Developmental Verbal Dyspraxia (DVD) is known as Childhood Apraxia of Speech in the US. It's #apraxiaawarenessday on 14th May 2017 and I just wondered...how many of you know what it is, know its symptoms and how to spot it earlier rather than later?
I know what you're thinking - not another bloody awareness day! But the whole point of awareness day's is - well - to raise awareness of lesser-known conditions and to learn a bit about them so that, if you come across a child with this condition, you can reduce the stress of parents and support a child in your setting.
I thought if I told you a little bit about it from a speech and language therapist's point of view, then if you are working in a nursery or an early years settings, you could be a little more able to identify which children might need early intervention. I was presenting at a Clinical Excellence Network on Speech Sound Disorders in Glasgow last week and at the conference was another SLT presenting on her fascinating study about identifying persistent speech disorders early, using the Avon Longitudinal Study of Parents and Children. This amazing study which started in the 1990s recruited 14,500 women living in the greater Bristol area, who agreed to take part in the project when they were pregnant in 1991 or 1992. Since then they have attended numerous Focus visits, donated biological samples including their placenta and DNA, and answered thousands of questions about themselves and their children. All in the name of science. Yvonne Wren a specialist SLT researcher has been looking at early signs of persistent speech disorders and some of them feature below.
What is Developmental Verbal Dyspraxia?
You may have heard of just Dyspraxia, otherwise known as Developmental Coordination Disorder (DCD), a general whole-body condition where there are issues with coordination, but Developmental Verbal Dyspraxia refers to difficulty in making and co-ordinating the precise articulatory movements required in the production of clear speech, so movements of the tongue, the lips, the vocal folds etc. I should also add here (which I didn't make clear in my video) that there is oral dyspraxia as well - the differences between the two can be found here. You can have Developmental Verbal Dyspraxia along with Developmental Coordination Disorder (DCD) and Oral Dyspraxia or they can be separate conditions. Confused yet? It's a minefield out there!
The best way I explain DVD to my parents is that there's nothing wrong with the child's brain; there's nothing wrong with the child's muscles. But the neural pathways between the brain and muscles are just not fully developed yet. It's likely that they will become fully developed, but only after a lot of time, effort and intervention. Like in the photo of the grooves in the road, the more often the truck takes that route, the more entrenched the track becomes. Likewise, the more often the sound is practised, the more entrenched the neural pathways become.
Early Identifying Features of Developmental Verbal Dyspraxia
you might see these at age 2 years, although a diagnosis of Developmental Verbal Dyspraxia is unlikely to be made until a child is 6 or 7 as that is when we would expect the neural pathways to be fully matured.
Feeding Issues as a Baby
If the baby has poor suck or has difficulty coordinating the suck-swallow-breathe pattern, this could be a telltale sign. Perhaps they gag or choke on food or drink because they haven't got the coordination to transfer the food or the drink safely to the back of their throat. They may find it difficult to tolerate lumpy textures.
Licking and Kissing
Although this is usually indicative of oral dyspraxia, this could also indicate DVD. When your child is two or three years old, if you put an ice lolly in front of them and they just put their face towards it but don't actually stick their tongue out to lick, you can see they are having difficulty coordinating the tongue to protrude. Likewise, if you ask them for a kiss, although it's quite typical for young children just to lean in with their open lips but not do anything, as they get a little bit older they do get that proper lip-smacking kissing action, i.e. bringing the lips together and apart, but sometimes children with developmental verbal dyspraxia find that quite difficult as well.
Perhaps they've got fantastic attention and listening skills; they're completely socially interacting with you, and they understand everything that you're saying, but if they are not yet babbling or they've got a very limited range of babble then this might ring alarm bells. But they might have some common easy words, like "bye" because that's quite automatic but if you were to say to them "say bye" then that's conscious rather than the automatic speech, and so they may have difficulty with that.
Groping for the Right Sound
It's confusing when you see a child automatically lick their lips to remove a bit of yoghurt, but when you ask them to lick their lips, then you might notice a little bit of groping going on, where they're trying to move the muscles but they're not quite getting it right. Also, when targeting specific sounds, if a child says the word "bee" correctly and you then want them to say "sea" they might get stuck on the same sound as before because their muscles have just done it and their muscle memory is formed for that particular sound.
Limited range of consonants and distorted vowels
A child with DVD will present with a very limited range of consonants, which can be inconsistent (i.e. one minute they say "dad" for dad, the next they say "bab.") They may also present with disordered vowels. Now this is usually uniquely associated with DVD as children with an articulation or phonological speech sound difficulty rarely have distorted vowels. So, this can give them an accent that is different to the other children in the setting (and there is no other reason for this to be the case, e.g. bilingual parents.)
So developmental verbal dyspraxia is not something that child is just going to grow out of and therefore speech and language therapists like to see them a little bit earlier. So, if you assessed the child with my speech sound assessment and every sound was difficult for them, then obviously you're not just going to hope that they're going to grow out of it. The child may well need the support from a speech and language therapist for a number of years, but I can reassure you (and so you can reassure parents) that they will get there in the end, with the correct support and intervention. Read my blog on How to Support Toddlers you suspect may have Developmental Verbal Dyspraxia. Even if they don't have the condition, the strategies are all useful for other speech sound delays too!
Here's a pdf for your communication file on Developmental Verbal Dyspraxia from ICAN the communication Charity. And here are some other websites which you might find useful, both are for Dyspraxia, but cover Verbal Dyspraxia too: