Developmental Dyspraxia of Speech Larry Burd, Ph.D. Department of Pediatrics 701-780-2477 laburd@medicine.nodak.edu

1. Developmental Dyspraxia of SpeechLarry Burd, Ph.D.Department of Pediatrics701-780-2477laburd@medicine.nodak.edu

2. Presentation • Typical Presentation: slow clumsy speech • Often with poor motor coordination • Nearly always presents with additional impairments. • Cognitive impairment 50% • Cerebral Palsy 20-50%

3. Neural Organization • System Disorder • Conceptual and/or Production

4. Pathways • Rule out: Sensory impairment • Area 4 by age 4 – Voluntary Movement • 1 step directions • Imitate eating with spoon • Coloring • Area 6 by age 6 – Multiple Actions • 2 step actions • 2 simultaneous actions • Abstract actions • Show comb – point to hair • Show sandwhich – imitate eating • Pretend to play catch • Show picture of toothbrush – brush teeth • Pretend of show me licking Popsicle • Eating

5. Pathways • Transcoding • Response to stimuli or command • No motor impairment • Imitation • Echophenonomena • Echolalia • Echopraxia

6. Pathways • Rule out: • Comprehension deficit • Hearing loss • Conversation disorder • Landeau Kleffner • Agnesis corpus collosum • Language to Gesture • Language to oral response • Phonology • Prosody • Voice

7. Motor Impairment • Rule Out • Low tone • Facial paralysis • Dystonia • Parkinsonism • Galactosemia

8. Motor Impairment

9. Clinical Exam • Recropical smile • Imitate or responds to gestures only • Responds to commands Must evaluate separately

10. Syndromal Delineation • Echolalia rules out dyspraxia for production but not conceptual impairment • Aphasia vs. conceptual dyspraxia • Cerebral palsy • Dystonia and focal dystonia • Conversation disorder • Neuro exam • Rarely Parkinsonism – childhood mystenia gravis

11. Syndromal Delineation • Dyspraxia only is rare • Common comorbid conditions • Mental retardation • Cerebral Palsy • Hearing Loss • Motor Disorder • Dysphasic Syndromes

12. The conceptual approach to Dyspraxia of Speech

13. Aphasia Imitation: Command to Action to speech Movement Disorder Clumbsy

14. Plan • Do not order any tests without a question - Why?

15. False positives and cost • Referral to speech language pathology • Pediatric neurology – other motor impairment • Child psychiatry – conversion disorder • Educational assessment – sight word reading • Acceptance • Cognitive evaluation - IQ

16. Phonology Syntax Semantics Syndrome Comprehension Production Comprehension Production Comprehension Production Pragmatics Fluency 1. Verbal auditory agnosia ↓a ↓ ↓ ↓ ↓ ↓ ↓ 2. Semantic-pragmatic ±a N ↓ N ↓ ± ↓ ↑a 3. Mixed phonologic-syntactic ± ↓ ± ↓ ± N N ↓ 4. Phonologic programming deficit Na ↓ N ± N N N ± 5a. Fluent autistic N N ↓ N ↓ ↓ ↓ ↑ 5b. Dysfluent autistic ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ aN = normal; ↓ = abnormal or decreased; ± = variable; ↑ = increased. Speech comprehension and production across dysphasic syndromesb (Modiefied from Rapin, 1992)