Definition

What is childhood apraxia of speech?

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.

How common is childhood apraxia of speech?

Childhood apraxia of speech (CAS) is an uncommon speech disorder. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of childhood apraxia of speech?

Children with childhood apraxia of speech (CAS) may have many speech symptoms or characteristics that vary depending on their age and the severity of their speech problems.

CAS can be associated with delayed onset of first words, a limited number of spoken words, or the ability to form only a few consonant or vowel sounds. These symptoms usually may be noticed between ages 18 months and 2 years, and may indicate suspected CAS.

As children produce more speech, usually between ages 2 and 4, characteristics that likely indicate CAS include vowel and consonant distortions; separation of syllables in or between words; and voicing errors, such as “pie” sounding like “bye.”

Many children with CAS have difficulty getting their jaws, lips and tongues to the correct position to make a sound, and they may have difficulty moving smoothly to the next sound.

Many children with CAS also have language problems, such as reduced vocabulary or difficulty with word order.

Some symptoms may primarily be seen in children with CAS and can be helpful to diagnose the problem.

However, some symptoms of CAS are also symptoms of other types of speech or language disorders. It’s difficult to diagnose CAS if a child has only symptoms that are found in both CAS and in other types of speech or language disorders.

Some characteristics, sometimes called markers, help distinguish CAS from other types of speech disorders. Those particularly associated with CAS include:

  • Difficulty moving smoothly from one sound, syllable or word to another
  • Groping movements with the jaw, lips or tongue to make the correct movement for speech sounds
  • Vowel distortions, such as attempting to use the correct vowel, but saying it incorrectly
  • Using the wrong stress in a word, such as pronouncing “banana” as “BUH-nan-uh” instead of “buh-NAN-uh”
  • Using equal emphasis on all syllables, such as saying “BUH-NAN-UH”
  • Separation of syllables, such as putting a pause or gap between syllables
  • Inconsistency, such as making different errors when trying to say the same word a second time
  • Difficulty imitating simple words
  • Inconsistent voicing errors, such as saying “down” instead of “town,” or “zoo” instead of “Sue”

Other characteristics are seen in most children with speech or language problems and aren’t helpful in distinguishing CAS. Characteristics seen in both children with CAS and in children with other types of speech or language disorders include:

  • Reduced amount of babbling or vocal sounds from ages 7 to 12 months old
  • Speaking first words late (after ages 12 to 18 months old)
  • Using a limited number of consonants and vowels
  • Frequently leaving out (omitting) sounds
  • Difficult to understand speech

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes childhood apraxia of speech?

Childhood apraxia of speech (CAS) has a number of possible causes, but in many cases a cause can’t be determined. Doctors often don’t observe a problem in the brain of a child with CAS.

CAS may be the result of brain (neurological) conditions or injury, such as a stroke, infections or traumatic brain injury.

CAS may also occur as a symptom of a genetic disorder, syndrome or metabolic condition. For example, CAS occurs more frequently in children with galactosemia.

CAS is sometimes referred to as developmental apraxia. However, children with CAS don’t necessarily grow out of CAS as they develop. In many children with delayed speech or developmental disorders, children follow usual patterns in development of speech and sounds, but they develop more slowly than usual.

Children with CAS don’t make typical developmental sound errors. They need speech therapy to make maximum progress.

Risk factors

What increases my risk for childhood apraxia of speech?

Abnormalities in the FOXP2 gene appear to increase the risk of childhood apraxia of speech (CAS) and other speech and language disorders. The FOXP2 gene may be involved in how certain nerves and pathways in the brain develop.

Researchers continue to study how abnormalities in the FOXP2 gene may affect motor coordination and speech and language processing in the brain.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is childhood apraxia of speech diagnosed?

An audiologist should perform a hearing evaluation to rule out hearing loss as a possible cause of the child’s speech difficulties.

A certified-SLP with knowledge and experience with CAS conducts an evaluation. This will 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.

An oral-motor assessment involves:

  • Checking for signs of weakness or low muscle tone in the lips, jaw, and tongue, called dysarthria. Children with cas do not usually have weakness, but checking for weakness will help the slp make a diagnosis.
  • Seeing how well the child can coordinate the movement of the mouth by having him or her imitate nonspeech actions (e.g., moving the tongue from side to side, smiling, frowning, puckering the lips)
  • Evaluating the coordination and sequencing of muscle movements for speech while the child performs tasks such as the diadochokinetic rate, which requires the child to repeat strings of sounds (e.g., puh-tuh-kuh) as fast as possible
  • Examining rote abilities by testing the child’s skills in functional or “Real-life” Situations (e.g., licking a lollipop) and comparing this to skills in nonfunctional or “Pretend” situations (e.g., pretending to lick a lollipop)

A melody of speech (intonation) assessment involves:

  • Listening to the child to make sure that he or she is able to appropriately stress syllables in words and words in sentences
  • Determining whether the child can use pitch and pauses to mark different types of sentences (e.g., questions vs. Statements) and to mark off different portions of the sentence (e.g., to pause between phrases, not in the middle of them)

A speech sound (pronunciation of sounds in words) assessment involves:

  • Evaluating both vowel and consonant sounds
  • Checking how well the child says individual sounds and sound combinations (syllables and word shapes)
  • Determining how well others can understand the child when they use single words, phrases, and conversational speech.

An SLP may also examine the child’s receptive and expressive language skills and literacy skills to see if there are co-existing problems in these areas.

How is childhood apraxia of speech treated?

Research shows the children with CAS have more success when they receive frequent (3-5 times per week) and intensive treatment. Children seen alone for treatment tend to do better than children seen in groups. As the child improves, they may need treatment less often, and group therapy may be a better alternative.

The focus of intervention for CAS is 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.

Some clients may be taught to use sign language or an augmentative and alternative communication system (e.g., a portable computer that writes and/or produces speech) if the apraxia makes speaking very difficult. Once speech production is improved, the need for these systems may lessen, but they can be used to support speech or move the child more quickly to higher levels of language complexity.

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.

One of the most important things for the family 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. For children who also receive other services, such as physical or occupational therapy, families and professionals need to schedule services in a way that does not make the child too tired and unable to make the best use of therapy time.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage childhood apraxia of speech?

The following lifestyles and home remedies might help you cope with childhood apraxia of speech:

  • You and your family can work with your child at home to improve his or her speech and language skills. Home practice, in addition to your child’s speech therapy sessions, may help your child’s progress.
  • Encourage and support your child as he or she practices speech and language skills. Your support can help your child feel that he or she is doing well and improving.
  • If your child is participating in physical or occupational therapy, as well as speech therapy, schedule different types of therapy at various times so that your child doesn’t become too tired from therapy.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: September 19, 2017 | Last Modified: September 19, 2017

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