Childhood Apraxia of Speech Explained
May is Apraxia Awareness Month! If you have a child in speech therapy or are within the therapy world, you may have heard the term apraxia. There is often a lot of confusion about apraxia – especially if it is new or unfamiliar to you. Apraxia can occur in both adults and children, but today we’re here to talk childhood apraxia of speech. Let’s dive in!
Apraxia is a neurological motor speech disorder that affects a child’s ability to plan and sequence the movements needed for speech. This can result in errors in speech sound production and prosody.
Here’s an example! You ask your child what they want for snack. Your child wants an cookie. They can a see a picture of a cookie in their mind, but may have difficulty initiating the movement needed to say “cookie” (tongue retraction for /k/, lip rounding for the vowel).
Think of it as a disconnect in the ‘wires’ (or motor pathways) from the brain to the mouth.
In children with CAS, we may also see difficulty with gross or fine motor planning.
So what does CAS actually look like? If your child has apraxia, you may notice…
Slower Rate of Speech
Consonant Distortions
Vowel Distortions
Voicing Errors
More errors as utterances increase in length or complexity
Insertion of a ‘schwa’ sound (“-uh”) between consonants or at the ends of words
Inconsistent Errors
Articulatory groping (think: excessive movements of the mouth to try to attain speech productions)
Apraxia is a motor speech disorder. When you hear the term ‘speech sound disorder,’ this may also refer to an articulation disorder, phonological disorder, or dysarthria, which is a different type of motor speech disorder. The confusing thing? Often times we get kids who present with a mix of speech sound disorders. So how can SLPs tell the difference?
Apraxia vs. Articulation Disorder: An articulation disorder is a type of speech sound disorder in which a child may have a few errors on specific sounds (think frontal lisp). Errors on these sounds are typically consistent, as opposed to apraxia, in which we often see inconsistent errors. Treatment for articulation disorders consists of targeting specific sounds, rather than a motor based approach (intervention focused on speech movement).
Apraxia vs. Phonological Disorder: A phonological disorder is a speech sound disorder in which we see patterns of speech sounds errors. For example, a child with a phonological disorder may consistently delete final consonant sounds or omit sounds in consonant blends. These errors follow the rules and are usually predictable! Errors related to apraxia are (again) likely more inconsistent, may occur more when is a child is combining more words/using a longer sentence, or may present as consonant/vowel distortions.
Apraxia vs. Dysarthria: Apraxia and dysarthria are both motor speech disorders. The difference between these two is that apraxia is a motor planning deficit. Difficulty with producing speech is related to reduced coordination of the movements needed for speech, making speech difficult to produce. Dysarthria is a speech disorder caused by muscle weakness or paralysis.
It can be difficult to know if your child truly has apraxia at a very young age. Here are some early characteristics of apraxia that your SLP may ask about or observe when gathering information for a diagnosis.
Limited babbling as an infant
Loss of previously produced words (she said it once and has never repeated it)
Delays with fine/gross motor skills
Using more vowels than consonants by 13-16 months
Using less than 3 consonants by 16 months
As a parent, you may read or hear about various apraxia treatment programs that can be implemented throughout therapy. Your SLP will likely use a treatment approach or combination of approaches based on the severity of your child’s apraxia, and their specific needs. The most important thing to know about treatment for apraxia is that it should focus on improving motor planning skills, rather than be focused on producing individual speech sounds.
UPDATED: Check out these 5 tips for practicing at home with your child. Thanks to Ms. Jordan for contributing!
Use a target word list – ask your child’s SLP to provide you with a list of words to practice at home. This list should include 3-5 words your child has been focusing on in their sessions.
Encourage your child to look at you during practice – during practice, encourage your child to look at you. Seeing your mouth movements helps them learn how to form the words correctly. Try practicing in front of a mirror together!
Quality over quantity — repetition is very important for children with CAS so they can learn the speech movements. Try to get successful repetitions of words rather than incorrect productions. This will help them carryover words into their spontaneous speech much faster.
Provide cues and feedback — use cues to help your child before they say a word and give feedback afterwards to let them know how they did. This helps them understand and improve their speech.
Make it fun – speech practice doesn’t have to be boring! Incorporate the target words into daily activities and keep things light-hearted. If frustration sets in, take a break and come back to it later with a fresh approach.
Childhood apraxia of speech is a neurological motor speech disorder in which the planning/programming of movements needed for speech are impacted. Apraxia is not a medical diagnosis! SLPs diagnose and treat apraxia. Apraxia may also occur with other speech sound disorders or diagnoses. In treatment of any speech sound disorder, communication between the SLP and the parent is so important! We need everybody to be on board and know what your child is working on. Practice at home is crucial to help your child make progress!
Have questions about apraxia, or if this might be relevant to your child? We are here to help! Contact us here or reach out to your SLP today!
If you have a child with CAS - be on the lookout for a follow up post later this month on how to help your child’s speech at home!
