Childhood Apraxia of Speech
By: Becca Jarzynski, M.S., CCC-SLP
If you are a parent of a child who has speech and language difficulties, you may have heard of childhood apraxia of speech (CAS). Or, you might not have. Why? For two reasons. First, childhood apraxia of speech is only one of the many reasons that children might have difficulty with speech or language. When reading about apraxia, it’s very important to remember that not every child who has difficulty with speaking has apraxia; in fact, most professionals think that apraxia is actually pretty rare. Second, the topic of apraxia of speech is much debated within our field–there is disagreement about how many kids have apraxia, how to diagnose it, how to treat it, what to call it (it’s also called developmental verbal dyspraxia and developmental apraxia of speech or DAS), and even if it actually exists at all. Which means that I must openly state that what follows is my personal opinion about childhood apraxia of speech– an opinion that is based on a mix of formal education, research review, and experience working with children who I believe do, indeed, fit into this category.
What is Childhood Apraxia of Speech?
So. First things first. What is childhood apraxia of speech? It’s thought to be a motor speech disorder which makes it very hard for children to accurately produce speech sounds. Children with childhood apraxia of speech can use their mouth muscles for things such as eating with no difficulty at all. They struggle, however, when they purposefully try to use their mouth to speak.Initial signs of childhood apraxia of speech are as follows:
- Limited history of babbling
- Late in starting to talk
- Use of only a few vowels
- Use of only a few consonant sounds
- Very hard to understand
- Might say words out of the blue and then never say them again
- Often (but not always), understands language very well and attempts to express her wants/needs/ideas through gestures, facial expressions, and intonation.
However, children can have these signs and not be diagnosed with apraxia of speech. This is because it’s really only possible to accurately diagnose apraxia of speech when a child does start talking, or at least when she’s only enough to really understand what is being asked of her and can try to imitate sounds and phrases upon request. This is when we start to see the following types of errors in speech that suggest that a more probable diagnosis of childhood apraxia of speech:
- Vowel errors
- Unpedictable and inconsistent speech sound errors— a child might say a word one way one time and another way another time. This helps us differentiate between apraxia of speech, typical speech development, and a phonological disorder. In both typical development and phonological disorders, kids make speech sound errors, but the errors are usually consistent (for example, a child might always say “tat” for “cat”). You can read more about what consistent errors children typically make here.
- Increased errors as sentence length increases (for example, saying “mama” well when saying it as one word only, but not being able to say it when saying it in a two-word phrase)
- Being able to produce a word in a learned and often repeated context (for example, while reading a repetitive book) but not another new context
- Difficulty producing new words and phrases as compared to words and phrases that have been practiced many times
- Groping or otherwise physically struggling when trying to produce a speech sound or word
- Difficulty imitating oral motor movements (for example, difficulty imitating you sticking out your tongue). This is called oral apraxia.
What should I do?What if you suspect (or know) that your child might (or does) have Childhood Apraxia of Speech? It’s impossible to capture all the possible suggestions in one little blog post, but here are some tips to get you started.
- Learn more. A really great website for learning more about apraxia of speech is www.apraxia-kids.org.
- Seek out a great speech-language pathologist. Apraxia of speech can be frustrating for everyone involved and can take a while to resolve– a good SLP can be a great guide down the road that you’ll be following for a while. You can read more about speech therapy for children with apraxia of speech here and learn how to find a good SLP with knowledge of apraxia of speech here.
- Use repetitive books, repetitive songs, and carrier phrases such as “Ready, Set, Go!” Children with apraxia of speech will often find it easier to begin to speak when they are able to “drop” a word into a phrase they have heard many, many, many times.
- Start small and build up. Children with apraxia of speech have difficulty moving from one place to another in their mouth, so we don’t make them do this at first. We start with very simple consonant-vowel words with easy sounds, such as “me” and “boo” and “hi” and then help them move to simple two syllable words such as mama and dada from there. Then we keep building. You can read more about which sounds and syllable shapes are easy and hard here.
- Help your little one learn to communicate with signs or pictures for a while. This will not prevent her from learning to talk, but it will help relieve some of the frustration that may result from her having difficulty expressing herself verbally.
- Have patience….this is the hardest, but the most important of all the steps. With hard work, determination, and time, things will get better.
Becca Jarzynski, M.S., CCC-SLP is a pediatric speech-language pathologist in Wisconsin. Her areas of specialty include child language, early intervention, autism, and developmental apraxia of speech. In her spare time, she can be found chasing her two children around, reading, and blogging about speech and language at http://www.talkingkids.org.
Forrest. K. (2003) Diagnostic criteria of development apraxia of speech used by clinical speech-language pathologists. American Journal of Speech-Language Pathology, 12(3), pp. 376 – 380