• Childhood Apraxia of Speech

    What is childhood apraxia of speech?

    Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words.

    What are some signs or symptoms of childhood apraxia of speech?

    Not all children with CAS are the same. All of the signs and symptoms listed below may not be present in every child. It is important to have your child evaluated by a speech-language pathologist (SLP) who has knowledge of CAS to rule out other causes of speech problems.  General things to look for include the following:

    A Very Young Child

    • Does not coo or babble 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)
    • May have problems eating 

    An Older Child

    • Makes inconsistent sound errors that are not the result of immaturity
    • 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
    • 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

    • Weakness of the lips, jaw, and/or tongue
    • Delayed language development
    • Other expressive language problems like word order confusions and word recall 
    • Difficulties with fine motor movement/coordination
    • 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 or other speech problems may have problems when learning to read, spell, and write

    How is childhood apraxia of speech diagnosed?

    An audiologist should perform a hearing evaluation to rule out hearing loss as a possible cause of the child's speech difficulties.

    A certified-SLP  with knowledge and experience with CAS conducts an evaluation. This will assess the child's oral-motor abilities, melody of speech, and speech sound development. The SLP can diagnose CAS and rule out other speech disorders, unless only a limited speech sample can be obtained making a firm diagnosis challenging.

    An oral-motor assessment involves:

    • checking for signs of weakness or low muscle tone in the lips, jaw, and tongue (dysarthria)
    • seeing how well the child can coordinate the movement of the mouth by having him or her imitate nonspeech actions (e.g., moving the tongue from side to side, smiling, frowning, puckering the lips)
    • evaluating the coordination and sequencing of muscle movements for speech while the child performs tasks such as the diadochokinetic rate, which requires the child to repeat strings of sounds (e.g., puh-tuh-kuh) as fast as possible
    • examining rote abilities by testing the child's skills in functional or "real-life" situations (e.g., licking a lollipop) and comparing this to skills in nonfunctional or "pretend" situations (e.g., pretending to lick a lollipop)

    A melody of speech (intonation) assessment involves:

    • listening to the child to make sure that he or she is able to appropriately stress syllables in words and words in sentences 
    • determining whether the child can use pitch and pauses to mark different types of sentences (e.g., questions vs. statements) and to mark off different portions of the sentence (e.g., to pause between phrases, not in the middle of them)

    A speech sound (pronunciation of sounds in words) assessment involves:

    • Evaluating both vowel and consonant sounds
    • Checking how well the child says individual sounds and sound combinations (syllables and word shapes)
    • Determining how well others can understand the child when they use single words, phrases, and conversational speech.

    An SLP may also examine the child's receptive and expressive language skills and literacy skills to see if there are co-existing problems in these areas.