Childhood Apraxia of Speech: Signs, Treatment, and Therapy

Apraxia is often a misunderstood disorder, especially for kids. Children may exhibit signs and symptoms that may be associated with other speech problems during development.

Contacting a speech-language pathologist is the best way to determine if your child is experiencing symptoms of childhood apraxia of speech (CAS), but here is some basic information about CAS and how therapy helps improve speech for kids with this disorder.

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What is Childhood Apraxia of Speech?

Childhood apraxia of speech (or CAS for short) 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).

It is also known as a motor speech disorder, so children with apraxia cannot send the proper messages to tell the muscles how to move. This includes the complex muscles of the face and mouth that help produce sounds such as lips and the tongue.

Their muscles are functioning properly, but they are not getting the correct or consistent commands from the brain. Because of this, a child with apraxia of speech knows what to say, but it’s hard for them to express it.

Causes of CAS

To date, there’s still no definite cause for childhood apraxia of speech. Research points towards a few factors, including:

  • the child’s language development
  • traumatic brain injury
  • neurological impairments from birth
  • genetic cause, some suggesting that it may run in the family
  • other associated disabilities such as cerebral palsy, autism, epilepsy and other mental or intellectual disorders.

More children are also being diagnosed with CAS over the years, but the reasons why are also still largely unknown.

What are the signs to look out for?

There are a few telling signs for childhood apraxia of speech. At around 18 months to 2 years of age, the child may:

  • be inconsistent when they produce sounds and may say the same word differently every time
  • put stress and tone on words and sentences incorrectly (improper prosody)
  • distort or change sounds for common vowels and consonants
  • have an easier time with shorter words (and a harder time with longer words)
  • exhibit a lack of fine motor skills, usually in the form of excessive mouth movements or many attempts to position the mouth properly (groping)
  • develop language skills late
  • have problems with reading, writing or spelling
  • use a small variety of sounds, and may gradually reduce the sounds they produce overtime

Childhood apraxia manifests differently for every child. Signs and behaviors may range from mild (where the child only has trouble with some speech sounds) to severe cases (where the child does not communicate well at all).

For evaluation, your child’s speech-language pathologist (SLP) will assess their language skills, such as his or her vocabulary, sentence structure and ability to understand speech.

Diagnosis for CAS isn’t based on any single test or observation. It depends on the pattern of problems that are seen. The specific tests conducted during the evaluation will depend on your child’s age, ability to perform speech and the severity of the problem.

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Treatment and Therapy

While CAS is sometimes called developmental apraxia, it is not something that children outgrow. Children with apraxia will need consistent treatment to show improvements. It will take effort and may take several years depending on the severity, but it is definitely possible for them to communicate normally.

If you suspect your child might have CAS, you should consult with an SLP. Due to the varying nature of apraxia, speech therapy will be personalized to your child’s specific needs, and will move along with the pace that they need for their development.

The goal of any treatment for CAS is for your child to speak clearly. This means using the correct mouth movements at the right time and for the right words. Mouth exercises that strengthen the muscles are not helpful for a child with CAS. As we mentioned before, their muscles are fine and the concern is neurological and are not due to weak muscles.

Some methods that may be employed are repeated, accurate practice of speech movements in words and phrases, some visual prompts to show the sequences of sounds or words and how they go together.

Using AAC to Help with Apraxia

Your speech therapist may recommend other non-verbal modes of communication such as AAC (Augmentative and Alternative Communication) devices, picture communication or sign language, especially when speech is proving to be extremely difficult. It’s also important to start using AAC early when it is greatly needed to support speech to help reduce the chance that the child will become frustrated from not being able to communicate effectively.

Many parents are afraid that their child will grow dependent on the AAC systems, but there has been no evidence to support this fear. Using non-verbal tools can actually promote better communication practice and decrease frustration for you and your child. As the speech improves, these systems may no longer be necessary and may be gradually removed.

How to Support a Child with Apraxia of Speech

Because CAS treatments take time, your child will need your support more than ever. Doing activities taught by your SLP and doing regular effective speech practice at home will help them improve their progress. This may include words and phrases to practice together. Remember to practice words or phrases in real-life situations so that your child uses the words with context.

However, it’s best not to push your child to do activities when they are tried. Make practice time as fun as possible as it will help them feel less pressured to practice. Practice can often be done within play. Remember to acknowledge your child’s efforts, big or small.

Your example will also help other family members or people around your child learn to support them.

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Childhood Apraxia of Speech may not fully resolve, but there are ways to gradually improve speech. Children with CAS will need significant support from their family.

It’s best to get in touch with an SLP early so that they can provide you with instruction on good speech practices at home, and recommend an appropriate AAC device when needed. If your child has signs of apraxia of speech, you can book a consultation today to learn about the next steps to take.

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Lauren Templeton - Apheleia Speech Therapy
Lauren Templeton

Owner & Speech-Language Pathologist

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