Research Assessment #4

Date: October 18, 2016

Subject: Speech Language Pathology
MLA Citation:
Gretz, M.Ed. By Sharon. "Using Sign Language With Children Who Have Apraxia of
Speech." Apraxia Kids. CASANA, n.d. Web. 20 Oct. 2016. <http://www.apraxiakids.org/library/using-sign-language-with-children-who-have-apraxia-of-speech/>.
Assessment:
In this article the key points talked about were the effects of speech therapy and sign
language on children suffering from apraxia of speech. The important ideas conveyed through
this article are the controversial theories that teaching a hearing child could delay their speech or
even their want to verbally speak. Another theory is that sign language is only for the deaf or
hard of hearing. Well this article puts all of those controversial ideas to rest by stating that sign
language isn't just for the deaf but also for people who can not effectively express themselves
such as children with apraxia of speech. It also says that through studies and consulting with
speech pathologists, sign language acts as a bridge in the child's life which increases their
willingness to try and verbally communicate.
This article really helped me understand a different way that speech pathologists can help
in a more medical setting. Before going on my interview with Carolyn Robertson, I had no idea
what apraxia of speech was, which led me to do more research. This adds to yet another one of
the branches of speech language pathology that I have already researched and considered
studying. One way that this job differs from the other careers I have researched and looked at, is
that in this job you would need to know sign language whereas it isn't as necessary in the other

ones. Another difference is that you would be working in a more medical setting instead of a
school. Due to all of the medical aspects that are involved with apraxia of speech you must really
communicate with the parents of the child, the doctor of the child and any other nurse or
technician that may be helping with this case. I was surprised at how many people are involved
in one case of apraxia of speech.
I personally think I would really enjoy pursuing this career because it would combine my
passions for sign language and speech into one job.

Using Sign Language With Children Who Have Apraxia of Speech

BY SHARON GRETZ, M.ED.

Often when someone raises the idea of using sign language for a child with apraxia, parents may
experience confusion and even fear. After all, The child can hear just fine! Why would we use
sign language for a hearing child? Or But wont using the sign mean my child wont need to
talk? Wont it keep him/her from speaking? Conversely, some parents report that their childs
speech language pathologist has told them that the child will rely on sign and thus not learn to
speak. This article attempts to address many of these myths about signing.
First of all, in our mainstream culture it is true that we most often see images of sign language
associated with people who are deaf or hard of hearing. However, that doesnt mean that for
some children those with apraxia that sign cannot help! For children with apraxia the sign
can be used to assist and augment their verbal communication, sort of as a bridge to
communication while they are learning to speak clearly. The use of signing with children who
have apraxia has nothing to do with their ability to hear or understand the spoken word. Most
children with apraxia have very good receptive language skills.
Secondly, it is rare that a childs speech output is diminished by using sign language. To the
contrary, therapists and parents alike nearly always report a heightened willingness to try new
words and say more. Nearly all parents are actually quite relieved when their child starts to use
some signs to help with communication. It makes life easier for the child and the parent!
For just a few children with apraxia of speech, sign may not be indicated. These children have
additional severe motor planning difficulties with their arms and hands, making it extremely
difficult for the child to use a fairly consistent manual sign to represent a word. However, it is
possible that even these children can benefit from sign if the adult uses the sign as a form of
visual cueing (explained in more detail below). And it is not necessary that the childs sign is
perfect, just that they can be fairly consistent with whatever approximation of a sign they can
achieve.

Below are some reasons why you might want to consider using sign and verbal attempts for a
child with apraxia:
1. Reduce Frustration: Reduce frustration and have basic needs understood.
Children who have access to sign language are at least able to communicate at some
level, which usually results in decreased frustration on their part and yours.
2. Symbolic Communication: Sign can be important to young children with little or
no speech because it is symbolic communication. They are learning that they can label
things and use the signs to communicate. This is important for all children. Those with
typically developing speech are doing so with speech attempts words. Our children with
speech apraxia also need a way to do this so that this part of the process of acquiring
language is not further delayed.
3. Expansion of Expressive Speech: For children who have apraxia and who are
really struggling to sequence sounds into words, sign can be a mechanism to insure that
their expressive language development isnt further impeded. Speech production is just
that: producing speech. Expressive language is the ability to understand and properly use
the rules of the language to construct sentences. So a child with apraxia is at risk, due to
the speech production struggle, of also falling seriously behind in expressive language
since they have no means to try out and practice how words go together to create
meaningful and proper messages. Using sign assists children to keep expanding their
expressive language. While they may not be able to speak a word or put two words
together, they can still, by using sign, be doing this same thing in a different way.
4. Successful Communication: Children with apraxia who use sign, may also use it
as an assist for the listener when accompanied by their vocal attempts. They may be
capable of, for example, three word sentences in which each word is an approximation,
not properly articulated, and thus the listener may not understand their message. When
the child uses sign, along with the vocal attempt, the listener (if they know the signs) can
have a better chance of understanding the message and thus, the child is successful at
communication. Our children very much need to feel successful in their attempts to use
their voice to communicate. If when attempting to use their voice to communicate, no one
ever understands, it is not uncommon for them to just stop trying to use their voice. When
they are understood (perhaps because they also used sign) they are delighted to realize
they were successful and are more likely to keep on trying.
5. Controls Rate of Speech: You will notice that when the adult uses sign, and even
when the child uses sign, it has the tendency of slowing down the rate of speech for most
people (obviously not for interpreters perhaps!). For some children with apraxia, this is
very helpful for them to have the additional time to allow for motoric transitions between
words, etc. It gives them a better chance, in many cases, of also being able to imitate you.
Many adults speak fast and that can have a negative effect on a child with apraxias
ability to imitate you.
6. Serves as Visual Cues: It is pretty much universally agreed that multi-sensory
input is helpful to children with apraxia of speech. The literature is full of examples of
cues from various modalities that, when consistently paired with verbal attempts, can
trigger for the child access to the motor plan they need to produce the word, sound, or
sound sequence correctly. One very powerful modality for many children with apraxia is

visual (thus the term visual cues). When the adult is also using sign to cue the child,
and an association between the visual cue and the word or sound has been made over
time, just the sight of the cue can help the child produce the correct word. Sometimes a
sign for an alphabet letter may be used in conjunction with a location to cue a sound (sign
for K being held at the throat). As a childs speech becomes more intelligible, they
almost always drop their use of the signs. However, many parents and therapists will
continue to use a sign themselves for the purpose of providing a visual cue for sound or
word production when the child is struggling.
7. Kinesthetic Reinforcement: Some people believe that the use of manual sign
provides the kinesthetic reinforcement of volitional movements and sequencing when
accompanying the verbal attempt.
Speech-language pathologists who successfully use sign language with children who have
apraxia do not have the child using the signs in isolation. Instead, they are encouraging the child
to use signs along with verbal attempts. Therapists and parents need to work together in
partnership on all aspects of a childs therapy, including the use of manual sign language to
augment speech attempts.