Walking with his mom down a hallway at MossRehab, second grader Jaseer Watson Williams hones in on the video camera. “Am I going to be in a movie?” he asks, his dark eyes shining.
Jaseer loves movies. And vintage TV shows like Bernie Mac. And YouTube, Michael Jackson, wrestling, and basketball. He loves to chat, too.
But you might not understand him. Most of the syllables in that simple sentence he uttered were slurred or missing. “Am I going to be in a movie?” sounded more like, “My be moo-vee?” Understandable, but just.
Four years ago, Jaseer, who will be 8 in August, was diagnosed with a condition called childhood apraxia of speech, a neurological disorder that affects the pathways by which the brain plans and executes the sequence of muscle movements that form words and sounds. Jaseer understands words and tries to say them but he’s sometimes unable to move his lips and tongue into the right places to make the sounds he wants to.
Words like Saturday or helicopter, for example, are condensed from three and four syllables into one or two, particularly if he speaks quickly—which he does. His mind races at supersonic speed; his mouth and tongue poke along behind, dropping the beginnings and endings of words—and sometimes even the middle—in an effort to get his thoughts out.
“If you had heard him a year ago you wouldn’t have understood a word he said,” says Becky Jackel, MA, CCC-SLP, the pediatric speech-language pathologist who works with Jaseer in MossRehab’s pediatric therapy program.
Most people, she says, are surprised to learn that MossRehab treats children with speech, language and swallowing difficulties, along with adults recovering from strokes, amputations, mobility disorders, and brain and spinal cord injuries. She’s been working at MossRehab for 30 years.
One Syllable at a Time
The waiting room down the hall from her office is filled with children, heads hunched over handheld video games or homework, waiting to see her, the occupational therapist, or the physical therapist who work with pediatric patients. Some are just impatiently waiting for siblings; they explode out the exit the minute a brother or sister appear, an exasperated mom calling for them to “slow down! Wait!”
Also in the waiting room is Jaseer’s mother, who has brought her son to Ms. Becky’s office for the hour-long session, which Jaseer has twice a week. Vickii Watson Costanzo is a peer specialist at Girard Medical Center. The entire family works as a team to help Jaseer carry over what he learns at MossRehab into his real life.
“When he’s telling a story I’ll correct him if he’s not pronouncing something the right way,” says Costanzo. “I remind him that Ms. Becky says, ‘One syllable at a time’ and tell him to go back and say it again. He does, and I’ll high five him.”
Part of Becky Jackel’s job is just this: training parents to practice the lessons their children learn in her office in real-life situations. “A big part of it is parent education,” she says. “I’m with a child for an hour or so a week and the rest of the time they’re with their teachers and parents. Everyone needs to be part of the team, and it’s a big team.”
Vickii Costanzo is the MVP of Jaseer’s team. “She practices with him all the things he learns with me. She’s really good with him.” Jackel says. “The whole family is.”
It was Costanzo who first realized that Jaseer had a speech problem. Her older son, Naheim, who was 19 years older than Jaseer, was speaking in clear, articulate sentences at the age of 2. “I know that all kids are different, but Jaseer wasn’t even talking at 2. I knew he wasn’t just going to catch up. I knew he had a speech delay.”
She took him to a specialist for a diagnosis and continued with private treatment until she learned about MossRehab’s program, which was covered by her insurance.
Cause of Childhood Apraxia of Speech Unknown
Jaseer needed more than speech therapy. In addition to his apraxia, Jaseer also had problems with his fine motor skills, which necessitated some time with an occupational therapist. “It took him time to learn to write with a pen,” she said.
It’s not unusual for children with childhood apraxia of speech to have motor skills issues as well, according the American Speech-Language Association. Some may have learning difficulties. Jaseer gets some help with reading. Others experience mouth sensitivity—for example, may not like brushing their teeth or the feeling of crunchy foods in their mouths.
The cause of childhood apraxia of speech isn’t known. It’s generally apparent from birth—some babies don’t even coo—and studies have not found any apparent brain damage or muscle paralysis to explain it, according to the National Institute on Deafness and Other Communication Disorders. It may have a genetic component, as well.
Jackel works with Jaseer to make him mindful of what he’s trying to say so his mouth and tongue can keep in step with his brain. “I tap him into forming the syllables, one tap for each syllable,” she explains. “He didn’t used to be able to say a lot of sounds, like Ps, Ms, Ss, Ks, Gs, and the SH sound. But he’s much, much better.”
In addition to working on his speech and pronunciation, Jackel also gave Jaseer tongue exercises to do to help him move his tongue separately from his jaw. “He always had what I call a soft tongue,” says his mother, “so we would do these exercises where he moved his tongue up and held it, then moved it down and held it.”
With children with other speech problems, particularly those with weak oral musculature, Jackel may use a straw to help them develop the muscles needed to suck—muscles that are later used for talking. Drop into her office one day and you may find her patients blowing bubbles, blowing horns, or holding their tongues to the roofs of their mouths for as long as they can to help build their speaking muscles.
Or you may just find her, as she does with Jaseer, asking them questions about their week. With Jaseer, every conversation is a teachable moment, punctuated by the mantra he knows as well as Jackel. “One syllable at a time.”
Despite Jaseer’s speech problem, he doesn’t suffer socially. He’s smart and outgoing and has plenty of friends at school, his mother says. “They understand him. If the teacher asks him what he said they all answer for him!”
And it doesn’t keep her “diamond in the rough,” as she calls him—“her sweetheart” —from talking her ears off. “We’ll be watching a movie and he’ll be talking and talking until I fall asleep,” says Costanzo, laughing. “I’m really glad he can talk, but sometimes I say, ‘Jaseer, just watch the movie!’”