Childhood Apraxia Of Speech Definition

What Research Is Being Done To Better Understand Apraxia Of Speech

Researchers are searching for the causes of childhood AOS, including the possible role of abnormalities in the brain or other parts of the nervous system. They are also looking for genetic factors that may play a role in childhood AOS. Other research on childhood AOS aims to identify more specific criteria and new techniques to diagnose the disorder and to distinguish it from other communication disorders.

Research on acquired AOS includes studies to pinpoint the specific areas of the brain that are involved in the disorder. In addition, researchers are studying the effectiveness of various treatment approaches for both acquired and childhood AOS.

Scientific Foundations: Genetic And Neurobehavioral Research In Cas

One research approach that meets some of the needs discussed in the previous section is studies of children suspected to have CAS who share some common biological difference or disorder. This section reviews findings from two examples of this approach. One approach is to study families of children with idiopathic CAS to determine if affected family members share one or more genetic differences not found in unaffected family members. The second type of design is studies of children reported to have CAS as a secondary feature in a well-characterized complex neurobehavioral disorder, such as fragile X syndrome. In each of these two designsstudying children with idiopathic CAS and studying children with CAS as secondary signs within complex neurobehavioral disordersinformation on the molecular genetics and developmental biology of the disorder can be used to develop an eventual explanatory account of CAS. Specifically, controlled investigations can be designed to study associations between the genotypic characteristics of children suspected to have CAS and phenotypic manifestations of the disorder. Genotype/phenotype studies are widely reported in complex neurobehavioral disorders but have only recently begun to appear in the genetics literature on speech sound disorders.

About Childhood Apraxia Of Speech

In order for speech to occur, messages need to go from your brain to your mouth. These messages tell the muscles how and when to move to make sounds. When a child has apraxia of speech, the messages do not get through correctly. The child might not be able to move their lips or tongue in the right ways, even though their muscles are not weak. Sometimes, the child might not be able to say much at all.

A child with CAS knows what they want to say. The problem is not how the child thinks but how the brain tells the mouth muscles to move.

CAS is sometimes called verbal dyspraxia or developmental apraxia. Even though the word developmental” is used, CAS is not a problem that children outgrow. A child with CAS will not learn speech sounds in typical order and will not make progress without treatment. It can take a lot of work, but the childs speech can improve.

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How Is Apraxia Different From Other Speech Sound Problems

Most children with speech problems either have trouble physically making the sounds or they have trouble with entire groups of sounds, like replacing all long sounds like /f/ and /s/ with short sounds like /p/ and /t/. Children with CAS have a different type of speech problem. Children with CAS know what they want to say but when their brains send the message to the motor-planning part of the brain , the signal gets all mixed up and doesnt make it to the mouth correctly. Theres a problem with the wiring!

Lets think of it in terms of your car. Imagine youre driving down the road and you realize that you need to turn left. You know that you need to turn on your left blinker so you tell your car to turn on the blinker . But, for some reason, the wiring in your car is all mixed up so instead of your blinker turning on, your clock starts flashing instead . You planned for the car to do one thing but it did something else instead . So you try again. This time, when you hit the blinker your headlights turn off. WHAT?? Every time you turn on your blinker, something different happens.

Can you imagine how frustrating that would be? Thats how these kiddos feel because they know they want their mouths to say something but every time they try it comes out differently. Sometimes its absolutely correct and clear as day, but then when they try to say that exact same thing again, they cant do it.

Developmental Apraxia Of Speech

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How Will Childhood Apraxia Of Speech Affect My Child

Childhood apraxia of speech affects how your child communicates verbally. Children with CAS have trouble carrying out the movements of their mouth to produce speech accurately even though the child knows what they want to say.

Although your childs inability to speak is the reason for their diagnosis, they may also have trouble coordinating the movement of their mouth, lips and tongue. Some children with CAS may have trouble eating, but for many children with CAS, only their speech is affected.

Treatment should address the movement patterns required to produce speech appropriately and help to improve communication. Treatment may also include using supportive techniques such as augmentative communication or gesture communication, depending on the severity of their diagnosis.

What Are The Types And Causes Of Apraxia Of Speech

There are two main types of AOS: acquired apraxia of speech and childhood apraxia of speech.

• Acquired AOS can affect someone at any age, although it most typically occurs in adults. Acquired AOS is caused by damage to the parts of the brain that are involved in speaking and involves the loss or impairment of existing speech abilities. It may result from a stroke, head injury, tumor, or other illness affecting the brain. Acquired AOS may occur together with other conditions that are caused by damage to the nervous system. One of these is dysarthria, as mentioned earlier. Another is aphasia, which is a language disorder.
• Childhood AOS is present from birth. This condition is also known as developmental apraxia of speech, developmental verbal apraxia, or articulatory apraxia. Childhood AOS is not the same as developmental delays in speech, in which a child follows the typical path of speech development but does so more slowly than is typical. The causes of childhood AOS are not well understood. Imaging and other studies have not been able to find evidence of brain damage or differences in the brain structure of children with AOS. Children with AOS often have family members who have a history of a communication disorder or a learning disability. This observation and recent research findings suggest that genetic factors may play a role in the disorder. Childhood AOS appears to affect more boys than girls.

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What Can I Expect If I Have A Child With Childhood Apraxia Of Speech

As your child grows, they may miss language development milestones, like saying their first words and using short sentences to express themselves. Developmental delays could prevent your child from learning in the classroom at the same level as their peers.

Children who have CAS do not outgrow the condition and there is no cure. Early treatment alleviates frustration that your child may show if they want to say something but are unable to communicate that message.

Your healthcare provider can make recommendations for treatment after a diagnosis and refer your child to a speech-language pathologist who will address your childs unique symptoms to improve their speech.

When Should I See My Healthcare Provider

If you notice symptoms or signs of CAS in your child, or if your child is missing language development milestones, like saying their first words or naming common objects, contact your healthcare provider for a referral to a speech-language pathologist.

If your child has trouble eating and coordinating movement with their mouth apart from speech, visit your healthcare provider immediately.

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How Can Parents Help

Childhood apraxia of speech undoubtedly requires the attention of a professional for confirmed diagnosis and treatment. However, since a child interacts with their parents most at home, it is the responsibility of the parents to ensure that the child feels motivated enough to practice at home.

At-home care, attention, and practice are of paramount importance for treating a child with AOS. Children who receive parental guidance and support show faster improvement rates than children who only practice their speech exercises in the clinic.

Hereâs how to help a child with speech apraxia â

Other Problems Associated With Cas

People who have a diagnosis of CAS may also experience:

• feelings of frustration because they can’t get their message across
• oral language difficulties
• difficulties with reading and spelling
• sucking, chewing, and swallowing problems
• difficulty performing movements with their tongue and lips when asked

CAS impacts children expressing their needs and wants, social interaction, and connections with others. People with CAS are often able to understand others well but have difficulty expressing their own thoughts and ideas, meaning some people underestimate their skills.

Children with CAS may have additional communication difficulties including dysarthria, Developmental Language Disorder, social communication difficulties and stuttering or voice issues. They may also have sensory processing difficulties or Developmental Coordination Disorder. They can also experience anxiety, depression, difficulties coping or have general learning difficulties. This means they need more supports and holistic care across health professionals like paediatricians, occupational therapists, and psychologists.

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Scientific Foundations: Behavioral Research In Cas

Studies of the developmental neurobiology of CAS are expected to provide an understanding of the relevant neural substrates and identify useful early diagnostic biomarkers. Even when such information becomes available, speech-language pathologists will still need to use behavioral tools to provide the individualized profiles needed to differentiate children suspected to have CAS from children with other types of speech-language disorders. To date, as previewed in the Introduction and Overview, no one test score or behavioral characteristic has been validated to differentially diagnose CAS . The present section provides an extended review of behavioral research in CAS.

What Is Childhood Apraxia Of Speech

Childhood apraxia of speech is a speech disorder in which a childs brain has difficulty coordinating the complex oral movements needed to create sounds into syllables, syllables into words, and words into phrases. Typically, muscle weakness is not to blame for this speech disorder.

Parents of children with childhood apraxia of speech commonly say things like, “No one can understand my son,” “It looks like he is trying to say the word, but can’t get it out,” and “He said that word one time, and then I never heard it again.”

The most common description of a child with childhood apraxia of speech is that he is often very difficult to understand.

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What Questions Should I Ask My Doctor

• Does my child need to see a speech-language pathologist?
• What should I do if my child misses language development milestones?
• Does my child need any language communication devices to speak?

A note from Cleveland Clinic

You might feel frustrated if you cant remember the name of a person youve met several times. If your child has CAS, they may experience a similar frustration when they know a persons name but are unable to formulate the correct sounds to express it. Your childs speech therapy treatment will be long-term to help them communicate, and treatment significantly improves their symptoms. Offer support and encouragement as your child reaches new milestones for communication each day.

Last reviewed by a Cleveland Clinic medical professional on 11/12/2021.

References

Childhood Apraxia Of Speech: Definition Diagnosis Symptoms Treatment And Prognosis

Teachers are in the position to observe the development of verbal language skills in their classrooms. When a childâs speech is unintelligible or inconsistent, apraxia of speech should be considered. Treatment of the disorder is essential to help the child develop the ability to accurately and consistently form words. This article explains what the disorder, details the symptoms and discusses the treatment and prognosis.

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Acute Apraxia Of Speech

Stroke-associated AOS is the most common form of acquired AOS, making up about 60% of all reported acquired AOS cases. This is one of the several possible disorders that can result from a stroke, but only about 11% of stroke cases involve this disorder. Brain damage to the neural connections, and especially the neural synapses, during the stroke can lead to acquired AOS. Most cases of stroke-associated AOS are minor, but in the most severe cases, all linguistic motor function can be lost and must be relearned. Since most with this form of AOS are at least fifty years old, few fully recover to their previous level of ability to produce speech.

Other disorders and injuries of the brain that can lead to AOS include dementia, progressive neurological disorders, and traumatic brain injury.

Support For People With Childhood Apraxia Of Speech

If your child has been diagnosed with CAS, the speech pathologist will then work with them to improve their speech and their reading, spelling and language abilities .

Your child may be eligible for some support under the Chronic Disease Management items that are available under Medicare to patients with a chronic medical condition. Ask your GP and speech pathologist for more information.

Children with CAS may be eligible for NDIS funding and supports.

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What Are The Symptoms Of Apraxia Of Speech

People with either form of AOS may have a number of different speech characteristics, or symptoms:

• Distorting sounds. People with AOS may have difficulty pronouncing words correctly. Sounds, especially vowels, are often distorted. Because the speaker may not place the speech structures quite in the right place, the sound comes out wrong. Longer or more complex words are usually harder to say than shorter or simpler words. Sound substitutions might also occur when AOS is accompanied by aphasia.
• Making inconsistent errors in speech. For example, someone with AOS may say a difficult word correctly but then have trouble repeating it, or may be able to say a particular sound one day and have trouble with the same sound the next day.
• Groping for sounds. People with AOS often appear to be groping for the right sound or word, and may try saying a word several times before they say it correctly.
• Making errors in tone, stress, or rhythm. Another common characteristic of AOS is the incorrect use of prosody. Prosody is the rhythm and inflection of speech that we use to help express meaning. Someone who has trouble with prosody might use equal stress, segment syllables in a word, omit syllables in words and phrases, or pause inappropriately while speaking.

Children with AOS generally understand language much better than they are able to use it. Some children with the disorder may also have other speech problems, expressive language problems, or motor-skill problems.

Treatment Goals: Speech Production

Most treatment research has focused directly on improving speech production, using several approaches that are consistent with the prevalent views, reviewed previously, of CAS as a motor speech disorder. Writing in a professional journal, but aiming primarily at a nonprofessional audience, Hall usefully classified CAS treatment approaches into four categories: linguistic approaches, motor-programming approaches, combinations of linguistic and motor-programming approaches, and approaches using specific sensory and gestural cueing techniques. Not included in Hall’s classification, but of historical interest, are early and influential rhythmic approaches such as melodic intonation therapy , which was discussed in earlier treatment reviews appearing as a book chapter , as well as in more recent such reviews .

Linguistic Approaches

Motor Programming Approaches

The generalizability of Strand and Debertine’s findings is limited by a lack of replication across subjects and because single subject experimental designs are not recognized within the SIGN hierarchy shown in Table 4. Nonetheless, such designs are thought to demonstrate a high degree of experimental control, especially for heterogeneous and rare participant populations for which randomized control trials may prove unfeasible or even ill-advised .

Combined Linguistic-Motor Programming Approaches

Approaches That Include Specific Sensory and Gestural Cueing Techniques

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Other Ways To Communicate

In order to communicate, your child may learn sign language or may learn to use picture boards or computers that talk. This is called augmentative and alternative communication .

Some parents are afraid that their child will only want to use AAC systems and not try to talk. There is no evidence to support this idea. AAC systems support communication and help your child as they work on their speech with the SLP.

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