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Early Intervention Speech Therapy

Checking in with Sharon Gretz, MEd

Published January 25, 2010 5:07 PM by Stephanie Bruno-Dowling
As some of you veteran blog readers may remember, last year I interviewed Sharon Gretz, the founder and current executive director of the Childhood Apraxia of Speech Association of North America (CASANA). The interview ran over two consecutive posts in January 2009 and was full of valuable and vital information for both parents and therapists [Read Part 1; Read Part 2].

Since then, many questions have continued to flow into the blog regarding CAS (Childhood Apraxia of Speech). Therefore, I decided to contact Sharon and revisit the topic that she knows best. Over the next two weeks, or 4 posts, apraxia and my latest interview with Sharon will be highlighted. I felt that the questions asked and answers given deserved extensive time and attention on the blog.

Please refer back to the post from January 27, 2009 to read about Sharon's background and personal and professional experience with CAS. Below is the first part of our most recent discussion:

Stephanie: Sharon, thank you so much for allowing me to pick your brain once again! One of the questions most recently raised on the blog is regarding the correlation between apraxia and eating issues. Do you see this often? What are your thoughts on this?

Sharon: Stephanie, there are certainly anecdotal reports from families that suggest children with childhood apraxia of speech or suspected to have CAS may have early feeding issues.  We also see this mentioned frequently among clinicians.  There is only one published study by Highman, et. al which compared parent reports of early history from 20 children with suspected CAS, 20 with Specific Language Impairment (SLI) and 20 typically developing children.  In this study, 45 percent of the parents who had children with CAS reported feeding and dribbling issues.  While there was some statistical difference between the CAS group and the early history of typical children, there turned out to be no or little statistical differences between the CAS and the SLI group.  That means that both of the clinical groups were reported to have these issues at a higher rate than typical children.  There are limitations to this study, especially the small numbers and the reliance on parent's memories.

Last year a student, Jessica Hoyer (under the guidance of her faculty advisor and CAS expert Dr. Kathy Jakielski) conducted a parental report type survey of 107 families who are part of our Apraxia-KIDS network as research for her undergraduate thesis. Out of these families, 48 percent reported choking or gagging on food; 35 percent reported sucking issues; 55 percent reported sensitivity to food textures; 52 percent reported overstuffing the mouth; and 40 percent reported dribbling.  Of course there are also limitations to this unpublished study including the reliance on parental memory; the lack of comparison groups; and the uncertainty whether or not the children represented truly had apraxia of speech, as this was not verified.

So, what does this mean?  I think it means that we still don't know for sure how significant early feeding issues are for kids with CAS.  It may be that many clinical populations have these early issues and it is not unique to CAS.  Children with CAS may have co-occurring disorders to which feeding problems may relate.  But I also think it is certainly worthwhile that questions about early feeding be asked of families who have children with CAS receiving services and obviously any presence of feeding problems should be addressed.

Please join us Friday for the second part of our CAS series with Sharon Gretz!


My son is 2 and was identified as having oral and verbal Apraxia about 8 months ago (3 speech therapists + 1 dev ped have "unofficially" diagnosed).    When he was 5 months old, a swallow study found that he was aspirating on liquids 40% of the time and he had a severe swallow delay.  He had a difficult time transitioning to solids (gagging, crying, overall refusal).  We worked with an OT and speech therapist through early intervention, but they really couldn't figure out what the feeding issues were - he had the skills to eat, but was so inconsistent with what he would eat.  By 18 months, he started to lose weight and finally everyone seemed to take notice that something more was going on with him.  It was suggested he be put on a feeding tube immediately as he was unable to eat or drink enough to keep him healthy.  We decided to give him Pediasure by bottle and started working with a speech/feeding therapist who said right away his issues are centered around a lack of coordination.  He has feeding therapy twice a week and 8 months later still only eats 3-4 things on a semi-consistant basis (I joke if the wind blows just right outside, he may eat).  His feeding therapist feels that 90% of his problems are just getting the food into his mouth, although he does have difficulty moving his tongue around to chew the food and also has issues w/ texture.  

Speech-wise, he's been in weekly speech therapy since he turned one and we recently increased to twice a week once he turned 2.  Over the past month or so, we have noticed a dramatic improvement with his verbal skills and he is up to about 20 words that he can say pretty consistently.

I would be happy to share more of our experience if it would help!  

February 16, 2010 5:33 PM

I think it is also important to note that many kids with apraxia do not have any eating issues.  I had a VERY tough time convincing my SLP and doctor to take my suggestions of apraxia seriously because my son did not have any eating issues whatsoever.  We were very worried when my next son had eating issues (gagging, texture sensitivity) from a very early age that he was showing signs of apraxia, but he has no speech problems!  Just goes to show that you need to fight for what your "gut" instincts are!  If you feel that there is a problem, even if all of the signs are not there, fight for it!  

February 15, 2010 12:36 AM

Today's post is a continuation of my most recent interview with Sharon Gretz, MEd, the founder and current

January 29, 2010 10:53 AM

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About this Blog

    Stephanie Bruno Dowling, M.S. CCC-SLP
    Occupation: Speech-Language Pathologist
    Setting: Early Intervention in Delaware County, PA
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