ChildHood Apraxia

Childhood Apraxia of Speech (CAS) is a motor speech planning & programming disorder that makes it challenging for a child to speak.  Although the exact cause of CAS is not usually known, Childhood Apraxia is a neurological or brain-based disorder that makes it difficult for a child to correctly sequence the movements of the oral speech components to correctly produce words, phrases, and sentences. A child with CAS may sometimes know exactly what they want to say but have trouble moving their tongue, teeth, lips, as well as various muscles involved with speaking to correctly say what they have in mind.

Child Apraxia is a very rare disorder with about a 1% prevalence rate.  It that can occur on its own or be present alongside other disorders such as autism spectrum disorders, learning disabilities, literacy disorders, language disorders, and Development Coordination Disorder.  More often than not, a child with apraxia will have one or more other conditions. CAS can range from a mild impairment to severe.

 

CAS Treatment

There are several treatments and therapy approaches that have proven to be successful for treating child apraxia: Dynamic Tactile & Temporal Cueing (DTTC), Rapid Syllable Transition Training (ReST), Nuffield Dyspraxia Program (NDP-3), and Integral Phonological Awareness Intervention (IPA).  Speech therapy for CAS can consist of one or more of these treatments.  Generally, treatments like DTTC and the Nuffield Dyspraxia program are used for a child with more severe CAS.  IPA and ReST are typically more appropriate for children with milder childhood apraxia or those who have progressed significantly that they would then be perceived as having a milder form of apraxia.

 The PROMPT method is an increasingly popular treatment method; however, we still have little evidence on how well the treatment works and if it is in fact better than the well-studied treatments above.  Currently, most PROMPT studies only show that the approach does have some positive impact and that it is better than no treatment.  It remains to be seen whether more studies will prove its effectiveness.

 

Frequently Asked Questions 

How do I know if my child has apraxia?

Only a licensed speech-language pathologist can diagnose your child with apraxia of speech.  However, there are some signs of this disorder that may indicate your child should be evaluated for CAS such as:

  • Limited babbling as an infant
  • Limited speech sound inventory (child is missing many of the consonant and vowel sounds expected for their age)
  • Inconsistent errors; the types of errors the child makes in speech are not the same from one day or even one comment to the next
  • Very hard to understand
  • Vowel errors or distortion of vowel sounds
  • You can see the child struggling to move from one sound to another or from one syllable to another in words.  It may look like his/her mouth is trying to move into the right positions but with effort and struggle. This is calling articulatory groping.
  • Monotone or robotic tone in speaking
  • Speech sounds choppy; the rhythm does not change and every part of a word is said with the same amount of stress/emphasis
  • Unusual errors that are not part of typical development such as not saying the first consonant in a word (ex: “eat” instead of “feet”)
  • More difficulty with imitating what someone says than speaking spontaneously
  • Mostly uses simple, short syllable shapes like consonant-vowel-consonant (example words: “cat”, “hit”).
  • More errors and difficulties as words get longer, have more syllables, and/or have more complex syllables
  • Possibly history of feeding difficulties

 

Can my child outgrow apraxia?

Apraxia of speech is not something that a child can outgrow.  The child needs speech-language services in order to make progress towards clearer communication and speech.

Will my child ever speak normally?

Many kids with childhood apraxia of speech achieve normal speech given treatment and intervention.  Some children never quite reach an adult-like level of typical speech but nonetheless make large gains in clearer communication and/or oral speech; such children may ultimately maintain some errors in speech but can still be understood.

For a small number of children, they may primarily use alternative-augmentative communication devices or AAC in order to effectively communicate.  This last group of children can also become extremely effectively communicators like so many AAC users around the world.  It is worth noting that even more verbal children benefit and make progress using AAC, and this is not a tool of last resort in terms of treatment and/or communication.

Does childhood apraxia occur with autism?

A child can both have a diagnosis of autism and childhood apraxia of speech; however, they are separate disorders and a child can have one diagnosis but not the other.

How can I help my child with apraxia?

Seek a comprehensive speech-language evaluation and speech therapy services for your child.  It is also quite helpful to learn more about the nature of childhood apraxia of speech and how to advocate for your child to get quality services in a school.  Websites like apraxia-kids.org and childapraxiatreatment.org have lots of information about what childhood apraxia is, how to treat it, and how to advocate and support your child with CAS.