by Sara Campbell

I am frequently asked about my speech impairment. “Why do you talk so funny?” or “Is there something wrong with you?” are the two most frequently asked questions. Most (if not all) of the people who ask me those questions have likely never heard of Oral Apraxia - the disorder which I have coped with for my entire life. I’m sure that most people reading this article are unfamiliar with Oral Apraxia as well. So when I was asked to write an article for Recruitment News, I asked if I could pick the subject. When the answer was “yes,” I knew exactly what I was going to write the article about. It is my hope to educate people about Oral Apraxia, and to provide information that could help readers notice any signs or symptoms of the disorder in the children with whom they work.

The Diagnostic and Statistical Manual-IV (DSM-IV) does not have Oral Apraxia or Apraxia as part of their lists of diagnoses; however, definitions and other information can be found on various web sites and in other information on the Internet. Nancy R. Kaufman, M.A., CCC/SLP states that “Apraxia of speech (Oral Apraxia) is a motor-speech programming disorder resulting in difficulty coordinating the oral-motor movements necessary to produce and combine speech sounds (phonemes) to form syllables, words, phrases and sentences. Oral-motor weakness may coexist but must not be a primary concern.” Kaufman, founder of the Kaufman Children’s Center for Speech, Language, and Sensory Disorders, Inc. (KCC) in West Bloomfield, MI, goes on to list several signs and symptoms for parents and professionals to aid them in the early detection of Oral Apraxia in children. The symptoms can include:

• Lack of cooing or babbling as an infant, first words may not appear at all, pointing and “grunting” may be all that is heard.
• Delayed first words with many phonemes deleted or replaced with other (easier) phonemes.
• Lack of a significant consonant repertoire: child may only be able to use b, m, p, t, d, h.
• All phonemes may be imitated well in isolation but any attempts to combine phonemes are unsuccessful.
• Words may be simplified by deleting consonants or vowels, and/or replacing difficult phonemes with easier ones.
• A syllable is favored, and used for all words.
• A word (may be a real word or a nonsensical utterance) is used to convey other words.
• Single words may be articulated well, but attempts at further sentence length becomes unintelligible.
• Oral scanning or groping may occur with attempts at speaking.
• A whole phrase may be clearly said and never heard again, or cannot be imitated.
• Other fine-motor problems may be present.
• Verbal preservation: getting “stuck” on a previously uttered word, or bringing oral-motor elements from a previous word into the next word uttered.

Observing these signs and symptoms in young children who are learning to talk may indicate that Oral Apraxia is present. Early detection is critical in order to begin treatment which can offer the child the greatest chance for success. While it is important to note that Oral Apraxia is a disorder that can not be “cured,” appropriate treatment significantly increases the likelihood that the child can become an effective oral communicator in the future.

Therapy for Oral Apraxia is strongly encouraged! People with Apraxia may be able to strengthen their speech dramatically, just as I have been able to do after years of therapy. Suzanne Rao, a Speech and Language Pathologist at the ACHIEVE Speech Language & Learning Clinic in British Columbia, Canada offers the following suggestions regarding therapy / treatment for Oral Apraxia:

• Frequency, type, and consistency of intervention are important.
• Divide the larger (long-term) goals into smaller (short-term) steps that are concrete and measurable so that a child can see his or her progress along with the caregivers.
• Help the child develop a positive self-image about himself/herself as a communicator.
• If the apraxia is profound and intelligibility is poor, introduce augmentative communication (sign language, communication boards) as a bridge for oral communication.
• Teach pacing, e.g. a slower and more rhythmic rate of speech
• Teach early developing and frequently occurring consonants first.
• Teach oral motor awareness.
• Associate tactile and visual symbols with sounds.
• Practice the sounds in the context of frequently occurring words and vocabulary relevant to the child’s daily life.
• Multisyllabic words need to be taught, using pacing and tactile cues.

Speech can improve dramatically in children with the help of a good speech therapist who is knowledgeable about oral apraxia. Having the guidance of a qualified speech therapist is one of the best tools with which to address this disorder.

As for my own personal experience with this disorder, it has made me the person that I am today. I have known from the time that I could comprehend that I have this disorder. For nearly eighteen years I have participated in speech therapy in various hospitals, through the public school system, and with therapists in private practice. Oral Apraxia has brought me a great deal of emotional pain throughout my life. I was often teased by my peers from the time I was in the sixth grade until I graduated high school. The pain of not being “popular” or “cool” hurt deeply. I didn’t see myself as “bad” or “strange.” And I did not understand that my peers were simply immature for not trying to understand me and not wanting to know more about Oral Apraxia. Relationships with peers and maintaining self-esteem are significant issues for a child with this disorder. Parents should be aware of this and must find support systems - both professional and on a peer level for a child, with this disorder. It is so important for parents to comfort their child if he or she is having difficulties with peers. Make sure that the child knows that they are loved, respected, and cared for in spite of the disorder, and that they do not have this disorder because they are “bad” or did something wrong.

Oral Apraxia is a disorder, and though it can not be cured, the condition can be significantly improved with a great deal of consistent therapy. While parents should be prepared for the trials ahead, they should also be proud of who their child is. Patience, love, and support are the three things that are needed to raise a child with Oral Apraxia. I’m sure readers of this newsletter have that in their heart already!

Sara Campbell is a student intern at MARE and is also an adoptee. She is completing a Bachelor of Social Work degree at Spring Arbor University in Spring Arbor, MI.

Resources on the World Wide Web:

www.apraxia.org

www.apraxia-kids.org

www.kidspeech.com

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Adoption Tax Credit

From time to time, the MARE staff makes mistakes. We erred in the February/March issue of FAM regarding the Adoption Tax Credit. We took the information directly from the IRS’s website; a number of our readers pointed out to us that the website information was incorrect -- thank you for letting us know.

Here we want to share the current and up-to-date information about the Adoption Tax Credit.

New Rules for 2002

Beginning in 2002, there are significant changes to the credit and exclusion.

Credit and Exclusion Extended. The credit, which was scheduled to end after 2001 (except for children with special needs), has been extended. The exclusion, which was also scheduled to end after 2001, has also been extended.

Amount of Credit and Exclusion Increased. In general, the maximum credit and exlusion will increase to $10,000 beginning in 2002.

Beginning in 2003, a $10,000 credit or exclusion will be allowed for the adoption of a child with special needs regardless of whether the taxpayer has qualifying expenses.

CAUTION: At the time this publication was being prepared for print, Congress was considering legislation to make this provision for special needs adoptions effective in 2002.

Income Limit. The income limit will also increase. The following table shows whether the income limit will affect the credit or exclusion.

IF your modified AGI is ...	THEN the income limit ...
$150,000 or less	will not affect your credit or exclusion
$150,001 to $189,999	will reduce your credit or exclusion
$190,000 or more	will eliminate your credit or exclusion

Expenses Paid Before 2002. Prior-law dollar limits continue to apply to expenses paid before 2002.

Example. To adopt a child without special needs, you pay $7,000 of qualified adoption expenses in 2001 and $3,000 of qualified adoption expenses in 2002. The adoption becomes final in 2002. The maximum amount of expenses you can take into account for this adoption is $8,000 ($5,000 from 2001 plus $3,000 from 2002).

Your Credit Allowed. The credit for adoption of a child with special needs will be allowed in the year the adoption becomes final, regardless of when any qualifying expenses are paid.

CAUTION: At the time this publication was being prepared for print, Congress was considering legislation to eliminate this provision.

Credit Allowed Against Alternative Minimum Tax. The provision presently in effect allowing the credit to reduce alternative minimum tax as well as regular income tax has been extended. This provision was originally scheduled to expire in 2002.