Childhood Apraxia Of Speech Cases On The Rise ScienceDaily (Oct. 30, 2007) — Speech pathologists at Nationwide Children’s Hospital report an increasing number of patients diagnosed with childhood apraxia of speech, a motor speech disorder in which children have difficulty saying basic sounds and words. As a result, they are urging parents and pediatricians to be on the lookout for symptoms of the condition. See also: Health & Medicine * Children's Health * Infant's Health * Attention Deficit Disorder Mind & Brain * Language Acquisition * Child Development * Perception Reference * Learning disability * Special education * Therapy dog * Hearing impairment In 2006, 150 kids at Nationwide Children’s, seven percent of all speech therapy patients, were diagnosed with apraxia of speech. That’s more than double the year before. Meanwhile, the number of speech pathology patients overall increased by just 13 percent from 2005 to 2006. While there is little national data available representing the number of children with apraxia of speech, speech therapists at Nationwide Children’s estimate as many as one to 10 children out of every 1,000 kids may have the disorder. Children with apraxia of speech know what they want to say, but their brains have difficulty coordinating the muscle movements of the lips, jaw and tongue necessary to say those words. Often, these kids speak in only vowel sounds or chunks of words and sentences are missing. “This is often very frustrating for the child, who desperately wants to be understood and can’t understand why he or she is unable to communicate,” said Christina Doelling, a speech pathologist at Nationwide Children’s Hospital. “Many times, kids with speech problems will act out, become aggressive or exhibit other behavioral problems.” Therapists say the earlier the condition is diagnosed and intervention begins, the greater the opportunity for significant improvement in speech and communication. Speech pathologists teach kids how to make individual sounds and then make those sounds longer to form words and eventually sentences. With therapy, many children are able to communicate normally. Some are also taught sign language to help them communicate. Nationwide Children’s speech pathologists encourage parents to pay attention to the following signs and symptoms that may indicate a speech or language problem, such as childhood apraxia of speech. The child: * Does not coo or babble as an infant. * Begins speaking late. * Only voices a few different consonant and vowel sounds. * Struggles combining sounds. * Has problems eating. * Has difficulty imitating speech. * Sounds choppy, monotonous and difficult to understand. * Appears to be groping when attempting to speak. Not all children are the same, so it is important not to jump to conclusions and to have a speech pathologist evaluate the child if there are any signs of a speech or language problem. Adapted from materials provided by Nationwide Children's Hospital. Expert Interview Autism Spectrum Disorder -- A Linguist's Perspective: An Expert Interview With Justine Stillings, PhD Medscape Psychiatry & Mental Health. 2007; ©2007 Medscape Posted 09/28/2007 Editor's Note: Justine Stillings, PhD, is a professional linguist who was diagnosed many years ago as autistic. One of her major research interest has been the linguistic deficits that underlie autism. Medscape's John Laurence Miller, PhD, interviewed Dr. Stillings about her theories on the cause of autism, the implications of these theories for treatment, and her own experience as a person with autism. At Dr. Stillings' request, questions were submitted in writing and she replied in kind. Medscape: As you know, our understanding of autism has benefited from contributions from specialists in numerous disciplines: psychiatry, psychology, speech and language pathology, genetics, and education, to name a few. Nevertheless, to the best of my knowledge, before your work, there were no contributions specifically from linguistics. What about linguistics holds promise of advancing our understanding and, perhaps, treatment of this condition? Dr. Stillings: Linguistics is able to show the enormous quantity and complexity of data that a speaker has to know in order to use even a single word correctly. I am not aware of any other approach to autism that shows how complex it is to know how to use even 1 word as correctly as a normal speaker would. To teach an autistic child to correctly use a word, attention should be paid to all of the complex elements that enter into the word use of the normal speaker. Medscape: I know that you accept much of the current professional consensus about the cause of autism, such as the broad agreement that it is, to a large extent, an inherited condition. But your ideas also go beyond this consensus. In a few sentences, could you share your main ideas about autism in terms that someone who has never studied formal linguistics might understand? Dr. Stillings: For normal speakers, each word is stored in the brain with a large amount of data related to the word: * Its pronunciation, or in deaf sign language its representation; * Grammatical category; * Grammatical particularities, such as plural forms for nouns; * Its conceptual meaning -- something like a dictionary definition; * The speaker's emotional reaction to the word, if applicable; and finally * What things in one's knowledge base are specifically referred to by the word -- for example, the word "bicycle" would refer to each of the bicycles one has owned or ridden, one's knowledge of various types of other bicycles, one's knowledge of how to ride a bicycle, recognizing and being able to name as a bicycle a new bicycle one is seeing for the first time, etc. Normal speakers have all of these categories of information available for each word they know. Autistic people are missing some or all of these mental categories for the words they have been exposed to. Medscape: Do these ideas have implications for how we treat children who meet the diagnostic criteria for autism? Dr. Stillings: I believe so. Medscape: What are these implications? Dr. Stillings: A careful diagnosis of an autistic child's language patterns (including nonverbal language) should be able to identify which elements of a normal speaker's language use are missing, and focus can be directed toward teaching the child the elements of word use which are missing (or some pragmatic equivalent). Medscape: Do your ideas apply equally across the autism spectrum or do they apply most naturally to specific types of autism or specific types of children who have been diagnosed as autistic? Dr. Stillings: I believe that this general approach can be applied across the entire spectrum of autistic disorders. Medscape: Like most contemporary linguists, the seminal work of Noam Chomsky has had a deep influence on your thinking. Could you explain how Chomsky influenced your ideas for understanding autism? Dr. Stillings: In a general sense, I have been influenced by Chomsky's belief that we can know what language information is stored in the brain even though we don't know how or where that information is processed. In a specific sense, I have been influenced by his belief that our knowledge of words is stored and processed separately from our knowledge of rules for constructing grammatical sentences. Word rules are separate from grammar rules.[1] Medscape: Chomsky is famous as well for his incisive, perhaps even strident, criticism of the behaviorist movement in psychology, which coincidentally is the source of Applied Behavior Analysis, perhaps the most widely recommended treatment for autism in early childhood. Do you share Chomsky's opinion of behaviorism? Dr. Stillings: I have been partly influenced by Chomsky's idea on behaviorism. [2] I think behaviorism is an excellent teaching tool to use with children who are autistic. But, since it views the brain essentially as a "black box," it cannot say exactly what it means to know a word, as opposed to the linguistic view proposed here, and, thus, all the types of information that must be taught to an autistic child for him to use words as normal speakers do. Optimally, I believe the 2 approaches should be used together. Medscape: If I am correct, you believe that autism is essentially an impairment in language rather than an impairment in social competence. Is this correct? Dr. Stillings: I believe impaired social competence occurs only because the child does not have language to express his wants, needs, desires, choices, etc. The child uses aberrant behavior as a form of "language" to express these wants or needs. For example, a person might bite his or her fingernails when feeling nervous or insecure, and not even realize that he or she is feeling nervous or insecure. Once the nervousness can be recognized and expressed verbally, one no longer needs to use fingernail biting to express this. In autistic children the same thing occurs -- it is simply that the aberrant behavior is more extreme, varied, and frequent. Medscape: Clinicians often point out that autistic children have difficulty with nonverbal as well as verbal communication. Is there any conflict between this observation and your viewpoint? Dr. Stillings: I do not really think there's a conflict. Nonverbal communication expresses ideas and concepts. For example, pointing at something is a way to bring it to someone else's attention. If an autistic child lacks the ability to handle concepts in connection with words, he or she will not be able to handle nonverbal concepts any more easily than verbal ones. Medscape: I know that you are a person with autism. Specialists often say that people with autism have trouble understanding the feelings of other people, but I suppose this works both ways: The rest of us have trouble understanding what it feels like to have autism. Do you believe that it is possible for the rest of us to understand how it feels to have autism? Dr. Stillings: Yes. Medscape: Could you say something that might help us understand autism from the inside? Dr. Stillings: I believe that each autistic person's experience of autism is different from every other person's experience of autism because the linguistic causes differ in each case. There is no such thing as "one" autistic viewpoint. Temple Grandin, in her book Thinking in Pictures,[3] gives an excellent picture of what it "feels like" to have absolutely no idea of abstract concepts as they relate to what words mean. She can handle only concrete pictures. I personally have no problems with abstract concepts. My own autism has taken the form of being unable to connect "emotion words" to the emotions they name. At any given time, I have absolutely no idea what I am feeling about something. I know I am feeling something, but I cannot tell you what it is. I cannot even distinguish "like" from "dislike" because I honestly do not know. Psychiatrists have told me that when I am asked what I am feeling about something, my face suddenly goes "dead" and I am completely unable to answer. I could probably describe for you how this feels and how it has caused me problems throughout my life if I had the length of a book to describe it in. Lacking that, the contrast between myself and Temple Grandin at least illustrates that no 2 autistic people have the same feelings about autism. Medscape: Dr. Grandin also argues that autism specialists err in emphasizing social skills at the expense of academic and vocational skills. She believes that it is important to emphasize both. Do you agree with her? Dr. Stillings: I agree with her 100%. However, as mentioned above, I believe that teaching language as the primary focus of speech therapy will cause progress with "social impairment" to occur naturally without the need for special intervention. Medscape: She also believes that it is important to intervene aggressively to force autistic children out of their autistic sphere into the world of other people, even if they hate and fight what is happening to them. Do you agree with her about this as well? Dr. Stillings: This is a tough question because I hate the thought of children being hurt in any way simply to teach them to say "mama" to their mothers (or whatever). The first thing an autistic child needs to learn is that forms of nonaberrant communication exist. Once a child learns what communication is, teaching words comes much more easily. But one need not begin with words. For example, the autistic Japanese composer of classical music, Hikari Oe, first learned the concept of language as communication through listening to a recording of birdsongs interspersed with the names of the birds. Once, out in the forest with his father, he heard one of the birdsongs from the recording and correctly named the bird. That was his first word. He was 5 years old at the time and it was a birdsong that gave him language. So if a child has extreme difficulty with words, it might be better to try teaching communication skills in some other way as a first step, such as with colored blocks, deaf sign language, text messages, musical jingles, etc. Medscape: In your opinion, what is the single most important change that needs to occur in order to improve the lives of people with autism? Dr. Stillings: That each child is an individual and there is no "cookie-cutter" approach that can handle teaching language to every autistic child. References 1. Chomsky N. Aspects of The Theory of Syntax. Cambridge, Massachusetts: The MIT Press; 1965. 2. Behaviorism. Part 7: Why be anti-behaviorism? Stanford Encyclopedia of Philosophy. July 25, 2005. Available at http://plato.stanford. edu/entries/behaviorism/ Accessed March 31, 2007. 3. Grandin T. Thinking in Pictures, Expanded Edition: My Life With Autism. New York: Vintage Books; 2006. Justine T. Stillings, PhD, Retired Professor of Linguistics, Royal Oak, Michigan Disclosure: John Laurence Miller, PhD, Associate Professor, New York Medical College, Valhalla, New York; Director, Distance Learning and Continuing Education, Westchester Institute for Human Development, Valhalla, New York Disclosure: Justine T. Stillings, PhD, has disclosed no relevant financial relationships. |
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