Childhood Apraxia
Additional Information
CHILDHOOD APRAXIA OF SPEECH(CAS)
Childhood apraxia of speech (CAS) is a motor speech disorder. A child with CAS will have problems saying sounds, syllables and words. These problems are not due to muscle weakness or paralysis. Rather, these problems are due to the planning to move the body parts that are needed for speech. These body parts include the lips, jaw, and tongue. The child knows what they want to say, but their brain has difficulty coordinating the muscle movements that are necessary to say those words. Not all children with CAS are the same. According to ASHA, all of the following signs and symptoms listed below may not be present in every child. These include:
A Young Child:
Does not coo or babble as an infant
First words are late, and they may be missing sounds
Only a few different consonant and vowel sounds
Problems combining sounds; may show long pauses between sounds
Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)
May have problems eating
An Older Child
Makes inconsistent sound errors that are not the result of immaturity
Can understand language much better than he or she can talk
Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
Has more difficulty saying longer words or phrases clearly than shorter ones
Appears to have more difficulty when he or she is anxious
Is hard to understand, especially for an unfamiliar listener
Sounds choppy, monotonous, or stresses the wrong syllable or word
Potential Other Problems
Delayed language development
Other expressive language problems like word order confusions and word recall
Difficulties with fine motor movement/coordination
Over sensitive (hypersensitive) or under sensitive (hyposensitive) in their mouths (e.g., may not like toothbrushing or crunchy foods, may not be able to identify an object in their mouth through touch)
Children with CAS or other speech problems may have problems when learning to read, spell, and write
Evaluating Childhood Apraxia of Speech
A hearing evaluation should be conducted by an audiologist to rule out hearing loss as a possible cause of the child's speech difficulties. Following, a speech therapist should conduct an evaluation to assess the child's oral-motor skills, speech sound development and melody of speech. When conducting an oral peripheral examination, the speech therapist will check for any signs of weakness or low muscle of the mouth (lips, jaw, and tongue) called dysarthria. The speech therapist will continue the oral-motor assessment by examining how well the child can coordinate movements of the mouth by having them imitate nonspeech actions (such as moving tongue from the right side to the left side). The speech therapist will also examine the coordination and sequencing of muscle movements for speech. Lastly, the oral-motor assessment will examine the rote abilities of the child by testing their functional or "real-life" situations while comparing them to "pretend" situations. An example would be asking the child to lick a lollipop versus pretending to lick a lollipop.
During a melody of speech (intonation) assessment, the speech therapist is looking to ensure that the child is able to appropriately stress syllables in words and words in sentences by examining whether the child uses the right pitch (ex. when asking a question) and to mark off different parts of a sentence (ex. to pause in between phrases when saying a sentence).
Finally, during a speech sound assessment, the speech therapist will examine both the vowel and consonant sounds of the child by checking each individual sound as well as sound combinations. Also, the test will determine how well others can understand the child when they are using parts of speech.
Treatment of Childhood Apraxia of Speech (CAS)
There has been research that shows that children with CAS have greater success in therapy when they receive intensive (3-5 times a week) and frequent treatment. It has also been found that children who attend individual sessions for treatment tend to do better than children who attend group sessions.
The focus of treatment is to improve the planning, sequencing, and coordination of muscle movements for the appropriate production of speech.
At KidsCare, we use a multi-sensory feedback approach when treating children with CAS. It is important for the child to receive feedback from a number of senses, including touch and visual cues (watching themselves in the mirror) and auditory feedback. With this type of feedback, the child can repeat syllables, words and sentences more readily to improve their muscle coordination and sequencing for speech. Additionally, practicing at home with your child is very important. The family members will often be given assignments to help the child progress optimally. The process of treatment for CAS takes time and commitment, and your child needs a supportive environment to help them reach their goals in successful communication.
Causes of Childhood Apraxia of Speech (CAS)
In most cases, CAS had been found to have no known cause. However, some possible causes include: genetic disorders or syndromes, and stroke/ brain injury. It is important to keep in mind that although CAS may be known as "developmental apraxia", it is not a disorder that children simply outgrow. There is no cure for this disorder, but with the appropriate treatment and intensive intervention, progress can be made. However, treatment is needed for CAS or progress will not be made.
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