Imagine you want to ride your bike. You put your helmet on, walk your bike to the driveway, position yourself on the seat, put your foot on the pedal and you feel ready to ride. You go to turn the pedals and your foot doesn’t move. The pedals don’t turn and the bike stands still. Confusion sets in and you don’t understand why your brain isn’t telling your feet to move! You sit there in silence, frustrated that a seemingly simple task has you sitting there like someone who doesn’t know how to ride a bike. This is what a child with childhood apraxia of speech (CAS) feels like when they want to speak.
What is apraxia of speech?
Childhood apraxia of speech is a motor planning or motor speech disorder that affects a person’s ability to communicate (speak) what they are thinking. It is a disconnect between the brain and the muscles that are needed to speak. It is not muscle weakness, but a disconnect between the messaging systems of the brain and the mouth. CAS has some other names. It is often called verbal dyspraxia or even developmental apraxia. The problem with calling CAS “developmental apraxia” comes from the idea that developmental disorders may be outgrown. CAS cannot be outgrown and cannot be remediated without intense intervention and therapy.
What is the cause of apraxia of speech?
In most cases, we do not know the cause of CAS. It can be caused by brain trauma such as traumatic brain injury or stroke. It can also be caused by a genetic disorder such as a syndrome though these causes are not as frequent. Now that we have more research, we know that CAS can coexist alongside another diagnosis such as autism or developmental delay. It is also important to understand that CAS can cause behavior difficulties or be present along with speech problems and language delays. A child who cannot communicate can show behavior difficulties because they are frustrated and misunderstood.
12 Ways to Identify Apraxia of Speech in Children
Children with childhood apraxia of speech may not have all the symptoms; they may show many or only a few. Know what to look for so you are educated on when to seek help.
- Lack of meeting typical speech milestones such as babbling or cooing as a baby or not saying their first word around age 1
- Difficulty saying a specific set of sounds (not being able to produce only a few sounds)
- Difficulty putting sounds together to make words
- Inconsistencies when saying sounds, such as producing them one day then not being able to produce them the next day
- Feeding problems
- Ability to understand what people are saying but having trouble responding
- Difficulty imitating (this is a BIG one for therapists, we often identify CAS with this symptom, the inability to imitate) Note: if a child CAN imitate, you may notice that imitation sounds much better than speech produced on their own
- Has low speech intelligibility (they are really hard to understand when they do speak)
- Uses inappropriate stress and intonation when they say words
- Ability to produce shorter words somewhat clearly, but longer words and phrases become very difficult to understand
- Groping while trying to speak (obvious difficulty while the mouth is moving, like they are trying to move their mouth but using too much effort)
- Fine and gross motor difficulties or lack of meeting these typical milestones
How to diagnose childhood apraxia of speech
Because CAS is a communication disorder, a licensed speech-language pathologist is typically the most qualified person to provide assessment and diagnosis. However, it is not uncommon for adjacent professionals such as neurologists, developmental pediatricians, or ABA therapists to refer a child who might be in their care or treatment to an SLP.
From there, an SLP will conduct a proper evaluation and work to connect with appropriate therapists to offer guidance towards their ABA framework. This will vary depending on your child’s age, as there are more finite clues for specific age ranges including:
18-24 months old:
Delayed onset of speech, limited number of spoken words, and constraints in vowel or consonant formation.
2-4 years old:
Voicing errors in similar-sounding words, distortion of vowels and consonants, and difficulty transitioning from word to word.
4 years old +:
Delayed language development, difficulty reading and writing, sensory processing difficulties, and chewing/swallowing difficulties.
These symptoms can appear or overlap at different age ranges, as no child’s case is the same as another’s. This is why it is critical to get them the proper professional diagnosis and treatment as soon as possible.
Childhood apraxia of speech assessment
Once you have gotten a proper referral to an SLP, they will begin by learning as much as they can about your child’s developmental history as well as any other known medical issues.
From there, they will conduct a structured assessment that will likely include:
–Interaction with your child to encourage speech. This may include asking them to repeat syllables, a list of words, or phrases in combination.
–Documenting the inventory of sounds that your child can make or the absence thereof. This includes irregularities or distortions of sounds and words relative to their existent skillset.
–An evaluation of your child’s ability to use and understand words, phrases, and grammar in comparison to their age range expectations.
–A non-intrusive examination of the mouth, oral structures, and respiratory system. This can be off putting to many children, especially those with autism, so make sure to let an SLP know if your child is particularly sensitive to physical touch.
–The intention and engagement your child has during communication – an SLP might note whether your child substitutes gestures or pointing in lieu of words and phrases they understand but are having trouble articulating.
–A motor speech exam designed to increase in difficulty and dynamic change between words and phrases. The length and complexity difference is a way to push further towards a potential CAS diagnosis once other characteristics are noted.
It is important to discuss what an evaluation consists of with any SLP before putting your child through them. Your child may have behaviors or sensitivities to some of these actions and they should be made clear beforehand so the evaluation goes as smoothly as possible.
How is childhood apraxia of speech treated?
Therapy starts with simple movements like sounds in isolation or CV (consonant-vowel) words that are developmentally appropriate for the age and then moves to more complex movements that involve multiple syllables and several word phrases. This is done after a comprehensive evaluation with diagnosis and then treatment planning that is individualized to the child. One specific program that is often used to treat CAS is called the Kaufman Speech to Language Protocol. This approach is backed by science and research and provides servicing therapists with a laid-out program for intervention.
We know that CAS is not a problem with muscle weakness or articulation; it is a dysfunction of motor movements, so we take a motor approach to treatment for apraxia of speech. Muscle memory and motor programming are key! In order to help the parts of the brain send those messages to the mouth, we have to have repetition – this means lots and lots of practice.
Speech-Language Therapy Services at Ally Pediatric Therapy
At Ally Pediatric Therapy, we have experienced professionals who can help from beginning diagnosis to full treatment of CAS. We understand that communication disorders require precise programming and dedicated care – after all, a proper diagnosis and treatment can make all the difference in a child’s development.
If you are looking to work with the top ABA clinicians and SLPs in conjunction to help your child or other family members, please contact us today. We’d love to start a conversation that leads to many more.