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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.
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:
Might say words out of the blueand 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.
Unpredictable 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 arepetitive 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.
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.
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.
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