Communication Disorders
Childhood Apraxia of Speech
Childhood Apraxia of Speech (CAS) is a motor speech disorder that makes it difficult for children to speak accurately. Children with apraxia of speech have difficulty coordinating the complex oral movements needed to create sounds into syllables, syllables into words, and words into phrases. In a child with CAS, there is usually nothing wrong with the muscles used in speech. The difficulty results from a breakdown when the brain sends a message to the muscles. However, this does not mean that the child has an intellectual impairment.
What causes CAS?
In most cases, the cause for CAS is unknown. CAS is not a disorder that can be “outgrown”, rather, children with CAS will not make progress without intervention. In some cases, damage to the brain can cause CAS. The brain damage may be caused by a brain injury, a genetic disorder or a syndrome.
Often, CAS may be a part of a larger disorder that a child has, such as:
Ψ Cerebral palsy
Ψ Autism
Ψ Epilepsy
Ψ Galactosemia
Ψ Certain mitochondrial disorders
Ψ Neuromuscular disorders
Ψ Other intellectual disability
Signs and Symptoms of CAS
The three most common features in children with apraxia of speech are:
Ψ Inconsistent errors on consonants and vowels in repeated productions of syllables or words. For example, a child may pronounce the same word differently each time he or she says it.
Ψ Difficulty producing longer, more complex words and phrases.
Ψ Inappropriate intonation and stress in word/phrase production. For example, the child may have difficulty with the timing, rhythm and flow of speech.
Other additional characteristics associated with CAS include:
Ψ Late development of the child's first words and sounds.
Ψ A decreased sound inventory (for example, a lack of variety of consonant and vowel sounds expected at a certain age).
Ψ Excessive movements of the mouth or attempting to position the mouth for sound production.
Ψ Errors in the order of sound production in words (such as sounds omitted, switched, or added to words and within words).
Ψ Feelings of frustration because they can't get their message across
Ψ Difficulties with reading and spelling
Ψ Sucking, chewing and swallowing problems
Ψ Difficulty performing movements with their tongue and lips when asked to copy movements
Testing and Diagnosis of CAS
An accurate diagnosis of CAS requires a comprehensive speech and language evaluation by a speech-language therapist (SLT). The SLT will evaluate the child's speech skills as well as receptive and expressive language abilities and gather information about how the child communicates at home and in other situations.
An assessment for CAS should include an evaluation of the child's expressive and receptive language abilities, as many children with this disorder have related deficits in their language skills. In addition, they may present with word order confusion and difficulty with word recall. Therefore, a thorough assessment of the child's abilities will allow an appropriate intervention plan and therapy goals to be developed based on his or her individual needs.
Intervention for CAS
Speech-language therapy is the main intervention for CAS, which is usually administered by SLTs. Within this therapy, SLTs often use a variety of methods, such as:
Ψ Articulation or phonological therapy
Ψ Adapted cueing technique
Ψ Orofacial myofunctional therapy
Ψ Prompts for restructuring oral muscular phonetic targets therapy (PROMPT system)
Ψ Biofeedback therapy
During the therapy session, the SLT may also engage in the following techniques:
Ψ Getting the child to imitate sounds, syllables and words
Ψ Teaching the child about sounds and explaining the rules about when to use certain sounds in words
Ψ Using gestures or pictures or touch specific points on the face or neck as biofeedback to help the child make the right sound or sequence of sounds
Ψ In severe more cases, alternative ways to communicate may be introduced. These include communication boards, key word signing or voice output devices. This aims to reduce some of the frustration when a child has difficulty getting their message across.
Speech language therapy is tailored to a child’s specific needs and will address other speech or language problems should they occur together with CAS. Children with CAS need frequent, one-on-one therapy sessions to start. The sessions may be tailored down as the child improves.
Benefits of Speech Therapy for CAS
Research has shown that speech therapy is successful in helping children with apraxia of speech. Children with CAS can benefit from:
Ψ Multiple repetitions and repeated practice of sound sequences, words and phrases during therapy
Ψ The use of visual prompting to show how speech sounds are made as sequences of sounds are combined into words
Ψ Co-production, or having the child say the word at the same time as the SLT or caregiver
A child who has a limited number of words in his vocabulary, will have part of the session focus on increasing the size of vocabulary. This is to help with his or her functional communication skills. It is critical for the child to have positive experiences with communication. Positive interactions may be achieved through other modes of communication, to supplement spoken communication to achieve successful interactions with others. Using other modes of communication, while working on speech production, has been found to promote verbal skills and decrease frustration in children while communicating.
Prognosis for Children with CAS
Children do not “grow out” of apraxia of speech. It is proven that CAS is manageable with the help of an SLT. Early diagnosis and intervention of CAS will help reduce the risk of long-term persistence of the disorder and improve communication abilities. The best outcomes are achieved with collaboration between the child, therapist, family and school.
Should your child experience problems in speaking, it is recommended that get your child evaluated by an SLT sooner rather than later.
My child has CAS - How can I support them?
Family support is a key part of intervention for CAS. Your child’s speech therapist (SLT)may also assign exercises for you to practice with your child. The most straightforward way parents and caregivers can help children, is to carry out some practice at home.
Here are more things you can do to support your child better:
Ψ Not pressuring your child to speak
Ψ Showing patience when your child does want to speak
Ψ Be positive and encouraging about your child’s efforts
Ψ Model to others how to be supportive of your child’s attempts to communicate