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Speechville Express

The Speechville Express web site is dedicated to
those who struggle with communicating, as well as the
parents and professionals that care for them.

Speechville was founded by a number of individuals
who share the belief that individuals and organizations
working together help bring even greater awareness
and help to those with communication problems:

www.speechville.com/diagnosis-
destinations/apraxia/insurance.html

The Apraxia-Kids Newsletter
January/February 2009

www.apraxia-kids.
org/January_February_2009_newsletter

In this issue you will find:

* CASANA Names Executive Director

* A Welcome to New Professional
Advisory Board Members

* "Advance Magazine Blog Features
Childhood Apraxia of Speech Interview"

* Sharon Gretz Wins "Community
Champions Jefferson Award"

* New Apraxia-KIDS Facebook
Discussion Group

* Parent Holds Home Interior Fund
Raiser to Benefit CASANA

* 2009 National Conference on Childhood
Apraxia of Speech

* 2009 National Conference Sponsorship
Opportunities

* Apraxia Research Studies

* In the News

- Abstract: Functional characteristics of
children diagnosed with Childhood
Apraxia of Speech

- Article: Gene for Epilepsy May Give
Insight into Speech Apraxia

- Special Education Legislative Update

* Success Comes in all Sizes

* Apraxia Related Conferences
and Workshops

* Upcoming Support Group
Meetings

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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