Verbal Apraxia and Fish Oil Frequently Asked Questions
Q. What brand of fish oil do you give your son? A. We used to give Owen Vital Choice's liquid fish oil. The liquid is good for a younger child who can not easily chew up a vitamin yet and can be hidden in other foods, and Vital Choice is a very high quality brand. However, Vital Choice's fish oil has additional vitamin D and A in it, so you must be very careful to calculate the overall amount of these vitamins that the child is getting along with their multi vitamin so they do not get an overdose, especially of vitamin A. We have found it to be easier to use one of the following brands which are vitamin A and D free; Carlson's and Nordic Naturals (scroll down to the children's products section). For Carlson's I would recommend the "Very Finest Fish Oil" and for Nordic Natruals I would recommend "3-6-9 Junior".
Q. Do those brands have mercury in them? A. No.
Q. What dosage do you give him? A. I currently am giving him 3000 mg, however, we started with 1000 mg. Each child is individual in this regard. To find the right dosage, start at 1000 mg (500 mg with breakfast and 500 mg with dinner). If you see progess, wait for a plateau, then up the dosage to 2000 mg (half in the morning, half in the evening). Continue this process until you see no more progress, or, until speech has reached the pace of a typical child in your child's age group. Owen gets 3000 mg because he tested as average for speech in his age group, and his language abilities didn't increase with the jump from 2000 mg to 3000 mg, so we left him at that level. Note: if you don't see progess initially, keep increasing dosage slowly until you get to around 3000 mg to 6000 mg, some children need that high of a dosage to see improvement.
Q. What is the conversion from millgrams to milliliters if I use a syringe to give my child the liquid? A. The ratio is roughly 1 to 1, so 500 mg = .5 mL, 1000 mg = 1 mL, 2000 mg = 2 mL, and so on.
Q. How do you get your child to take the liquid fish oil? A. He used to take it with no problems, even squirting it into his mouth himself. He also takes liquid vitamin E. He claimed that these things tasted good, and he even likes to eat salmon now too after taking his salmon fish oil for so long. Shortly after he turned 4 years old he started refusing the liquid fish oil, saying that it tasted yucky. Nordic Naturals sells a child's lemon flavored chewable tablet, which supposedly tastes like gummy candy, and Carlson's has an orange flavored liquid. I suggest you go with this either of these two options. Some people hide the liquid fish oil in foods or juices, such as peanut butter, pudding, or orange juice.
Q. Aren't you worried you will give him to much? A. No. Fish oil is basically a food that we no longer have enough of in our diets. Children get a lot of oil, like in chicken nuggets, or french fries, but it is the wrong type of oil. Giving them high quantities of the correct type of oil will not harm them. One thing to be aware of is that some brands also have vitamins in with the fish oil, such as A or D, like Vital Choice that I mentioned above. I recommend avoiding these brands to be on the safe side. If you want to take one of these brands, make sure to calculate the amount of vitamin your child is getting carefully. The current upper intake level of vitamin D for children is 2000 IUs, though some scientist claim this should be raised to 10,000 IUs. The upper intake levels for vitamin A are: ages 0-3 2000 IU; ages 4-8 3000 IU; ages 9-13 5610 IU. Add together how much vitamin A and D your child is getting from their multivitamin and from their dosage of fish oil. Then calcluate how high of a dosage of fish oil you could give without going over the upper intake levels of vitamins A or D. Your child will likely not even approach the upper intake level of vitamin D. With vitamin A, you may want to stay well away from the upper intake level, as the side effects of overuse can be dangerous. Again, I recommend staying away from fish oil with added vitamin A. The only other concern with the amount of fish oil you are giving is with your child's digestive system. They may have looser stools initially, and gradulally increasing dosage will allow their bodies to adjust to the increase in oil in their system.
Q. Does my child need to take this for the rest of their life? A. Yes, and so should you. Fatty acids are esential to human brains, and due to the increase of mercury in fish, and the fact that our diets have moved away from eating as much fish as we used to, we aren't getting enough fatty acids anymore. Fatty acids have lots of benefits for us; increased speech in apraxic children is just one of those. It is also said to help with things such as heart disease, high cholesterol, MS, migraines, alzheimer's, depression, ADHD, asthma, cancer, etc. It really is an essential nutrient that we should all be taking. When Owen skips a few dosages of fish oil, he does regress in his speech. His apraxic tendancies become more obvious, and he has a great deal of trouble getting words out, or saying words he used to know correctly. I am not sure if he will continue to need the same dosage throughout his life, but, it can simply be taken along with his multivitamin every day so it is not a problem if he does.
Q. What does fish oil do to help children with apraxia to talk? A. As you probably know, the issue with apraxia is not the muscles themsleves, but the signals that the brain sends to those muscles. There is some kind of interuption with the signal, and the muscles aren't reading the message. The way it was explained to me is that there are "wires" in our brains, and those wires are covered with "insulation". The more insulation, the better the wires work. Fatty acids make up that insulation. Once the fatty acids from the fish oil build up the insulation on those wires, the signals go through faster and more efficiantly, thus allowing a child to talk better then ever before. Perhaps the underlying apraxia is still there, and there is still an issue with the way the signals are being sent through the wires, but the fish oil patches things up enough that for some children the apraxia gets much better or even "resolves". Or, perhaps an insuficiant amount of fatty acids in the system is causing the apraxia, and building that insulation up to normal amounts actually "cures" the condition. Until there are more studies done on apraxia, and the phenomenon of fish oil helping the condition, we won't really know.
Q. Do all children with apraxia respond to fish oil? A. No, they don't. Many children who are not neurotypical, in other words, they have things like apraxia, speech delays, sensory issues, ADHA, autism, etc., respond to fish oil to some degree. However, for many of these children, fish oil has no noticeable effect. When fish oil does work, it seems to particularly help with speech related problems, but others have reported it helping with other aspects of their children's issues as well. Fish oil only helped Owen with his speech, he still has sensory and anxiety issues that can go along with apraxia that the fish oil did not help. Some children with apraxia do not respond in any way to fish oil. One thing to note here though is to first make sure that your child is getting a good brand. The brand is important because the ratio of fatty acids needs to be correct, and the fish oil needs to be high quality. We originally started Owen on a generic fish oil, and it did help, but it didn't help in the dramatic way that the better brand later did. Another thing to note is that some children require a lot of fish oil to see improvements. I have heard of some children being on 6000 mg of fish oil. If you start them at 1000 mg, don't give up at that point, push them to 3000 mg or even higher to see if you see any improvements before giving up altogether. Some children just don't respond though. For these children, keeping them on at least 1000 mg of fish oil is still very good for their general health and their brain and may have some effects that you aren't noticing.
Q. My child hasn't been diagnosed with apraxia yet, but I want to start fish oil and see if that would help, what do you think? A. I think you should consider that the fish oil may mask the symptoms of apraxia. If you are in the process of getting a diagnosis and you need that diagnosis so that your child will qualify for more speech therapy, or for other services, then you may want to delay starting the fish oil until after you get the diagnosis. However, don't wait too long. The younger they are when you start the fish oil the better. If you do not need the diagnosis for any reason, or, if you are unable to get one for months or years, then go ahead and start the fish oil and see if it helps. Even if your child just has a speech delay and not apraxia, fish oil may still help with this.
Q. How is it that your son was diagnosed at only age two, I thought they didn't diagnose apraxia until age three or four? A. My son was diagnosed with suspected verbal and oral apraxia. They generally do not give an official diagnosis until age three or four. Certain speech clinicians are diagnosing children at a younger age these days, because they have realized the earlier a child gets help with apraxia the better the outcome. Children with apraxia need 2 to 4 speech therapy sessions a week, and often they will not qualify for these services without a diagnosis. This is why we pursued a diagnosis for Owen, and we were then able to increase his speech therapy sessions to twice per week, which is what the speech clinician who evaluated Owen recommended. There was no doubt though that Owen had verbal apraxia. He had classic symptoms of both verbal and oral apraxia, and he fit perfectly into the diagnostic criteria.
Q. Where did you learn about fish oil and apraxia? A. Mostly from reading various information online, and from my experience with giving it to Owen. For more information on apraxia, visit cherab.org. To get more information on taking fish oil for apraxia, join Cherab’s Yahoo group and check out the “links” on the side of the page, where you will find an article called “Essential Fatty Acids - Fish Oil”. If you happen to live in Minnesota and your child has apraxia, check out the Minnesota Children With Apraxia support group.
Q. Do you recommend any other treatments for apraxia? A. Owen has greatly benefitted from developmental movement therapy. There are certain areas of the brain that are "exercised" by certain movements. For example, babies who do not recieve a lot of tummy time may have difficulty with things like speech, because that movement activates those parts of the brain that also deal with speech. Doing activities that challenge children to do movements that will activate those parts of their brain are really beneficial to them in learning these new skills. We have worked with a developmental movement therapist for quite awhile, and it has been very good for Owen. I also recommend speech therapy of course. Owen had a wonderful speach therapist that he still remembers. She really helped us to see how to work with Owen to help him to do more talking. I also recommend doing a lot of communication. Talking is only one aspect of communication. Your child may also be using sounds, signs, and body langauge to communicate with you. Listen to these things the same way you would listen to speech, and use these tools as a way to communicate. Avoid demanding speech as the only form of communication. We used the Signing Time! videos and our whole family learned new signs so we could communicate more effectively. I learned to tune in to Owen and I often knew what he meant with very little being said or signed between us. I encourage you to try to tune into your child and communicate as often as possible. Having a back and forth conversation, no matter what tools you are using to communicate, lays the foundation for speech and language. Demanding speech at all times may increase anxiety levels around speech and actually discourage it. Also, we included Owen in family chores from a very young age and this proved to really build his self esteem. He would throw things away for us, or help us unload the dishwasher, or other simple tasks, from the time he was thirteen months old. This encouraged communication. We often asked Owen quesitons, or talked to him as if he could talk back, and he often responded with "huh" or "huh uh", and by the way it would sound I would know what he meant. I've never felt like our communication with him was lacking in any way, even though he wasn't talking when we communicated. However, he was talking before he turned 3 years old, which is an age of more complex thoughts and ideas. If he had not been talking at that point, I am sure that frustration levels would have gone up and communication would have been affected.
Q. How long did it take your son to start talking after he started taking the fish oil and what does he sound like today? A. See Owen's story below and a video from six months after he started taking the fish oil to see how much he improved in such a short time.
Owen's Story
Owen started talking at 8 months old when he said four words. However, he only had about four words for months and months. At around 14 months, instead of talking, he started inventing signs and he would also use sounds in place of words. When Owen was 21 months old he was evaluated and qualified for speech therapy through Early Intervention in our state. From 21 - 27 months he received once a week home visits from a speech therapist provided and paid for by Early Intervention. He was evaluated by a speech clinician on September 12th, 2007 at age 27 months, and was diagnosed with ‘Suspected Verbal and Oral Apraxia’. He had about 20 - 30 words at the time, but mostly communicated with made up signs, ASL signs, and noises that meant certain words. He also had some mild sensory and anxiety issues. To see how Owen communicated around this time, please view this video, Part I and Part II, of his second birthday party, which was filmed in May of 2007. Also view Owen’s Day at Fawn-Doe-Rosa and Our Family Vacation from July 2007. Additionally, I kept pretty close track of his progress on his blog, found here (specifically the entries from September ’07 - March ‘08). After Owen’s diagnosis in September, we were able to increase his speech therapy visits to twice weekly. They were shorter visits, and more focused on specific Apraxia issues he was having. We also immediately started giving him a generic brand fish oil that I was already taking along with my multivitamins. They were in capsule form, but I simply pierced the capsule with a knife and squirted it into his mouth. At this time, I knew fish oil was good for a child with Apraxia, but I knew little about what brands or what dosage was appropriate. We did see a small amount of improvement in his speech while he took this generic brand, but not enough to be certain that it was the fish oil. Owen had been seeing a developmental movement therapist also from the age of 21 months, specifically for his anxiety and sensory issues. The activities he did in therapy have definitely had a positive effect on his speech and language development, as well as his anxiety and sensory issues. Since his anxiety and sensory issues were considered to be mild, he did not qualify for any services that would have addressed them, so providing him with the developmental movement therapy was essential. I then did some research and discovered that I should be giving Owen at least 1000 mg of a high quality fish oil. I recommended Vital Choice (though I do not recommend this brand now, see above for details). In October of 2007 we started him on 1000 mg of Vital Choice fish oil in liquid form, which we simply squirted into his mouth using a syringe. Owen took this just fine and has never complained about the fishy taste. In the beginning of November of 2007 we were already seeing amazing progress. Owen had begun adding at least two new words daily! He also started stringing several words together to create long sentences, albeit with much mouth contorting and pausing in between words, but even being able to say a three word sentence was totally out of his reach only weeks before and now here he was using several words in a row with meaning! By December of 2007, he had completely dropped all of his sounds he used in the place of words, his ASL signs, and the made up signs he had been relying on since he was 14 months old, in favor of speaking understandable words. He continued to make amazing progress, adding words to his vocabulary daily and perfecting pronunciation. He also seemed to become more open to physical affection, even smothering his cousin in hugs instead of pushing her away when she approached him. In January of 2008, Owen took an “off the record” articulation test given by his speech therapist, a test he could not have even taken only three months earlier as he did not have enough language to complete it, and he scored in the 28th percentile. A child would not qualify for speech therapy through our State unless they scored in the 2nd percentile or below, but since Owen was already in speech therapy he continued to get services twice weekly. In February of 2008, I increased Owen’s dosage of fish oil from 1000 mg daily to 2000 mg daily after he hit a plateau. This increase in fish oil corresponded to another significant language increase. I was still concerned at this time about his anxiety and sensory issues, which did not seem to be getting any better with the fish oil. In the beginning of March of 2008, at 33 months old, Owen had an official articulation test, and scored in the 38th percentile. His speech therapist said he had met all his first set of goals, and all the new goals we set for him after that, and she was unsure what goals to even set for him now. That month we moved and said goodbye to Owen's speech therapist, whom he had started calling "Zippity-Do-Dot". Owen missed Zippity-Do-Dot and still talked about her for over a year afterward. That same month we moved to a new city one hour away. We had an Early Intervention therapist come out and evaluate Owen to see if he qualified for speech therapy. He did not qualify. He tested as being either average or ahead for his age. Around this time we increased his fish oil to 3000 mg per day, and saw no improvements. Since there were no improvements in the jump from 2000 mg to 3000 mg, we plan to keep him on that dosage. Below is a video of Owen talking. He is 2 and a half (33 months) in the video. At the time this video was taken, Owen had spent a total of 12 months in speech therapy, 12 months in developmental movement therapy, and 6 months on fish oil, all of which I think contributed to his improvements in speech, though the dramatic improvements we saw I strongly feel are most related to the fish oil as they directly corresponded to a change in brands, and an increase in dosage. His speech therapist commented that she had never seen anything like it. Showing so much improvement that he could test out of speech therapy at this age is almost unheard of. I hope to someday make a video splicing together footage over these six months to show his rapid progress, but for now this will have to suffice. To contact me, Email: mamaofoz@gmail.com
March
2008
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