Apraxia is a speech-sound disorder. People with apraxia of speech know what to say, but they experience difficulty in coordinating the movements of different parts of the mouth necessary for producing the correct sounds.
If you are an adult with apraxia or the parent of a child with apraxia of speech, you may find the diagnosis demoralizing. You may be struggling with difficult emotions and it’s completely normal.
We are here to answer all the questions you have about apraxia, its symptoms, and speech therapy for childhood apraxia of speech.
- What Is Apraxia?
- What Are The Types of Apraxia?
- Is Apraxia of Speech Common?
- What Are The Symptoms of Apraxia?
- What Are Some Early Signs of Childhood Apraxia of Speech (CAS)?
- What Are Other Developmental Complications Associated With Apraxia of Speech?
- What Causes ‘Apraxia of Speech’?
- Is There A Prevention For Childhood Apraxia of Speech?
- How Is Apraxia Diagnosed?
- Is There a Treatment For Apraxia of Speech?
- Myths and Misconceptions about Apraxia
- Difference between Aphasia and Apraxia
- Tips for Parents to Help a Child with Apraxia of Speech
- Are Speech Apraxia & Autism Spectrum Disorder (ASD) Related?
- How Can Stamurai Help In The Evaluation & Treatment Of Apraxia Of Speech?
What Is Apraxia?
Apraxia of speech is a speech sound disorder. It is also known as verbal apraxia, acquired apraxia of speech, or childhood apraxia of speech (CAS).
To produce speech, our brain sends signals to the lips, tongue, jaws, and other parts involved in speech production. These parts have to work in coordination with one another to produce normal speech. In apraxia of speech, the process is disrupted. The signals from the brain don't flow smoothly to the muscles.
The brain of the person knows exactly what to say, but the disruption in signal flow prevents the planning and execution of the movements necessary for speech sound production.
People with apraxia of speech face immense difficulty in coordinating the muscle movements needed to produce syllables, words, and phrases. It is extremely difficult for them to communicate via spoken language. If you know someone with apraxia, you may have described them as "hard to understand."
What Are The Types of Apraxia?
Although we use the term "apraxia" to describe individuals who have trouble coordinating mouth movements that produce sounds, there are different types of speech sound disorders. There are two common categories –
Childhood Apraxia of Speech
Children may have apraxia of speech since birth. In such cases, the disorder is referred to as childhood apraxia of speech (CAS). Difficulty in planning speech movements is the defining symptom of this disorder.
To parents, it may seem similar to speech delay. It may appear as if the child wants to speak, but is grasping to make the right sound. It may also appear similar to babbling for children between the ages of 6-months and 2-years. That makes the early detection of CAS challenging.
Acquired Apraxia of Speech
Acquired apraxia of speech (AOS) can affect individuals of all ages. It occurs most commonly in adults. Apraxia of speech in adults is caused due to injury or damage to the parts of the brain responsible for the planning and production of speech.
Acquired apraxia of speech can cause the impairment and loss of the existing ability to speak.
Is Apraxia of Speech Common?
Data on the prevalence of speech apraxia is still lacking. However, researchers estimate that around 1 out of 1000 children have childhood apraxia of speech. CAS is more common among male children as compared to female children.
According to recent reports, the incidence of CAS has increased in recent years. This sudden rise can be attributed to –
- Increasing awareness (and subsequent diagnosis) about speech sound disorders
- A higher number of children receiving early evaluations for CAS from professionals
- More research being conducted on apraxia of speech
What Are The Symptoms of Apraxia?
Apraxia of speech may present differently in different individuals. The symptoms of CAS can vary significantly between two people.
In the case of mild apraxia of speech, the person may face difficulty with only a handful of speech sounds. They may be able to speak almost normally, but have trouble saying longer multisyllabic words.
In severe cases of apraxia, the person may not be able to communicate via spoken language at all. The most common symptoms of apraxia of speech include –
- The affected individual may not be able to say the same words, in the same way, every time.
- They may distort the sound of the words while speaking.
- They may have more trouble saying longer, multisyllabic words.
- Those with AOS may stress the wrong syllable while speaking.
- They may use improper intonations and rhythm while talking.
- Children and adults with verbal apraxia seem to grope for sounds as they try to produce the correct sounds.
- Most individuals with AOS also face difficulties with fine motor skills.
- Children with CAS experience delays in speech and language development.
- Many children with CAS exhibit difficulties in reading, writing, and spelling.
What Are Some Early Signs of Childhood Apraxia of Speech (CAS)?
Some signs and symptoms associated with childhood apraxia of speech in infants and toddlers include –
- The child says their first words later than their same-aged peers.
- A child with verbal apraxia babbles less during the appropriate age.
- They may show excessive movements of the mouth (groping for sounds).
- The child may exhibit regression in the number of words they produce.
- They may say phrases like "thank you" or "hello" correctly but have trouble with voluntary speech production.
- Children with CAS make frequent errors in the production of sounds in words. They can omit, switch, or add sounds to words.
What Are Other Developmental Complications Associated With Apraxia of Speech?
Children with apraxia of speech seem to struggle with several issues that affect their ability to communicate. Sometimes, they exhibit developmental delays which are not the cause or effect of apraxia of speech but co-occur with CAS.
Some of these complications that co-occur with apraxia of speech in children include –
Delays in speech-language development
Children with CAS may exhibit a limited vocabulary and minimal understanding of grammar. They may also have trouble understanding spoken language.
Intellectual and motor delays
Children with apraxia of speech can have trouble walking, running, doing fine work with their hands (fine motor dexterity), coordinating movements, and motor planning. The inability of a child to learn at the level expected for their age is an intellectual delay, which may be present in someone with CAS.
Hypersensitivity
It is less common in children with CAS, but some children exhibit severe aversion to specific sounds, textures, temperatures, and lighting. It is more common among children with autism spectrum disorder (ASD).
Often children with apraxia of speech receive a dual diagnosis. Specialists often diagnose CAS with autism spectrum disorder (ASD), learning disorder, and hearing loss.
What Causes Apraxia of Speech?
Childhood apraxia of speech is present since birth. Although experts often refer to it as developmental apraxia of speech, children do not "grow out of it," like developmental stuttering. It is in no way similar to or synonymous with developmental delays in speech.
In most cases, the cause of CAS is unknown. There are several potential causes of childhood apraxia of speech. The brain imaging studies like MRI and PET scans rarely show any anomalies in the brain structure of a child with CAS. That makes it difficult to pinpoint the cause of CAS.
Nonetheless, here are some of the most probable causes of childhood apraxia of speech (CAS) –
- Injury or damage to the brain caused by stroke, traumatic brain injury (TBI), and infections such as meningitis.
- A genetic disorder or metabolic disorder. Research shows the co-occurrence of galactosemia in children diagnosed with CAS.
- Children with mutations in the FOXP2 gene have higher risks of developing CAS.
Is There A Prevention For Childhood Apraxia of Speech?
It is impossible to predict who will develop childhood apraxia of speech. Currently, there are no tests that can determine the chances of an unborn child (fetus) developing CAS in the future. It is primarily because the main causes of CAS are not yet well-established. That makes it impossible to prevent CAS in children.
However, early diagnosis and interventions in children make it possible for children to acquire communication skills and improve their quality of life.
How Is Apraxia Diagnosed?
Speech-language pathologists (SLP) play a key role in the diagnosis of CAS. There is no single sign or symptom that defines apraxia of speech, especially in children. Currently, there is no test that can differentially diagnose CAS. SLPs look for a bunch of symptoms that we have described in the section above, to make the diagnosis.
During the evaluation process, the SLP may ask the child or adult to perform several speech tasks such as repeating a word multiple times, repeating a list of words that range from monosyllabic to multisyllabic or repeating a sentence. For diagnosing CAS, the SLP may have to observe the child's speech for an extended period (days to weeks).
In the case of acquired apraxia of speech (AOS), the SLP may also test the individual’s ability to read, write, converse and carry out non-speech movements.
Several developmental conditions have symptoms that can be confused with apraxia of speech. The SLP makes careful observations to rule out aphasia, cerebral palsy, receptive language disorders, and muscle weakness that can cause speech disorders. Ruling out other disorders and conditions that have the same or similar symptoms can help with the diagnosis.
Is There a Treatment For Apraxia of Speech?
In the rarest of the rare cases, individuals with acquired apraxia may recover on their own. SLPs refer to such instances as spontaneous recovery.
However, children with verbal apraxia (CAS) will not outgrow the condition on their own. CAS often requires one-on-one speech-language therapy with exercises for childhood apraxia of speech. The SLP might take time to assess the child’s acquired language and communication skills before devising a tailored apraxia treatment plan.
Treatment or speech therapy for apraxia can continue for months or years alongside normal schooling.
Children with childhood apraxia of speech (CAS) may benefit from –
- Exercises that involve repetition of word sounds, words, and phrases.
- Visual cues that exhibit how two or more sounds produce words.
- Repeating words and saying them together with the speech therapist or parents.
- The treatment may be similar for adults who have acquired apraxia later in life.
Since the symptoms of the disorder vary, the progress varies as well. Two kids receiving the same childhood apraxia of speech treatment may progress differently at their own pace. Parents, caregivers, and friends have to be constantly appreciative and encouraging of the child or adult's trials and achievements.
Continuing practice of at-home apraxia exercises is of paramount importance for catalyzing progress.
In more severe cases of apraxia, both children and adults may need to learn augmentative and alternative methods of communication. AAC may include –
- Sign language (ASL)
- Using a notebook or photos or written words
- Using a communication board or tablet to produce speech from written words
These alternative methods of communication can help a person express themselves. However, they may not have to use AAC devices for life. Using these models while attending offline or online speech therapy sessions for apraxia of speech can help in the progress. Most importantly, they can reduce the frustration of a person who's currently unable to communicate due to apraxia of speech.
Myths and Misconceptions about Apraxia
Apraxia is not a common speech disorder. As a result, the web is riddled with several misconceptions and myths about apraxia. Here are some of the most common ones that can derail the treatment for apraxia in children and adults –
There’s Only One Type of Apraxia
There are at least two types of apraxia – childhood apraxia of speech (CAS) and acquired apraxia of speech (AOS). Both the conditions affect how signals travel from the brain to the parts of the mouth that produce speech. CAS is typically present from birth, but AOS can be a result of TBI, stroke, or tumors.
Apraxia of Speech Is Muscle Weakness
There is no muscle weakness involved in apraxia of speech (CAS and AOS). The signaling mechanism between the brain and mouth may be disrupted. Activities to strengthen the muscles of the mouth do not help with speech production in the case of childhood apraxia of speech or acquired apraxia of speech.
Children Will Grow Out Of CAS
CAS is not a developmental disorder and children cannot grow out of CAS on their own. It is a complex speech disorder that demands prolonged speech therapy and exercises.
CAS Is a Sign of Intellectual Disability
Although intellectual disability (ID) can co-occur with CAS, apraxia of speech is not a sign of ID. A child with CAS knows exactly what they want to say, but they have trouble making the accurate movements necessary for producing speech.
A Physician or Pediatrician Can Diagnose Apraxia of Speech Successfully
It is a common belief that your GP or pediatrician will be able to diagnose apraxia of speech in children, but in reality, you need to consult an SLP for a conclusive diagnosis.
Your GP or another health professional may be able to guide in the cases of acquired apraxia of speech (AOS) in adults following a stroke, or traumatic brain injury. However, for proper treatment of apraxia, you need to contact a licensed and experienced speech-language pathologist.
Apraxia of Speech Is Untreatable
Apraxia of speech is completely treatable through speech therapy. It takes time and persistence. You or your child may require months to be able to gain the ability to speak, but apraxia of speech therapy techniques are effective.
For more facts on apraxia of speech and childhood apraxia of speech, you can refer to this article.
Difference between Aphasia and Apraxia
Aphasia is a language disorder that affects a person's ability to communicate. It can affect your speech, reading, and writing abilities. It may also have an impact on how you understand language. It can appear after a head injury or stroke.
Since aphasia and apraxia both affect a person’s ability to talk, people often confuse the two. Distinguishing apraxia and aphasia may be difficult unless you are working with a speech therapist or speech-language pathologist (SLP).
Some Tips for Parents to Help a Child with Apraxia of Speech
Learning that your loved one has apraxia can be disheartening and worrisome. It is completely normal, but you should know that you aren’t alone. Here are a few tips for parents of children with CAS from our in-house SLPs –
- Always respond to their efforts of communication.
- Take help from an SLP to teach your child other forms of communication.
- Use the sounds, words, and phrases the SLP targets during therapy.
- You can request your child to correct their speech once in a while.
- Don’t ask too many open-ended questions.
- Do not ask your child to repeat words that they are saying incorrectly. Talk to their SLP instead.
Are Speech Apraxia & Autism Spectrum Disorder (ASD) Related?
A recent study shows that childhood apraxia of speech and autism spectrum disorder (ASD) tend to co-occur. So, if your child has been diagnosed with CAS, you should pay closer attention to see if they are also showing any symptoms of ASD.
Consult a speech therapist for apraxia of speech to know if your child is at risk of any other co-occurring speech-language or communication disorder.
How Can Stamurai Help In The Evaluation And Treatment Of Apraxia Of Speech?
Stamurai has licensed speech-language pathologists, who first evaluate the child or adult with apraxia symptoms. Next, they determine the severity of the symptoms. The SLPs devise a therapy plan based on the thorough evaluation and assessment of childhood apraxia of speech.
However, here’s a general view of online therapy for apraxia from Stamurai –
Online Speech Therapy for Apraxia: Ages 0-3 years
The parents talk directly to the speech-language pathologist. The SLP works with both the child and the parents to teach apraxia exercises that can improve the movement of the lips, jaws, and tongue. The parents have to continue practicing at home with the child to ensure the maximum efficiency of the therapy.
Online Speech Therapy for Apraxia: Ages 3-6 years
When the child is a little older, the SLP can work directly with them. Parents should sit in, so they can also learn valuable communication skills and at-home speech therapy exercises for apraxia of speech.
Online Speech Therapy for Apraxia: Ages 7-years and above
Older children can attend online speech therapy for apraxia of speech by themselves. Parents receive regular updates from their speech therapist after every session. The at-home practice of speech therapy exercises for apraxia of speech is mandatory for older children as well!
Online Speech Therapy for Apraxia: Adults
Adults typically come to us with acquired apraxia of speech (AOS). The Stamurai SLP will talk to the adult and, if necessary, their family members or caregivers to find out more about the incidence of the condition. Adults can typically attend the video therapy sessions all by themselves, but they can also ask their loved ones to sit in with them.
Book an online consultation with a certified and experienced speech-language therapy (SLP) for quick and accurate assessment of apraxia of speech symptoms right away!
