Childhood apraxia of speech (CAS) is an uncommon speech disorder in which a child has difficulty making accurate movements when speaking.
In CAS, the brain struggles to develop plans for speech movement. With this disorder, the speech muscles aren't weak, but they don't perform normally because the brain has difficulty directing or coordinating the movements.
To speak correctly, your child's brain has to learn how to make plans that tell his or her speech muscles how to move the lips, jaw and tongue in ways that result in accurate sounds and words spoken with normal speed and rhythm.
CAS is often treated with speech therapy, in which children practice the correct way to say words, syllables and phrases with the help of a speech-language pathologist.
Children with childhood apraxia of speech (CAS) may have many speech symptoms or characteristics that vary depending on their age and the severity of their speech problems.
CAS can be associated with:
These symptoms are usually noticed between ages 18 months and 2 years, and may indicate suspected CAS.
As children produce more speech, usually between ages 2 and 4, characteristics that likely indicate CAS include:
Many children with CAS have difficulty getting their jaws, lips and tongues to the correct positions to make a sound, and they may have difficulty moving smoothly to the next sound.
Many children with CAS also have language problems, such as reduced vocabulary or difficulty with word order.
Some symptoms may be unique to children with CAS and can be helpful to diagnose the problem. However, some symptoms of CAS are also symptoms of other types of speech or language disorders. It's difficult to diagnose CAS if a child has only symptoms that are found both in CAS and in other types of speech or language disorders.
Some characteristics, sometimes called markers, help distinguish CAS from other types of speech disorders. Those particularly associated with CAS include:
Other characteristics are seen in most children with speech or language problems and aren't helpful in distinguishing CAS. Characteristics seen both in children with CAS and in children with other types of speech or language disorders include:
Some speech sound disorders often get confused with CAS because some of the characteristics may overlap. These speech sound disorders include articulation disorders, phonological disorders and dysarthria.
A child who has trouble learning how to make specific sounds, but doesn't have trouble planning or coordinating the movements to speak, may have an articulation or phonological disorder. Articulation and phonological disorders are more common than CAS.
Articulation or phonological speech errors may include:
Dysarthria is a motor speech disorder that is due to weakness, spasticity or inability to control the speech muscles. Making speech sounds is difficult because the speech muscles can't move as far, as quickly or as strongly as normal. People with dysarthria may also have a hoarse, soft or even strained voice, or slurred or slow speech.
Dysarthria is often easier to identify than CAS. However, when dysarthria is caused by damage to certain areas of the brain that affect coordination, it can be difficult to determine the differences between CAS and dysarthria.
Childhood apraxia of speech (CAS) has a number of possible causes, but in many cases a cause can't be determined. Doctors often don't observe a problem in the brain of a child with CAS.
CAS may be the result of brain (neurological) conditions or injury, such as a stroke, infections or traumatic brain injury.
CAS may also occur as a symptom of a genetic disorder, syndrome or metabolic condition. For example, CAS occurs more frequently in children with galactosemia.
CAS is sometimes referred to as developmental apraxia. However, children with CAS don't necessarily grow out of CAS as they develop. In many children with delayed speech or developmental disorders, children follow usual patterns in development of speech and sounds, but they develop more slowly than usual.
Children with CAS don't make typical developmental sound errors. They need speech therapy to make maximum progress.
Abnormalities 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 abnormalities in the FOXP2 gene may affect motor coordination and speech and language processing in the brain.
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, it's a good idea to have a speech-language pathologist evaluate your child as soon as you notice any speech problems.
To evaluate your child's condition, your child's speech-language pathologist will review your child's symptoms and medical history, conduct an examination of the muscles used for speech, and examine how your child produces speech sounds, words and phrases.
Your child's speech-language pathologist will also assess your child's language skills, such as his or her vocabulary, sentence structure and ability to understand speech.
Diagnosis of CAS isn't based on any single test or observation. It depends on the pattern of problems that are seen. The specific tests conducted during the evaluation will depend on your child's age, ability to cooperate and the severity of the speech problem.
It can sometimes be difficult to diagnose CAS, especially when a child speaks very little or has difficulty interacting with the speech-language pathologist.
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 an appropriate treatment approach for your child, even if the diagnosis is initially uncertain.
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, or 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 observe 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 will be observed during play or other activities.
Your child may be asked to name pictures to see if he or she has difficulty making specific sounds or speaking certain words or syllables.
Your child's speech-language pathologist may evaluate your child's coordination and smoothness of movement in speech during speech tasks. To evaluate your child's coordination 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 produce sentences, your child's speech-language pathologist will observe your child's melody and rhythm of speech, such as how he or she stresses syllables and words.
Your child's speech-language pathologist may help your child be more accurate by providing cues, such as saying the word or sound more slowly or providing touch cues to his or her face.
Speech-language pathologists may treat childhood apraxia of speech (CAS) with many therapies.
Your child's speech-language pathologist will usually provide therapy that focuses on practicing syllables, words and phrases.
When CAS is relatively severe, your child may need frequent speech therapy, three to five times a week. As your child improves, the frequency of speech therapy may be reduced.
Children with CAS generally benefit from individual therapy. Individual therapy allows your child to have more time to practice speech during each session.
It's important that children with CAS get a significant amount of practice saying words and phrases during each speech therapy session. Learning to say words or phrases takes children with CAS time and practice.
Because children with CAS have difficulties 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 and watch him or her form the target word or phrase with his or her mouth.
Your child's speech-language pathologist also may touch your child's face as he or she makes certain sounds or syllables. For example, your child's speech-language pathologist may use his or her hands to help your child round his or her lips to say "oo."
No single speech therapy approach has been shown to be most effective for treating CAS. But, some important general principles of speech therapy for CAS include:
Because 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.
Your child's speech-language pathologist may give you words and phrases to practice with your child at home that he or she has learned in speech therapy. Each home practice session can be short, such as five minutes in length, and you may practice with your child twice a day.
Children also need to practice words and phrases in real-life situations. Create situations where it will be appropriate for your child to say the word or phrase spontaneously. For example, ask your child to say "Hi, Mom" each time mom enters a room. Practicing words or phrases in real-life situations will make it easier for your child to say the practice words automatically.
If your child has a severe speech disorder and can't effectively communicate, alternative communication methods can be very helpful.
Alternative communication 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 communicate he or she wants a cookie. Sometimes electronic devices, such as electronic tablets, can be helpful in communication.
It's often important to use alternative communication methods early. Using these methods may help your child become less frustrated when trying to communicate. It may also help your child to develop language skills such as vocabulary and the ability to put words together in sentences.
As speech improves, these strategies and devices may no longer be necessary.
Many children with CAS also have delays in their language development, and they may need therapy to address their language difficulties.
Children with CAS who have fine and gross motor movement difficulties in their arms or legs may need physical or occupational therapy.
If a child with CAS has another medical condition, then effective 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 to show 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 to improve his or her speech and language skills. Home practice, in addition to your child's speech therapy sessions, may help your child's progress.
Encourage and support your child as he or she practices speech and language skills. Your support can help your child feel that he or she is doing well and improving.
If your child is participating in physical or occupational therapy, as well as speech therapy, schedule different types of therapy at various times so that your child doesn't become too tired from therapy.
It can be difficult 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 your situation 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 (pediatrician) or a doctor trained in treating children with neurological conditions (pediatric neurologist). Your child will then be referred to a specialist in speech and language conditions (speech-language pathologist).
Because appointments have limited time, and because there's often 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 what to expect from your child's doctor and speech-language pathologist.
Your time with your child's doctor or speech-language pathologist is limited, so preparing a list of questions ahead of time will help you make the most of your time together. 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 to ask your child's doctor or speech-language pathologist, don't hesitate to 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 ask questions about your child's diagnosis and recommended treatment. Your child's speech-language pathologist may ask:
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