Compiled by Josette Portelli, B.Sc. (Hons) M.A. (Ling)
What is DVD?
Developmental Verbal Dyspraxia (DVD) and childhood apraxia of speech (CAS) are the main two terms used to describe the same condition, commonly called dyspraxia. DVD is a difficulty with planning or programming the motor-speech movements required to produce speech. It is not a muscle disorder and it is not a cognitive disorder, although it may have an impact on both language and speech. Dyspraxia occurs when the brain tries to tell the muscles what to do, and somehow the message gets scrambled.
Verbal dyspraxia may occur with oral dyspraxia. This is the inability to perform non-speech tasks on command. Examples are blowing, licking lips, puffing out cheeks, sticking out the tongue and so on.
DVD is not an articulation problem and therefore the child does not have a difficulty that involves structural, physical or motoric problems.
A child with DVD will have the physical ability to produce a sound, but will still be unable to produce this sound because of an immature sound system.
DVD is not caused by hearing impairment, autistic spectrum disorder, intellectual disability or a neuromotor disorder such as cerebral palsy. However, it may co-occur with all of these disorders.
Dyspraxia affects the voluntary rather than the automatic movements of speech. The child may be able to say certain words or phrases spontaneously (automatic speech) but is unable to repeat them on request (voluntary speech).
Characteristics to look out for:
- Feeding difficulties – either as babies or ongoing difficulties (picky with textures, temperatures etc.)
- Oral dyspraxia
- Delayed language – there is usually a history of delayed vocalization, babble and production of words. Ongoing difficulties will vary in degree from one child to another
- Difficulty in producing consonants and/or vowels in isolation – so that the systems can be very limited
- Difficulty in sequencing sounds – in isolation and in the production of words. This can result in the normal syllable structure being totally distorted
- Difficulties with consonant clusters: may say tar for star and leep for sleep
- They may replace difficult consonants by simpler consonants: tar for car
- Difficulties with multi-syllabic words. They may say the word different each time they try. Errors made are inconsistent and unpredictable. The child may be able to say a particular word in isolation, but when combined with others (such as in a sentence or phrase) they make errors
- Difficulties in prosody – volume, rhythm, pitch, intonation, resonance and/or voice quality
- They may speak too fast or too slow
- They may put stress on the incorrect syllable;
- Unintelligibility – such that even parents may have considerable difficulty understanding their child
- The child uses other forms of communication – pointing, grunting, and other gestures instead of talking
- Failure to improve with a conventional approach to therapy.
- Involves a great deal of repetition to teach basic placements and movements required in speech and sound production
- Requires frequent practice at varying degrees of difficulty and range of sound contrasts
- Includes activities involving speech sounds. The need to practice co-ordinating these movements into sequences at all levels (oromotor, single sound and in syllables sequences so that they become automatic, thus building accurate patterns of speech
- May include activities not involving speech sounds (soft palate, tongue and lips)
- Requires patience and understanding from all those around child
- Requires a reduction of pressure on the child since children with DVD tend to become more frustrated than others
- Should be encouraged to undertake low-pressure activities such as singing repetitive songs
- Child should be given cues, but sentence not completed for them
- Encourage use of alternative forms of speech such as gestures, sign systems, body language and pictures
- Give the child choices and breaks.
A child with DVD will not “grow out” of the problem. He will need help from a Speech-Language Pathologist. Outcome will depend on:
- Regular practice
- Support in home environment
- Correct modelling techniques
- Positive reinforcement.
The child could also have persistent reading and writing problems when he reaches school-age. The condition may also have residual effect throughout life.
Bibliography & Useful Links
- Addy, L. M. (2003). How to understand and support children with dyspraxia. Cambridge: LDA.
- Nuffield Centre Dyspraxia Programme (1992) The Nuffield Hearing and Speech Centre, Royal National Nose, Throat and Ear Hospital, UK.
- Ozanne, A. (2005). Childhood apraxia of speech. In B. Dodd (Ed.), Differential diagnosis and treatment of children with speech disorders. (pp. 71-82). London: Whurr.
- What is Dyspraxia? – (http://dyspraxia.org.nz/?page=what-is-dyspraxia) – retrieved on May 19th 2006