- Lori Melnitsky
Case study: 4 year old severe stuttering and apraxia diagnosis…
Do we treat stuttering first? Do we treat oral motor, articulation first? Do we ignore stuttering? Do we ignore the fragmented language? What do we do first? Stuttering in itself is so complex…How do we deal with both?
I wanted to share a case study with you and hope some of these tips help…
In April of 2019 a young man I will call Max came to see me. Max was a little over 4 and aware of his speech difficulties. Parents were unsure of which direction to take. He was previously diagnosed with childhood apraxia of speech and I agreed with this. His language was at the three word level. Eye grimaces, eye contact avoidance, missing syntax, repeating syllables and words were evident. Max was stuttering on 82 percent of his words. That means 82 out of 100 words were dysfluent. I am breaking that down because that is a huge amount of time talking with stuttering and secondary characteristics. Social and emotional implications were evident with peers.
He was groping for words. Max had been receiving speech therapy in the form of Prompt but the speech pathologist had felt stuttering was increasing. She was not a stuttering specialist and referred her out. I admire her for doing that because without her knowing she greatly helped his communication. Max displayed jaw sliding, poor lip rounding and retraction and poor mandibular control upon analysis. Was is true apraxia or did the stuttering make it worse? He was blocking on every word and frustrated.
To make a long story short and looking at this child as a whole the first goal was to enhance communication because he was starting to avoid talking and did not want to go to preschool. My usual protocol is to start with fluency first… Why? because without smoother sentences language is halted and in my experience often times oral motor movements appear distorted. It took approximately four months to get two to three words fluent in structured settings. In that time he started to use pronouns and take some chances in adding more prepositions. Using words which helped with lip rounding improved intelligibility. Little by little each month improvement was shown. At month five I was able to prompt for a short time.
To make a long story even shorter Max started kindergarten stuttering mildly ( 6 out of every 100 words). He still has characteristics of apraxia and some phonemic awareness issues but he talks all the time. His teacher says he is a chatter box. He is still in speech but has no fear.