Amplifying Voices Through Evidence-Based Practice: Amy Graham, MA, CCC-SLP on Supporting Children with Apraxia
In honor of Apraxia Awareness Day and National Speech-Language-Hearing Month, we’re proud to feature Amy Graham, MA, CCC-SLP—an expert in speech sound disorders and a dedicated advocate for children with Childhood Apraxia of Speech (CAS). In this interview, Amy dives into what sets Apraxia apart from other speech sound disorders, why timely access to AAC can be life-changing, and how accurate diagnosis paired with motor-based intervention is essential for meaningful progress. With both professional insight and a deeply personal connection to the field, Amy is helping shape a more informed, empowered future for children with apraxia—and the SLPs who support them.
Can you discuss the role of AAC in supporting children with apraxia, and how you determine when to introduce it in therapy?
Kids with CAS know what they want to say, but they have trouble planning the precise movements needed for clear and understandable speech. That means intelligibility can be super limited, especially in the early stages of therapy. When kids don’t have a reliable way to express themselves, frustration, behavior issues, and social isolation can follow. So, AAC gives them a voice NOW. Whether it’s a speech-generating device, a robust app, low-tech core boards, or even signs, AAC offers communication access even while we work on speech. Any time a child struggles to communicate, it’s a good time to consider AAC.
How is Apraxia different from other speech articulation or phonology disorders?
Apraxia is a disorder of *movement* rather than sound production… a motor planning disorder. So, the child knows what they want to say, but their brain has trouble planning and coordinating the complex movements needed for clear, consistent, and intelligible speech. It’s not about muscle weakness, but rather the message from the brain to the mouth that’s getting scrambled. So we’re dealing with observable speech characteristics, such as:
- Inconsistent errors (e.g., the same word comes out differently each time)
- Groping (e.g., visible struggle to get sounds out)
- Disrupted prosody (e.g., speech might sound choppy or monotone)
- Increased difficulty with longer or more complex words/phrases
Other speech sound disorders, like articulation disorders or phonological impairments, are when children have difficulty producing a particular sound (e.g., lateral lisp) and/or have difficulty understanding the “rules” for when and how we use sounds to change meanings of words (e.g., consistently using “w” in place of “r” and “l”). These types of errors are predictable and much more common. So, it’s important to make the distinction because CAS is treated very differently from articulation errors and phonological disorders. If we use the wrong approach, kids will make slow progress in therapy.
How can SLPs advocate for better understanding of speech sound disorders like CAS in schools, healthcare, and the community?
Love this question! Because CAS isn’t just “late-talking” or a typical speech delay… It’s a neurological motor planning disorder that requires an evidence-based motor approach to remediation. So, awareness about differential diagnosis and appropriate interventions is a must! I’m trying my best to spread the word with my social media platform (@grahamspeechtherapy), as are so many others, like Jennie Bjorem (@bjoremspeech), Breanna Waldrup (@breannawaldrop.slp), Laura Smith (@slpmommyofapraxia), Child Apraxia Treatment (@childapraxiatreatment), Jenya Iuzzini-Seigel’s CML Lab (@jenya_cml_lab), and so many more! Sharing social media posts from reputable sources is a great place to start.
What inspired you to pursue a career in Speech-Language Pathology?
My SLP origin story started when my younger sister started speech therapy as a preschooler. She had a significant speech sound disorder as a child and a residual lateral lisp into adulthood. So, I decided to go to school and become a speech language pathologist to help people with speech impairments. After grad school, my sister became my first client when she asked me to help her *fix* this speech error that had been agonizing for her as a teen. So, I helped her remediate her lateral lisp at the age of 20, and I have since developed a widely-used method for remediating lateral lisps using the same strategies that worked for her… one of my most gratifying achievements.
What is one thing you’ve learned since becoming a speech language pathologist that you wish all people knew?
The learning never ends! Don’t ever assume your SLP knows all there is to know about a particular area of the field. For example, I specialize in speech sound disorders, so my knowledge base is probably pretty limited compared with other SLPs who may specialize in other areas within our very enormous scope of practice. Even within my specialty, I’m constantly learning from colleagues and researchers regularly. So to those who *tried speech therapy* and have been frustrated with lack of progress, it’s okay to seek out other SLPs that may be a better fit and have more specialized knowledge.
