The act of speaking is a highly sophisticated one! It involves transmitting the message from the brain to the muscles of the mouth, face, tongue, and soft palate. Any interruption along this pathway may cause Apraxia of Speech.
Childhood Apraxia of Speech (CAS) is a motor speech disorder. There is no weakness of the speech muscles, but they don’t perform normally because the brain has difficulty planning and/or coordinating the precise movements necessary for speech.
As a result, even though the child knows what he wants to say, he cannot say it correctly at that particular time. At that particular time, the motor plan to say the sound or the word is not accessible. Often, the child will be able to produce a sound or word at one time and not be able to say is again when he wants to. A parent may hear words when the child is playing alone, but when asked to say the same word, he can’t. This can be very frustrating for both the child and the parents.
Apraxia of speech is sometimes called verbal apraxia, developmental apraxia of speech, or verbal dyspraxia.
CAS may be caused by:
- Genetic disorders or syndromes
- Stroke or brain injury
Often, the cause is unknown.
Recent research also suggests that the children with apraxia may have difficulty with sensory feedback.
It is important to note that while CAS may be referred to as “developmental apraxia,” it is not a disorder that children simply “outgrow.” For many developmental speech disorders, children learn sounds in a typical order, just at a slower pace. In CAS, children do not follow typical patterns. There is no cure, but with appropriate, intensive intervention, significant progress can be made.
Signs of Childhood Apraxia of speech?
Not all children will present with all of the signs. General things to look for include the following:
A Very Young Child
- Limited babbling as an infant
- First words are late, and they may be missing sounds
- Only a few different consonant and vowel sounds
- Problems combining sounds; may show long pauses between sounds
- Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)
An Older Child
- Inconsistent and variable sound errors
- Can understand language much better than he or she can talk
- Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
- May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
- Has more difficulty saying longer words or phrases clearly than shorter ones
- More difficulty with volitional, self-initiated utterances as compared to over-learned, automatic, or modeled utterances
- Errors increase with length or complexity of utterances, such as in multi-syllabic or phonetically challenging words.
- May be able to produce the target utterance accurately in one context but is unable to produce the same target accurately in a different context.
- Appears to have more difficulty when he or she is anxious
- Is hard to understand, especially for an unfamiliar listener
- Sounds choppy, monotonous, or stresses the wrong syllable or word
Potential Other Problems
- Delayed language development
- Other expressive language problems like word order confusions and word recall
- Difficulties with fine motor movement/coordination. Referral to an occupational therapist may be necessary.
- Over sensitive (hypersensitive) or under sensitive (hyposensitive) in their mouths
(E.g. may not like toothbrushing or crunchy foods, may not be able to identify an object in their mouth through touch)
- Children with CAS may have problems when learning to read, spell and write. They may have difficulty retrieving the words from their memory. They find it difficult to sequence the letters into words or the words into meaningful sentences.
As with most speech disorders, the exact treatment routine will vary based on the severity of the child’s speech apraxia.
Children with CAS usually benefit from frequent and intense therapy as early as possible.
Treatment based on strengthening the oral muscles will not benefit the child with CAS. The focus of intervention needs to be on improving the planning, sequencing, and coordination of muscle movements for speech production.
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