Category Archives: apraxia

Landmark Study

This is an older article from Jan. 11, 2010, but I found it fascinating.  It is taken from ADVANCE for Speech-Language Pathologists and Audiologists.  I have deleted some of the content due to time restrictions, but have included the main points of the article and the implications of the study. 

This study suggests that verbal apraxia symptoms are part of a larger syndrome.  It reveals that a new syndrome in children presents with a combination of allergy, apraxia and malabsorption.  Autism spectrum disorders were variably present.

Verbal apraxia had been understood to be a neurologically-based speech disorder, although hints of other neurological soft signs had been described.  The recent study suggests the symptoms of verbal apraxia are part of a larger, multifactorial neurologic syndrome involving food allergies, gluten sensitivity and nutritional malabsorption-at least for a subgroup of children.

“While it is critical to treat verbal apraxia symptoms that often include severe delays in expressive speech production with speech therapy, we need to start asking why these kids are having these problems in the first place so we can identify mechanisms we can target to treat the cause of the symptoms,” said Claudia Morris, MD, of Children’s Hospital and Research Center in Oakland, CA.  She conducted the study in conjunction with Marilyn Agin MD, a neurodevelopmental pediatrician at Saint Vincent Medical Center in New York.  The study takes a major step toward identifying the potential mechanisms that may contribute to apraxia symptoms. 

The symptoms that the children demonstrated were a common cluster of allergy, apraxia and malabsorption, along with low muscle tone, poor coordination and sensory integration abnormalities.  The children also revealed low carnitine levels, abnormal celiac panels, gluten sensitivity and vitamin D deficiency, among others. 

The data indicate that the neurologic dysfunction represented in the syndrome overlaps the symptoms of vitamin E
deficiency.  While low vitamin E bioavailability may occur due to a variety of different causes, neurological consequences are similar, regardless of the initiating trigger.

The study suggests that vitamin E could be used as a safe nutritional intervention that may benefit some children.  Growing evidence supports the benefits of omega-3 fatty acid supplementation in a number of neurodevelopmental disorders. 

Anecdotally, children with verbal apraxia often demonstrate leaps in speech production when taking high-quality fish oil.  The addition of vitamin E to omega-3 fatty acid supplementation in this cohort of children induced benefits that exceeded expectations from just speech therapy alone, according to parental report.

“While data from a case series is by no means conclusive, the results clearly point to the need for further attention to this poorly understood disorder and a placebo-controlled study to investigate the potential role of vitamin E and omega-3 supplementation in this group of childreen,” said Dr. Morris.

Children with an apraxia diagnosis also should receive a more comprehensive metabolic evaluation than what is current practice, she pointed out.  Many nutritional deficiencies like low carnitine, zinc and vitamin D are treated easily.  If nutritional deficiencies are not addressed, children will continue to experience significant medical consequences. 

The underlying cause of these deficiences and a fat malabsorption syndrome should be determined after deficiencies are identified and treated.  In the meantime, the new study provides the essential foundation for identification.

“By identifying the early red flags of this syndrome, we have provided a way to get these kids treatment at the earliest possible moment,” she said.  “While 75 percent of the kids identified as late bloomers are just that, the rest have a true pathologic condition.  To miss it is to miss critically valuable time for early intervention.”

Children who have all these symptoms are likely to fall into the 25 percent who have a condition that needs further evaluation and treatment, Dr. Morris stated.

References:
Morris, C.R., Agin, M.C. (2009) Syndrome of allergy, apraxia, and malabsorption: Characterization of a neurodevelopmental phenotype that responds to omega 3 and vitamin e supplementation.  Alternative Therapies in Health and Medicine, 15 (4)

Atladottir, H.O., Pedersen, M.G., Thorsen, P., et al. (2009).  Association of family history of autoimmune diseases and autism spectrum disorders. Pediatrics, 124: 687-94.