At the end of her son's first therapy session to treat his apraxia, Sharon Gretz broke down and cried. "I heard more sounds from Luke's mouth that day than I had heard in his first three years," says Gretz. "Just seeing him so excited about being able to make those sounds and knowing that he was getting the right kind of help filled me with emotion."

Some of that emotion, unfortunately, was regret at the time they had wasted in traditional speech therapy when, in fact, apraxia of speech is not a traditional speech disorder. Gretz, of Indiana Township, Penn., who went on to found the Childhood Apraxia of Speech Association, notes that apraxia is often wrongly diagnosed because it's thought of as an adult disorder.

About Apraxia
The reason diagnosing apraxia of speech can be difficult is because it was once thought of as something that adults developed after a neurological incident such as a stroke. It has only been in recent years that therapists and researchers have come to realize that children can present with the same types of language difficulties – even when there is no known neurological incident. Because apraxia of speech in children is rather rare, many graduate programs in speech therapy don't even touch on it. Therefore, the programs that are commonly in place to treat speech disorders caused by developmental delays don't work with apraxia.

The name apraxia comes from the root word "praxis," which means "planned movement," and there are actually several forms of the disorder. With verbal apraxia, children have difficulty planning and producing the specific series of movements of the tongue, lips, jaw and palate that are necessary for intelligible speech. With oral apraxia, they are unable to carry out facial movements on command, such as blowing out a candle or licking their lips. This also impacts the ability to verbalize.

Dr. Marilyn Agin, a neurodevelopmental pediatrician and co-author of The Late Talker: What to Do If Your Child Isn't Talking Yet (St. Martin's Press, 2003), says that often children with oral apraxia also have verbal apraxia.

"It's important to understand that with oral apraxia there is no muscle weakness or problem; it's just that specific movements can't be performed on command," says Dr. Agin. "Apraxia is motor planning without overt weakness."

Dr. Agin says that a classic verbal symptom of apraxia is when a child can say one-syllable words but can't go on to sequence the words and make longer, more complicated words or phrases. Because of this, a toddler with apraxia doesn't seem to have a growing vocabulary, as is normal for a child at this age. Out of frustration, they may even stop using words they already know. It's also not unusual for them to develop non-verbal ways to communicate.

This is how Lisa Geng's son, Tanner, used to fill gaps in his ability to communicate. For example, on a trip home from an amusement park, he wanted to tell her that the roller coaster's flip was awesome. Excited and overwhelmed, he used his hand to make a dipping motion while saying "whoosh."

Now, at age 8, Tanner's speech is almost completely normal, and he doesn't use signs nearly as much as he used to. Like Luke Gretz, Tanner was in six months of unsuccessful traditional therapy before being diagnosed with oral apraxia when he was nearly 3. Geng, who was appalled at the lengths she had to go to in order to get a correct diagnosis, started The Cherab Foundation and co-authored Late Talker with Dr. Agin.

"There are a lot of assumptions about speech disorders because they are considered the No. 1 learning disability, but a lot of apraxic children don't have a learning disability and are, in fact, brighter than average," says Geng. "This is why a correct diagnosis is so important, because there's no reason for them to ever fall behind."

Timing Is Everything
Still, Gretz cautions against any parent jumping to the conclusion that their child has apraxia just because he or she is a late talker.

"Although we do have an interest in the importance of early diagnosis, apraxia is over-diagnosed as well. I'll often hear from the distraught parents of a 15-month-old who has been diagnosed with apraxia, but there's no way a child that young has the ability to cooperate in the type of assessment necessary to correctly diagnose apraxia," says Gretz. "The earliest they can really be diagnosed is about age 2."

Once the diagnosis is made, finding a therapist qualified to treat apraxia is paramount. Therapist Nancy R. Kaufman, director of Kaufman's Children's Center for Speech, Language, Sensory/Motor and Learning Potential Inc., says that it's important to focus on building vocabulary in whatever manner the child can express that particular word – and not necessarily on drilling correct pronunciation (which is more like traditional speech therapy) because that doesn't work.

"If you tell a child with apraxia to say 'cookie' and try to articulate it over and over they will become very frustrated,” says Kaufman. “Instead, we find out how they can best say 'cookie' with their abilities. The idea is to build from simple to more complex patterns. This approach gives children a functional way to communicate while they become more proficient and articulate."

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