Unleash the Power of the Mind with Active Listening for Verbal Apraxia

Have you heard of saying “neurons that fire together wire together”?  It is a saying from neuropsychologist Donald Hebb stating, repeated thoughts and actions create and strengthen neural pathways.  Repeated thoughts and actions become easier and automatic as the pathways become stronger.  Just like lifting weights gets our muscles stronger, thinking strengthens neural pathways.

Neural pathway development is especially important for children with apraxia.  Verbal apraxia can be described as a disconnect from the brain to the mouth, meaning it doesn’t have strong neural pathways.  The brain knows what it wants to say but doesn’t have the complex motor movements figured out and coordinated.

There is a speech therapy strategy for apraxia called DTTC.  It stands for Dynamic Temporal Tactile Cueing, developed by Edyth Strand.  One of the foundations for this method, is look at a model before repeating the word back.  If the child cannot repeat the word, then additional prompts are provided.  One is called simultaneous production where both the therapist and child say the word together at the same time.  Looking at the model is considered critical for learning in this method.  If a child is unable to look, then encourage them to feel your mouth move.

Did you know that 80% of the brain is developed by your child’s 3^rd birthday?  That is why early intervention is so critical, especially for (suspected) childhood apraxia of speech.  The earlier the signs are detected the faster the child can switch to a motor planning approach and get them ready for programs like DTTC. 

Children under three years old are experiencing life for the first time.  They are often in awe as they process their environment and sensory experiences.  They learn about their body and how to work it.  They can become easily distracted and need to learn to prioritize watching a speech model.  We do this by making it fun and playful.  Remember, neurons that fire together wire together.  We want child’s brains analyzing our speech movements as much as possible so that they are firing their brains along with ours to establish new speech neural pathways. 

FOCUS TIP:

Join your child in their focus.  Acknowledge what they are saying.  Then guide their attention to your model in a fun and engaging way.

In addition to focused attention, we want to ensure the child’s brain is thinking and establishing new neural pathways.  When a child is looking, listening, thinking, and visualizing, I call it “active listening.”  You know the magic is happening when the child is locked in on your speech model and you can see their mouth start to quiver and move.  You can keep repeating and they are locked in analyzing every movement.

Active listening is helping the child establish new neural pathways for speech.  We know this by studying Olympic athletes.  Research shows, athletes who engage in mental rehearsals (meaning, they think about performance and outcome in detail) vs athletes who don’t, achieve better results.  Their brains and bodies actually fire like they are physically doing the event by just thinking about it.  Read more here

We need to put realistic expectations on young children with suspected apraxia.  Instead of putting so much pressure on the desired outcome of spoken words, we need to encourage the mental speech practice.  Each time they think about it their brains get a little stronger and stronger.  Then one day when you aren’t even trying, you’ll hear your child say the word you have been modeling diligently for weeks.  Support the development of their mental training.

How to Encourage Active Listening and Mental Practice

1.         Be curious about the different movements your mouth makes.  I bring attention to what I want the child to focus on in a playful way.  If a child omits /p/ in the word up then I might say, “Uuup.  giggle That’s funny.  My lips popped.  Did you see that?  Uuuup.  giggle I did it again.  I wonder if I can move this piece of tissue paper with my popping lips.” 

2.         Remove pressure to say it.  Research shows children with apraxia don’t do well with communication pressure.  Tell your child, “Don’t say it”.  Sometimes I ask the child to put their hand over their mouth and again, tell them not to say it.  I do this for three reasons.  One, it removes the pressure.  With the pressure removed they are more likely to comply. Secondly, kids love proving you wrong.  Its reverse psychology.  When you tell them not to, then they are going to want to do it.   Lastly, I tell them not to say it to break the pattern of repeating a word back without mindfully paying attention first.

3.         Inspire them to look at your mouth.  – Bring attention to your mouth by being on their level, put a toy next to your face, make a silly sound, put their hands/feet up to your mouth, use a toy microphone, point to your mouth, anything that will get their attention on your mouth. 

BONUS TIP – If a child has difficulty with eye contact or feels too much pressure looking at your face wear sunglasses or cover up your eyes with your hand.

4.         Work on increasing attention through completion of the word.  Its important your child looks at all of the movements in the word.  If a child looks away, then I stop modeling and say “Oopps.  I wasn’t finished.  Let’s try that again.” 

BONUS TIP: Use a hand or visual cue to show when to look and when its finished.  I have a butterfly finger-puppet I like to use.  It flies near my mouth when I’m saying the word and it flies away when the word is over.

5.         Praise active listening.  If you see your child automatically actively listening praise them for looking and thinking.  If they aren’t, tell them they need to look and think.  You could say “imagine your mouth moving like mine.”  Praise them when you see them thinking and moving their mouth.  Explain it helps them learn to talk.

6.         Establish expectation and pause to encourage imitation.  At this point, the pressure is removed and they know they need to look and think.  Work towards a “rule of three.” You model a word three times while the child is actively listening.  You pause after each time you model giving an opportunity to process what just happened and creates an opportunity for them to imitate it if they are ready.  The build in repetition helps them learn the movement.  Setting up a boundary of three times prevents frustration later on.  Your child knows they only have to do it three times to get what they want.

BONUS TIP:  Embed the rule of three during naturally occurring routines.  For example, every time you open the Cheerios box you model “open” three times followed by a pause.

7.         Remember to support your child’s emotions.  If you force when a child is protesting, then you are creating a negative association and an avoidance pattern.  Be curious and think, “I wonder why my child pushed me away.”  Is my child sensing I am worried about their speech?  Does it feel like too much pressure?  Is it fun?  Is my child hangry?  Adjust based on your assumptions.  Your child needs to be in a regulated state to support learning.

Remember we all usually think about things before we do them.  We think about what we want to make for dinner before we get the ingredients, cook it and eat it.  We had to think about our career path and learn about it before we did it.  Some humans have more of a tendency to just jump in and learn as they go, while others need to carefully study it before they are ready to try it.  Support your child with empathy and go at their pace.  It can be hard not to rush things.  Appreciate where they are in the process and the good things they are doing.  We learn the best from a place of regulation, connection and love.  Celebrate what your child can do with love every step of the way. 

Written by Laura Deer, M.S. CCC/SLP, CAS without the use of AI