What is Dyspraxia? 
A motor programming disorder. In simple terms: The brain and the muscles are working normally, but the message being sent from the brain to the muscles gets lost, resulting in coordination difficulties.
What is Developmental Verbal Dyspraxia?
A type of dyspraxia that begins in infancy and affects the muscles needed for speech.
It is thought that developmental dyspraxia can occur as 3 separate subtypes, and it is possible for children to have just one, two or all 3 of these:
1. A general body dyspraxia (e.g. may be clumsy, difficulty with coordinating movements for riding a bike etc)
2. Oro-motor dyspraxia (difficulty voluntarily moving tongue/ lips, not related to speech)
3. Verbal dyspraxia (affecting coordination of speech sounds)
Developmental Verbal Dyspraxia (DVD) is the term used in the UK, whereas Childhood Apraxia of Speech (CAS) is preferred in the US, Australia and many other countries. There are subtle differences in the meaning behind these terms, which is why the UK have opted to keep DVD, but in essence they are describing the same condition. It would be wise to search for both terms if you were looking for research or information into the condition.
What does it look like?
A child with DVD often has severe speech sound difficulties, that persist over a number of years. Researchers have not been able to come up with one set of symptoms that allow us to easily identify DVD, and separate it from other conditions. There is uncertainty around its diagnosis, although there is no longer any doubt that it does exist. Some believe that DVD is over-diagnosed, and that children may have ‘Expressive Language Disorder’, ‘Inconsistent Speech Disorder’ or ‘Phonological Disorder’ rather than DVD. It is advised to wait until children are 6 or 7 before giving a diagnosis and it may be better to describe the child as having ‘suspected DVD’ or ‘features of DVD’. The RCSLT favour using the description ‘symptom cluster’ and describe it as an unfolding and changing condition as the child grows.
Most clinicians agree that:
- Children with DVD often find involuntary movements easier than voluntary ones. So they can perform a task automatically when they are not thinking about it, but that same movement becomes extremely difficult when asked to perform it on demand. This makes therapy challenging for the child as they find imitating speech movements very difficult.
- You may also see evidence of the child searching for the correct placement of the mouth/ tongue.
- Children will have difficulty sequencing sounds. Their speech may be made up of lots of vowel sounds; or just one or two same consonants repeated throughout their talking. Their speech is often very difficult to understand (intelligibility). Vowel sounds may not be accurate.
- They may have an unusual voice quality, or uneven rhythm when talking.
- May have had feeding difficulties or excessive drooling.
- Likely to have been late to talk and may have not babbled.
- Sometimes there is a family history of speech, language or literacy problems
Assessment:
Assessment should be carried out be a specialist Speech and Language Therapist who has knowledge and experience of working with children who have severe speech sound difficulties. There is one specialist centre in the UK who can provide diagnosis and management support, or give second opinions: the Nuffield Centre in London. You can view their referral guidelines here: http://www.ndp3.org/dyspraxia-referral-guidelines.html, however they require the child to have 20-30 spoken words before they will consider assessing them. They also offer training for speech and language therapists in using their assessment and treatment package: ‘The Nuffield Centre Dyspraxia Programme’ (NDP3).
Therapy and Intervention
The Nuffield Dyspraxia Centre advocate a ‘bottom-up’ approach whereby the child is taught the individual building blocks for each individual speech sound and is then taught to combine these into small segments, these are then practiced in simple words. Each level is carefully graded so that the child has consistent motor programs for each element and then builds on this.
Another treatment approach that is gaining popularity for inconsistent speech is known as ‘Core Vocabulary’. Therapy targets a particular set of words that are motivating to the child and aims to ensure they use their best attempt at saying these words clearly.
For some children alternative methods of communicating will be needed, such as using signs, symbols or an electronic device. Children with DVD will need a considerable amount of therapy and support from parents and school to provide frequent practice of their therapy goals. Some children may benefit from a specialist school placement such as a Speech and Language unit attached to a mainstream school.
ASHA (2007) stress the need for intensive and individualised treatment. RCSLT (2011) state there is no robust evidence for ‘blocks and breaks’ of style of therapy or consultative/ advisory models of service delivery (p.18)
Summary:
DVD is a speech sound disorder affecting children’s ability to learn and coordinate movements for speech. As yet, there is no known cause and it can occur alongside other difficulties. Most children with DVD can develop clear speech with appropriate help from a specialist speech and language therapist. Patience, encouragement and plenty of practice are all essential, as well as consideration for the child’s emotional well-being
Resources:
The Royal College of Speech and Language Therapists (RCSLT) Policy Statement on DVD (20011) https://www.ucl.ac.uk/pals/study/cpd/cpd-courses/files/dvd-rcslt-policy-nov-2011.pdf
The American Speech-Language-Hearing Association Position Paper on Childhood Apraxia of Speech (2007) http://www.asha.org/policy/PS2007-00277/
Nuffield Centre Dyspraxia Programme http://ndp3.org/
http://www.dyspraxiafoundation.org.uk
Support and information regarding communication difficulties:
https://www.thecommunicationtrust.org.uk/
Find and Independent Speech and Language Therapist in your area:
speechbubbletherapy 