Asperger's, Language Delay, and Childhood Apraxia of Speech

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Tuttle
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26 Jun 2012, 5:35 pm

I hadn't thought about this before, but CAS is often considered related to language delay - even if the person began babbling "on time" (or even early), speech for communication doesn't develop normally because of the difficulty with pronunciation and such.

The reason I think of this, is because I just realized recently that we managed to overlook entirely mentioning to the person who diagnosed me with Asperger's that I had quite a bit of speech therapy growing up. It wasn't relevant now, and unlike others on this forum, I didn't go in having prepared everything, because I wanted to explicitly not have done any preparing.

If he knew about that, about a decade of speech therapy from ages 3-13, would it have had any effects on my diagnosis?

(Overall I feel rather strongly that just going to the DSM-5 proposed ASD is by far the best for me in particular, but I'm curious still about this.)



League_Girl
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26 Jun 2012, 6:13 pm

I think it depends on why you had a language delay. Speech problems run in my family so I may have had them anyway even if I didn't have hearing loss as a baby. I talked late because I had hearing loss and then I had tubes put in and I still had a speech delay and needed speech therapy.

If an NT child can have speech problems like with pronunciation, why not an aspie child?


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Tuttle
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26 Jun 2012, 6:25 pm

League_Girl wrote:
I think it depends on why you had a language delay. Speech problems run in my family so I may have had them anyway even if I didn't have hearing loss as a baby. I talked late because I had hearing loss and then I had tubes put in and I still had a speech delay and needed speech therapy.


Doesn't run in my family but I seem to have apraxia of speech/ verbal dyspaxia (haven't heard what diagnosis I was given, but that matches symptoms). Basically this is a motor planning dysfunction where a person can plan to say things right and their muscles don't respond properly because of messed up signals - its related to sensory processing difficulties and is at least associated with things associated to my autism.

Quote:
If an NT child can have speech problems like with pronunciation, why not an aspie child?


NTs can have speech delays, my boyfriend's sister is very much not autistic (though not NT, she's profoundly gifted), but she didn't speak until much later than expected. However Asperger's is defined to not have a speech delay and has things explicitly about speech in its criteria and that's one of the things that people tend to actually care about when it comes to that diagnosis. I'd still be the same person with the same traits, and I'm definitely on the spectrum, but I'm curious if they'd have ended up giving me PDD-NOS because I had non-normal speech before age 3.

It is mostly irrelevant. I'm just curious if CAS has effects on diagnoses within the spectrum.



btbnnyr
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26 Jun 2012, 6:26 pm

I don't know much about childhood apraxia of speech, but I have read that a significant proportion of autistic children have it. If your psych had know about it in your case, then perhaps he or she would have diagnosed you with autism instead of Asperger's.

Can you describe what it was like to have childhood apraxia of speech? Did you try to speak, but the words didn't come out as anything that anyone else could understand? Did you know what you were going to say in your mind, but you couldn't translate those words into moving your mouth to say them?

I had speech delay, but no apraxia. My pronunciation was clear, and I had no trouble moving my mouth to say words, but I lacked spontaneous speech, speech for communication, non-verbal communication, and communication in general, until I started learning to speak and communicate at age eight. I had no thoughts of what I was going to say in my mind, but if I had those thoughts, then I could have said the words clearly, no problem. I had a little echolalia and said a spontaneous sentence, one and done, eberry six months or so, starting from age four. I also neglected the speech delay issue initially, because I simply assumed that I had typical speech development, but my mother told me that I did not, and I did not believe it at first, but then, I realized that I have zero memories of myself speaking before age nine or ten, and that my mother had told me throughout my teenage and adult life that I never spoke when I was little, but I thought that she was joking and making fun of me, which she was, but it also turned out to be true.



Tuttle
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26 Jun 2012, 6:35 pm

btbnnyr wrote:
Can you describe what it was like to have childhood apraxia of speech? Did you try to speak, but the words didn't come out as anything that anyone else could understand? Did you know what you were going to say in your mind, but you couldn't translate those words into moving your mouth to say them?


It varies somewhat case by case. In my particular case, I knew what I wanted to say, said it, thought I said it right, and the sounds that came out of my mouth were not the same sounds I thought I said. Sometimes this involves words ending up jumbled (still, though not often sometimes), often it was just missing entire sounds. The rhythm of speaking a sentence was entirely off of what it was supposed to be. and for a good while I couldn't even force myself to do things like raise my pitch at the end of a question - I'd try to copy people doing that and it wouldn't come out how I was trying to do. When I was in 1st grade this was enough that if I read reading out loud, my teacher was unaware that I was trying to properly pronounce words I was reading, and thought I just didn't know the words at all. I also have difficulty manipulating my face and purposefully making facial expressions.



zemanski
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04 Jul 2012, 3:54 am

Speech delay is the only diagnostic criteria separating a diagnosis of Kanner's autism and AS. To have AS you must have speech by 3 years, to have autism you must have significant speech delay at 2-3 years. All the other differences are qualitative.

However, it is now beginning to be recognised that it is not actually a significant difference at all because almost all people diagnosed with AS do have speech and language delay even if they were talking early and apparently fluently as young children.

This is because although speech may be superficially perfect or even precocious in AS children, there are other less obvious developmental patterns in language which show delay including things like verbal apraxia .

Receptive and expressive language development can be seriously impaired, especially in the area of emotional language; the literalism of AS language development and the difficulty in accessing the more subtle aspects of language are delays, not just idiosyncrasies
- when a 12 year old thinks his sausages are going to be beaten up when asked at the chip shop if he wants them plain or battered it is clear he has language delay, he cannot access the double meaning of the word battered, typically developing children understand this linguistic pattern by the time they are 5!
- When a 25 year old thinks that a "relationship" means having sex with someone then that person has misunderstood the very core of the meaning of the word and is not accessing the wider picture - this is due largely to atypical language development and can create significant problems in social and emotional development that are ongoing, and often lifelong, if there is no intervention to support the development of emotionally relevant language, both receptive and expressive, from an early age.

If we were to reassess all AS people for this type of subtle delay in language development then almost all AS people qualify for an autism diagnosis (and there has been recent research backing this up - sorry can't find the link). It also explains why those whose speech "catches up" get an AS diagnosis rather than autism when diagnosed after the age of 5 or so and why it is known for children to be reassigned from autism to AS if they become verbal later.
This is one of the main reasons that AS and autism will be considered to be the same condition in the new DSM V; this crossover cannot exist if the conditions are separate.



League_Girl
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04 Jul 2012, 4:55 am

Tuttle wrote:

It is mostly irrelevant. I'm just curious if CAS has effects on diagnoses within the spectrum.



I didn't effect mine when I was 12 but it may have when I was older but younger than 12 because they said my autistic behavior was due to hearing loss. I don't know what this was supposed to mean but it said in my IEP from when I was five years old "She isn't classically autistic but she displays the behavior" something like that. I don't know if they meant I had a form of it but it was not full blown autism or that I am not autistic at all meaning not on the spectrum. Even when I was eight, a doctor that re evaluated me said he doesn't agree with my early diagnoses and I am too social to be autistic but yet mentioned my odd behavior and said I can get better if I work on it. He also noted he does not see how my speech delay made them think autism since my speech delay is not the way of an autistic person. Heck even another doctor I had been seeing since age two didn't see autism in me either nor another one I saw when I was ten. I don't know why they all said that. Then Asperger's was brought up when I was in 5th grade by my speech therapist and then my shrink brought it up when I was in 6th grade. Then it lead to me seeing a psychiatrist and I was very tough to diagnose because of my early history with hearing loss so maybe it can effect diagnoses in the future. But what about people who had speech problems without hearing loss?

I don't care what the DSM says, I have also noticed that you can't have schizophrenia and autism but yet what happens if an autistic person develops schizophrenia in their late teens or adulthood, does that mean they don't have autism anymore? What if autism was never diagnosed in their childhood and then they ended up being a schizophrenic and that was the first thing they were diagnosed with? The other DSM also says you can't have autism and ADHD at the same time. I have been challenging the DSM since high school asking these questions.

I notice not all doctors follow the criterias either. I mean if an aspie had poor motor skills, it would have to effect their self help skills right so that would mean they can't have AS according to the DSM. So very bad dyspraxia would keep them from being an aspie according to the DSM.


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Son: Diagnosed w/anxiety and ADHD. Also academic delayed.

Daughter: NT, no diagnoses.