Childhood apraxia of speech is a type of speech disorder. It's present from birth. A child with this condition has problems making sounds correctly and consistently. Apraxia is a problem with the motor coordination of speech. It's different from aphasia, which is a problem with the use of words.
The speech centers of the brain help plan and coordinate what a child would like to say. These parts of the brain send complex signals to the speech muscles of the face, tongue, lips, and soft palate. Normally, all this signaling works smoothly, and a child can make all the sounds he or she needs.
With childhood apraxia of speech, something in this process goes wrong. The speech muscles seem to work properly, and the child knows what he or she wants to say. But the brain has trouble working with the muscles to create the movements needed for clear speech.
Childhood apraxia of speech is not the same as developmental delay of speech. Developmental delay is when a child follows a normal path of speech development, just at a slower rate.
Childhood apraxia of speech can range from mild to severe. It's not a common condition. It happens more often in boys than in girls.
Researchers don't yet understand what might cause childhood apraxia of speech. Some think that it is related to a child’s overall language development. Others think of it as a problem with the brain’s signals to the muscles needed for speech. Imaging tests have not found any real differences in brain structure in children with the condition.
Childhood apraxia of speech may be a part of a larger disorder a child has, such as:
- Cerebral palsy
- Certain mitochondrial disorders
- Neuromuscular disorders
- Other intellectual disability
The condition may run in families. Many children with the disorder have a family member with a communication disorder or a learning disability.
Your child may have a higher risk of the condition if other members of your family have had communication disorders or learning disabilities.
Not all children with childhood apraxia of speech have the same signs. Not all speech experts agree on the core signs of the condition. Some possible signs include:
- Trouble putting sounds and syllables together in the correct order
- Inconsistent errors in consonants and vowels when repeating sounds
- Long pauses between sounds
- Problems with “prosody,” the varying rhythms and tones that help express meaning (the emotional content) of speech
- Understanding language much better than expressing it
Some children have additional signs, such as:
- Fine motor delays
- Sensory processing difficulties
- Overall delayed language development
- Problems with reading, writing, spelling, or math
- Chewing and swallowing difficulties
The signs may vary with a child’s age. They also may be mild to severe. A child with a mild case of apraxia may only have trouble with a few speech sounds. A child with very severe apraxia may not be able to communicate very well with speech at all.
Many other speech and language disorders can cause limited or unclear speech. Childhood apraxia is a very complex disorder. It can be difficult to diagnose. Because of this, a speech language pathologist (SLP) may need to diagnose the condition. An SLP has a lot of experience with speech problems. This helps him or her to distinguish childhood apraxia from other kinds of speech conditions.
The SLP will ask about your child’s medical history. He or she will ask you about what signs of speech problems you note. The SLP may also need to rule out other possible causes. These may include muscle weakness, comprehension problems, or hearing problems.
A child’s parents and the SLP may need to observe a child’s speech over a long period of time. Your child may also need language testing. For example, the SLP may ask your child to repeat a word several times. Or, your child might need to repeat a list of words of increasing length. No medical test can be used to diagnose childhood apraxia of speech.
Speech language therapy is the main treatment for apraxia of speech. SLPs often use a variety of methods to treat it. Your child’s SLP might try methods such as:
- Articulation or phonological therapy
- Adapted cueing technique
- Orofacial myofunctional therapy
- Prompts for restructuring oral muscular phonetic targets therapy (PROMPT system)
- Biofeedback treatments
Speech therapy is tailored to a child’s specific needs. The therapy can also address other language problems. Children with apraxia often need frequent, one-on-one speech therapy to start. The results of therapy are different for each child. Some children make more progress than others.
In severe cases, children may need to use other ways to express themselves for a while. For example, your child might need to use:
- An informal sign language
- A language notebook with pictures
- A portable computer that writes and produces speech
Your child may not need to use these tools long-term.
Some children may also be helped by working with other health professionals. These may include:
- Occupational therapists
- Developmental pediatricians
- Special education specialists
Family support is a key part of treatment for a child with apraxia of speech. Parents and caregivers can help children practice their speech. Your child’s speech therapist may assign exercises to practice with your child. This can help improve your child’s progress.
You can also help by:
- Not pressuring your child to speak
- Showing patience when your child does want to speak
- Be positive about your child’s efforts
- Model to others how to be supportive of your child’s attempts to communicate
- Be generally supportive and encouraging to your child
- You can find resources about apraxia from The Childhood Apraxia of Speech Association of North America at www.apraxia-kids.org.
Childhood apraxia of speech is a type of speech disorder. It is present from birth. A child with this condition has problems making sounds correctly and consistently. Apraxia is a problem with the motor coordination of speech.
- Researchers don’t yet understand what causes most cases of apraxia of speech.
- Some key signs include trouble putting sounds and syllables together and long pauses between sounds.
- Some children with apraxia of speech also have other language and motor problems.
- Speech therapy is the main treatment for the condition.
- Some children may need to use other methods of communication for a while.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
March 14, 2019
Ashutosh Kacker MD,Raymond Kent Turley BSN MSN RN ,Raymond Kent Turley BSN MSN RN