Sam came in with a diagnosis of Autism Spectrum Disorder and Apraxia of Speech. During the initial intake over the phone, his mother informed me that her main concern for Sam’s speech was his vowel production. And sure enough, all of Sam’s vowels were substituted by a neutral /Ʌ/. There was no discrimination even for round vowels like /Ʊ/ or /Ɔ/. On further observation, it was evident that Sam had oral motor deficits. There was limited if any jaw grading. He tended keep his jaw height at 1 for all his words. His lips did not appear to dissociate from his jaw with no rounding or retraction. Similarly, tongue and jaw dissociation was also limited. Basically, he used his jaw to elevate his tongue. For vowels, the tongue stayed at the floor of his mouth with little to no tongue elevation. Sam had difficulty imitating non-speech oral postures such as a lip pucker, smile, a wide open mouth, even with visual cues like a mirror. It was clear that using purely auditory and visual models to increase his vowel repertoire was a path to frustration and limited success. I therefore planned a unique treatment program that used a two pronged approach:
- Building sensory awareness, increasing strength, coordination, grading and dissociation skills,
- Using tactile approaches (P.R.O.M.P.T, TalkTools Therapy Tactile Tools for Apraxia of Speech and TalkTools Ice Stick) to build speech production for vowels.
TACTILE TUBES FOR APRAXIA
ICE STICK
