Apraxia Defined by Not Defined By

Tuh. Mmm. Nah.

These were some of the few sounds Jaxon made at almost 2 ½ years old. Based on typical child development, at two years old he should have been able to say at minimum 50 words while also combining some of those words into two-word phrases.
Not only was verbal communication extremely difficult for him but he relied on pointing, gesturing, grunting and taking his parents to what he wanted to communicate his wants and needs.

Jaxon was displaying characteristics of Childhood Apraxia of Speech (CAS) – a disconnect between the brain and the formulation of speech. Technically speaking, it means a child cannot accurately motor plan out his speech patterns.

Some signs to look for according to Mayo Clinic include:

  • Difficulty moving smoothly from one sound, syllable or word to another
  • Groping movements with the jaw, lips or tongue to make the correct movement for speech sounds
  • Vowel distortions, such as attempting to use the correct vowel, but saying it incorrectly
  • Using the wrong stress in a word, such as pronouncing “banana” as “BUH-nan-uh” instead of “buh-NAN-uh”
  • Using equal emphasis on all syllables, such as saying “BUH-NAN-UH”
  • Separation of syllables, such as putting a pause or gap between syllables
  • Inconsistency, such as making different errors when trying to say the same word a second time
  • Difficulty imitating simple words
  • Inconsistent voicing errors, such as saying “down” instead of “town,” or “zoo” instead of “Sue”

Understandably, children and their parents can get overwhelmed and frustrated. Please know there is help. A trained Speech-Language Pathologist will be able to determine if your child has CAS or another speech disorder and can help lead you in the right direction for support.

Therapy for a child with CAS is much like a dancer learning to perform a new routine. It requires learning the individual moves, stringing them together and then time and patience to rehearse and master.

Jaxon started his therapy journey learning to imitate vowels and consonants in isolation. After beginning to improve with this skill, Jaxon then began working to combine some of these consonants and vowels together to make words. With engaging therapy and consistent practice, Jaxon made steady progress and began to master the skills that come so natural to other children his age.

Now a year later, Jaxon’s vocabulary is exploding. He is gaining new words everyday and has a vocabulary of well over 300 words and is putting 2-3 words together in short phrases. Although Jaxon’s progress started slow, he has made significant gains. He continues to work to reach his speech and language developmental milestones.

Children like Jaxon may have to work a little harder to communicate and there may be extra challenges along the way–but their perseverance and resilience is a great teacher for us all.

What started as a boy who could only mutter a few unintelligible sounds is now a boy who is belting out songs at school. There is always hope and you can find it here. Please call or email us if you have any questions regarding CAS.

App Review: PEEP Where’s Quack?

As a speech-language pathologist, I individualize my treatment plan for each child.  For example, some children are more motivated by outdoor play whereas others might be more interested in books or structured games.  One tool that I have added to my bag of tricks over the last few years is an iPad.  With iPads and similar devices becoming more and more commonplace, many of the children I work with have access to a tablet and most of them show a lot of interest in them.


I have downloaded a wide variety of apps and have developed a list of favorites that I would like to share.  I plan to review one of my favorite apps each month to give parents and caregivers ideas for making their child’s screen time more beneficial.  This list consists of apps that are free or inexpensive and can be beneficial to different ages and skill levels.  My favorite apps are ones that all children could benefit from.  Please note, however, that an iPad or other tablet is NOT a necessary requirement for developing speech and language skills.  Please read my reviews as supplemental suggestions to the real-life experiences that your child is already learning from.

Where's Quack?

PEEP Where’s Quack? by WGBH is an app that I was introduced to by the Smart Apps for Special Needs blog.  (I highly recommend this blog!  It is where I have found many of the apps on my favorites list.)  It is a rather simple app in which two animated characters play a game of hide-and-seek.  The hidden character, Quack, calls out periodically to encourage the listener to use the sound of his voice to determine his hiding place.  Touch a location (a tree, a doghouse, a pile of leaves, etc.) and if Quack is not there, another creature emerges.  When you find Quack, a new game automatically begins in a new scene.  There is a total of four scenes and Quack hides in new places each time.

While playing this app with your child, you will foster development of several communication skills such as:


  1. Understanding and answering where questions – Ask your child, “Where’s Quack?” while holding the screen in sight, but out of his/her reach.  Encourage your child to tell you a location such as “Tree!” or “Slide!” or, in older children, “Behind the tree!” and “Under the slide!”
  2. When your child names a location, allow him or her to touch that location and see what animal emerges.  Ask, “Is that Quack?” to work on yes/no questions.
  3. When an animal comes out of a hiding spot ask, “Who is that?” to work on answering who questions and foster vocabulary development.  The app includes some less-common animals such as hummingbirds and raccoons in addition to easier vocabulary.
  4. If your child is not responding to your questions, you can still ask and provide simple answers as models.  For example, “Where’s Quack?…Behind tree?… No!…Porcupine!”


Although your child may enjoy independent play with Where’s Quack, he or she will receive little to no language stimulation unless an adult is participating as well and maintains control over the screen.  You can continue to foster the development of the skills practiced in Where’s Quack with these extension activities:


  1. Play hide-and-seek with your child.  Depending on his or her developmental level, they might benefit from having a hiding partner (sibling or another parent, etc.).  Talk about places you’re looking (e.g., “Is she under the bed?”) and even ask, “Where are you?” to see if your child can label his or her location.
  2. Play hide-and-seek using your child’s toys.  Give your child directions for where to hide each toy (e.g., “Put the train in the drawer.”) or if your child wants to hide the toys on his or her own, you can ask, “Where is the __________?”  Your child will love being in charge!
  3. For older children, make the hide-and-seek game more of a scavenger hunt.  Hide pieces of a favorite game or activity (e.g., train tracks) around the house.  Give clues (verbal or written) that include location words (e.g., behind, between, beneath, above, etc.).  After your child has found all the necessary pieces, play the game or do the activity together.


Theresa Sonderman, M.A., CCC-SLP
Speech-Language Pathologist at Marian Hope

Movie Premire – The Princess & the Thief

The Princess & the ThiefBen Affleck, George Clooney, and Tyler Perry aren’t the only triple threats writing, directing, and starring in their own movies these days.  Just last month, we held an exclusive movie premiere for a very special film right here in Independence, MO.

The students in Marian Hope Center’s Improving Life and Social Skills class met weekly for two months to create an original movie from start to finish.  Working together under the guidance of a speech-language pathologist, they wrote the movie, gathered props, created the scenery, put together costumes, acted in the movie, and edited the film.  The five students, ranging in ages from 8-13 years, learned important skills for working with peers, memorization, displaying emotions, narration, speaking clearly, responding to social cues, and forming friendships.  The students were challenged to step out of their comfort zone to take on new tasks and roles.

The students even worked together to  plan and host an official premiere  to show off their hard work.  No details were forgotten – students served healthy versions of traditional movie foods – organic popcorn, casein- and gluten-free pizzas, and fruit smoothies.  The premiere concluded with an awards ceremony and each child received a copy of the film.

We are so proud of the hard work these students put into this project.  Please enjoy their original short film below, The Princess and the Thief.


(A special thanks to our OT grad student, Kat, for help with the technological aspects of editing.  We couldn’t have done it without you!)