Childhood Apraxia Of Speech

Childhood apraxia of speech (CAS) is a rare disorder of speech characterized by inappropriate movements of muscles necessary for speech.

CAS is not due to weakness of muscles rather it occurs due to inability of your child’s brain to regulate speech muscles while producing certain words or sounds. 

The symptoms of Childhood apraxia of speech vary with age of your children and severity of the condition. Some characteristics of CAS are:

• Late first words
• Few spoken words and 
• Few consonant and vowel sounds
• Sound errors such as “pie” sounding like “bye”
• Limited vocabulary
• Difficulty with word order
• Difficulty understanding speech

These symptoms usually appear between 18 months and 2 years. More CAS-indicating symptoms such as, vowel and consonant distortions, separation of syllables in or between words, and sound errors may be noticed between 2 to 4 years.

The symptoms arise due to inappropriate positions of jaws, lips and tongues while making a sound. Speech therapy can help children with CAS to produce understandable speech.

Some differential symptoms associated with CAS include:

• Problem switching smoothly from one sound, syllable or word to another
• Uncoordinated movements of the jaw, lips or tongue while speaking 
• Sound errors such as saying a vowel incorrectly 
• Inappropriate stress in a word
• Inappropriate gap between syllables 
• Inconsistency with speech such as being unable to repeat a word
• Problem while imitating simple words 
• Producing wrong sound such as saying "down" instead of "town

Some other speech sound disorders such as articulation disorders, phonologic disorders and dysarthria may be confused with CAS.

Though there are a number of causes responsible for Childhood apraxia of speech, the exact cause may not always be noticeable.

A child with CAS may have no brain problems. However, neurological conditions like injury, such as stroke, infections or traumatic brain injury can cause CAS.

It might also occur due to genetic disorder, syndrome or metabolic condition. 

No single test is enough to diagnose Childhood apraxia of speech.

You may take your child a pediatrician (a doctor trained in the general care and treatment of children) or pediatric neurologist (a specialist in treating children with neurological disorders).

Then, your child can be referred to a speech-language pathologist (specialist in speech and language conditions).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.
List out all the symptoms. Write down your key medical information. Write down the names of all your medications, vitamins or supplements.

Make a list of the questions to ask your doctor and speech-language pathologist. Some typical questions can be:

• Can you explain CAS?
• Is my child suffering from CAS, or any other speech or language problems? 
• How do you differentiate CAS from other types of speech disorders? 
• Is my child's condition going to improve? 
• What are treatment options and which one is most suitable for my child? 
• What can I do at home to help my child? 

What your speech-therapist wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

• When did you start noticing problems with your child's speech development?
• Did your child babble? If so, when did that start?
• When did your child start speaking? 
• When did your child start using specific words repeatedly? 
• Do you know the number of understandable vocabulary your child currently has?
• Do you have a family history of speech or language problems?
• How does your child communicate without using words? 
• Did your child suffer ear infections? 
• Can you tell the time when your child's hearing was tested? 
• Was your child detected with any hearing loss?

After reviewing your child's symptoms and medical history, the speech-language therapist can conduct an examination of speech muscles to evaluate how your child produces speech sounds, words and phrases.

Other speech related skills that might be evaluated include your child's language skills, such as his or her vocabulary, sentence structure and ability to understand speech. Differentiating CAS from other speech disorders is an important factor that drives your child’s treatment strategy. Some tests for CAS diagnosis include:

• Hearing tests: These tests help your speech-language therapist to identify if hearing problems could be responsible for your child's speech problems.

• Oral-motor assessment: It involves examining 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. Movements of lips, tongue and jaw while blowing, smiling, and kissing can give an overview of how the speech muscles are working. 

• Speech evaluation: This test evaluates your child's ability to say sounds, words and sentences. Your child may be given a picture to describe and how s/he speaks is evaluated. It also evaluates your child's ability to repeat a word. Other speech components such as melody and rhythm of speech are also evaluated.

Treatment of Childhood apraxia of speech includes a number of therapies:

• Speech therapy: This is the first line therapy for CAS. This therapy involves practicing syllables, words and phrases. In severe cases, speech therapy should be performed more frequently, three to five times a week, which may be reduced later as condition improves. Individual therapy, that provides more time for practice, is more fruitful for children with CAS.

• Speech practice at home: This is a type of speech therapy which is done by you at your home, involves five-minute session of practice two times a day. Utilizing the skills learnt through speech therapy in real-life situations is important. For this, you may create an environment at your home where your child can practice what s/he learnt during the session.

• Alternative communication methods: Alternative communication methods include non-verbal means of communication such as sign language and gestures. You can also utilize technology to help your child communicate by using electronic devices, such as electronic tablets. These methods are more useful when your child has severe CAS.

• Therapies for coexisting problems: Therapies to correct language problems in your child is another aspect of treatment as CAS can be associated with delayed language development. To address fine and gross motor movement problems in arms or legs, you may consult a physical or occupational therapist.

Childhood apraxia of speech cannot be prevented but early diagnosis and treatment can reduce chances of lingering problems.

Consult a speech-language pathologist immediately if you observe any speech problems in your child.

There are no medications, vitamins or alternative and homeopathic remedies that can help a child with Childhood apraxia of speech.

The only treatment that seems to work is speech therapy. 

Lifestyle modifications are necessary for your child in order to cope with Childhood apraxia of speech.

“Working together” is the key to improving your child’s condition. Here are some tips that you can follow:

• Home practice: It provides your child more time to practice the words, syllabus and phrases, in a homely environment.

• Motivate and support: A pat on the back for good performance fuels your child’s ability to perform better. You can also help your child by properly scheduling the different sessions of speech therapy, physical or occupational therapy. This helps to reduce stress on your child who is learning something new in life.

• Join a support group: You may join a support group in your community or online where you can share your condition with parents who are facing the similar situation. To learn about support groups in your area, see the Apraxia-KIDS website.

There are several risks and complications associated with Childhood apraxia of speech.

Risk

• Gene: Abnormalities in the FOXP2 gene may increase the risk of CAS and other speech and language disorders.
• Gender: CAS is more common in boys. However, if CAS occurs in girls, it is likely to be more severe.

Complications

• CAS can affect intellectual ability of your child and may also cause problems with reading, spelling and writing.
• Child with CAS can have problems with gross and fine motor movement skills or coordination.
• Hypersensitivity: A child with CAS may be sensitive to some textures in clothing or the texture of certain foods and tends to avoid them. Or, the child may avoid brushing teeth as s/he does like it.