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.
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.
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.