Childhood Apraxia Of Speech — What The Heck Is That?!?
There are many reasons and diagnoses that can apply when children are having trouble learning to talk. One of the less common and complicated-sounding diagnoses is childhood apraxia of speech. If you are here reading this, maybe you are researching this diagnosis for your child or a child you care about. I can break down this scary sounding term and make it more digestible.
What is Childhood Apraxia of Speech
Childhood apraxia of speech, sometimes called by its acronym CAS, is a disorder where people have trouble moving their mouth in the specific way required to produce speech. It is a movement disorder. It is not caused by weakness or cognitive impairment and it is not something that parents or caregivers have caused.
Children with childhood apraxia of speech often know what they want to say and understand what is being said to them, they are just not able to move their mouth in the specific sequences to make speech sounds. They are often very difficult to understand.
The issue is not with thinking about what to say but rather there is a disruption when the brain is telling the muscles how to move. Childhood apraxia of speech falls under the umbrella of motor speech disorder, meaning that it is a movement-based difficulty, not a cognitive-based difficulty.
What are the Characteristics?
Childhood apraxia of speech has characteristic, sometimes called markers, and they are present from birth. This disorder does not develop after a child has developed normally for years. Symptoms of CAS may be visible as soon as the child starts to speak. Some children will have all of these characteristics, and some children will only have some of these markers. Characteristics may include:
Very limited babbling.
- When babies learn to speak, they will practice saying sounds such as “ba ba” or “da da”. Children with childhood apraxia of speech often don’t make many speech sounds early on. Caregivers often describe them as “quiet” babies.
Loss of words or sounds.
- Children with childhood apraxia of speech may have sounds or words that they were able say for a period of time but then they disappear. Children without CAS typically keep all of the sounds and words they learn.
Difficulty with repeating words but then are able to say them volitionally later.
- For example, when asked “Say Dada!” they are unable to make the sounds but then later may shout out “Dada!” very clearly. Children without CAS are often able to repeat words and will often echo words that they hear.
Having a very limited amount of speech sounds.
- Children with childhood apraxia of speech may only have a few sounds that they are able to say. Some children are able to use the limited sounds they have to make words. Many times these words may only be understandable by family. For example, “ba” might be the word they say for bottle but also ball, bear, and bread. Children without CAS may do this but for a short period of time.
Inconsistent errors when trying to speak.
- They may say something different for each time they try to say a word. For example, when trying to say ‘pay’ they might say “day” but then later will say “puh” or “bah”. Children without childhood apraxia of speech will say words, even when they are articulating them incorrectly, pretty consistently. For example, they may say “tat” for ‘cat’ every time they try to say ‘cat’ until they learn the correct way to articulate it.
Leaving out parts of words such as the beginning sound or one syllable of a larger word.
- Children with CAS often will leave out a part of a word. For example, “at” for ‘cat’ or “pi-le” for ‘pineapple.’ Children without childhood apraxia of speech may leave out the last sound of a word or a syllable of a larger word but will often grow out of this pattern. Some children that don’t grow out of the pattern on their own require support from a speech therapist.
Difficulty with saying vowel sounds, especially diphthongs (for example the “ay” in ‘play’ and “ow” in ‘town’).
- Children without childhood apraxia of speech are often able to say most vowels but learning consonants are sometimes trickier. This particular characteristic is significant as it impacts intelligibility and can have serious consequences for production of consonants.
Groping for sounds.
- The term ‘groping’ means that their mouth is moving around trying to make the speech sound but they are not able to. Their mouth may move in ways that are seemingly unrelated to what they are trying to say. Groping movements are not seen in children without CAS. This is one of the biggest indicators that the child is having trouble volutionally moving their mouth.
Difficulty with rhythm and stress when speaking.
- Children with childhood apraxia of speech may sound robotic when speaking or have trouble with spacing out their words. They may sound monotone and have trouble showing emotion with the tone of their voice. Children without CAS will use inflection as they start to make sentences. You can tell when the child is happy, sad, or mad based solely on the tone of their voice. This would not often be the case with CAS.
Difficulty saying longer words but are able to say shorter words.
- This can be true for all children, but children with a diagnosis of childhood apraxia of speech have more difficulty and will have this difficulty across vocabulary.
Very poor intelligibility.
- The limited amount of sounds, difficulty with saying vowels, and inconsistent errors make children with childhood apraxia of speech very difficult to understand.
How Is Childhood Apraxia of Speech Treated?
Speech pathologists are the best specialists to diagnose and treat childhood apraxia of speech. Speech pathologists are specialists in the areas of speech, language, communication, and a few other things. Learn more about what a speech pathologist is in our blog article here.
All speech pathologists have had some amount of training but not all specialize in this diagnosis. Many speech pathologists don’t have to tools or experience to know where to start or what to look for. For the best outcomes, finding someone who specializes in the treatment of this diagnosis is crucial.
A diagnosis is typically made after the age of 2–3 years. This is the age that children can participate in the assessment required to make an accurate diagnosis. Once a diagnosis is made, frequent, specific, and intensive speech therapy is recommended. This means that speech therapy is happening multiple times a week to learn the motor planning needed for speech production. Specific techniques are used to help improve speech production and communication skills. As the therapy required is distinct, it is important to work with a speech pathologist that knows these techniques.
Speech therapy can occur at school, in outpatient clinics, or through private therapy. Apraxia Kids is a great resource to find qualified speech pathologists in your area. They have tons of information, a community of those impacted by CAS they, and a directory of speech pathologists. Speech therapists in their directory have completed competencies around the assessment and treatment of childhood apraxia of speech.
Check out their directory here: Apraxia Kids Speech-Language Pathology Directory
Summary
Childhood apraxia of speech (CAS) is a unique disorder. It is a motor speech disorder, meaning that children with this diagnosis have trouble making the complex movements required for speech production. Children with CAS often know what they want to say and understand what is being said to them but have trouble speaking clearly and intelligibly.
It has a set of characteristics, some of which are unique to the disorder. It impacts the body’s ability to produce speech even though the person knows what they want to say. CAS is not caused cognitive impairment or weakness. A qualified speech pathologist is able to diagnose the condition and provide therapy to help improve the child’s ability to produce speech. Children with childhood apraxia of speech require frequent and specific therapy.
TLC Speech Therapy is a speech pathology private practice, headquartered in Boston, Massachusetts, that specializes in feeding, swallowing, and communication skills in infants, children, teens, and adults.
For more information check out our website at tlcspeechtherapy.com or contact us at hello@tlcspeechtherapy.com
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