early intervention therapist questions

Q&A: 5 Year Old Cannot Put Sentences Together

Tamara Guo Speech, Therapist Q&A

blockquote_bgMy son is 5 years old. He has been in speech therapy off and on since he was three. He cannot put a sentence together. If you ask him to say I like puppies, you might get him to say like puppy. He rarely can put three words together. He does not have a direction. What I’ve read about his case, I think that he fits. His school speech therapist says she’s heard of apraxia, but doesn’t know much about it. My son does most of his communicating by pointing and attempting to say words in bits and pieces. I had him evaluated at child development centers 2 years ago and didn’t get any direction there either. He needs help by someone who knows about childhood apraxia.

Childhood apraxia of speech often is defined as a motor speech disorder where the child has difficulty saying sounds, syllables and words. Children often have a small number of sounds they can produce, their vowels are distorted, difficulty combining sounds (can say /m/ but may have difficulty adding one sound /ma/ or more sounds /mam/.) Children with CAS may try to say a sentence but correct syllables and words may sound like a melody instead of clear words. Frequently used phrases may be easier for the child to use and words may be clear sometimes but not other times.

The child may also have non-speech characteristics such as feeding difficulties, drooling, and oral motor (mouth/tongue movement) is not coordinated. CAS occurs when the brain tries to tell the mouth parts needed for speech to move certain ways but the brain signal is interrupted and the accurate movement does not occur.

Often CAS is not diagnosed when the child is very young (usually 3 years or younger) because of the developmental level needed for evaluation. The speech language pathologist should conduct an oral motor assessment where the child imitates or follows a request for mouth movements and how the mouth moves with specific sounds asked. The therapist also examines the child’s melody of speech and how the child produces single sounds, sound combinations, words, phrases and sentences. There are formal tests that the therapist may also use.

I would take your child to a certified (CCC-SLP) speech language pathologist who specializes in apraxia and childhood speech/language disorders for a re-evaluation. He is at an age that he should be able to participate in the evaluation.

I found a website that lists therapists in your area and several note apraxia and childhood speech/language. Go to www.asha.org. Scroll down to Quick links, Click on “Find a Professional Near You” Type in your city and state and you will see therapists pop up. Click on the therapist’s name or company’s name and it will list the areas they specialize in. When you find a location you like request a therapist that has experience with apraxia if you feel your child fits this description.

I would continue to encourage your child to point to items to get his needs met. I would try to use any form of communication to keep him from being frustrated and to be able to get his point across. You can also use sign language, pictures and augmentative communication systems are sometimes used to assist with speech/language while the child is working on oral language.

Tamara GuoQ&A: 5 Year Old Cannot Put Sentences Together