What is Childhood Apraxia of Speech?
By Cheryl D. Lindsay MS, S-LP
The term Childhood Apraxia of Speech, (CAS) may not sound familiar to you. Occurring in only 3 – 5 % of speech impaired preschoolers, it is not a very common condition, nor is it easily diagnosed.
CAS can be described as a motor speech disorder affecting the ability to organize, plan and execute proper movement of the speech muscles necessary for accurate speech. CAS is not related to any muscle weakness, slowness, or paralysis of the face or mouth.
CAS can affect a child’s intelligibility, or clear speech, and ranges from mild to severe. You may recall the speech model from last month’s column on phonological disorders. Before a sound output is produced, the brain plans the appropriate placement and movement of the articulators.
One way to explain what happens with apraxia is by using a simple analogy. Think of the brain as a computer keyboard. When attempting to produce the sound, /m/, you hit the correct key but somewhere between selecting /m/ and the output, the result is not /m/ on the screen. Similarly, a child with apraxia may know that she wants to say, /m/, but cannot coordinate her articulators to do so, despite sending the correct message.
Although the preferred terminology is Childhood Apraxia of Speech, it may also be known as verbal apraxia, developmental apraxia of speech, or verbal dyspraxia. The root word “praxis” means planned movement. The “a” in apraxia means “absence”: which together, means “absence of planned movement.”
Some common characteristics of CAS are:
1. The child produces errors inconsistently in repeated productions. For example, the child may be observed to say “ma ma da ba” spontaneously, but when requested to “say mama”, is unable to do so.
2. The child’s speech is relatively clear in single words but unintelligible in longer sentences.
3. The child struggles to use correct placement of their articulators, primarily lips and tongue. Trial and error or “groping” behaviours of the articulators are observed.
4. The child understands more language than they are able to use; meaning that their receptive language ability is better than their expressive language ability.
5. The child has a limited consonant and vowel inventory.
6. The child has an overall slow rate of speech, perhaps monotone and choppy.
7. The child uses unusual speech error patterns.
8. The child will likely have difficulty with phonological awareness skills, reading, writing, and spelling if the apraxia persists, or is left untreated.
9. The child is easily frustrated: they appear to know what they want to say, but have difficulty saying the word(s).
A speech-language pathologist can help to diagnose CAS in children, typically between the ages of three and four years. Those between the ages of 2 and 3 may be “suspected” of having CAS, but a diagnosis at this young age is more difficult. As well, some children with severe apraxia may be nonverbal and therefore, challenging to diagnose.
Some of the key principles of therapy for apraxia are:
- Frequent practice and repetition of motor placement for sounds and sound sequences so that they eventually become automatic
- Sensory cueing including touch cues and verbal cues
- Slower rate of speech, modeled first
- Focus on speech movements versus individual sounds
- One on one, more frequent therapy, with typically slower progression
- Augment with sign language, and picture books always pairing verbal cues with gestures or visuals
(Information for this article was obtained from: www.apraxia-kids.org )
(Next Month: Fluency (Stuttering) Disorders)