Do understand the importance of your role.

As a Board Certified Behavior Analyst (BCBA), your role is imperative for a child with autism who also has apraxia of speech. I cannot stress this enough. How you handle a program for a child with this diagnosis could mean the difference between a child talking or not talking for the rest of his/her life. No pressure! This IS a big responsibility; but if you are successful, you can make a difference for many children. 

There is so much variability within each ABA program and the experience-level of individuals writing treatment plans. This presents a challenge that is not anyone’s fault; it just is. As we all know, time is of the essence with autism treatment. There is a massive demand for qualified behavior analysts to get children the help they need in a timely manner. It is not realistic for every child to have access to professionals and therapists with the resources, experience, and training to effectively treat apraxia, especially using your typical ABA curriculum. Many Speech-Language Pathologists (SLPs) would argue that it is not in your scope of practice to treat speech disorders at all. The reality is that you are. Every day. ABA curriculums are speech and language curriculums. Therefore, your role is of the utmost importance with regards to apraxia.

Don’t be afraid to admit that you don’t know.

 You are in a powerful position with your training and education as a BCBA. You know how to analyze and change the behavior of living beings! That is a fantastic skill. You see speech as a behavior, and you know you can manipulate the environment to change it. However, you don’t always know what you don’t know. That is why having a strong relationship with an SLP who “gets you” is so important. SLPs go to school for six years or more, focusing on the ins and outs of speech and language disorders. Even if they do not have a firm grasp on behavioral terms and techniques, they know speech disorders. Just like a mechanic or a doctor may not know all of the behavioral terms and methods that you do; they know the ins and outs of a car or a human body. If your regular bag of tricks is not getting results, it is okay to seek help. A child and their family are depending on you to seek advice to develop the most efficient and effective course of treatment.

Don’t assume all SLPs have the same skillset.

SLPs have general knowledge on a wide variety of topics such as anatomy and physiology of the head and neck; that means everything inside and out and how it all works together. (Side note: I don’t know if all schools do this, but we had training on ACTUAL human heads! I know.) They have training in speech and language development and disorders across the lifespan from babies to aging adults, augmentative and alternative communication, reading, acoustics, voice, aural rehabilitation, swallowing, and much more. While some are “generalists,” there are SLPs who specialize in motor speech disorders, which includes apraxia. Ideally, you would work with someone who specializes in apraxia if the child has that diagnosis OR if the child is presenting with apraxic-like characteristics.

Do learn everything you can about apraxia of speech.

A large population of children with autism present with apraxia symptoms. Therefore, you must make it a priority to learn everything you can about this disorder and how specialists treat it. That way when you are collaborating with the SLP, you have a knowledge base. You will also be in a better position to recognize it right away and not waste valuable time. If a child is non-verbal, it is likely (not always) a good indication that there is a motor-planning issue. It is not going to get diagnosed as apraxia, but knowing about working with apraxia will be very helpful in this case as well.

Do work on imitation, imitation, imitation.

My goal today is not to tell you everything you need to know about apraxia, but to urge you to become more knowledgable and to seek the services of an SLP. I know that doesn’t help you immediately with your current caseload. It will take some time and work on your part. However, there is something you could focus on immediately that is very much within your scope of practice and in your skillset: imitation. The key to getting a child with motor issues to talk is to teach them to imitate. If the child cannot imitate gross motor movements or sounds or words, you can teach them to imitate with objects. If a child can imitate sounds and motor movements, but becomes visibly frustrated by these tasks, do not do it. Work on imitation with objects as many times a day as you can. Start now.

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