What Is Childhood Apraxia Of Speech And How Does It Affect Children?
In some cases, speech difficulties arise during childhood. Speech impediments can be challenging to overcome and may significantly impact a child's emotional and mental development. Some speech challenges are minor and can be fixed with time, while others are more difficult to change and can last into adulthood.
One condition that can occur in very young children is childhood apraxia of speech (CAS), also called verbal apraxia. Understanding how apraxia occurs and how to treat it can help parents and caregivers provide quality support to children experiencing this condition.
What is childhood apraxia?
Childhood apraxia of speech (CAS), also known as developmental apraxia, is a speech disorder involving inaccurate movements of a child's speech muscles. This condition falls under the broader category of communication disorders and is specifically classified as a speech sound disorder. However, it’s not the muscles that are impacted by this condition – CAS affects the brain.
A neurotypical brain formulates a plan to speak, commanding the speech muscles to move so words can be spoken. With childhood apraxia of speech, there is miscommunication between the brain and the muscles, causing difficulty in formulating words. While many children develop some speech difficulty or have speech problems that interfere with functional communication, CAS is uncommon. It affects approximately one in 1,000 children.
Children with CAS often have difficulty planning and coordinating the complex sequences of movements needed for speech, which impacts their overall speech and language development.
How does childhood apraxia of speech work?
To speak, messages must go from your brain to your mouth. These messages tell the muscles what movements are needed to make sounds. If your child has apraxia of speech, messages do not pass correctly. Your child might not be able to move their lips or tongue to say sounds, even though they are not experiencing muscle weakness. In some cases, children with CAS experience a loss of speech.
Understanding developmental apraxia in children: A rare speech disorder
A child with CAS has normal thoughts and may know what they want to say along with the correct grammar to express their thoughts. As CAS is a problem with their brain getting their mouth muscles to move, it does not impact a child’s progress with intelligence or social skills. Other names for CAS are verbal dyspraxia or developmental apraxia.
Early intervention
Although you may hear the term "developmental" regarding this condition, CAS is not a problem children can outgrow without support. A child with a developmental speech disorder learns sounds in a typical order but at a slower pace. If your child has CAS, they may not follow typical patterns or progress without treatment. With speech treatment, apraxia can sometimes be managed early in life.
What are the symptoms of CAS?
Childhood apraxia of speech symptoms can vary, and different children may struggle with different parts of speech. CAS can affect children before they learn to speak and can affect children past the toddler stage.
Symptoms for children under three
Below are some of the symptoms children under three with apraxia may experience:
Difficulty eating
Long pauses between words or sounds
Pronouncing words differently each time
Not making many noises as an infant
Delayed speech development, only seeming to know a few sounds
If your child has multiple symptoms, it could be a sign of CAS. However, some symptoms can also represent other conditions related to communication difficulties, such as childhood disintegrative disorder, autism spectrum disorder, or cerebral palsy. For this reason, seek a professional evaluation if you notice symptoms in your child.
Symptoms for children over three
Below are some of the symptoms children over three may experience:
Understanding words but struggling to speak clearly
Ease in imitating words but difficulty saying them independently
Struggling to move the mouth when speaking
Struggling to say longer words
Saying words differently each time
Not being understood by strangers
Struggling to stress syllables
Difficulty with fine motor skills
Children with CAS may also be moody and frustrated due to the inability to communicate their thoughts. Some children may also face bullying from others. If your child has these symptoms, having them checked by a professional early on may be beneficial.
How are speech disorders like apraxia diagnosed?
If you suspect your child has CAS, take them to a speech-language pathologist (SLP). These professionals might examine your child’s specific progression along developmental milestones, such as when they spoke their first words (or if they have).
Resources like Apraxia Kids provide support and information for families navigating this condition. A doctor or a speech-language pathologist specializing in speech, language, hearing, and sound disorders can be very helpful in properly diagnosing and treating childhood apraxia of speech.
This type of doctor can listen to your child's speech and diagnose any speech difficulties. They will test how well your child can comprehend speech and check their fine motor skills. There are several factors they will test to determine if your child has CAS, including the following.
Key speech-language assessments for diagnosing childhood apraxia of speech (CAS)
This type of doctor can listen to your child's speech and diagnose any speech difficulties. They will test how well your child can comprehend speech and check their fine motor skills. There are several factors they will test to determine if your child has CAS, including the following.
Oral motor skills testing
When you take your child to a speech-language pathologist, the doctor may first test their oral motor skills and motor coordination. They will do this by seeing if the child has dysarthria, which is a weakness in the mouth area. While many cases of CAS don't present with dysarthria, it can be a sign of this condition.
They may also look at the child's mouth movements to see their development. Your child may be asked to perform everyday mouth movements such as sticking out their tongue, puckering their lips, or smiling.
The doctor may check the speed of your child's mouth movements as they test motor skills for fine motor issues to treat CAS or other language problems the child may be experiencing. It could be a sign of apraxia if they struggle to perform quick mouth movements. The doctor may also compare pretend mouth movements to real life. For example, the child could pretend to suck on candy and then do so in real life to showcase any differences between the two.
Intonation testing for speech sounds
After testing their motor skills, your child's intonation (speech melody) may be tested. To test this, the therapist may see how the child stresses certain syllables. Syllables are stressed in specific ways, and how they are stressed can change the word's meaning. The word "subject" is an example. Subject has two meanings differentiated by which syllable is stressed. Children with CAS may struggle with stressing the syllables correctly.
After testing syllables, the doctor may test for pitch changes. If your child's pitch goes up at the end of the word when it should go up in the beginning, or vice versa, it may be a sign of CAS. Listen to how your children pause when they are speaking. Pauses are the commas of your spoken sentences, and if they are pausing at the wrong times, it can change the meaning of the sentence or make it more difficult to understand meanings.
Your child's doctor may also listen to how your child says the sounds of letters, whether combined or individually. These factors can combine to show the doctor whether the child has CAS or another form of speech impediment. Regardless of the diagnosis, your child's SLP may help you find treatment options. While CAS has no quick cure, therapy can help your child learn how to speak correctly.
CAS treatments: Speech therapy and speech-language pathologists (SLP)
If your child has CAS, you may wonder how it can be treated and if it will last into your child’s school years or into adulthood. The length of your child's condition may depend on the severity. Those with more severe cases can still benefit from speech-language therapy, but it may take longer to show growth.
Treatment often involves learning to move the speech muscles in time with the brain's command to speak. A treatment plan can be developed based on the severity of your child's CAS. Speech therapy is offered by a speech therapist or speech pathologist and employs all the senses to work on pronouncing certain syllables. For example, there may be physical cues, such as touching their arm when they say a particular sound they have trouble pronouncing. It may require listening to recordings of themselves as well.
Alternative communication methods
Depending on the severity of the CAS, alternative communication methods may be used until the CAS improves. Children may use computers, phones, or other ways to communicate instead. Speech-generating devices and augmentative and alternative communication (AAC) options are commonly suggested. This method does not teach the child to be dependent on technology but gives them an outlet to speak until their condition improves. The goal is to learn how to speak.
Treatment may take time, so monitoring your child's behavior may be beneficial. Some children may become frustrated or experience bullying by peers. By keeping your child's spirits up, treatment may seem more doable, and there may be a higher chance of success.
If your child has a moderate case of apraxia, they may start treatment by attending therapy five times a week. The more they improve, the less they may be asked to go to therapy. As speech improves, the speech therapist may monitor progress to ensure slip-ups don't occur.
Does childhood apraxia of speech last forever?
Childhood apraxia of speech is considered lifelong when untreated. However, it can be treated with early intervention and support. Frequent speech therapy is often the most successful treatment option for this condition.
Support options for parents and caregivers
It can be challenging to support your child with speech. Watching them experience frustration or bullying because of their condition may cause caregivers and parents to have thoughts of hopelessness. You may benefit from talk therapy if you're experiencing this as a parent.
Benefits of online therapy
If you have a busy schedule, online therapy through platforms like BetterHelp may provide a flexible option for finding support. Research has shown that family members or caregivers participating in online therapy find successful methods for coping with challenges together. Individually, parents may learn that they are not alone and gain strategies for getting through the day-to-day.
With online therapy, parents can choose an appointment slot that works for them. Many online therapists offer sessions outside of standard business hours, which may be valuable for those with a busy schedule due to their child's speech therapy. You can also choose between phone, video, or live chat sessions with your provider, offering control over how you receive support.
Takeaway
What are the symptoms of apraxia in children?
Childhood apraxia of speech (CAS) is a motor speech disorder that affects the planning and coordination of the movements necessary for speech production. Apraxia symptoms typically vary between children and may sometimes be confused with symptoms for other speech sound disorders such as dysarthria or developmental disorders like autism spectrum disorder, cerebral palsy, or childhood disintegrative disorder.
Some typical apraxia symptoms in children under three include:
- Not making any noises as an infant.
- Delayed speaking or slow speech development.
- Speaking or pronouncing the same word differently each time.
- Difficulty eating.
- Long or strained pauses between words or sounds.
Children over three may experience:
- Imitating words effectively but having difficulty saying them independently.
- Struggling to enunciate consonant and vowel sounds, say longer words, or stress syllables in typical speech.
- Difficulties with speech movement of the mouth.
- Speaking or pronouncing words differently each time.
- Challenges with motor skills.
Speech-language specialists, such as speech-language pathologists (SLPs), are typically involved in assessing and diagnosing apraxia and other speech disorders in children. It's important to note that the assessment process is individualized, and the specific tests and procedures may vary based on the child's age, the severity of the speech disorder, and other factors.
Following the speech-language pathology assessment, the specialist can develop an appropriate treatment plan tailored to the child's needs. The assessment process for kids with speech childhood apraxia may include:
Case History— The specialist will gather information about the child's development, medical history, and family history. This information can provide important context for the evaluation.
Observation— The specialist may observe the child in various settings to understand their overall communication abilities, including nonverbal communication, play skills, and social interactions.
Standardized Tests— Speech-language pathologists often use standardized tests to assess different speech and language development aspects. These tests may include measures of articulation, phonology, and language skills.
Non-standardized Assessment— Besides standardized tests, specialists may use non-standardized assessments to gather more specific information about the child's speech development and sound production, motor planning, and coordination.
Speech Sound Inventory— The SLP may conduct a more comprehensive speech sound inventory, examining the sounds the child can produce accurately and those consistently resulting in poor speech intelligibility.
Oral-Motor Examination— An oral-motor examination assesses the strength, coordination, and movement of the oral structures involved in speech production, such as the lips, tongue, and jaw.
Motor Speech Assessment— Focuses on the child's ability to plan and execute the precise movements required for speech. It may involve tasks that target motor planning and coordination.
Contextual Speech Tasks— The specialist may observe and conduct a language evaluation within different contexts, such as during play or conversation, to measure how well they can apply speech skills in real-life situations.
Differential Diagnosis— The SLP will consider other potential causes for intelligibility and rule out conditions that may mimic CAS.
Parent and Teacher Input— Input from parents and teachers is crucial. Specialists often seek information about the child's communication at home and in educational settings. If necessary, an SLP may teach children sign language to communicate effectively until they develop language skills.
Does childhood apraxia go away?
CAS does not go away on its own, and children with apraxia will not "outgrow" it without treatment. Treating childhood apraxia may take time, but lessening or even eliminating symptoms is possible.
What is the most common cause of childhood apraxia?
The cause of CAS is still unclear, but in some cases, it may be the result of brain damage caused by a traumatic injury, syndrome, genetic disorder, or stroke.
Do children with apraxia ever speak normally?
Because its nature and severity typically vary between children, it may or may not be possible for kids with apraxia to speak normally. Other factors that influence therapeutic progress may also include:
- Early intervention.
- Cooccurring symptoms such as cognitive impairment and oral/limb apraxia.
- The child's ability to pay attention.
- Cooperation and motivation to engage in therapy.
- Reachability to services.
At what age is apraxia diagnosed?
Though there is no specific age for diagnosis, it is often difficult to diagnose children under three with apraxia. Most younger children (under two or three) cannot follow the assessment directions necessary for a diagnosis, or they may have difficulty paying attention to the extent they would need to for a diagnosis.
Kids with CAS may find the difficulty to communicate frustrating, causing mood swings, irritability, depression, or anxiety. They may also face bullying, which can create significant issues with mental health and well-being.
How does apraxia start?
Apraxia is caused by a dysfunction in the areas of the brain concerning movement coordination and sensory processing. This may be caused by damage, disease, or hereditary conditions.
How do you detect apraxia?
Potential apraxia is often first detected by a child's pediatrician, professional caregiver, or educator and then referred to a licensed speech-language pathologist (SLP) for evaluation. From there, the SLP will conduct age-appropriate tests to determine the child's verbal and language abilities.
The three most common speech errors associated with CAS are:
- Inability to consistently use consonant-vowel sounds when asked to repeat words and syllables.
- Difficulty transitioning between speech sounds or syllables, resulting in notable pauses in speech.
- Misplaced cadence or intonation of words or syllables.
Is apraxia a form of autism?
Autism Spectrum Disorder (ASD) and CAS are different types of developmental disorders, each with their own epidemiology and diagnostic criteria. They are closely linked, however, and feature many of the same symptoms. Current research posits that these similarities can be attributed to common neurological abnormalities and genetic etiology.
Can a child have apraxia without autism?
Children can have apraxia without autism; however, the two are often co-occurrent. Early treatment of apraxia is essential for identifying potential signs of autism.
Is apraxia a disability or disorder?
Apraxia of speech is a motor speech disorder, not a disability. Speech disorders are also different from language disorders in children. With a language disorder, individuals typically have problems using expressive language to communicate thoughts and feelings. Individuals with speech disorders have trouble physically saying words or sounds. It's possible for people to have co-occurring language (expressive) and speech (receptive) disorders.
Why is speech language important for a child with childhood apraxia of speech, or CAS?
Is developmental apraxia considered autism?
What percentage of children have dyspraxia?
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