans for walking, standing, reaching, grabbing, and eating. Although speech seems effortless in typical development, it too is made up of a series of very fine, very coordinated movements, which are combined into motor plans. It is these motor plans that allow us to talk without really thinking about it.
When a child has motor planning difficulties in speech, movements that should be easy and automatic take a lot of extra thought and effort. These difficulties are sometimes diagnosed as Childhood Apraxia of Speech (CAS). It is important to note, however, that motor planning difficulties in speech can also occur without a specific diagnosis. These challenges are often referred to as difficulties in Motor Speech. It is well documented in research that children with Autism Spectrum Disorders often demonstrate difficulty with motor planning in both large motor (e.g., walking, running) and fine motor (e.g., writing, grasping) movements, and this difficulty often extends to speech movements as well.
The most significant symptom of Motor Speech difficulties is a decreased ability to automatically produce simple sounds and sound combinations. Children may only be able to produce a few sounds or words and will often have difficulty imitating new sounds and words. Words and phrases that they use frequently (e.g., names, favorite foods and toys, etc.) are easier for them to produce because the repetition of the word or phrase helps to establish the correct motor plan. Children who are using sounds and words may be difficult to understand because the words and sounds they are producing are not accurate or clear from one word to the next. The most challenging aspect of Motor Speech difficulties is the fact that some words and sounds will be easy and effortless, while learning new ones is much more difficult.
Treatment for Apraxia of Speech and Motor Speech Difficulties
There are many different approaches and philosophies when it comes to treating Motor Speech difficulties. No matter which specific approach is used, it should focus on two components: making it easier for a child to communicate meaningfully and functionally; and improving their ability to produce sounds and words clearly and easily.
Increasing Functional Communication
Functional communication refers to the way we connect with the people around us and let them know what we want or need. The best way to increase functional communication is to teach children words that are important to them and useful in their current environment (e.g., names of important people and objects, words that can be used in many different phrases, etc.). With functional words, the goal is not to have perfect productions, but to instead give the child approximations that they can use to be understood by family and friends.
For children with very few sounds and words, increasing functional communication might mean introducing other methods of communication. Pictures, gestures, sign-language, and software on tablets or computers should all be trialed to see what method works best for a particular child. Parents may worry that introducing these other ways of communicating will discourage their child from using verbal speech; however, both research and clinical experience have shown that giving a child other ways to communicate does not take away at all from a child trying to talk. Instead, it ensures that the child has a way to continue to develop language even if verbal speech is very difficult for them.
Making Sounds and Words Easier to Say and Understand
Improving a child’s ability to say things clearly and easily is accomplished by doing tasks and exercises that help to establish and solidify motor plans for speech. Research has found three basic foundations of intervention for children with Motor Speech difficulties: repetitive practice and intensity of service, treatment target selection, and multi-sensory cueing.
Repetitive Practice and Intensity of Service
Repetitive practice is essential when treating Motor Speech difficulties. During treatment, therapists work to help children make sounds more accurately and automatically. Speech motor plans are established through practice—the more we say a specific sound or combination, the more automatic the motor plan becomes. To learn a new sound or a new combination, children need to perform the sound or word many times over several days. This is why children with motor planning difficulties often benefit from shorter, more frequent speech therapy sessions so that sounds can be targeted multiple times each week as opposed to just once. The more they practice, the faster the motor plan will be established and the easier it will be for the child to say the sound or word they have been practicing.
Treatment Target Selection
Specific sound and word targets for therapy should be chosen based on typical development and on the sounds or words that a child is already able to produce. Working from sounds and words that the child is already successful with will make it easier for the child to learn new, similar motor plans. It also makes therapy more fun and rewarding for the child because they are able to see success more quickly. Another useful technique is to pick only a few target sounds at a time, as opposed to working on all sounds that a child has difficulty with at the same time. Focusing on just a few sounds allows those sounds to get increased repetition and practice, which in turn establishes the motor plan needed to make them easier to say in words and conversation.
Children with Motor Speech difficulties may also experience reduced awareness of the muscles used in speech, making it difficult for them to make specific movements just from someone telling them what to do. Visual cues such as pictures, diagrams, and using a mirror can help a child be more aware of what their muscles are doing and what they are trying to make them do. Providing tactile and touch cues in and around the mouth can also be useful in helping to increase oral sensitivity and awareness. Techniques such as PROMPT and TalkTools can help the child to feel what their muscles are supposed to do to make specific sounds, and then match those movements on their own. Children who have learned ways to replace or change sounds that are difficult to them have actually taught themselves an incorrect motor plan for that sound. By cueing a child to produce the correct motor plan as much as possible, they get increased positive practice and this helps them to relearn the correct motor plan. It is important to give specific feedback so that the child knows when they are producing the sound correctly. Producing sounds over and over again can also be frustrating for the child, so lots of positive feedback and praise for correct productions can help a child feel successful and excited.
In summary, Motor Speech difficulties can be challenging and frustrating for both parents and children; however, with intensive, focused speech therapy, a child’s ability to speak clearly and communicate functionally can be greatly improved. Although verbal speech is important, functional communication is so much more than just talking! As with any child, the ultimate goal for children with Motor Speech Difficulties should be to improve their ability to meaningfully and easily connect with the people and the world around them.
Elizabeth Ho, M.H.Sc., CCC-SLP is a Speech-Language Pathologist and the Early Intervention Coordinator at TALK: Teaching and Assessing Language for Kids in Burlingame. Elizabeth has been working as a Speech-Language Pathologist for five years. She has experience working with children with Autism and Apraxia, and has a passion for combining Augmentative and Alternative Communication strategies with traditional speech therapy to increase functional communication.
Alexia Mazzone, M.S., CCC-SLP is a Speech-Language Pathologist and the Director of TALK. Alexia has been working as a pediatric Speech-Language Pathologist for over ten years and has extensive experience working with children with all types of speech and language difficulties. She has a special passion to help children with Autism and Apraxia reach their communication potential.