Apraxia

Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words.

Signs or symptoms

Not all children with CAS are the same. Some of the signs and symptoms listed below may not be present in every child. General things to look for include the following:

A Very Young Child

• Does not coo or babble as an infant
• First words are late, and they may be missing sounds
• Only a few different consonant and vowel sounds
• Problems combining sounds; may show long pauses between sounds
• Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)
• May have problems eating

An Older Child

• Makes inconsistent sound errors that are not the result of immaturity
• Can understand language much better than he or she can talk
• Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
• May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
• Has more difficulty saying longer words or phrases clearly than shorter ones
• Appears to have more difficulty when he or she is anxious
• Is hard to understand, especially for an unfamiliar listener
• Sounds choppy, monotonous, or stresses the wrong syllable or word

Potential Other Problems

• Delayed language development
• Other expressive language problems like word order confusions and word recall
• Difficulties with fine motor movement/coordination
• Over sensitive (hypersensitive) or under sensitive (hyposensitive) in their mouths (e.g., may not like toothbrushing or crunchy foods, may not be able to identify an object in their mouth through touch)
• Children with CAS or other speech problems may have problems when learning to read, spell, and write

Diagnosing Childhood Apraxia of Speech

We perform a hearing evaluation to rule out hearing loss as a possible cause of the child's speech difficulties. We are certified-SLPs with knowledge and experience with CAS. After we assess the child's oral-motor abilities, melody of speech, and speech sound development, the SLP can diagnose CAS and rule out other speech disorders, unless only a limited speech sample can be obtained making a firm diagnosis challenging.

Treatment

Children with CAS have more success when they receive frequent (3-5 times per week) and intensive treatment. They also respond better when seen alone for treatment as opposed to being treated in groups. As the child improves, they may need treatment less often, then group therapy may be an option.

We focus on improving the planning, sequencing, and coordination of muscle movements for speech production. Isolated exercises designed to "strengthen" the oral muscles will not help with speech. CAS is a disorder of speech coordination, not strength.

To improve speech, the child must practice speech. However, getting feedback from a number of senses, such as tactile "touch" cues and visual cues (e.g., watching him/herself in the mirror) as well as auditory feedback, is often helpful. With this multi-sensory feedback, the child can more readily repeat syllables, words, sentences and longer utterances to improve muscle coordination and sequencing for speech.

Practice at home is very important. Families will often be given assignments to help the child progress and allow the child to use new strategies outside of the treatment room, and to assure optimal progress in therapy. It is important to remember is that treatment of apraxia of speech takes time and commitment. Children with CAS need a supportive environment that helps them feel successful with communication.