Question
I have a 5 year old son who was diagnosed at the age of 3 with apraxia. Since then he has been diagnosed with PDD (I also have a son 7 years old with PDD..verbal). The school's speech therapist now says Michael has dyspraxia and not apraxia. I really do
Answer
The confusion between the difference in apraxia and dyspraxia is not uncommon. In fact, the literature as well as many professionals use these terms interchangeably. Often, the debate among professionals leads to the misuse or overuse of the terms. However, the literature does attempt to make a distinction between the two terms.
Apraxia is commonly defined as difficulty in planning and executing motor speech which is not the result of any muscular disturbance (Love, 2000; Portwood, 2000; Yorkston, Beukelman, Strand, & Bell, 1999). Apraxia can occur in the oral area and/or in the limbs. Amazingly an individual can do automatic speech motor acts but can not perform the same motor act for speech purposes. In children, apraxia of speech is referred to as developmental verbal dyspraxia (DVD) or developmental apraxia of speech (DAS). Yorkston, Beukelman, Strand, and Bell (1999) define DAS as "children who exhibit severe articulatory output problems due to difficulty formulating and executing motor plans for speech "(p. 52). In fact, Yorkston, Beukelman, Strand, and Bell provided an answer to a similar question in their book Management of Motor Speech Disorders in Children and Adults. Their approach to differentiating between the two terms was to look at the basic definition of the "prefix a-, means not or without, whereas the prefix dys- means abnormal or difficult" (p52). Thus, apraxia of speech could be interpreted as not having speech and dyspraxia of speech could be interpreted as abnormal or difficulty with speech.
Speech characteristics of DAS include inconsistent articulatory errors (substitutions, omissions, distortions, additions), increase in articulatory errors with longer words or utterances, groping behaviors when trying to speak, slower rates of speech, and receptive language skills are higher than expressive language skills (Love, 2000; Yorkston, Beukelman, Strand, & Bell, 1999).
Portwood (2000) uses the term developmental dyspraxia to describe individuals who have co-ordination (motor) difficulties as well as perceptual difficulties. In addition, Portwood defined dyspraxia as a developmental condition with a high "comorbidity with autistic spectrum disorders, dyslexia and Attention Deficit and Hyperactivity Disorder (ADHD)" (p. 1).
Speech characteristics of developmental dyspraxia include many of the same characteristics described as DAS. However, Portwood (2000) advances the notion that this is a co-occurring deficit within other developmental disorders.
Thus, your school speech therapist may be using a definition similar to Portwood's definition to describe your son's speech disorder in relation to his diagnosis of PDD. Hopefully, this information will provide you with a working definition of the terms and an understanding that the use of the terms is as confusing to parents as well as to professionals. The confusion will most likely continue due to the lack of specific diagnostic criteria for either term.
Suggested Resources:
Apraxia-Kids website sponsored by the Childhood Apraxia of Speech Association
www.apraxia-kids.org
American Speech-Language-Hearing Association website: www.asha.org
References:
Love, R. J. (2000). Childhood motor speech disability. Boston, MA: Allyn and Bacon.
Portwood, M. (2000). Understanding developmental dyspraxia: A textbook for students and professionals. London, England: David Fulton Publishers.
Yorkston, K., Beukelman, D., Strand, E., and Bell, K. (1999). Management of motor speech disorders. Austin, TX: Pro-Ed Publishers.
Kerrilyn R. Phillips, SLP.D., CCC-CLP has been a speech-language pathologist for over 20 years. She is an Assistant Professor at Louisiana Tech University in Ruston, LA. Teaching and research areas are in early intervention, advanced diagnostics, child language, medically fragile, and professional issues. She has presented at local, state, and national conferences and meetings. She is the current Chair of the licensure board in Louisiana and serves on the Board of Directors for the Louisiana Speech, Language, and Hearing Association.