A Parent’s Guide to ApraxiaTuesday October 16, 2018
Receiving the news that your child has childhood apraxia of speech (CAS) can be devasting, shocking and confusing. Because this speech/sound disorder is rare—occurring in 1-2 children per 1,000—many doctors, educators, professionals and even speech-language pathologists have minimal understanding of CAS, its causes, characteristics and treatment. Listed below is what YOU should know about childhood apraxia of speech.
What is childhood apraxia of speech?
Childhood apraxia of speech is a motor speech disorder that first becomes apparent as a young child is learning speech. Children with apraxia of speech have great difficulty planning and producing the precise, highly refined and specific series of movements of the tongue, lips, jaw and palate that are necessary for intelligible speech.
CAS is sometimes called verbal apraxia, developmental apraxia of speech, or verbal dyspraxia. No matter what name is used, the most important concept is the root word “praxis.” Praxis means planned movement. To some degree or another, a child with the diagnosis of apraxia of speech has difficulty programming and planning speech movements.
While CAS is considered a specific speech disorder, difficulty in planning speech movements is the hallmark or “signature” of apraxia and what makes treatment strategies for CAS different than those of children with other kinds of speech disorders.
What causes childhood apraxia of speech?
The current knowledge that we have about CAS is that it occurs in the following 3 conditions:
- Neurological impairment: Caused by infection, illness or injury, before or after birth, or a random abnormality or glitch in fetal development. This category includes children with positive findings on MRI’s of the brain.
- Complex neurodevelopmental disorders: We know that CAS can occur as a secondary characteristic of other conditions such as genetic, metabolic and/or mitochondrial disorders. Examples of complex neurodevelopmental disorders include autism, fragile X syndrome, galactosemia, some forms of epilepsy, and chromosome translocations involving duplications and deletions.
- Idiopathic speech disorder (a disorder of “unknown” origin): With this condition, we currently don’t know “why” the child may have CAS. Children do not have observable neurological abnormalities or easily observed neurodevelopmental conditions.
What are the characteristics of childhood apraxia of speech?
- Difficulty moving smoothly from one sound, syllable or word to another
- Groping movements with the jaw, lips or tongue to make the correct movement for speech sounds
- Vowel distortions, such as attempting to use the correct vowel, but saying it incorrectly
- Consonant distortions, such as attempting to use the correct consonant, but saying it incorrectly
- Using the wrong stress in a word, such as pronouncing "banana" as "BUH-nan-uh" instead of "buh-NAN-uh"
- Using equal emphasis on all syllables, such as saying "BUH-NAN-UH"
- Separation of syllables, such as putting a pause or gap between syllables
- Inconsistency, such as making different errors when trying to say the same word a second time
- Difficulty imitating simple words
- Inconsistent voicing errors, such as saying "down" instead of "town," or "zoo" instead of "Sue"
How should childhood apraxia of speech be treated?
Children who have CAS do not progress well in speech production with therapy tailored for other articulation problems or solely with language stimulation approaches. Additionally, in young children the speech motor/sensory techniques and repetitions of words and target phrases should be woven into play activities that are highly motivational to them. Families and experienced therapists report that children with apraxia need frequent, one-on-one therapy and lots of repetition of sound sequences and speech-movement patterns to incorporate these new skills and make them automatic.
Parents and caregivers are critical to the success of children who have apraxia of speech. Parents should look to their child’s speech-language pathologist as a coach, tutor and guide so that the practice they encourage at home is appropriate for their child’s current ability level. Children who have apraxia need to gain confidence in the speech therapy process and in themselves. Appropriate speech therapy and home practice, woven with support and understanding, can go a long way to assist children to become “risk-takers” in their speech.
What are some important resources for parents of children with childhood apraxia of speech?
- Apraxia Kids
Apraxia Kids (formerly CASANA) is the leading organization whose mission is to strengthen the support systems in the lives of children with childhood apraxia of speech, so that each child is afforded their best opportunity to develop speech and optimal communication skills. Apraxia Kids has a website full of valuable information for parents, educators, therapists and professionals. Listed below are links to just a few of the great resources offered on their website:
- Family Start Guide: https://www.apraxia-kids.org/guides/family-start-guide/
- SLP Start Guide: https://www.apraxia-kids.org/guides/slp-start-guide/
- CAS Library: https://www.apraxia-kids.org/learn-about-apraxia/library/
- Letter to Teachers:
- How to find a SLP when your child has CAS: https://www.apraxia-kids.org/wp-content/uploads/2013/01/Find-an-SLP-Flyer.pdf
- Mayo Clinic
The Mayo Clinic, located in Rochester, Minn., is one of the leading research, diagnostic and treatment facilities for children who have CAS. Their website is also full of valuable information related to childhood apraxia of speech: https://www.mayoclinic.org/diseases-conditions/childhood-apraxia-of-speech/symptoms-causes/syc-20352045
The Carruth Center at The Parish School is a sponsor for the 2018 Houston Walk for Apraxia. Join us on Saturday, November 3 at The Westview School (1900 Kersten Dr.) to support children who have apraxia of speech. This fun, family-friendly event features food, games, face painting and auction, as well as the opportunity to meet local specialists and other families of children who have apraxia.
For information, visit http://community.apraxia-kids.org/site/TR?fr_id=2789&pg=entry
- Pediatric Adaptation of the Mayo 10 (ASHA, 2007, Davis, Jacks, & Marquardt, 2005; Luzzini-Seigel et al, 2015; Shriberg and Strand, 2014)