Speech, Apraxia and Therapy

Cortical Humunculus

Cortical Homunculus – Large areas of brain map to oro-motor function and hands

Two major problems facing the youngest patients who are most affected with signs and symptoms of Autism Spectrum Disorder are aggression and speech. These factors shape socialization, the final step in ‘normal’ communication. Therefore, achieving self control and enabling speech is key to reversal.

Aggression
Often, combativeness appears to come from pain. Sensory overload, sinus problems, gastrointestinal discomfort (from reflux to abnormal stooling), infections and headaches can produce a variety of stimming behaviors; including lashing out against self and others. Combined with a short fuse protruding from accompanying sleep difficulties, the resulting picture is often misunderstood by conventional specialists who invoke potent CNS medications, only meant for adults.

So, the first step to successful intervention is the achievement of better health. Modern therapists who recognize this, and refer the children for appropriate diagnosis and intervention, will be rewarded with more attention and compliance.

Speech Apraxia
There is no other more perplexing condition associated with ASD. Almost all vertebrates exhibit the ability to utilize vocal communication. In humans, articulated speech should be a pre-wired state. Parents don’t teach Junior to speak at 12-18 months. He just talks.

Apraxia’ refers to the inability to perform a desired ‘natural’ motor activity, presumably due to difficulties with central nervous system processing. So, neuro-typical individuals do not have ‘trombone apraxia’ because there wouldn’t be a preexisting neural pathway for that activity (unless the person is a prodigy). Research must be targeted at unravelling this mystery. For the great majority of patients, it’s not Autism AND Speech apraxia. It’s autism. Furthermore, I don’t think that those newly minted Autistic Japanese monkeys are ever going to speak.

A scholar.google.com search for medical treatment of speech apraxia in autism returns few specific, well-proven, evidence-based choices. It appears that modern medicine does not understand the cause, or even the site of verbal malfunction in ASD patients, let alone pharmaceutical interventions.

Discussion
By the way, language does not appear to be the problem. It is common to hear parents exclaim that, “Grandpa (from Romania) and Grandma (Haiti) can tell him to do anything.” Additionally, there are patients with speech difficulties who spend hours on the Internet learning other languages, including those not even spoken in the home. Jake, our Practice Administrator’s son, was found practicing Japanese one day!

There is little doubt that the child’s ability to respond to the therapists’ prompts is directly related to the success of intervention. Parents have frequently observed children merely staring into space while the professional works, and may go years without improvement. Or worse, the child becomes belligerent as the S&L person approaches the front door, often leading to violent behaviors.

Conclusion
Biomedical intervention is available for the modern patient to address problems with muscle tone, fog, and processing, in order to better address oro-motor function, and therefore increase chances of successfully addressing this very symptom.

The experience at The Child Development Center of America, and with the doctors who practice under the auspice of Medical Academy of Pediatric Special Needs, has been consistent as far as the ability of methyl-B12 injections, to engender useful speech. When combined with good health and traditional therapies, this could be the best possible advice for confused but determined parents.

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Brian D. Udell MD
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