When Words Can't Explain

By Rocco

Most parents of newborns anxiously count the days until their baby makes his or her first sounds or utters that magical first word. When those days turn into months, or even years, anxiousness turns to anxiety.

At 6 months, when most babies are happily cooing or have begun to babble, little Rocco wasn’t making any sounds at all. By 2, the age at which a child’s “language explosion” typically has already begun, Rocco could say “bah” and not much else.

“It was clear he had some speech problems,” remembers Rocco’s mother Liz, a Hood River resident.

Indeed, Rocco was diagnosed with childhood apraxia of speech (CAS), a condition in which “a child’s mouth, tongue and teeth have a hard time doing what the brain instructs them to do,” says Sarah Miller, a speech language pathologist with Hood River Therapy.

Children with CAS know what they want to say, they just have difficulty saying it. Often, they speak in only vowel sounds or chunks of words and sentences are missing.

CAS can be the result of a neurological impairment caused by infection, illness or injury, a secondary characteristic of another condition or have an unknown origin.

Miller began working with Rocco last September. Rocco did show progress when a speech therapist from St. Rita School for the Deaf in Cincinnati stayed a week with the family last summer. But children with CAS show the most gains from regular therapy, which Miller has been able to provide Rocco.

Miller is a member of Hood River Therapy’s comprehensive pediatric program, where area children benefit from an array of physical, speech and occupational therapy services.

Therapists with specialized training in childhood conditions collaborate closely with area schools and care providers, including local doctors, dentists and OHSU specialists referring young patients back to the community.

The clinic includes bilingual staff members and others trained in American Sign Language. Liz says her son has shown measurable progress since working with Miller. The master’s-trained therapist has been using drill-based exercises to help Rocco train his lips, tongue and teeth to “do the right thing.”

“It’s like training for a sport,” she says. “You want to work the movement pattern over and over and over again to create muscle memory. Rocco has been great. He will do word after word after word.”

Miller uses hand signals to help Rocco visualize sounds, like “p,” “b” and “d,” in the context of spoken words. Each week she sends him home with a list of new words to work on. And he is definitely working on them. “He has made significant progress,” Miller says. “Before he wasn’t marking final consonants. For example, the word “up” would come out as “u” without the “p” sound. Now he has mastered vowel-consonant combinations and is working on consonant-vowel-consonant words (e.g., “pop”).”

With three siblings, ages 4, 8 and 10, in a busy household, Rocco’s continued progress is important to his development and relationships, says his mother. Children with CAS don’t always have a cognitive deficit. Some, like Rocco, have expressive language problems but excellent receptive language skills.

“He can get frustrated when people can’t understand what he is saying, so it is important for him to be able to use the words he needs to communicate,” says Liz, adding that his older siblings are very supportive and help him communicate with others at school.

She says she has high hopes that in the next few years her son will be “speaking like everyone else.” Before Rocco began working with Miller, she wasn’t so optimistic.


The Building Blocks Pediatric Therapy program at Hood River Therapy offers personalized one-on-one services for children and families in conjunction with school-based therapies, for additional treatment or to address critical mobility, daily living and communication skills that may not be provided in other settings.

Physical therapy, speech language pathology and occupational therapy is provided to children of all ages (adults also have access to the same services at Hood River Therapy).

For more information about the pediatric therapy program or other services and referrals, please call Hood River Therapy at 541-386-2441.