Why can't my child speak?

Speech involves intricate and complex motor movements. Consider the simple act of saying your own name and observe how your lips, tongue, jaw, soft palate, and vocal cords move. These components must work together precisely, in a coordinated and sequential manner. When a neurotypical child or adult speaks, we often don't consciously think about these movements because they occur automatically through muscle memory.

A child with motor planning difficulties (dyspraxia) may struggle to move their articulators in the precise, coordinated, and sequential manner required for fluent speech. Some of them may be able to say many words independently, but they may have difficulty responding to questions in real-time. For example, you may have heard them say "cow" many times, but when a therapist shows them a picture and asks what it is, the child may not respond or may say "cat" instead.

For someone with mild motor planning difficulties, tying a shoe can become challenging. Here's how:

1. Initiation: They may struggle to start the process, not knowing where to begin or how to organize the steps involved in tying the shoelaces.

2. Sequencing: Even if they manage to start, they might have difficulty remembering the correct sequence of movements required to create a knot. This could lead to confusion and frustration as they attempt to figure out the order of actions.

3. Coordination: Once they understand the sequence, coordinating their hands and fingers to perform the precise movements needed for tying the shoelaces can be tough. They may find it challenging to manipulate the laces and form the loops and knots accurately.

4. Consistency: Even if they successfully tie the shoelaces once, they might struggle to replicate the process consistently. Each attempt may vary in terms of effectiveness and efficiency, leading to inconsistency in their ability to perform the task.

A child with moderate to severe motor planning difficulties, even pointing to desired objects can be challenging. Many parents observe that their child may grab their hand to point to what they want. This difficulty is evident in standardized testing and therapy scenarios. During such assessments, a therapist may present pictures of various animals, including a rabbit, elephant, giraffe, and cow, and ask the child to point to the cow. However, a child with moderate to severe dyspraxia may struggle to point accurately in real-time, despite recognizing the cow. At times, they may point to objects other than the cow. This inability to control their body movements in real-time can lead to frustration, resulting in tantrums, self-injurious behaviors, anxiety, or withdrawal.

Furthermore, the complexity of the situation is compounded by the inconsistency of these difficulties. Some days, the child may successfully point, while on other days, they may struggle. Moreover, the level of difficulty may vary throughout the same day.

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Dyspraxia, is a neurological condition that affects movement and coordination. Individuals with dyspraxia may have difficulty planning and executing movements. Symptoms of dyspraxia can vary widely and may include no speech to very limited speech, poor balance and posture, difficulty with fine motor skills like writing or buttoning clothes, trouble with spatial awareness, and challenges in organizing tasks or remembering sequences of movements. Dyspraxia can impact various aspects of daily life, including communication, academic performance, social interactions, and self-care activities.

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Dyspraxia is not attributed to muscle weakness or intellectual impairment. Dyspraxia can occur in older individuals after a stroke, contributing significantly to our understanding of dyspraxia today. However, when a child is born with dyspraxia, it impacts every aspect of their motor development, speech, imitation, and learning. Dyspraxia may manifest independently or alongside symptoms of autism. Based on our experience, most autistic children exhibit some degree of motor planning issues (or dyspraxia).

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1. Variability in Symptoms: The presentation of apraxia/dyspraxia can vary widely among individuals. Children may exhibit a range of motor difficulties, including problems with coordination, planning, sequencing, and executing movements. These symptoms can manifest differently depending on the specific tasks or activities involved, making it difficult to recognize a consistent pattern of impairment.

2. Overlapping Symptoms: Apraxia/dyspraxia often co-occurs with other neurodevelopmental conditions, such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), or developmental coordination disorder (DCD). 

3. Developmental Variability: Motor development follows a broad and variable trajectory in children, with each child progressing at their own pace. It can be challenging to differentiate between typical variations in motor skill acquisition and clinically significant difficulties indicative of apraxia/dyspraxia, especially in younger children.

4. Lack of Standardized Diagnostic Criteria: Unlike some other neurodevelopmental disorders, apraxia/dyspraxia does not have universally accepted diagnostic criteria. In case of verbal dyspraxia therapists generally rely on standardized tests to diagnose a condition. In order to use the standardized test of dyspraxia/apraxia, a child should have enough verbal production. Often time children do not have that much verbal output. 

5. Limited Awareness and Understanding: Apraxia/dyspraxia may not be well-known among parents, educators, or even some healthcare professionals.                                      Identifying and addressing these challenges early on can be crucial for supporting the child's overall development and improving their quality of life.

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