Apraxia of Speech

The Frustrating Disconnect Between Knowing What To Say But Not Being Able To Say It

apraxia of speech

 

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.

Childhood apraxia of speech is a motor planning or motor programming 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. 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. While most therapists would not diagnose CAS alongside another diagnosis such as autism or developmental delay, it’s important to understand that CAS can cause behavior difficulties or be present along with speech and language delays. A child who cannot communicate can show behavior difficulties because they are frustrated and misunderstood. 

What does it look and sound like?

Children with CAS 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.

  1. Lack of meeting typical speech milestones such as babbling or cooing as a baby or not saying their first word around age 1
  2. Difficulty saying a specific set of sounds (not being able to produce only a few sounds)
  3. Difficulty putting sounds together to make words
  4. Inconsistencies when saying sounds, such as producing them one day then not being able to produce them the next day
  5. Feeding problems
  6. Ability to understand what people are saying but having trouble responding
  7. 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
  8. Has low speech intelligibility (they are really hard to understand when they do speak)
  9. Uses inappropriate stress and intonation when they say words
  10. Ability to produce shorter words somewhat clearly, but longer words and phrases become very difficult to understand
  11. 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)
  12. Fine and gross motor difficulties or lack of meeting these typical milestones

How is it treated?

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. Muscle memory and motor programming is key! In order to help the brain send those messages to the mouth, we have to have repetition-this means lots and lots of practice. 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.

 

Natalie Erling M.A., CCC-SLP, is a licensed and certified speech-language pathologist at Ally Pediatric Therapy. Her clinical focus includes treating patients with Autism Spectrum Disorder and other developmental disorders, apraxia therapy, sensory motor therapy for feeding and swallowing, language disorders and speech sound disorders.

published on Wednesday, May 15th, 2019