Wednesday, February 15, 2012

Apraxia: Yes, No, Maybe So...

Last month Sweets had a speech eval at NCEENT which diagnosed her with apraxia. Today we had our second opinion on the apraxia diagnosis at Duke.

The Duke examiner said she does NOT think that Sweets has apraxia. She said maybe phonological disorder instead. But she is reluctant to make any call before 4 years old. Of note, this was (by chance) the same examiner we saw last year, who said she didn't think Sweets had apraxia then either. She said she still stands by that opinion today.

She said that Sweets is able to mimic well enough, and she doesn't hear a lot of variability in her mimicked words, specifically in the vowels. She had her say "Bye bye bubbles" as she blew and popped bubbles, which Sweets said. The examiner said that a kid with apraxia would have a really hard time saying that.

The examiner at NCEENT had told me that just because Sweets can mimic, it doesn't mean it's not apraxia. She said that while adults with apraxia can't mimic, kids often can. One reason she thinks it is apraxia is because of the difference between her spontaneous pronunciation and her mimicked pronunciation.

The Duke examiner still thinks that tactile cuing therapy would be useful though, which is the same thing that the NCEENT examiner said. She said she isn't that familiar with PROMPT (which the NCEENT examiner had recommended), but that she knows it is a type of tactile cuing therapy, and would support that on top of play-based therapy. So the general recommendations are the same at least.

She thinks that we should go back to using ASL signs with Sweets again. We had been using them successfully for about a year, but when she started the new daycare in August it dropped off a lot because they don't know the signs and it wasn't reinforced. She also recommended communication/picture boards, which we have had in the past but we didn't get much use out of them because Sweets was signing a lot at the time. She gave me a simple one with "I Want" on it, that you can velcro different things that you want on the board.

This afternoon, the NCEENT examiner just happened to call me to see if I wanted to start Sweets in PROMPT therapy there. I did book a PROMPT session for Monday. I also told her about what the Duke examiner said. She said she wasn't surprised at all that the Duke therapist does not think Sweets has apraxia. But she really thinks it is apraxia.

How confusing.

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