Apraxia of Speech in Children (CAS)
A Guide for Parents
What is Childhood Apraxia of Speech?
Childhood apraxia of speech (CAS) is a neurological disorder that affects a child’s ability to speak. Children with CAS have difficulty coordinating the complex movements of their lips, tongue, and jaw, which makes it difficult for them to produce clear and understandable speech.
Even though children with CAS have a good understanding of language and know what they want to say, they may struggle to say it. They may make errors in the order of sounds, or they may leave out sounds altogether. They may also have difficulty saying long or complex words.
CAS is not a speech delay or a learning disability. It is a motor speech disorder that requires specialized treatment from a speech-language pathologist. With early intervention, children with CAS can learn to improve their speech and communication skills.
What Causes Apraxia of Speech?
The exact cause of apraxia of speech is still unknown. However, it is believed to be a neurological condition, meaning it is related to how the brain functions. Some children may develop apraxia of speech due to genetic factors or as a result of certain neurological conditions, such as cerebral palsy or genetic disorders like Down syndrome.
Signs and Symptoms of Apraxia of Speech:
Apraxia of speech can manifest differently in each child.
Some common signs and symptoms to watch for include:
- Inconsistent speech: Your child’s ability to produce sounds, syllables, or words may vary from one attempt to another. They may say a word correctly one day but struggle to say it the next.
- Difficulty with complex words: Your child may find it challenging to pronounce longer or more complex words. They might simplify or omit certain sounds or syllables.
- Ineffortful groping: You might notice your child making unusual facial or oral movements when attempting to speak. This can include groping or struggling to find the right position for their articulators.
- Slow rate of speech: Children with apraxia of speech often speak at a slower rate compared to their peers. They may pause frequently, searching for the correct sounds or words.
- Language development delay: Apraxia of speech can also impact a child’s overall language development. Your child might have difficulty combining words into sentences or expressing themselves effectively.
The American Speech-Language-Hearing Association (ASHA) published the following 10 early signs and symptoms of childhood apraxia of speech (source):
- Limited babbling, or variation within babbling
- Limited phonetic diversity
- Inconsistent errors
- Increased errors or difficulty with longer or more complex syllable and word shapes
- Omissions, particularly in word initial syllable shapes
- Vowel errors/distortions
- Excessive, equal stress
- Loss of previously produced words
- More difficulty with volitional versus automatic speech responses
- Predominant use of simple syllable shapes
What is the Difference Between CAS and a Speech Delay?
Children with a developmental delay in speech will follow the same general path of speech development as other children, but they will do so at a slower pace. Children with apraxia of speech, on the other hand, are on a different path altogether. They have difficulty planning and executing the complex movements required for speech, which can lead to inconsistent errors and difficulty making smooth transitions between sounds and syllables. This can make it difficult for them to produce clear and understandable speech.
How is Childhood Apraxia of Speech Diagnosed?
Diagnosing childhood apraxia of speech (CAS) is a meticulous process that involves several steps to ensure an accurate assessment. The evaluation typically begins with a referral to a licensed speech-language pathologist (SLP), often initiated by a pediatrician, neurologist, or developmental specialist.
Comprehensive Evaluation
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Initial Review of Histories:
The SLP will start by examining your child’s birth, medical, and developmental histories. This background information helps in understanding any factors that might influence speech and language development. -
Speech and Language Assessment:
- Language Understanding and Usage: The ability to understand and express language through words, gestures, or sign language is assessed.
- Sound and Speech Production: The SLP evaluates how well your child can produce various sounds, including consonants and vowels, and how they form words and phrases.
- Speech Characteristics: The assessment includes timing, rhythm, and flow to understand any disruptions in speech patterns.
- Oral-Motor Skills: The movement and coordination of the tongue, lips, and jaw are observed to identify potential difficulties.
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Interactive and Play-Based Observations:
To get a comprehensive view, the SLP will note how your child communicates during play and social interactions, which can reveal additional insights into their speech abilities.
Diagnostic Challenges and Recommendations
- Specific Tests for CAS: The pathologist will prompt your child to articulate specific sounds, words, and phrases to detect signs of CAS. This can be challenging, particularly in young children or those with limited language skills.
- Possibility of Repeat Visits: Since diagnosing CAS can be complex, it may require more than one appointment. The SLP might recommend a follow-up for further evaluation.
Post-Evaluation Steps
- Therapies and Home Activities: If CAS is suspected but not confirmed, the SLP may suggest therapy sessions and provide language-building activities for parents to engage in at home.
- Monitoring Progress: A future evaluation may be scheduled to monitor your child’s speech development and adjust strategies as needed.
Supporting Your Child
- Early intervention: If you suspect that your child may have apraxia of speech, seek an evaluation from a speech-language pathologist (SLP). Early diagnosis and intervention can greatly improve outcomes. You can schedule a free consult with a speech-language pathologist here.
- Speech therapy: Working with an experienced SLP is crucial. The SLP will design a customized therapy plan to help your child improve their speech production skills and overall communication abilities.
- Practice at home: Consistency is key! Your child’s SLP will likely provide you with exercises and strategies to practice at home. Regular practice in a supportive environment can reinforce the progress made during therapy sessions.
- Encourage non-verbal communication: While your child works on their speech skills, encourage alternative forms of communication, such as gestures, sign language, or visual aids. This can help reduce frustration and enhance overall communication.
- Create a positive environment: Patience, understanding, and positive reinforcement are essential. Celebrate your child’s efforts and successes, even if they are small steps forward. Building their confidence and self-esteem is crucial for their progress.
What Activities are Included in Speech Therapy for CAS?
Speech therapy for Childhood Apraxia of Speech (CAS) focuses on fostering engaging and effective communication skills. The activities are designed to be both fun and educational, maximizing the child’s motivation to learn.
Core Activities in Speech Therapy
Interactive Games and Play: Games specifically tailored to encourage speech can help make the learning process enjoyable. Activities such as storytelling, role-playing, and using toy telephones can create engaging scenarios for practice.
Drill-Work Exercises: These activities involve structured repetition of sounds and words. By repeatedly practicing specific speech patterns, children can improve their articulation and fluency.
Repetitive Practice and Feedback: Techniques like consistent repetition and immediate feedback help reinforce learning. This approach ensures children understand how to correct their speech in real-time.
Cues and Imitation: Therapists often use a variety of prompts, including visual aids, tactile cues, and verbal hints, to guide children in producing correct sounds. Imitation exercises, where children mirror the therapist’s speech, can be particularly effective in building skills.
Enhancing Communication
Core Vocabulary Development: Establishing a foundation of essential words such as personal names, family titles, basic needs (“help,” “open”), and common responses (“yes,” “no”) is crucial. These power words serve as a communication baseline, reducing frustration and aiding overall speech development.
Alternative Communication Methods: To support verbal communication, tools like sign language, picture boards, and electronic communication devices (such as tablets with speech apps) may be introduced. These methods ensure children have multiple avenues to express themselves.
Overall, speech therapy for CAS is a multifaceted approach that leverages a combination of playful interaction and structured exercises. By incorporating various activities tailored to the child’s needs, therapy sessions become a dynamic platform for enhancing communication skills.
Understanding the Related Specialties and Programs for Childhood Apraxia of Speech (CAS) Treatment
When navigating the complexities of Childhood Apraxia of Speech (CAS), it’s essential to engage with a comprehensive care team and explore specialized programs. Here’s a breakdown of the most pertinent specialties and resources that support effective CAS treatment:
Core Specialties Involved
- Audiologists
Assess and manage hearing issues that can impact speech development and overall communication. - Speech-Language Pathologists
Specialize in evaluating and treating speech disorders, focusing on improving articulation and oral motor skills. - Educational Consultants
Help integrate therapeutic strategies within school settings, ensuring that academic support is aligned with therapeutic goals. - Child and Family Therapists
Provide emotional and psychological support to children and families, facilitating coping strategies and promoting holistic well-being. - Otolaryngologists
Address medical issues related to the ear, nose, and throat that might affect speech and communication.
Specialized Programs and Support Resources
Speech Therapy Programs
These programs are tailored to address the unique challenges of CAS, emphasizing repetition and multi-sensory cues to improve speech clarity.
Family-Centered Communication Workshops
Workshops geared towards equipping families with practical tools and strategies to support daily communication and language practice at home.
Technological Aids and AAC Devices
Utilize Alternative and Augmentative Communication (AAC) devices and software to enhance communication for children struggling with verbal expression.
Team-Based Approach
Your child benefits from an integrated care team dedicated to holistic treatment. By bringing together specialists from various fields, all work collaboratively to support your child’s unique needs. The goal is to ensure continuous progress by addressing communication challenges both medically and therapeutically.
These combined specialties and programs create a supportive environment that tackles CAS from multiple angles, giving children the best opportunities for improvement in their speech and communication skills.
Will My Child Ever Speak Normally?
The journey of a child with childhood apraxia of speech (CAS) through therapy is influenced by many factors, such as the severity of the disorder, the presence of other disorders (such as autism), and the frequency of therapy. However, professional articles and experienced speech-language pathologists (SLPs) report that most children with CAS can achieve optimal verbal communication to some degree with the right help.