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Developmental Verbal Dyspraxia (DVD) can be diagnosed by a qualified Speech and Language Therapist with experience of children’s speech sound disorders.
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Developmental Verbal Dyspraxia (DVD)
Claire Madeira BSc (Hons) Reg.MRCSLT
Claire Madeira is a Highly Specialist Speech and Language Therapist and Clinical Lead for Speech Sound Disorders. She works both independently and has worked for Kent Community Health NHS Foundation Trust for over 25 years.
What is DVD?
Also known as Childhood Apraxia of Speech (CAS), DVD/CAS is a rare and distinct speech sound disorder, comprising only a tiny percentage of children with speech disorders.
DVD is a complex motor speech sound disorder. Children with DVD have difficulty formulating, organising and coordinating accurate movement plans to control the muscles of the face, lips, tongue and soft palate (which directs air through the nose or mouth) in order to produce clear and accurate speech sounds. They may also have difficulty coordinating and organising voice and breathing patterns used for the making of speech sounds.
DVD often results in a child initially being highly unintelligible both to familiar and unfamiliar people.
Characteristics/features of DVD
- Difficulty with isolated consonant or vowel sounds
- Inconsistent errors on consonants and vowels in repeated productions of syllables or words
- Difficulty with transitioning/blending between sounds resulting in: for example lengthened or disrupted sounds
- Unusual prosody (intonation, tone, stress, and rhythm) may make children sound flat, uneven or staccato.
- Variations in speech rate due to prolonged sounds or pauses between sounds/syllables/words.
- Oro-motor difficulties including drooling and/or infant feeding problems which may persist
Children with DVD may have one or some of the following co-existing characteristics:
- Difficulties with understanding and using language
- Difficulties with language organisation, particularly sequencing
- Difficulties with social interaction with peers
- Atypical development of early speech skills, such as babbling
- Generalised Developmental Coordination Disorder (DCD/Dyspraxia) affecting other parts of the body
Causes of DVD
Currently, there is no identified cause for DVD in most children.
Diagnosis of DVD
A qualified Speech and Language Therapist with experience of children’s speech sound disorders is able to assess and diagnose DVD.
Three features are agreed to be a prerequisite for a diagnosis of DVD, these are inconsistency; difficulties with joining and sequencing sounds together and difficulties with using the correct stress patterns
It is therefore important to note that in order for a diagnosis of DVD to be made children need to have a sufficient level of speech so that the Speech and Language Therapist can assess the child’s use of single sounds, and multisyllabic words in repetition and obtain a conversational speech sample.
What helps?
A Speech and Language Therapist can assess and treat these disorders and give specific advice to individual children. But there are several things parents and teachers can do in addition.
- Try not to worry as this can make your child anxious and less able to make themselves understood.
- Try to be relaxed and give your child good examples of speech, to watch and listen to, by using short sentences and good, clear speech.
- Encourage your child to use gestures to point, to indicate by movements, what they wish to communicate. Play at making happy faces, sad faces, surprised faces and funny faces, to assist your child to use facial expressions to help convey what they mean or want.
The most important aspect of speech therapy for children with DVD is practice and repetition of the work daily. Evidence suggests that children should be seen at least twice weekly on an ongoing basis and that block and breaks are not as successful. This type of therapy is not always available in each local area. This is why parents, school, nursery and Speech and Language Therapist need to work as a team so the child can continue the work every day.
Following specialist assessment speech therapy may be based on the following areas:
- Helping the child to make single sounds
- Improving speed, rhythm, loudness and intonation of speech
- Improving the ability to repeat sounds and to swap from one sound to another
- Helping the child to sequence these sounds accurately within words
- Building up from words to sentences
What will progress be like?
The rate of progress varies considerably from child to child. Children with DVD find speech work difficult and progress will be slow, probably taking years rather than months, though this depends on the severity of the problem and the amount of work that can be continued at home/school/nursery. We expect steady progress to be made so that most children should end up with a clear, intelligible speech. However, there is an even smaller of children that this is not the case and these children may need to access an alternative means of communication (either a communication book or high-tech communication aid).
What is the relationship between oral and verbal dyspraxia?
Verbal dyspraxia refers to difficulty in making and coordinating the precise articulatory movements required in the production of clear speech, whereas oral dyspraxia refers to difficulties in making and coordinating movements of the vocal tract (larynx, lips, tongue, palate) in the absence of speech. Oral dyspraxia might affect a child’s ability to protrude his tongue on request or to round his lips when copying an adult model. It may affect individual movements or sequences of movements eg moving your tongue quickly from side to side. Although it may seem logical that a child with verbal dyspraxia will also have oral dyspraxia, research and clinical experience suggest otherwise. Some children with verbal dyspraxia do also have oral dyspraxia, but others do not and may in some cases have surprisingly well-controlled oral movements when speech is not involved. Most professionals now distinguish between oral and verbal dyspraxia, but occasionally they are used interchangeably which can be confusing.
What is the relationship between oral dyspraxia, verbal dyspraxia and generalised dyspraxia?
In any individual child, it is possible for these conditions to occur in isolation or in combinations. However, when they do co-occur, they do not necessarily do so to equal severity. In addition, although there may be co-occurring motor and/or speech features, they may not necessarily be dyspraxia. For example, some children with generalised dyspraxia have immature or delayed speech development. However, their motor coordination difficulties stand out as their main area of difficulty and their speech difficulties would not match the profile expected in verbal dyspraxia. For other children, their main area of difficulty is with speech production, rendering their speech unintelligible, but they may also have some minor motor coordination difficulties.
Where can I obtain a second opinion on my child’s speech?
The Royal College of Speech and Language Therapists holds a register of private practitioners. Independent practitioners list their specialisms. You can visit their website at: www.rcslt.org.uk The Nuffield Speech Clinics held at the Nuffield Hearing and Speech Centre at RNTNE Hospital offer a 2nd opinion NHS service for children with severe speech disorders/verbal dyspraxia, who meet the relevant referral criteria. For further information, see the details at the end of the downloadable fact sheet on developmental verbal dyspraxia on this site.
Who can diagnose verbal dyspraxia?
Speech and language therapists are the appropriate professionals to assess a child’s speech and language skills and to diagnose verbal dyspraxia, where appropriate. If a child has a complex profile involving a range of difficulties (eg affecting learning, behaviour, motor skills and speech and language), a speech and language therapist will be one of a team of professionals involved in the assessment process.