Developmental or Childhood apraxia of speech (CAS) is a motor speech disorder.

Signals need to go from the brain to the mouth for producing speech. These signals tell the muscles of and around our mouth how to move to make sounds.

A child who has apraxia of speech experiences disruptions in the relaying of these signals. In most cases, children with childhood apraxia of speech can understand language but cannot use it efficiently. It happens due to their inability to move their lips or tongues correctly.

The characteristics of apraxia of speech in early childhood may include limited vocalization and sound play, distortion of sounds and vowel errors, limited consonant sounds and groping movements of the mouth.

CAS is a motor speech disorder that affects around 1 to 2 in 1000 children. Individuals with developmental apraxia of speech (AOS) do not have weak muscles. Therefore, exercises that aim to strengthen muscles of the mouth and jaws are not very effective in treating the signs and symptoms of apraxia of speech in children.

What Are The Causes Of Childhood Apraxia of Speech?

Childhood apraxia of speech is present from birth. Experts sometimes refer to it as developmental apraxia of speech, articulatory apraxia, or developmental verbal apraxia.

It is not to be confused with developmental delays in speech.

There can be several potential causes of childhood apraxia of speech. Interestingly, brain imaging studies rarely show any anomalies in individuals with CAS. Hence, in most cases, the causes of CAS cannot be determined.

However, here are some of the most commonly observed potential causes of apraxia of speech in children–

1. Brain injury and neurological conditions such as a stroke, traumatic brain injury, and infections may cause CAS.

2. A genetic disorder, metabolic or mitochondrial disorder may also be the cause of CAS. Speech pathologists and neurologists have seen that galactosemia in children often co-occurs with CAS.

3. Children with mutated FOXP2 gene experience a higher risk of developing CAS as compared to others.

What Are The Complications of Childhood Apraxia of Speech?

Children with apraxia of speech have multiple problems that influence their ability to communicate. The disorder does not necessarily cause these issues. However, these conditions are common in children who have childhood apraxia of speech.

1. Delayed speech and language development – Children with developmental apraxia of speech have limited vocabulary, trouble understanding speech, and using the correct grammar.

2. Intellectual and motor delays – Children with CAS may experience problems in reading, writing, and spelling.

3. Hypersensitivity – Some children with CAS show dislike or aversion towards certain textures, foods, and clothing. It is a trait common in children with speech apraxia and autism.

Is There A Way To Prevent Childhood Apraxia of Speech?

It is difficult to predict which children will develop apraxia of speech. Since the causes of childhood apraxia of speech are still not well-established, it is indeed challenging to prevent it.

However, it is possible to diagnose childhood apraxia of speech in young children. Starting the correct treatment as early as possible reduces the long-term severity of the disorder.

What Are The Signs And Symptoms of Childhood Apraxia of Speech?

Not all children exhibit the same signs and symptoms of childhood apraxia of speech. Your child may show one or more early signs of childhood apraxia of speech mentioned below.

  1. Your child does not always say the same words, in the same way, every time.
  2. S/he may distort or change the sounds while saying a word
  3. They may be able to say shorter words more clearly as compared to longer words
  4. Children with apraxia of speech may grope for sounds – they repeat the same word/phrase multiple times till they can say it correctly
  5. Your child may stress the wrong syllable or word while speaking
  6. They may have difficulties with fine motor skills
  7. Children with CAS may experience delayed language development
  8. Some children with CAS also exhibit problems with reading, writing, and spelling

In most cases, children with apraxia of speech can understand language. However, some of them have additional speech problems like expressive language disorders.

What Is The Treatment for Childhood Apraxia of Speech?

Your child’s speech-language pathologist (SLP) may suggest multiple therapies for the treatment for childhood apraxia of speech.

Some of the more common and most effective therapies have been discussed here –

1. Speech Therapy

Children with apraxia of speech benefit from personalized and individual therapy. It allows children more time with the speech therapist or SLP to practice.

During each session, children get to practice common phrases and words. Since learning words and phrases for children with apraxia of speech (AOS) takes a long time, SLPs and parents need to be consistent and patient.

It is not uncommon for the SLP to touch your child’s face to help them make certain shapes with their lips to produce the correct sound.

Some of the general principles of speech therapy for children include –

  • Speech drills – The SLP will emphasize speech drills. It includes asking your child to say particular words or phrases multiple times during a session.
  • Speaking practice – The SLP will guide your child through saying multiple syllables, words, and phrases. Your child will slowly master moving from one sound to the next during these sessions.
  • Sound and movement practice – The SLP will ask your child to watch their mouth as they say a particular word or phrase. Next, they will ask your child to mimic the movement while trying to produce the same word or phrase.
  • Vowel practice – Many children with AOS distort vowel sounds. Your child’s speech therapist will focus on words with vowels in different syllable types. Some common words include “hi,” “out,” “bite,” and “house.”
  • Paced learning – In cases of children with severe CAS, the SLP will use small sets of practice words. The number of words will gradually increase as your child begins to improve.

2. At-Home Speech Practice

Practice is most important in any speech therapy. You will have to work with your child at home on the particular speech exercises the SLP recommends.

The SLP may give you words and/or phrases to practice with your child. They will show you how to properly guide your child.

Remember that at-home sessions can be short, but they can be frustrating for a parent. Children with apraxia of speech can take a long time to say a word or phrase correctly.

Simple exercises like encouraging your child to say "Hi dad" or "Hi mom" every time you enter the room can help their speech.

3. Therapies for Coexisting Problems

Many children with CAS also experience delays in language development. Some may even have problems with expressive language.

Their SLP should note the complications and coexisting problems that a child with apraxia of speech may have.

Some children may have an additional medical condition along with childhood apraxia of speech. The treatment of that condition may improve the prognosis of CAS for the child.

4. Alternative Communication Methods

If your child's CAS is particularly severe, they may require alternative communication methods.

In addition to speech therapy guided by the SLP, your child may benefit from learning sign language. Teaching them how to use PECS or communication boards may also help them express themselves and communicate more efficiently.

Teaching your child alternative communication methods can be beneficial for their mental health and wellbeing. They can efficiently communicate when they want or need something.

Children with severe apraxia of speech who know sign language often become less frustrated while trying to communicate with others.

Speech Therapy Activities for Childhood Apraxia of Speech

Your child’s SLP should show, recommend and list the speech therapy activities that they can practice.

Here are some activities SLPs use during speech therapy of a child with apraxia of speech –

1. Make Animal Sound Puppets

You can buy sock puppets or make them. Turn your old socks and mittens into cow, goat, dog, cat, or chicken puppets.

Use them to encourage your child to mimic animal sounds. For example, during play therapy you can say, "a cow goes moo." Allow your child to repeat "moo" after you.

Do the same for each animal puppet.

You can also play animal games and puzzles together. Discuss the respective animal and the sound it makes while playing with your child.

2. Make Short Movies

Work with your child to make short movies or videos about daily activities like going to the park, feeding the cat, talking the dog out for a walk, or waiting for the school bus.

Encourage your child to imitate the sounds you hear and name the things around you.

Allow your child to be the cameraperson, and you be the star of these short movies. Later, encourage your child to re-enact the scenes they particularly like.

3. Sing a Song

Now, your child may already know one or two lines of a rhyme or popular song. Sing with your child.

Repeat the lines if your child doesn't get the pronunciation correct on the first go.

Individuals with childhood apraxia of speech often struggle to maintain phonation and rhythm while speaking. Therefore, singing a song or rhyme is a particularly effective speech therapy technique for apraxia of speech since it has rhythm.

Differentiating Developmental Apraxia of Speech from Other Speech Disorders

Telling childhood apraxia of speech apart from other speech disorders can be challenging for laypersons.

Two children with apraxia of speech may present different sets of symptoms of the disorder. Some of these symptoms may overlap with other disorders as well.

It is always a wise decision to consult an experienced speech-language pathologist for a differential diagnosis.

How Can Parents Help?

Childhood apraxia of speech (CAS) undoubtedly requires the attention of a professional for confirmed diagnosis and treatment. However, since a child interacts with their parents most at home, it is the responsibility of the parents to ensure that the child feels motivated enough to practice at home.

At-home care, attention, and practice are of paramount importance for treating a child with AOS. Children who receive parental guidance and support show faster improvement rates than children who only practice their speech exercises in the clinic.

Here’s how to help a child with speech apraxia –

1. Fostering a Positive Environment

The child who has apraxia of speech may experience frustration, anger, and disappointment every day when s/h tries and fails to communicate. Therefore, parents must remember to be supportive no matter how severe the apraxia.

Depending on the severity of AOS the child may have to attend consecutive therapy sessions every day of the week for a month or longer.

Parental support is of utmost importance, so the child retains a positive attitude towards speech therapy and speaking.

It’s up to the parents to foster a supportive environment at home. They should not ask too many questions, but at the same time, encourage their child(ren) to speak spontaneously.

If your child has severe apraxia, you may want to consider an alternate communication language. It may include picture boards, sign language, or gestures. It is equally important for a parent to acknowledge these communication efforts.

2. Practicing at Home

Firstly, you should acknowledge your child's efforts to communicate. Secondly, you should correct your child's speech only a few times per day. Correct only those words that your child has been learning at therapy.

Always pick a particular time to practice and keep it short. Make sure that the practice is enjoyable for the child as well.

If, one day, your child does not feel like talking, don't force them to talk. Engage in bonding activities that both of you can enjoy. Work on puzzles, building blocks, or crafts – pick something your child likes. It will engage their fine motor skills as well as creativity without seeming like a therapy activity.

3. Helping Them Move Forward

There are times when a child with apraxia of speech may get stuck on a word or phrase. As a parent, you have to be patient and not show frustration.

Bring the difficult words up with their speech-language pathologist (SLP) and discuss constructive ways to help your child through their speech.

If your child is old enough to communicate which part they find the most challenging, you can talk to them about it.

Your child may be tired or bored after days of practicing the same words and phrases. In such a case, talk to the speech-language pathologist and find new ways to engage your child in their daily home speech practice for childhood apraxia of speech.