Re: Assessing the severity of apraxia

[Guest guest]

Hi Tracey,

 

I have always wondered that too.  My son 's Developmental Pediatrician and

SLP's have always said they hated to label the level of paraxia.  But last week,

one of his SLP's told me she considers his speech a " severe problem so yes, it

is severe. "    can be understood by his Dad and I about 80% to 90% of the

time.  But I would say strangers can only pick up on about 20% of his language. 

He is 3.6 so that would be a severe problem.  Hope this helps.

 

Gretchen

From: drtraceyburrell <drtraceyburrell@...>

Subject: [ ] Assessing the severity of apraxia

Date: Sunday, March 29, 2009, 1:52 AM

Hi everyone,

I am still relatively new here but have already gained more information here in

the last few weeks than I have from all of the professionals working with and

treating my son over the last 6 months.

My question is, how do you assess the level or severity of a child's apraxia?

How can you determine if your child had mild, moderate, or severe apraxia?

Thanks so much.

Tracey

------------------------------------

[Guest guest]

That is an excellent question!!!

My experience has been that there are some things that have to be left up to an

" apraxia expert " which is an SLP who has a track record of successfully treating

apraxia for a period of 7+ years or so. This is just my made-up opinion of who

can judge but in my humble opinion, I think CAS is so tricky and those who

really understand it - that treat it and treat it well - are the ones most

qualified to make the judgement as to its severity.

I would also rate 20% intelligible as severe. There is a table that defines

severe, moderate, etc. The link is below. I disagree, however, with the

recommended amount of therapy to treat each level of apraxia. For example, I

think mild is recommended to receive only 30 minutes of school based SLP

services weekly. There is no way that is going to close the gap before age 10+.

That is also my humble opinion but here is the table:

http://www.speechville.com/special-education/therapy-matrix.html

Inerestingly, I never noticed this footnote on the table before:

By the age of 7 years, the student's phonetic inventory is completed and

stabilized. (Hodson, 1991). Adverse impact on the student's educational

performance must be documented. If the collaborative consultation model of

intervention is indicated at the meeting, the student receives one additional

service delivery unit. "

Are there any SLP's that can clarify my understanding of this footnote? Has

anyone ever used this table with their district?

I googled " collaborative consultation model of intervention " and it seems to me

to mean if the classroom teacher is providing indirect therapy during the school

day (but I have to admit, I don't really get this at all so certainly don't qote

me on it).

Definately check out the table. It is no joke (apraxia). I think apraxia

should be more of a public health problem. Then, it would be funded whereas in

the education framework, the treatments are never enough and if a child is

treated with " educational " recommendations, the child's apraxia is never really

resolved soon enough to ward off the worst of the educational boogeymen

(dyslexia, spelling concerns, etc.). If apraxic kids just got 5 days of SLP (30

mins each session) until fully resolved, the kids would all be speaking well by

age 5-8 and they would all probably read well as well. I don't think spelling

would be as responsive as reading but I think you understand what I am saying -

the table is undersized even when one factors in an extra SLP session for the

" collaborative consultation model. "

Kids with moderate to severe apraxia should get daily speech therapy. The table

recommends 2-3 days per week (or perhaps 3-4 days per week if you get an extra

session for the collaborative consultation model). The problem becomes

convincing your district that your child needs this and convincing them before

the clock that is tickiing on your child's early intervention period runs out.

I suspect very few children with apraxia receive the recommended amount from

trained SLP's, and even fewer receive this therapy effectively in the public

school setting alone. I think a lot of parents pick up a lot of the slack. If

one goes the route of supplementing whatever school based therapy is provided,

it can become financially overwhelming quickly. It really is a public health

crisis that this country does not have more trained speech therapists and speech

therapy aides and that the ones that are in private practice charge so much and

that insurance doesn't pay for it (or at least not nearly enough).

Don't you ever just dream you are going to wake up in the morning, and you find

President Obama on T.V. announcing he will be doubling the amount of speech

therapists employed in every single public school in America and that the

therapy will often take place away from the school day (after or before school)

so the kids don't have to be pulled out from class all day long. Or that there

is a plan to open a regional school for children with communication disorders

and dyslexia and kids in any district in the " region " can go there and get some

serious intervention in a timely manner (i.e., intensive early intervention).

Wouldn't that be awesome if every child could get the amount of speech therapy

that would be recommended in the " medical model " conveniently and it were done

under the funding of the federal government so that your district would

enthusiastically recommend that program for your child. If these regional

schools employed the best SLP's for apraxia, aphasia, perhaps even autism amd

dyslexia (5-20% of the population overall is thought to have Dyslexia).

Interestingly, phonological awareness difficulties are a strong predictor for

Dyslexia). Or, wouldn't it be awesome if you received a tax credit from the

federal government for up to $10,000 of private speech therapy a year for kids

with apraxia, aphasia, autism, phonological disorders, and dyslexia. Or

wouldn't it be even more awesome if each family could pick from the menu of

above choices as to which one suited their child's needs and personality and the

family' s schedule the best as chosen by the parent. OK, somebody can splash

water on me and wake me up from this dream, but why not give to these kids who

definately need the help the help and in the process, create jobs for people.

If a generic " floor of opportunity " for each of these disabilities was defined

for 2 - 10 year olds across the board, and these issues were fully funded until

the child was resolved with the above menu of choices, it would relieve a lot of

the burden of the current special educational system we have in this country

today (the fighting for services, the stolen futures of early intervention

opportunities foregone, etc.).

I mean, to say that we should just across the board double the number of speech

therapists/reading teachers working in this country treating these kids and

funded by tax dollars is not unreasonable. It would actually be a good value

when you consider that our prisons are filled with kids with learning

disabilities disproportionately (no, I am not by any means saying your baby is

going to prison). Seriously though, think of how much money could be saved if

these kids could be saved! As a taxpayer, if I was asked to fund this one

specific item across the board, I would enthusiastically fund it as I would view

it as a good value in the long term as it would mean less special education

later and broader employment opportunities later. There is waaaaaay too much

red tape in the special education system and waaaaaaay too few effective

interventions for this subset of kids (at least that is what I see occurring).

-Cris

>

> Hi everyone,

>

> I am still relatively new here but have already gained more information here

in the last few weeks than I have from all of the professionals working with and

treating my son over the last 6 months.

>

> My question is, how do you assess the level or severity of a child's apraxia?

How can you determine if your child had mild, moderate, or severe apraxia?

>

> Thanks so much.

> Tracey

>

[Guest guest]

The Kaufman Praxis Test will assess levels of severity.

>

> Hi everyone,

>

> I am still relatively new here but have already gained more information here

in the last few weeks than I have from all of the professionals working with and

treating my son over the last 6 months.

>

> My question is, how do you assess the level or severity of a child's apraxia?

How can you determine if your child had mild, moderate, or severe apraxia?

>

> Thanks so much.

> Tracey

>