Children with autism (ASD) often experience delayed speech and language development. They may show reluctance in communicating verbally. It poses a challenge for parents since autism may not occur alone!
Experts on developmental disorders in children now recommend that non-speaking (non-verbal) children with autism should undergo screening for apraxia of speech. The evaluation may not be as simple or easy since children with ASD may require more than one session to feel comfortable.
Apraxia or childhood apraxia of speech (CAS) is a rare motor speech disorder that affects 1 or 2 in 1000 children in the US.
Apraxia: The Severity Is a Spectrum
The symptoms of apraxia depend upon the severity of the condition.
A child with mild apraxia of speech may say an entire sentence with some stuttering. Another child with severe apraxia may not be able to say a word correctly without multiple repetitions and extensive support.
However, in the cases of children with autism, the signs of apraxia may become incredibly difficult to notice because of the already present atypical vocalizations, use of jargon, and self-stimulatory behaviors.
Some of the more common symptoms of apraxia include –
Distortion of Sounds
Children with apraxia may not be able to move their tongue, lips, and jaw muscles coherently to produce a target sound. It results in the distortion of sounds.
Inconsistencies in Sound Errors
A child may say the same word differently each time during conversation or therapy. It may also happen that they say a word perfectly one day but they cannot say it correctly the very next day.
Errors in Prosody
A child with apraxia is typically unable to use the same stress, rhythm, or tone while saying the same word repeatedly.
Groping For Sounds
The said child may have to attempt multiple times to move their articulators correctly to produce a target sound.
Children who don’t have autism, but only apraxia, can understand language as per their developmental level. However, those with autism and apraxia have trouble understanding and producing spoken language.
Atypical Vocalizations and Autism
Children on the autism spectrum can exhibit specific phonological patterns. These are distinct and should not be confused with echolalia in children with autism.
Studies conducted by Schoen et al on 30 toddlers diagnosed with autism show that all of them produced atypical vocalizations whereas the control population did not. A subsequent study showed that children with autism performed worse when given phonetic targets or specific words to match.
Using these studies, as well as, conducting their own research, Shriberg et. al. concluded that children with autism are more likely to make frequent errors in speech sounds and prosody. There is also a high likelihood of children with ASD to experience speech delay.
Apraxia and Autism: They Frequently Occur Together
A study published in 2015 showed that 64% of the children initially diagnosed with ASD also have apraxia. 36.8% of the children diagnosed with apraxia of speech also had autism, and 23.3% of the children received a dual diagnosis.
With improved evaluation and testing models, more children are receiving a dual diagnosis of apraxia and autism (autism spectrum disorder, or ASD). The previously mentioned study showed a diagnostic precision (autism) of 96.7%.
Studies conducted by the Penn State Milton S. Hershey Medical Center show that childhood apraxia of speech is common among children with ASD.
They referred to the checklist for autism spectrum disorder (CASD) for this study to show that children are not being overdiagnosed with either of the disorders.
The new finding seems to support the hypothesis that apraxia may be the reason many children diagnosed with ASD do not develop speech. Most children with ASD have praxis deficits that influence the imitation and execution of speech production along with a range of other motor commands.
Evaluating Apraxia in Children with Autism
It makes the diagnosis of apraxia particularly challenging in children with ASD who don’t use verbal communication. The evaluation process requires children to say at least a few words before a conclusive diagnosis of apraxia of speech can be made.
As a result, some parents may have to wait almost a year or longer to receive a proper assessment and diagnosis.
A trained child psychologist should be able to diagnose autism spectrum disorder in kids as young as 3-years old. To get your child evaluated for apraxia of speech, you should speak to a speech-language pathologist who has the experience of working with children with ASD.