Mispronunciations... is it Apraxia of Speech?

Hey. Hello. Welcome to the Monday lives at 9pm WIB, which stands for Jakarta time. I'm in Indonesia right now and if you're watching somewhere else, then this happens at Est Eastern standard time at 10am okay. And what we go through here is basically me congregating all the questions that I have, I had been asked by parents through email, through Facebook, the Facebook group. If you're watching it, own a Facebook group. Great. And if you haven't joined our Facebook group, you should. All right, just search Agents of speech. No Parents of Speech Delayed Children Support Group by Ming Phone. So that it's a little self loving to put my name in it, but it's just, it makes more sense. You understand it a little bit more that it's from me, not from anyone else. Okay, so what the topic today is apraxia of speech. And the problem with the why I want to talk about apraxis speech a little bit. Let me put the camera down a little bit. I was trying to look at it too far. So why we're going to talk about aprective speech is because some parents have been saying, oh, is it a practice of speech? Is it something else? Is it whatever? Well, the thing is actually when your child has mispronunciations, when they have errors in speech, what we call speech errors, there are a lot of reasons where it might affect someone's speech. It might be a tongue tie, it might be a general speech disorder, it might be a phonological disorder, it might be that apraxia this Austria, there's many, many words and names that people throw around. Okay, but seems like apraxia of speech has gotten more attention from everyone else. And why I say this is because basically it's the most asked thing for speech disorders. For me, no one has asked me, ever asked me about, oh, is my child having dysarthria? No one asked that. Right? No one is asking, oh, does my child has a phonological disorder? No one asked that either. So there's a somehow, right? Somehow in the therapy world, I don't know if something cannot be explained, they tend to lean towards apraxia's speech and I don't know why. Okay. Have I ever misdiagnosed apraxia? Yeah, most probably I have. I've changed my mind throughout afterwards anyways. And the thing is, if your child right now has a pronunciation problem, you should think about, you should really think about the reason why and, and you cannot do it yourself. You need someone to look at the problem. Okay. Need someone. And that someone is a speech therapist. And this is what we call in our, in our language, a differential diagnosis. We need to know whether, like, why a child has a problem, okay? Why is there a problem? What is it? Is it the tongue cannot reach somewhere? Is it that they cannot understand certain sounds? They cannot hear certain sounds, right? These things, you have to think. You have to think and you have to find. All right, so with that said, let's hop on. Let's hop on to talk about how you're going to try, try and find out. Okay? So motor exercises, Oral motor has been, you know, thrown around for a lot, you know, and there's a lot of information out there about oral motor exercises. Not only speech therapists do it, but occupational therapists actually do it too. And also special needs teachers, they also try to do it. All right? And I've got this whole other video about it. You can just search it and like on Google or something like agents of speech or motor. And then you will find that article or the video. And basically what I say, right? I just put it in a nutshell, is that if your child has been doing oral motor, you need to be certain that it's paired with a speech sound or else you're doing it for no reason. Okay, so about the oral motor, right? About using oral motor as a speech therapy tool. It's important, yes? But actually, like 75% of children who have a speech disorder, they have nothing to do with motor, right? If you want to want to know the quote, the scientific paper, just like, comment that you want it, I'll send it to you. 75%. So, you know, three in four children who cannot speak properly, their problem isn't really in motor, okay? Which means most probably they have a problem with listening to the sound. They cannot understand the sound, okay? Like comprehending it and like differentiating that sound from other sounds. Let me give you an example. I've said this many times, right? So when you are learning a new language, right? Let's say that now it's not going to be a disorder, right? Because it's very natural for someone who doesn't speak a language to be not able to pronounce something. So for instance, a Japanese person cannot really pronounce like two consonants together, okay? For instance, if they, if they need it pronounced S E S P E E D, like speed, they would like, say something like that, right? And that's because they don't. They've never. In the language, they don't have two consonants together. That's why when they say it it's kind of, like, weird. So for your child who is maybe has a speech disorder, I'm not saying that they. They have the same problem. What I'm saying is, is that because they didn't have a language before, like a first language, and then they're learning their first language right now, right? And they have articulation problem or mismatch. Mispronunciation. It's maybe. Maybe that your child cannot understand certain sounds. Okay, maybe. All right, so what you do, you can go to agents of Speech.com. there's a blog post on it. You can do something called a minimal pair. Minimal pair, meaning can they listen to the difference between two sounds? Okay, let's say that your child. Right now, one of the parents asked this week about, like, the S sound. Like, this one says the child cannot do. It becomes a T. So for instance, if she says something like soup, it becomes dupe. Right? Very common. All right, so what I would do to check, to assess, right, is I would see that. Okay, there's two pictures. There's one. There's one picture that is like. Let me think about minimal pair right now. S. SAP. Okay, so maybe one word is SAP, right? Like the tree SAP. Another would be tap. Right? So I would have two pictures. I would ask the child to, like, listen. Oh, which one is SAP? And then he points. Okay, this is. Right. Which one is SAP? Which is tap. Okay, this one's good. And then you keep on doing it to see if he can actually listen to 100% and get it right. Okay, this is important. So this is to check if he can listen to it. So if your child right now has problems with the L sound, the Y sound, whatever. Some people, Some child ask some. Some client of mine actually has a problem with the T and the K sound alternating in between, which is very common, by the way. This is what I would do. I would try to get them to do that. Okay, let's see. Nikki says B and br. Sorry, we did that combo. He got them right. So I don't know. Nikki, please type. Tell me what kind of sounds are you, like, trying to teach your child? And then like this B&BR. I guess it is a minimal pair. That's. I guess that's right. If he can listen to it, then he doesn't have a problem with comprehending it. Right? He's got a problem with, like, actually saying it. So what you need to do now is to see what's the lowest level of him being able to do it, like being able to say that sound. Okay, I'm guessing you're going for the R sound, right? The R. I'm guessing. I'm not entirely sure. Please let me know. But, yeah, let's keep on going. So once you get the minimal pair, if you can see that. Oh, right. They can comprehend it, like Nikki said just now. Right. That's not about really them not being able to hear the difference. It's about them being. Being. What's that called? It's actually being a. Being a production thing. Right. Yeah. So that's actually suggested. Sorry, Nikki. There's so many parents, I sometimes forget what I say to people, which is a bad thing. I should write them down. Yeah. But anyway, so, yeah, you do pictures. Put one. Sorry, put two on either side. And you tell that person, the kid to show you which one. So good job. So it's not a matter of. Not a matter of comprehension for a child. Nikki. The R sound is very tricky in English. There are 21 different Rs in English. And the reason why behind that is because R is not. Is a consonant, what we call as liquids, meaning it's like very close to a vowel. I'm not trying to be very technical, but what I mean is the R changes depend. It changes depending on the vowel behind it. So that's why in English There are 21 different Rs, which can be difficult. So what I would say usually for. For treating R is to check which Rs can your child do and then try to stick to that and go on and try to treat accordingly. Okay. And let them know that, okay, you can actually do some Rs in some situations. That's great. Now these are also Rs. You need to increase the awareness. Okay. But in terms of like, treating Rs or. And treating Rs and other liquids, as we say, is rather difficult because especially R. So children typically acquire an R a different languages, meaning like in English, in Spanish, in, like, Bahasa Indonesian, or we don't have R in Cantonese, but we have Rs in Mandarin Chinese. Typically is around like four to five years old, you know, so it's rather late because Is hard. It's difficult. All right, so don't worry about the R. If your child is rather young, it does take some time. Okay, so what do you do if your child cannot, like. Cannot do the minimal pairs? Well, then you just do it as a task for now. And what you want to do is to increase their phonological awareness. And phonological means their knowledge about the sounds. Okay. Whether they Know, like, for me, okay, if I hear Indonesian word, I am incapable of spelling it out in my brain because my phonological awareness and knowledge is low. Okay? Whereas if you say to me in any English word, I probably have a pretty high chance of pronouncing it correct the first time if it's not from a French origin. Like, I don't know. Like, I don't know. I cannot think of any French word right now which we use in English. But anyways, that's what I mean. Okay? That's what I mean. When, like, you know, when a child takes a few times to actually totally grasp the whole. The sounds inside a word, right, they might get it wrong. The more syllables they are, the harder it is. So it's the same for me as well if it's in a foreign language. So don't worry about that. Just increase the phonological awareness. Talk, talk to them slowly. Tell them that, oh, there's a. Spell it out for them, like, slow, like, articulate it so clearly that they can start to imagine, start to think, oh, there's a B and then there's a R and then ee, ze, that's breathe, you know, like, slowly they will understand that and it will become better. Okay? So if it's a phonological thing, like if they can't do the minimal pairs, that is not apraxia, right? It's definitely not apraxia. Sorry. If it cannot do the minimal pairs, if they cannot do the minimal pairs, it's definitely not apraxia because they can't even comprehend the difference between two sounds, right? So, yeah, 75% of children have a problem that is not motor based. So what, what is it? What, what is it? Phonological meaning, their knowledge and their sounds. And how you can help a child with that is to talk slower, clearer, as I said. Okay, you can do minimal pairs, right? And tell them phonics is a good way to help them out, I guess. There's no studies about it, but from what I know, right? Once a child knows how to spell, it actually helps them to write it out and tell them, like, the structure of the sound. It makes it easy for them to understand what's going on. Okay? So 75% of the time you might be doing that, you might be doing a lot of phonological work. So how about the 25% of the time, hey, it's 25% of the time it's motor based, right? And I remember Nikki, her child, if you're still watching Nikki, her child is, Is on The motor side that she's has aos, I think prexia. Please correct me if I'm wrong. Wrongly accusing you of having, of a child of having something that she, he or she doesn't have. But the thing is, the 25% is rather rare for a child to have apraxia. Speech is also hard to diagnose. Sometimes they have something called this arthria and what that means, right? I mean if you're, if you have a family member who has a stroke before or you know, like, you know someone who has a stroke before, there is a high chance that. Not high chance. There is a chance that they might have this arthria, meaning they have some weakness around the mouth muscles. Okay. And that impedes them to speak clearly. And it will happen in children as well. All right. And children who have weak muscles, oral muscles, you can tell, you know, they drool, they're unable to do like non speech oral motor tasks like, like doing that, like pucker lip, whatever. And it doesn't really help. It doesn't really help them like get to certain places in the mouth. For instance, the L sound like if the. I've said this many times here, right? On. On, on Lives and Videos. If your child has, has a problem with elevating the tongue to the top, then it'll be difficult for him or her to say the L sound. And that is actually a range problem. There's a weak range. Okay, so Facebook user. I don't know. Who's that? Oh, defitri. I can see it from the Facebook group. You should join a Facebook group if you haven't. But anyways, she asked my understanding. My might understand when I ask this and that, but he can't speak. Speak it. For example, colors. He can speak blue and green, but when he see white, he will say wa. And when he see yellow, he will say Y. Yeah. So it's a. Probably a speech problem. And he's, he's simplifying the syllables, the words himself, right? The white becomes wa. Yeah. And yellow becomes ya. So he's speaking in a way that is called a CV structure, a consonant and a vowel, which is super easy, right? Super, super, super easy. And in this case what you need to do is to slow down because he already can do it. So you need to add to his structure slowly. So for instance, if you can say wa, can you say wa? Like add one more at the end. Like, I don't know, it needs to be. You need to check how much he can say, you know what I'm saying? You cannot just. You cannot just teach him the whole sound because it's too difficult. All right? The future. So you need to do that. All right. Nikki said no full diagnosis yet in Canada. Really? Awesome. Yeah. Yeah. So, you know, everyone's reluctant to make a diagnosis about, like, apraxia of speech or differential diagnosis. Right. And because your child hasn't spoken enough spontaneously, I guess they don't have enough speech sample to rule everything else out. Okay, cool. That's. That's a bummer. You know, like, if your child can imitate on command. I don't. To be honest, I think there is a way to do, like, a full diagnosis, but that doesn't really matter because obviously your child doesn't. If he can, like, differentiate between. Yeah, he's five, Right. He should be able to have a differential diagnosis. That's rather frustrating, kind of annoying, but, you know, like, I would say that definitely is not phonological because you can do the minimal pair. At least the speech therapist there would have done that as well. Right. And I would also check his range of motion of his muscles. So let me tell you some here, Nikki, and you can try it. Okay. So number one, can he do, like, when we're always talking about speech, we're thinking about the three muscles. Lip, jaw, and tongue. Okay? So when you think about it, the jaw is the basis, the foundation for moving our mouth because it's the biggest muscle. And then if our jaw moves, it will move other stuff. So, for instance, if. If I put my jaw down, what's happening? My lip is opening and my tongue is going down. It's going down with the jaw. So it really is. The whole structure is the jaw. So jaw and then lip and then tongue. Okay. Tongue is the most fine motor, as we call it. So what you want to try, right, is to see if he can do certain oral motor movements to the maximum. So see if he can go, like, shut the jaw. Totally, like. Like that. Right? And then he can go, like, totally, like, the biggest as he can go like that. And then the next thing you want to try is if he can go left and right with a draw, which is kind of stupid, right? Why would you want to do that? Well, it's just check if he has, like, dysarthria, if he has any weakness in, like, his. Limitless. In his range, his strength. There's endurance of oral. Oral muscles. Okay, so let's see if you can do like. Like that upon imitation. And after that, that's pretty much about the jaw. Like, you can try the speed as well. You can go like that. See if you can do that. And then after that you can do a puck lip like that. See how big it can go. And then like spread lips, see how far it can go. And go like that a few times to see the coordination. And that's pretty much the lips as I can remember. Obviously, you know, I need to have. It's better if I write everything down, but I'm doing this on impromptu anyways. So the tongue, you would want to check if you can stick it out and put it back in. Right. And then the next step is to go left and right. But he doesn't need to go all the way out. Just at the. At the. At the corner. That's fine. All right. Can he do it? Can he do it fast with coordination like that? And the last one is like to put the tongue up. Can you sustain it there for a long time? And if he can, then obviously the best thing is for him to say, la, la, la, la, la, la. Like that. La, la, la, la, la, la, la. See the coordination of up and down. Okay, so that's something you have to try to make. A differential diagnosis is there? But because, Nikki, you haven't had seen other children, it makes it difficult for you to judge whether it's within normal limits or not. Right. So obviously, when I'm telling you this, I'm trying to make you do my job or the speech therapist job in terms of doing that. So if. If you think that. If you think that he can do all these exercises nicely, then it's most probably that his oral motor is oral must. Muscle culture, as we call it in a technical term, is good. So the only thing left really might be that it's apraxia. But the thing is, apraxia is very rare, and that's why they're reluctant to make a diagnosis. Right. It's a lot of bureaucracy, especially in Canada where you're from, right? So the thing is, when you are doing these things, there's something else called the oral oral apraxia, which, by the way, is very, very, very common to have with apraxia of speech. Meaning when you tell them to do some oral motor exercise, they fail to begin. Right. The hallmark of apraxia as a whole is that they cannot begin, they cannot initiate. There's a problem with their motor. Motor planning, right? They cannot plan ahead. That's why when they start, they are finding the right thing to do. So when the hallmark is something we call groping, right? Some children have it, some children don't. Actually childhood apraxia, which is more we should call developmental apraxia, meaning it comes from the child being born, is more of something that is probably much less understood than acquired. Meaning if someone got a stroke and got apraxia, it's much less, you know, understood. All right, so with that said, hopefully you kind of got what I meant. Okay, we need to look at how he performs for these non oral. Sorry, non speech. Oral motor exercises and then also listen into his speech sounds. Okay. For apraxis, speech is more of inconsistent. Inconsistent errors. But at the same time, it's really crazy because one of my students who has had apraxia for the most of her life, like I. I say most, meaning it has affected the most of her life. But she now speaks clearly, like with the grace of God. But the thing is, right, she actually has some consistent errors, whereas some people say that, you know, I practice speech is more of inconsistent errors all the time. So it's really difficult. It's really difficult. Yes. Nikki? Yeah. If you have any problems, just put it in the group or something or email me. Yeah, that's. That's the good thing about you being on my email is that you can just like, you know, send me stuff in private and then I'll just reply to you. Right? Yeah. Try out these mouth movements. If you can like take a video and then, you know, I can tell by a little bit just. Just guesstimating. I can't tell you for sure what's going on. Is it like he cannot do it or, sorry, he doesn't have the strength to do it. He doesn't have the range, doesn't have the endurance, doesn't have the coordination. Or is that he's got a problem with planning or executing the. The thing. All right, so here we are again. I want to talk about apria. And today I've shared more about aprexia than I really wanted to because I really think that you should really leave it to the professionals. But sometimes it does happen, like for Nikki. Right. People are reluctant, reluctant to make an diagnos diagnosis because of all the implications. But. But there are a few things I would like to highlight. Number one is that, hey, if there isn't a reason and you can't find a reason, don't jump into like saying that it's apraxia of speech. Okay. Number two, if you are thinking, what's the implication of that? Well, the implication is that, you know, your child will have to go through vigorous speech therapy. Okay. Whether it is a motor based or Phonological based speech disorder. And we've talked about what the differences are, right? So 75% of children actually have a phonological disorder. Right. In terms of chance, like, probability wise, it's pretty low that your child has a practice of speech. Okay. And for me. Really? Yeah, really. Most of the time, it really comes down to, like, just understanding the sounds, getting them to have a heightened awareness about it. And that's because usually children who are language delayed or disordered, they will have an impaired sense of where speech sounds go or how they sound like or where they, you know, where they are placed within the word. That's why when some of the. My clients, when they say. My students, when they say helicopter, they helicopter or something. When they say, like vegetables, they say vegetable or something. When you tell them to say something like, what's that called? Tomato or remember, they say remember or something because they don't understand it. They don't understand the word. They don't understand the word enough. Okay? So with that said, most of the time, as a phonological thing, okay, sometimes it will be a motor thing, but within the motor, you have to. Especially for motor, you need to know exactly why your child has a problem. Might be a tongue tie, right? Might be the range, okay. Might be that their muscles are weak, right. Might be that they have a practice of speech. Might be that they have other things, right? But be. They have the cliff. Cliff palate, you know, cleft palate or. Or something. So you need to understand that. Or sometimes if some children has a cerebral palsy, half of their mouth is like, paralyzed or they have a sensory issue. Okay? So this is what I want to talk about today is be careful not to jump in the rabbit hole of talking about apraxia, like labeling your child right away, okay? Because there's always a way to find out. And that way is to see a therapist, which is very hard right now. Super, super difficult. Right? But if you're willing to, you can obviously join our Facebook group and ask, you know, our members there, our parents, especially moms there, are very loving. You know, they share about how they're struggling. And the best thing about, like, what I can do right now and during this pandemic is to answer your questions. And I can't answer your questions if it becomes, like, very surface. I'm getting a lot of questions like, what should I do? Please help. Please support. Yeah, I know, but what's the problem? You didn't tell me yet, right? You didn't tell me. I cannot tell. I cannot like, give suggestions about what you should do if you don't do it. Like, even if I suggest it, just suggest it and you don't do it. Whereas Nikki here, like, she does it and she tells me and then I can think, oh, yeah, well, what's the next step? This is the next step. Try this, right? And just the other day on Facebook, someone asked about something totally irrelevant about feeding, about, like eating, like behavior, like they eat too long. What should I do? I told her to try this. It works great. You know, like it's a matter of luck as well on my part because I've tried it before on a client. I don't know if it will work on her. So at the end of the day, at the end of the day, what I want you to get out of this live video for tonight on Monday is that, hey, there are times where you don't know why and there are times that you need to understand repetition. Practice is important. And there are times that you know, you have to know exactly why your child has a speech disorder, meaning they can't speak properly because speech and language are very different. Language doesn't matter. If you just do some of the techniques that I tell you here, like a language facilitation, you know, to teach language in a way that makes sense for a child. It's universal, Nearly. Nearly universal, right? But if you teach speech disorder, like you want to treat speech disorders, you need to know exactly why, okay? If you're doing like minimal pairs for motor based speech disorders, that's stupid. At the end of the day, that's just stupid. If you're doing oral motor for a child who has phonological disorder, which means they cannot really understand the sounds within the word, that's also stupid. That is really stupid. I've seen it multiple times as well. And to avoid being stupid, I'm not targeting at you at all. I'm saying that now that you know that you need to know exactly why in order to treat it right, then you should go ahead and, you know, you should go ahead and try difficult techniques from what the speech therapist says, okay? And a lot of people go for a way that was symptom based, you know, oh, my leg hurts. So therefore I will treat my leg. But sometimes in speech especially, it's not as easy as that. There might be that, you know, it sounds like they cannot say a long word. And then you will try to treat it. Like for instance, one of my parent, like coaching clients, right, she says, oh, my kid can't say this word. So I'm like constantly drilling that word into her brain because it's important for her to know this word. I'm like, okay, that's very symptomatic. Like you, you have a fever, I'll put ice on you. Yeah, but how about taking medicine or like boosting immune system. Whatever it needs to be the root cause, right? The root cause of her not being able to say like, long syllable words is because. Don't know how to. Don't know how to like. It's a phonological thing, right? They cannot understand the sounds within the word. That's why they can't do it. The longer the syllable, the harder it becomes. So I would treat it with like. I would start with one syllable word, see if they can two syllable words, see if they can, and then increase the structure, like the complexity within the syllable. Right? So let's say like, for instance, like a two syllable word, like mama is super easy. It's not complex at all. But when you increase it with a whole load of consonants. For instance, let me think. For instance, like scoopa, like scuba diving. That. Scuba. Scuba is two syllables, but it's super hard, right? You got an S and a C together. And you also have to put a U, like scoop, like so hard. So I would try that and slowly add towards until they can hit that. Because if you, if you treat a child that way, it really makes them very, very, very discouraged. All right? I have a client today who said, oh, whenever I try to do like speech stuff with my child, he just like cries and just tries to get out of it and rolls on the floor. And just when the mom's not looking, he will like sneak away and slowly fall down the chair. Which happens a lot, by the way. By the way, when I was like a much younger therapist, that happened to me a lot. And I'm not saying that I have a whole load of experience. I'm not that I haven't. I've been doing this for some time. Right? But there are a lot of people who are, who have been doing it longer than I am. What I'm saying is when I was, when I just started off, children also fell off the chair. But so when, when children do that to you, it means that the stuff's too hard. Okay? So do not treat on the level that you think that they can't do it, okay? The camera isn't. Camera isn't focusing. But anyways, so with that said, please remember what we are talking about today, okay? The thing is, you should always remember I'M trying to make it focus. Nope, not happening. Okay, so I'm gonna end this video right here. If you have any questions, please do put it in the comment section below. If you want to get on our email list, just comment down below and tell me, I want, I want in. And I'll send you an invite for you to get on our email list. And why we would I tell you to go on an email list? Right. It's because I send emails more often than I do lives and make videos. Because making videos are difficult. Right? It's hard, man. It's hard work. So what I'm proposing is that especially next. Next week, I think. Yeah, next week on the 14th. Yeah. We're gonna have a live with one of my students. We're gonna talk about when she was young. She was non verbal and she only started talking about around like five plus. I'm not entirely sure about the history. But you, you'll get the gist of it. She also had a practice of speech. She's on the spectrum. And now she finally speaks a whole lot better. Yeah, it's nearly short of a miracle where she is right now. Okay. And because she also teaches like special needs children, I can really ask her about the stuff that I always wonder about. Like for instance, how does it feel to not be able to say a word? Like how. How is it that, you know, when I tell you to say something harder, then you can do it. How does it affect you psychologically, you know? Because I know how it will affect them in terms of them able to do it or not. Oh, there we go. We got it. We got it. We got the focus back. Yeah. So being on the email list, I'll tell you about this like earlier on. And if you're on it, you put your hand up, you want to watch it. Then I'll also put you on the list where I will tell you when I get the recording of the interview, I'll share it with you. Okay. I cannot get you guys on the Zoom because, you know, I'm doing it with another mom's group and basically it's already full. It's 100 people on Zoom, so I can only give you the recording. So tell me if you want the recording of this interview. And you can only get it through email. Okay, just PM me, I don't know, Private. Message me private. Put it in the comments, whatever. I'll let you know. Okay. And it's important that you know, it stays private because this is sensitive stuff, man. So you can only watch it there. Okay. And I will be asking all the questions, so it'll be very targeted. If you have any questions you want to ask her, you can tell me in advance so that I can put it in and let her answer your questions as well. Okay? So with that said, thank you so much for hanging out with me on this Monday night. If you have any questions, please do put in the comment section. Join our Facebook group. Ask there. I hang out there all the time, more than on Instagram by a whole load because Instagram isn't great for interactions, I don't know why. And also get on our email list where I tell you more about all the things that you need to know, like whatever I learn, what kind of breakthroughs I have, me answering some parents and then sharing the results with you guys. And that's pretty much it. Thank you so much for hanging out and I'll see you next Monday at 9 00pm Jakarta time, Indonesia, or 10am EST Eastern Standard Time. Okay, thanks. Goodbye.