Apraxia of Speech or Childhood Apraxia of Speech (CAS) is an often misunderstood diagnosis. Childhood apraxia of speech (CAS) is a neurological childhood (pediatric) speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g. abnormal reflexes, abnormal tone).
CAS may occur as a result of a known neurological impairment, in association with complex neurobehavioral disorders of known and unknown origin, or as an idiopathic neurogenic speech sound disorder. The core impairment in planning and/or programming spatiotemporal parameters of movement sequences results in errors in speech sound production and prosody. (ASHA, 2007b, Definitions of CAS section, para. 1).
Phew! What does that even mean? Basically, when a child is diagnosed with CAS, they know exactly what to say, but their speech articulators (mouth, tongue, muscle weakness), prevent them from producing the sound clearly. You may have to ask the child to repeat themselves several times and still may not know what they are trying to say.
Apraxia of Speech in Numbers
- It is not very common; occurring in 1-2 children per every 1,000,
- It occurs more in males than in females,
- Children born with CAS have a higher likelihood to be diagnosed with subsequent language, reading, or writing disorders (Lewis et al., 2004; Lewis & Ekelman, 2007),
- CAS, or its characteristics, were seen more prevalently in children who were diagnosed with Fragile X Syndrome, Galactosemia, and Velocardiofacial syndrome (Kummer, Lee, Stutz, Maroney, & Brandt, 2007),
- Although children with Autism Spectrum Disorder are often diagnosed with speech and language difficulties, it does NOT mean they will be diagnosed with CAS.
Apraxia of Speech Signs and Symptoms
Currently, there are no distinctive features that discriminate CAS from other speech sound disorders; however, there are certain features that have been noted consistently in children who are diagnosed CAS:
- Inconsistent errors on vowels and consonants in repeated syllables or words. This means that the child can say the word “ball” correctly three times in a row, but then not be able to say it the fourth time.
- Lengthened and disrupted periods between words and sounds. A child who exhibits this characteristic may pause at odd times when they say sentences, or may break up words into “chunks,” which can make communication difficult and hard to follow.
- Inappropriate prosody means that the child will have patterns of their voice being loud, quiet, or nasal. The child often does not realize this is occurring.
- Articulatory groping is a very common sign that I have seen in my patients. This is very easy to notice because the child/person will move their mouth as if they are talking, but no sound comes out. It looks painful at times and can be very distracting.
- Slower than typical speech occurs because the child is concentrating on how they should be talking.
There may also be non-speech related issues that occur when children are suspected of having CAS. These symptoms may include: oral sensitivity (either really sensitive or under sensitive), gross and fine motor delays, feeding difficulties, and limb apraxia (weakness in arms or legs).
Apraxia of Speech Evaluations and Diagnosis
Children who are suspected as having CAS should be referred to a speech-language pathologist for a full assessment and diagnosis. The assessment will consist of a variety of standardized and non-standardized assessments, such as parent interview. A speech pathologist will not only do assessments, they will also conduct an oral-mechanism check. This is where they will look inside your child’s mouth and see what their oral structure looks like. They will also look at motor movements that your child can or cannot create. This may include smiling or making a kiss-smile face. This is important because children who do not have CAS can perform these tasks successfully and without difficulty.
After an assessment is conducted, several things might occur.
These can include:
- Diagnosis of CAS or diagnosis of other speech sound disorder (e.g., articulation and/or phonological disorder) – please see my other blogs for more information regarding articulation disorders vs. phonological disorders;
- Description of the characteristics and severity of the disorder;
- Identification of factors that might contribute to the speech disorder;
- Recommendations for intervention that relates to overall communication adequacy, including Alternative Augmentative Communication device measures (AAC). AAC devices are ways that your child can communicate if their speech sound disorder is very severe. These things may include sign language, a picture board, or an iPad-esque board that communicates for them.
- Diagnosis of a spoken language (listening and speaking) disorder;
- Identification of literacy (reading and writing) problems;
- Monitoring of literacy learning progress in students with identified speech sound disorder by SLPs and other professionals within the school setting;
- Recommendations for a multi-tiered system of support in the child’s school to support speech and language development; and
- Referral to other professionals as needed, including
- an occupational therapist for non-speech, sensory-motor, or fine-motor issues;
- a physical therapist if gross motor skills or overall muscle tone are of concern;
- a pediatric neurologist if neurological indicators (e.g. potential seizure activity, tremors, or imbalance) are present; an
- a geneticist if the child’s medical or family history suggests the possibility of a neurobehavioral disorder of genetic origin (e.g. fragile X syndrome, Rett syndrome, dysmorphology).
Read more: ASHA: “Childhood Apraxia of Speech” 2011
SLP Story Time: My Cousin That No One Could Understand
I had a cousin growing up, whom I didn’t see often, but when I did, I realized his speech was very hard to understand. All of us had to ask him to repeat himself and no matter how many times he did, we still had no idea what he was attempting to communicate. Nicholas was later diagnosed with Childhood Apraxia of Speech by a Speech-Language Pathologist.
Flash forward to Nick’s grade-school years and his speech was not improving. Thinking about it now, his speech was about 25% intelligible when he entered high school. At this point, he was no longer receiving speech therapy because the school district stated he wasn’t making enough progress to stay on their caseload. My aunt and uncle didn’t feel that outside speech therapy was important enough to enroll Nick into, so unfortunately, his speech never got better.
I was at a wedding a few years ago and was sitting with Nicholas, who is a student at MIT and is a very intelligent young man. My husband turned to me and said, “I didn’t understand a word he said. What’s going on with his speech?”
I’m telling you this story for two different reasons:
(1) I want you to know how important it is to advocate for your child and push services. If the school won’t provide them, look into outside therapy. If my aunt and uncle would’ve pursued and pushed harder, I guarantee Nicholas wouldn’t sound the way he does in his 20s.
(2) Therapy is only a small portion of the day. You also need to work diligently on concepts at home, as well. This is applicable to ANY SPEECH DISORDER!
Speech Blubs App is one of the tools you can use at home to practice speech. Feel free to check the reviews from some of our parents.
Download Speech Blubs App for some engaging fun activities and start practicing now!
Stacie Bennett has been practicing as a Speech-Language Pathologist for the past ten years. Currently, she works full-time at a vocational high school in New Jersey and have her own private practice. Feel free to contact Stacie if you have any questions!