Childhood apraxia of speech (CAS) is a rare speech disorder. Children with this disorder have trouble controlling their lips, jaws and tongues when speaking.
In CAS, the brain has trouble planning for speech movement. The brain isn't able to properly direct the movements needed for speech. The speech muscles aren't weak, but the muscles don't form words the right way.
To speak correctly, the brain has to make plans that tell the speech muscles how to move the lips, jaw and tongue. The movements usually result in accurate sounds and words spoken at the proper speed and rhythm. CAS affects this process.
CAS is often treated with speech therapy. During speech therapy, a speech-language pathologist teaches the child to practice the correct way to say words, syllables and phrases.
Children with childhood apraxia of speech (CAS) may have a variety of speech symptoms. Symptoms vary depending on a child's age and the severity of the speech problems.
CAS can result in:
These symptoms are usually noticed between ages 18 months and 2 years. Symptoms at this age may indicate suspected CAS. Suspected CAS means a child may potentially have this speech disorder. The child's speech development should be watched to determine if therapy should begin.
Children usually produce more speech between ages 2 and 4. Signs that may indicate CAS include:
Many children with CAS have trouble getting their jaws, lips and tongues to the correct positions to make a sound. They also may have a hard time moving smoothly to the next sound.
Many children with CAS also have language problems, such as reduced vocabulary or trouble with word order.
Some symptoms may be unique to children with CAS, which helps to make a diagnosis. However, some symptoms of CAS are also symptoms of other types of speech or language disorders. It's hard to diagnose CAS if a child has only symptoms that are found both in CAS and in other disorders.
Some characteristics, sometimes called markers, help distinguish CAS from other types of speech disorders. Those associated with CAS include:
Some speech sound disorders often get confused with CAS because some of the symptoms may overlap. These speech sound disorders include articulation disorders, phonological disorders and dysarthria.
A child with an articulation or phonological disorder has trouble learning how to make and use specific sounds. Unlike in CAS, the child doesn't have trouble planning or coordinating the movements to speak. Articulation and phonological disorders are more common than CAS.
Articulation or phonological speech errors may include:
Dysarthria is a speech disorder that occurs because the speech muscles are weak. Making speech sounds is hard because the speech muscles can't move as far, as quickly or as strongly as they do during typical speech. People with dysarthria may also have a hoarse, soft or even strained voice. Or they may have slurred or slow speech.
Dysarthria is often easier to identify than CAS. However, when dysarthria is caused by damage to areas of the brain that affect coordination, it can be hard to determine the differences between CAS and dysarthria.
Childhood apraxia of speech (CAS) has a number of possible causes. But often a cause can't be determined. There usually isn't an observable problem in the brain of a child with CAS.
However, CAS can be the result of brain conditions or injury. These may include a stroke, infections or traumatic brain injury.
CAS also may occur as a symptom of a genetic disorder, syndrome or metabolic condition.
CAS is sometimes referred to as developmental apraxia. But children with CAS don't make typical developmental sound errors and they don't grow out of CAS. This is unlike children with delayed speech or developmental disorders who typically follow patterns in speech and sounds development but at a slower pace than usual.
Changes in the FOXP2 gene appear to increase the risk of childhood apraxia of speech (CAS) and other speech and language disorders. The FOXP2 gene may be involved in how certain nerves and pathways in the brain develop. Researchers continue to study how changes in the FOXP2 gene may affect motor coordination and speech and language processing in the brain. Other genes also may impact motor speech development.
Many children with childhood apraxia of speech (CAS) have other problems that affect their ability to communicate. These problems aren't due to CAS, but they may be seen along with CAS.
Symptoms or problems that are often present along with CAS include:
Diagnosing and treating childhood apraxia of speech at an early stage may reduce the risk of long-term persistence of the problem. If your child experiences speech problems, have a speech-language pathologist evaluate your child as soon as you notice any speech problems.
To evaluate your child's condition, a speech-language pathologist reviews your child's symptoms and medical history. The speech-language pathologist also conducts an exam of the muscles used for speech, and looks at how your child produces speech sounds, words and phrases.
Your child's speech-language pathologist also may assess your child's language skills, including vocabulary, sentence structure and ability to understand speech.
Diagnosis of CAS isn't based on a single test or observation. A diagnosis is made based on the pattern of problems that are seen. The specific tests conducted during the evaluation depend on your child's age, ability to cooperate and the severity of the speech problem.
It can sometimes be hard to diagnose CAS, especially when a child speaks very little or has trouble interacting with the speech-language pathologist.
Still, it's important to identify whether your child shows symptoms of CAS because CAS is treated differently from other speech disorders. Your child's speech-language pathologist may be able to determine the best treatment approach for your child even if the diagnosis is not certain at first.
Tests may include:
Oral-motor assessment. Your child's speech-language pathologist will examine your child's lips, tongue, jaw and palate for structural problems, such as tongue-tie or a cleft palate. The speech-language pathologist also will look for other problems such as low muscle tone. Low muscle tone usually isn't associated with CAS, but it may be a sign of other conditions.
Your child's speech-language pathologist will watch how your child moves his or her lips, tongue and jaw in activities such as blowing, smiling and kissing.
Speech evaluation. Your child's ability to make sounds, words and sentences may be observed during play or other activities.
Your child may be asked to name pictures. This allows the speech-language pathologist to check to see if your child has trouble making specific sounds or speaking certain words or syllables.
Your child's speech-language pathologist also may evaluate your child's coordination and smoothness of movement in speech. Your child may be asked to repeat syllables such as "pa-ta-ka" or say words such as "buttercup."
If your child can speak sentences, the speech-language pathologist observes your child's melody and rhythm of speech. Melody and rhythm are heard in the way your child puts stress on syllables and words.
Your child's speech-language pathologist may help your child by providing cues, such as saying the word or sound more slowly or providing touch cues to the face.
A trial of speech therapy to observe how your child responds to CAS treatment can help the speech-language pathologist confirm CAS.
Children don't outgrow childhood apraxia of speech (CAS), but speech therapy can help them make the most progress. Speech-language pathologists may treat CAS with many therapies.
Your child's speech-language pathologist usually provides therapy that focuses on practicing syllables, words and phrases.
Depending on the extent of the speech problems, your child may need speech therapy 3 to 5 times a week. As your child improves, the number of weekly speech therapy sessions may be reduced.
Children with CAS generally benefit from individual therapy. One-on-one therapy allows your child to have more time to practice speech during each session.
It's important that children with CAS get a lot of practice saying words and phrases during each speech therapy session. It takes time and practice to learn how to say words and phrases the right way.
Because children with CAS have trouble planning movements for speech, speech therapy often focuses your child's attention to the sound and feel of speech movements.
Speech-language pathologists may use different types of cues in speech therapy. For example, your child's speech-language pathologist may ask your child to listen carefully. Your child also may be asked to watch the speech-language pathologist's mouth form the word or phrase.
Your child's speech-language pathologist also may touch your child's face as your child makes certain sounds or syllables. For example, a speech-language pathologist may help round your child's lips to say "oo."
No single speech therapy approach has been shown to be most effective for treating CAS. But some important principles of speech therapy for CAS include:
Speech practice is very important. Your child's speech-language pathologist may encourage you to be involved in your child's speech practice at home.
The speech-language pathologist may give you words and phrases to practice with your child at home. Each home practice session can be short, such as five minutes in length. You might practice with your child twice a day.
Children also need to practice words and phrases in real-life situations. Create situations for your child to say the word or phrase. For example, ask your child to say "Hi, Mom" each time mom enters a room. This makes it easier for your child to say the practice words automatically.
If your child can't effectively communicate through speech, other communication methods can be helpful.
Other methods may include sign language or natural gestures, such as pointing or pretending to eat or drink. For example, your child could use signs to ask for a cookie. Sometimes electronic devices such as tablets can be helpful in communication.
It's often important to use alternative communication methods early. It may help your child become less frustrated when trying to communicate. It also may help your child develop language skills such as vocabulary and the ability to put words together in sentences.
Many children with CAS also have delays in their language development. They may need therapy to address language issues.
Children with CAS who have trouble with fine and gross motor movement in their arms or legs may need physical or occupational therapy.
If a child with CAS has another medical condition, treatment for that condition may be important to improving the child's speech.
Some treatments aren't helpful in improving the speech of children with CAS. For example, there is no evidence that exercises to strengthen speech muscles will help improve speech in children with CAS.
You and your family can work with your child at home. Home practice, in addition to your child's speech therapy sessions, may help your child's progress.
Encourage and support your child as your child practices speech and language skills. Your child is likely to feel good about making improvements in speech with your support.
Be mindful of giving your child rests from therapy, as well. If your child has physical or occupational therapy along with speech therapy, schedule the sessions so that your child doesn't become too tired.
It can be hard to have a child who has problems communicating. There are a number of support groups available for parents of children with childhood apraxia of speech. Support groups may offer a place for you to find people who understand what you're going through and who can share similar experiences.
To learn about support groups in your area, see the Apraxia Kids website.
Your child is likely to start by seeing a doctor trained in the general care and treatment of children, known as a pediatrician. Or your child might see a doctor trained in treating children with neurological conditions, known as a pediatric neurologist, or a doctor specializing in developmental disorders experienced by children, known as a developmental pediatrician. Your child will likely be referred to a specialist in speech and language conditions, known as a speech-language pathologist.
Because appointments have limited time and there's a lot to talk about, it's a good idea to be well prepared for your child's appointment. Here's some information to help you and your child get ready and to get an idea of what to expect.
Your time during the appointment is limited. Prepare a list of questions ahead of time to help make the most of your time. For childhood apraxia of speech (CAS), some basic questions to ask the speech-language pathologist include:
In addition to the questions that you've prepared, ask questions during your appointment at any time that you don't understand something.
Your child's speech-language pathologist is likely to ask you a number of questions. Being ready to answer them may allow more time to talk about your child's diagnosis and recommended treatment. Your child's speech-language pathologist may ask:
