Childhood Apraxia Of Speech, Autism, Or Both?

Childhood apraxia of speech (CAS) is a motor speech disorder which makes it difficult for children to speak sounds, syllables, and words. The difficulty has nothing to do with weak muscles or paralysis. Instead, in childhood apraxia of speech, the brain has a problem with planning out how to move the body parts used for speech, such as the mouth, jaw, tongue, and lips. The child knows what sounds or words  s/he wants to say, but his or her brain can’t figure out how to make all the face parts work together to make the sounds come out.

Signs Of Childhood Apraxia Of Speech

The brain is a complicated place. That means that not every child with childhood apraxia of speech will have the same signs and symptoms. The brain of each child with CAS will have different strengths and weaknesses in planning out sounds and words. One child may have no trouble using her tongue for speech, but her brain may not be able to make her jaw work in tandem with her tongue, for instance.

For this reason, that every child’s brain is different, the signs and symptoms of childhood apraxia of speech will differ from case to case. That is why any child suspected of having CAS must be evaluated by a speech-language pathologist (SLP) who has experience with childhood apraxia of speech. An SLP with experience in CAS will be able to figure out if the child’s problem with speech is childhood apraxia of speech or one of the many other difficulties that can cause speech problems. Knowing the cause of the speech difficulty  goes a long way toward getting your child help.

Here are some general signs you might notice in childhood apraxia of speech:

Childhood Apraxia Of Speech: The Very Young Child

• Doesn’t coo or babble as a baby
• First words are late, and may be missing sounds
• Can only make a few different consonant and vowel sounds
• Has trouble putting sounds together; there may be long pauses between the sounds
• Tries to simplify words by switching hard-to-say sounds with easier ones, or by leaving out the trickier sounds (all children do this, but children with childhood apraxia of speech do this more often)
• May have problems with eating

Childhood Apraxia Of Speech: The Older Child

• Makes mistakes with speech sounds, but not always the same sounds, and not the sort of speech mistakes young children tend to make
• Understands what people are saying, better than he can speak
• Finds it hard to imitate speech, but this is easier than just speaking
• Looks like he finds it hard to make his lips, tongue, and jaw work together when trying to make sounds or speech
• Long words and sentences are more difficult, so he may choose shorter words and phrases, instead
• When he’s anxious, it’s even more difficult to make sounds and words
• He’s hard to understand, especially when the listener is someone he’s never met before
• His speech sounds different—he sounds choppy, or his voice doesn’t go up and down, or he may stress the wrong syllables or words

Childhood Apraxia Of Speech:  Other Problems

• Delayed language development
• May forget words or put words in the wrong order
• May have trouble with fine motor movement (coordination)
• May be oversensitive or under-sensitive in their mouths, for instance, may find brushing his   teeth unpleasant, may not like eating crunchy foods like popcorn, or he may not be able to tell what an object is, when placed in the mouth
• Children with childhood apraxia of speech may have it hard learning to read, write, and spell

Childhood Apraxia Of Speech: Diagnosis

The first step in diagnosing childhood apraxia of speech or any other speech difficulty is to have your child’s hearing tested by an audiologist. You may need to have your child seen by an ear, nose, and throat specialist, first. You want to make sure that your child doesn’t have a hearing loss, which could make it hard for your child to hear how sounds are supposed to be made. If he can’t hear sounds, he would have trouble speaking. So first check his hearing.

Assuming your child’s hearing is fine, the next step in diagnosing speech difficulties is to have your child evaluated by a certified speech language pathologist. Make sure that the SLP has experience in evaluating children with childhood apraxia of speech. During the evaluation, your child’s oral-motor skills will be tested, along with his melody of speech and his speech sound development. The SLP should be able to diagnose CAS and at the same time, rule out other speech difficulties. Sometimes, however, it’s difficult for the SLP to get a large enough sample of speech from a child to confirm the diagnosis for sure.

Assessing Oral-Motor Skills in CAS:

• The  SLP will check your child for dysarthria: signs of poor muscle tone or weakness of the lips, tongue, and jaw. Children with childhood apraxia of speech often don’t have muscle weaknesses. This is more about ruling out CAS.
• The SLP will look to see if the child can coordinate the parts of the mouth when not making sounds. For instance, your child may be asked to smile, frown, or pucker up his lips.
• The SLP will look at how your child uses his mouth parts, for instance, the order in which the parts of the mouth are used to make a specific sound. Your child may be asked to repeat a long list of sounds as fast as he can, for instance kih, pih, fih, tsih.
• The SLP will watch to see how your child uses his mouth in real situations and pretend situations. For instance, he may be given a lollypop to lick, and then later be asked to pretend to lick a lollypop. This is the SLP’s way of checking how well your child does when performing tasks by rote or imitation.

Assessing Melody Of Speech (Intonation) In CAS:

• The SLP listens to the child speaking to see if she knows when to stress syllables and words within sentences.
• The SLP evaluates whether the child understands how to use pitch and pauses to show the type of sentence, for instance a question versus a statement; and to show the different parts of sentences, for instance to pause after a phrase and not in the middle of a phrase.

Assessing Speech Sound (Sounds In Words) In CAS

• The SLP listens to how your child says vowels and consonant sounds
• Your child will be assessed for how he says individual sounds (syllables) and how well he puts certain sounds together (word shapes)
• The SLP looks to see how well others understand what your child is saying when he speaks words, phrases, or carries on a conversation
• Some SLP will look to see if the child has problems understanding and expressing himself in words, and how well he writes and understands the written word in order to check for coexisting problems or to rule them out

Childhood Apraxia Of Speech: Treatment

Research finds that children with CAS do better when they have many sessions of treatment a week, for instance 3-5 times a week. It is better for children to have individual treatment rather than be treated in groups. But after there’s some improvement, children with childhood apraxia of speech may not need so many treatments per week, and group therapy sessions may be useful or even preferred to individual treatments.

In treating childhood apraxia of speech, the therapist aims to improve the planning, ordering, and in tandem movement of the muscles used in making sounds and speech. There is no need to work to strengthen the muscles used in sound, as CAS has nothing to do with oral muscle weakness. Childhood apraxia of speech is all about coordination.

The most important thing for improving speech in a child with childhood apraxia of speech is to practice, practice, practice. But it can help to use the different senses to make such practice have more of an impact. A child with CAS might, for instance, watch herself in the mirror as she practices making sounds, to add a visual cue. Or, the child can listen to a recording of someone saying the word the correct way, with pauses for the child to repeat what she hears. This would add an auditory cue, something the child can hear. She can even tap herself on the jaw when that part of the jaw is used to form a word, to add  the sense of touch. Using all the senses is called a multisensory approach and helps makes lessons stick.

Some children with childhood apraxia of speech are taught sign language or may use a device such as an iPad to help them communicate. This can be helpful in the case where the apraxia makes it very hard for the child to speak. Once the treatments begin to help, the child can phase out the use of sign language and devices, but they can really help lower the child’s level of frustration in certain cases.

In addition to treatment sessions, children with childhood apraxia of speech will need to practice speaking at home. The therapist will give homework to the family, at times, designed to help the child get better at speaking in real situations.

Families must be very patient since treating childhood apraxia of speech may take a long time to yield results. It takes lots of time and a commitment by the whole family to help the child with CAS progress. Children with childhood apraxia of speech need to feel they have the full support of their families.

Childhood Apraxia Of Speech: Helpful Organizations

Here are some organizations that can be helpful to children with childhood apraxia of speech and their families:

• Apraxia-Kids information site
• National Institute on Deafness and Other Communication Disorders
• Speechville Express

Childhood Apraxia Of Speech:  Causes

Most of the time, we don’t know why a child develops childhood apraxia of speech. Some of the known causes of this motor speech disorder are:

• Genetic disorders or syndromes
• Stroke or brain injury

Sometimes, experts refer to childhood apraxia of speech as “developmental apraxia.” This term can lead parents to think that CAS is something a child can outgrow, which is not the case. Some children with developmental speech disorders outgrow them.  But CAS is not outgrown and there is no cure.  Children with childhood apraxia of speech can, however, make great progress with  lots of hard work and support. Getting a diagnosis as early as possible, and getting the right kind of treatment, is really important.

Childhood Apraxia Of Speech: Is It Common?

Actually, there’s not a lot of data on the topic, so we just don’t know how many children have childhood apraxia of speech. It does seem like more children than ever are being diagnosed with CAS. But that may be because we’re getting better at spotting  speech difficulties and diagnosing them.

Research shows, on the other hand, that a full seventy-five percent of cases of childhood apraxia of speech are misdiagnosed. And then you have the cases of CAS that get confused with autism. Finally, as it turns out, sixty-four percent of children diagnosed with autism, turn out to have childhood apraxia of speech in addition to autism. This is why it is so important to get an expert evaluation of your child by different specialists, as soon as you possibly can. And if you’re not satisfied with your child’s progress, consider having her evaluated by another expert in the field.

It’s hard watching a child struggle with childhood apraxia of speech, but your love and support will serve her well!