Here are the "late talker vs. apraxia" or delay vs. disorder signs that I saw/see in my four year old Tanner as he was/is "learning to talk."

1. It took forever for Tanner to learn how to say ANYTHING other than the word "ma" or the sound "mmm," which were his only "words" up until almost 3 years old. Even though the therapy he received was not appropriate for apraxia (we didn't know this at the time), it was some type of therapy, and it took months of this speech therapy, 1/2 hour sessions, two or three times a week (from 2 years, 4 months, to 2 years, 8 months) for him to learn simple sounds like "t" or "ch" or "sh," sounds most babies and toddlers say when they babble.

During this time, even though Tanner was in speech therapy, we followed our pediatrician's advice that Tanner was a "late talker" and never knew Tanner was qualified for early intervention by the state (a federal program) so we paid out of pocket for all the therapy (insurance didn't cover it and even though we appealed, at that time, we didn't know how to fight the denials). Tanner did babble with some of these sounds, though rarely. Many apraxic children babble very little. The problem was that when Tanner wanted to use one of these sounds, on command, he didn't know how. Many parents of apraxic children have examples, like us, of their child starting to develop speech and then, for some reason, they losing the speech they had developed. Since there is still no large scale research on apraxia in children, nobody knows why this happens. In a small research project by Tom Campbell out of the Pittsburgh Hospital, the findings were that it required 81% more therapy for apraxic children to show results than children with severe phonological delays.

2. Tanner did not go through normal speech development as he aged. He would say a sound (before 3) or word (3 and up) and not say it again for months. Most children with delays of speech will learn sounds and words and build upon that, in a developmentally typical pattern.

3. Another frustrating aspect of verbal apraxia is that even when Tanner learned how to say a sound like "p" before a vowel, he could not say the same sound after a vowel, so he would either drop it, or change it to another sound. For example, if the therapist modeled (said) the sounds "pa," Tanner could say "pa." If the next word the therapist modeled for him was "up," Tanner would say "uf." This has to do with the difficulty of movement of the tongue and mouth positions. Professionals refer to this as "motor planning" (which is why apraxia is also called a motor planning disorder.)

4. Tanner understood us and knew what he wanted and developed his own "sign language" to try to communicate. They say this is very common with apraxic children. When Tanner has more to tell us than he is able to say yet with words, he now also uses sound effects with his unique sign/body language. He's actually pretty good at making himself understood. (Remember Harpo Marx?) Many children with apraxia have high receptive (understanding) ability, and low expressive (talking) ability. There was never a doubt to anyone that Tanner was intelligent and apraxia does not affect a child's cognitive (intelligence) ability. (To discern your child's cognitive ability, view what his/her evaluations state about expressive and receptive ability.)

It is horrible that apraxic children are sometimes misdiagnosed as autistic, or even mentally retarded. Apraxia can co-exist with conditions like autism, cerebral palsy, downs, etc., but apraxia is often times there "alone." (I'll explain later on.) Too often, children are diagnosed as having "receptive" delays, when they do not have receptive delays. Receptive delays are a "red flag" that there could be cognitive issues going on. It's one thing if there really are cognitive issues, but seek second opinions privately from a speech and language pathologist, developmental pediatrician and/or neurologist knowledgeable about apraxia and other disorders.

5. Even when Tanner learned to say the sound "t," if he tried to say the word "pot" it would come out "pop," because he will switch the "t" to a "p." The professionals say this is due to motor planning difficulties and children with apraxia will carry the sound from the beginning of the word to the end.

6. Tanner's intelligibility will "break down" the longer the word or sentence is. Even with a model, he can't repeat back a longer sentence using all the words yet, he will repeat back only a few of the words.

7. Tanner never "picked up" speech like other children. He also seemed to regress and didn't talk at all when he was around large groups of children that were talking and playing, even when they tried to play with him. He tended to do better with one other child, or his brother and maybe one more. Then he would try to talk too. Tanner's older brother was also a late talker, but that was because of birth injuries that he was in therapy for from birth. (He's doing great now! He's 6 and unless I tell someone, they never would have known.) Where Tanner wilted in
groups of children, Dakota thrived, and Dakota did "pick up" speech when I put him in a wonderful preschool a few times a week.

8. When Tanner started to use words, he would repeat the same sound over, using sentence inflections, rather than saying the different words. A good example is, he would point to the door, or out the window, while saying, "die, die, die, die, die." Of course that meant, "I want to go outside." I heard some apraxic children are monotone, but that wasn't Tanner.

We would have to say to Tanner, "I...want...to...go...outside," really emphasizing and waiting after each word, so he could repeat it. Tanner can now say many words clearly, but he still does better when he hears someone say them first. Now at 4, Tanner will, "I doe side now peas. Tay?"

9. Tanner's apraxia still affects his ability to use the back of his tongue to say sounds like "k" or "g." He substitutes the "k" for the "t," so cookie is "tootie." And the "g" for the "d," so girl is "dirl." He has yet to make either the "k" or the "g" sound, but we are working on it. When Tanner said, "hud n' tiss," the other night, I had to stop and switch the "d" and "t" to know he was asking for a hug and a kiss.

10. Tanner talks better when he is singing, or playing, when he isn't thinking about it.

11. I could go on, but another one Tanner has developed now that he is really pushing himself is stuttering (dysfluency.) This does not always happen with apraxic children, it's partly developmental, but it's not uncommon with apraxia. Many children with apraxia can get "stuck" here for a bit. I say how cruel, he has trouble talking, and to add stuttering to that is like addinig insult to injury. Many experts say his brain is working faster than his mouth. You can visibly see him struggle to talk when he does. Lots of thought goes into each word; you don't see that with late talkers. I never did.

Some "soft" neurological signs that are not uncommon to apraxic children:

I thought Tanner only had apraxia, with no other issues, but I was wrong. These other "issues" however are typically overlooked by us as parents, and by many pediatricians. Tanner had other "neurologically based" signs, hypotonia and sensory integration disorder. I know that sounds severe, and perhaps they could be, but fortunately because Tanner had early intervention, he is overcoming them, and they are now only noticeable to experts. Both of these are treated by Occupational Therapists, but can be addressed by Physical Therapists and Speech Professionals as well.

Hypotonia, or low tone, gave Tanner the appearance of a Cherub, and that was his nickname when he was 2, "Cherub Boy." Everyone said that Tanner looked like a Cherub because he was so cute. Hypotonia, however, needs to be addressed, because it affected Tanner's truncal strength and breath control, which is important for many reasons, including speech.

Tanner also had mild sensory integration (SI) issues. There is lots of information online about SI, but mostly it makes the child seem like the tantrum child, for "no" reason. Children with hSI do not sense things like we do, the same way all the time. One example from when Tanner was a baby (and this is before I knew what SI was, or that Tanner had it) is that he would sometimes "freak out" when I tried to bring him into a store. He would scream like he was in intense pain, like there was a pin in him, tighten his whole body and act hysterical. Other shoppers would look at me like, "What are you doing to that child!" My sister, who is a certified nanny, was often with me when this happened, and we would check his diaper, offer a bottle, take all his clothes off, looking for what was causing the screaming, but we never found anything. This same child would go for shots and wouldn't cry. I used to call him the "tough one." More recently, I was tickling his arm and he said, "Ow! Hurt me." I asked him, "Does this hurt?" and tickled him again. He pulled his arm away and said, "Yes." Sometimes if I pat his head he says "Ow," too. SI is another unknown one, and it can affect different senses. For Tanner, it's touch.