Experts Speak: Autism and Apraxia

June 21, 2024
Experts Speak

Autism and Apraxia with Elizabeth Vosseller

Early childhood educators play a critical role in the lives of young children and their families around the world. As the administrator of the Child Development Associate® (CDA), the Council for Professional Recognition is at the forefront of ensuring that early childhood educators are aware of and trained in education best practices and the highest quality of care for young children. The Council does this by meeting with many experts in the field, as well as adjacent fields, to discuss, understand, and evaluate the latest research on topics impacting early childhood education. As part of these efforts, we are excited to bring you the first in our new series, Experts Speak, in which the Council sits down with experts to discuss topics that impact the field of early childhood education.

Autism impacts 1 in 36 children today1. For those tasked with caring and nurturing the minds of young children with a severe diagnosis, it can be a tumultuous journey for all involved as families, educators, and autistic children struggle desperately to communicate with one another. And for early childhood educators and parents, they are also presented with the responsibility of teaching autistic children and keeping them safe.

But without reliable communication, this can feel impossible. So how are early childhood educators supposed to care for and teach young children with complex communication difficulties, such as autism? Simply aim low? For Elizabeth Vosseller, this isn’t an option.

Director of Growing Kids Therapy Center, Elizabeth Vosseller, known as “EV” for short, attended Loyola College in Maryland, where she took a class in sign language, which led her to pursue a career in Speech-Language Pathology. Elizabeth tells us, “I didn’t intend to specialize in autism or complex communication disorders. But that’s sort of what fell in my lap. And as I saw clients with complex communication disorders, I loved trying to figure out the complexities and their needs.”

Elizabeth began to specialize in helping those with autism and other complex communication disabilities, both complex and genetic, such as Craniofacial anomalies (such as Cleft Palate), Down Syndrome, Phelan-McDermid Syndrome, Prader-Willi Syndrome, Pitt-Hopkins Syndrome, and Angelman Syndrome. Over the course of her career, Elizabeth has worked with children and adults using traditional speech-language intervention. According to Elizabeth, traditional perspectives “assumes that because people couldn’t say the words, they didn’t understand the words.”

However, she wasn’t seeing the desired progress, “There was not a complete lack of progress, but it wasn’t what I was expecting, given the intensity of the services I was doing and knowing that the kids were smart, because I’d been outsmarted by them too many times.”

The sentiment is reminiscent of the experience of Anne Sullivan, who worked with Helen Keller by helping her make a breakthrough in being able to communicate. With the same determination as Sullivan, Elizabeth disagreed with the idea that there wasn’t more that could be done. “I constantly saw that light in their eyes that told me they understood. I just had this burning feeling that there was something in there.”

Elizabeth wasn’t the only one who felt there had to be something more that she and other educators, therapists, and parents could do. Elizabeth and others, found that one answer to communication seems to be using spelling. For example, the book The Reason I Jump by Japanese author, Naoki Higashida2 helped to spread awareness of spelling as an alternative form of communication. The book contains an interview with Naoki, a 13-year-old boy with autism, where he spelled out his answers on what it was like to live with autism using a method of communication that incorporated spelling that he and his mother developed. Meanwhile around 2015 in the states, Vosseller began developing her own methodology called Spelling to Communicate (S2C), which in the last decade has been gaining traction and increased use across the United States as an augmentative and alternative communication (AAC).

“There’s been use of spelling and typing for some time in the disability field. We’ve done it with adults for some years. If you think about it, going back to Helen Keller and Anne Sullivan,” Elizabeth elaborates, “The first time I saw somebody using spelling as a way of communication, I was like ‘this is it.’”

S2C is designed to target and improve motor capabilities, not the level of intelligence. It operates based on the idea that those with complex communication difficulties have the condition apraxia, a neurological condition that makes it difficult or near impossible to make certain movements3. During Spelling to Communicate sessions, individuals with apraxia work to control their muscles to the point that they can confidently and accurately point to letters on a letter board or type letters on a keyboard. This gives them the capability to spell out what they want to say.

So, what does this new success Elizabeth has seen mean for early childhood educators and families struggling to communicate through speech? Does it mean completely switching treatment or therapies immediately to S2C? Not necessarily, Elizabeth cautions, “We don’t tend to start with spelling to communicate until about four. Partly because I really want early intervention to have a good chance.”

She advises that it’s best to see if traditional early intervention is the answer first, “I want good early intervention to have a chance, such as, special education, OT, PT and speech therapy.”

If one suspects that a young child struggling to communicate has apraxia, Elizabeth states the first thing one should do is presume competence, “If somebody walks through the door, I’m going to presume that they’re the age mentally of their chronological age. They must actually prove me wrong, and then I’ll adjust.”

What’s the next step? Should you practice the alphabet? Should you read out loud to them? Do physical therapy? Elizabeth says yes to all of these steps but talking is especially important. “If you have a child who is speech delayed, talk to them. In early childhood, it’s called parallel talk and self-talk.”

Parallel talk is when you narrate what a child is doing. Elizabeth provides one example, “If the child is playing with blocks, you can say ‘Oh, you’re reaching for the blue block. Oh, that’s a nice blue block, right?” Meanwhile, self-talk is indicating out loud what you’re doing and why. For example, Elizabeth says in the grocery store, you may say to a child, “Oh, Mommy’s going to make pasta tonight. So, I need to get some noodles. Now, I’m going to get some tomato sauce.’ You’re just talking out loud to your child”

Reading is also important, “Sometimes when people find out a child is having some delays, they stop reading books to them, because they think oh, my kid can’t understand,” Elizabeth laments. Rather, she advises exposure to many different words and photos, not just the same limited set. “The brain loves change. The brain responds to change, which is why we are startled when something unexpected happens.” So, if you just keep it limited to a small group of words, a small group of books, you’re limiting that knowledge going in”. Elizabeth reminds us just because folks are not speaking, doesn’t mean they don’t understand.

Early childhood educators may face other challenges aside from teaching children with complex communication challenges. Keeping children safe in the event of uncontrollable temper tantrums is also a concern for many. So how should one approach those scenarios? Keep those with apraxia separate?

“I believe in radical inclusivity,” Elizabeth states firmly, “I think if we start early, we could learn how to interact appropriately.”

The big key, she says, is to explain that people with apraxia do not always have control over their body. Knowing that impulsive actions can be the result of one being startled, scared, or excited can help educators and families avoid creating situations that may trigger dangerous or harmful actions. Family members and educators can also de-escalate these situations by guiding those with apraxia through the motions needed to prevent hurting themselves or others.

“When someone with apraxia pulls my hair, I know sometimes it’s because they’re overwhelmed meeting me or they’re in distress,” Elizabeth says, “I coach them through how to use the motor skills needed for them to open their hands. I say in a very calm voice, ‘Open your hands, open up your fingers, straighten out your fingers,’ and then I slowly pull my hair out.”

Elizabeth emphasized that many early childhood educators are uniquely qualified and well trained in recognizing early signs of struggle. However, she noted that it’s also vital to stay up to date with the latest research and educational methods to provide the best care for children, especially those with disabilities.

In 1887, Helen Keller had her “water” moment. In Anne Sullivan’s words, “A new light came into her face. Within hours, she had learned thirty new vocabulary words.” It wouldn’t have been possible without the hard work and dedication of Sullivan, who would not give up on Helen.

Most of all, Elizabeth encourages early childhood educators and families not to give up hope. “Hope is one of our most precious commodities.”

Doing the research and constantly seeking out new educational practices, such as those emphasized in Essentials for Working with Young Children is key to successful interactions with all children in early childhood education. This dedication is what has allowed educators and therapists around the world to make a difference in the lives of children. As a result, many children are able to live more fulfilled lives and can create meaningful connections with everyone around them, especially their loved ones.

And that’s why all the work in ECE and special education matters.

More information on Elizabeth Vosseler, Growing Kids Therapy Center, apraxia, and spelling to communicate therapy can be found at:

Growing Kids Therapy Center –

I-ASC (The International Association for Spelling as Communication) –

Jaswal, Vikram K., Allison Wayne, and Hudson Golino. “Eye-Tracking Reveals Agency in Assisted Autistic Communication.”, May 12, 2020.

Jaswal, Vikram K., Andrew J Lampi, and Kayden M Stockwell. “Literacy in Nonspeaking Autistic People.” Sage Journals, February 21, 2024.

1- Maenner, Matthew J, Zachary Warren, and Ashley Robinson Williams. “Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020.” Centers for Disease Control and Prevention, March 24, 2023.
2- Higashida, Naoki. The Reason I Jump: The Inner Voice of a Thirteen-Year-Old Boy with Autism. New York, New York: Random House, 2016.
3- Rausch, Sarah Ludwig. “Apraxia: Symptoms, Causes, Tests, Treatments.” WebMD, October 12, 2008.


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Experts Speak: Autism and Apraxia

Experts Speak Autism and Apraxia with Elizabeth Vosseller Early childhood educators play a critical role in the lives of young children and their families around the world. As the administrator of the Child Development Associate®...