Apraxia of Speech
Speech is one of the most intricate and complex actions in which humans can be engaged. It requires a high degree of oral- and verbal-motor coordination involving the “articulators” (i.e., lips, tongue, teeth, palate, jaw). Children with apraxia of speech have difficulty initiating and coordinating the oral- and verbal-motor movements needed for the production of speech sounds and for sequencing them into syllables, words, phrases, and sentences. Apraxia of speech is grouped with other conditions as a “motor speech disorder”. It varies significantly from child to child, and its severity can range from mild to severe.
CAS is considered to be a neurologically based speech disorder. However, for most children, a problem or difference would not be identified on an MRI scan. Some children may have a previously identified particular damage to the brain that may have been present at birth or caused by an accident or illness. For many others, the cause may be genetic or unidentifiable. Researchers are working to achieve a better understanding of the cause and nature of this disorder.
Some children with CAS have a history of feeding difficulties (e.g., poor coordination for sucking, chewing, and/or swallowing) and difficulty using the lips and tongue for non-speech tasks, such as puckering lips to kiss or blow bubbles, or using the tongue alone (without lip or head support) to lick an ice cream cone. Such difficulty with non-speech tasks is termed “oral apraxia”. However, the signs of oral apraxia are absent in many children with CAS. Following are the verbal-motor difficulties experienced by most children with CAS:
- Limited frequency and diversity of sounds, vocal play, and jargon as a baby.
- Slow acquisition of words and of the ability to put them together into phrases.
- Poor speech understandability due to numerous sound errors and omissions of sounds and syllables.
- Discrepancy between receptive and expressive language skills (i.e., The understanding skills of children with CAS is usually stronger than their ability to express themselves.)
- Inconsistency in how the child produces a sound or word (e.g., A child may say the /s/ sound correctly in the word “sun”, but then say the word “sit” as “hit”.)
- The ability to correctly produce a sound or word spontaneously, but the inability to do so when asked to imitate the sound or word.
- A decrease in accuracy and understandability as the utterance length and/or complexity increases (e.g., The child can say each of the words, “cow” and “boy” clearly, but says the word “cowboy” as “buckoy”.) The speech of some children with CAS sounds slurred and run together, as they attempt to express themselves in longer phrases and sentences. Such children may be able to imitate the single words “butterfly” and “beautiful”, but when spontaneously using them in a sentence, they may omit sounds and syllables, making the words difficult to understand (e.g., “The buhfie is booful.” for “The butterfly is beautiful.”)
- A relatively poor repertoire of syllable and word shapes (e.g., The child may mainly produce consonant (C) + vowel (V) syllables, such as “boe, tee, doo” or CVCV reduplicated syllables, as in “mama”, “wawa”, “baba”).
- The ability to produce some consonant and vowel combinations, but not others (e.g., The child can say, “kay”, “kee”, and “kie”, but not “koe” or “koo”.)
- Distortions of vowel sounds. For children who are developing speech typically, accurate vowel acquisition is occurs early. Children with CAS often possess some vowel distortions (e.g., “tom” for “time”, “bod” for “bad”, and “ott” for “out”).
- Difficulty sequencing sounds in words (e.g., “ticky” for “kitty”), especially when attempting to produce longer words (e.g., “cuhvanoe” for “volcano”).
- A relatively poor repertoire of consonants and vowels (e.g., The child may only produce the consonants /p, b, m, t, d” and the weak vowels “eh” and “uh”.)
- Unusual stress or rhythm patters. The child may sound “robotic” due to the placement of equal stress or emphasis on each syllable (e.g., “I-am-pe-tting-the-pu-ppy.”)
We make therapy for the child with CAS a fun experience using a combination of toys, games, and picture tasks. Since a great deal of speech practice is needed to help children conquer this disorder, we incorporate a lot of reinforcement and motivating tasks in our sessions. A specific therapy program is designed for each child, depending upon her age, interests, personality, strengths, and speech needs. The primary goal of therapy for the child with CAS is to help her develop the motor control and sequencing abilities needed to produce all age-level sounds clearly and to easily and accurately sequence those sounds into words of increasing length. Each little achievement made by the child adds a great deal to her competency and confidence and makes the next step easier to attain.
First of all, your child’s speech-language pathologist will provide you with specific suggestions and activities for home practice. Consistent home practice is a big factor in helping your child overcome her difficulties. As we always suggest, make your child’s message more important than how she says it. Don’t feel the need to correct your child when she tells you something. If you do not understand the whole message, try to mentally fill in the misunderstood parts in order to get the “gist” and respond to your child accordingly. In many cases, a parent is one of the only people who understands their child with CAS. This is extremely comforting and freeing to the child, when the rest of the world does not know what she is trying to say. At the beginning, you may need to speak for the child, but as she becomes more skillful and gains confidence when communicating with others, your role will be more supportive in nature It is so helpful to know what your child’s abilities and limitations are, and it is crucial that she not be put on the spot to say something (e.g., “Tell Grandma what we did today!”) Instead, it is helpful to ask your child choice-of-two questions that would allow for a simple single-word or short phrase response (e.g., “Did we paint or make cookies?”) Be patient and encouraged. With therapy, home practice, and time, your child should be able to make great strides toward becoming a clear communicator. Most children we see who had CAS tend to make up for lost time, becoming little chatterboxes!