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Developmental Dyspraxia of Speech Larry Burd, Ph.D. Department of Pediatrics 701-780-2477 [email protected]

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Developmental Dyspraxia of Speech Larry Burd, Ph.D. Department of Pediatrics 701-780-2477 [email protected] Presentation. Typical Presentation: slow clumsy speech Often with poor motor coordination Nearly always presents with additional impairments. Cognitive impairment 50%

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Presentation Transcript
presentation
Presentation
  • Typical Presentation: slow clumsy speech
    • Often with poor motor coordination
  • Nearly always presents with additional impairments.
      • Cognitive impairment 50%
      • Cerebral Palsy 20-50%
neural organization
Neural Organization
  • System Disorder
    • Conceptual and/or Production
pathways
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
pathways1
Pathways
  • Transcoding
    • Response to stimuli or command
      • No motor impairment
      • Imitation
      • Echophenonomena
        • Echolalia
        • Echopraxia
pathways2
Pathways
  • Rule out:
    • Comprehension deficit
    • Hearing loss
    • Conversation disorder
    • Landeau Kleffner
    • Agnesis corpus collosum
  • Language to Gesture
  • Language to oral response
    • Phonology
    • Prosody
    • Voice
motor impairment
Motor Impairment
  • Rule Out
    • Low tone
    • Facial paralysis
    • Dystonia
    • Parkinsonism
    • Galactosemia
clinical exam
Clinical Exam
  • Recropical smile
  • Imitate or responds to gestures only
  • Responds to commands

Must evaluate separately

syndromal delineation
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
syndromal delineation1
Syndromal Delineation
  • Dyspraxia only is rare
    • Common comorbid conditions
      • Mental retardation
      • Cerebral Palsy
      • Hearing Loss
      • Motor Disorder
      • Dysphasic Syndromes
slide13

Aphasia

Imitation:

Command to Action to speech

Movement Disorder

Clumbsy

slide14
Plan
  • Do not order any tests without a question - Why?
slide15
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
slide16

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)

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