What to Know About Childhood Apraxia of Speech

Do you have a late talker who has difficulty imitating your speech? Does your child only use limited sounds and words to communicate? Is your preschooler hard to understand? Then it might be time to talk to a Speech Language Pathologist about Childhood Apraxia of Speech (CAS).

What is it?

Childhood apraxia of speech is a motor speech disorder. That means the brain knows what to say, but the articulators (mouth, tongue, etc) have trouble moving correctly and coordinating speech. It’s the motor movements required for speech that are causing the issue. And, while it’s known to be neurological in nature, an exact cause has yet to be discovered.

How is it diagnosed?

CAS can only be diagnosed if a child is verbal and can imitate speech tasks within a formal motor speech assessment. However, even if your child is minimally verbal or non-speaking, the presence of certain signs of CAS can lead a SLP to the diagnosis of suspected CAS. Some of those common signs are: 

• Difficulty imitating sounds or words

• Inconsistent sounds or word errors

• Groping or struggling when trying to speak

• Trouble producing words with two or more syllables 

• Vowel errors

• Difficulty with volitional speech (comments, questions) versus automatic speech (saying ABCs, counting)

• Disappearance of words that they said at one time

What if those signs are present in my child?

If you suspect your child has CAS, find a SLP who can provide a diagnosis and offers the appropriate therapy. A traditional articulation approach that just focuses on producing certain sounds isn’t the best therapy method. Instead, children with CAS need therapy based on the principles of motor learning.

How can I support my child?

If you have a child with CAS or suspected CAS, here are some ways to best support them:

• Create communication risk-takers. Acknowledge any attempts to verbalize and provide lots of praise, especially for minimally verbal or non-speaking kids. Show them that any attempt to verbalize is meaningful.

• Encourage frequent practice. Motor learning requires repetition and practice of speech sounds and motor sequences. Short, frequent practice sessions throughout the day may be more effective than a few, longer sessions.

• Use multi-sensory techniques. Engage multiple senses in therapy activities and incorporate tactile, visual, and auditory cues to reinforce motor patterns. For example, use tactile cues, like tapping or touching the face, visual cues, such as mirrors or gesture prompts, and auditory cues, like rhythm or music, for motor planning and sequencing.

• Provide feedback. Offer specific, constructive feedback to help the child understand and correct their speech movements (i.e. “I like how you popped your lips”, “Great job putting your tongue up!”).

• Incorporate play. Make therapy sessions enjoyable and engaging by incorporating play-based activities. Play can naturally facilitate motor learning and encourage spontaneous communication attempts.

What else should I know?

CAS can be present on its own or co-exist with other disorders. Autism and CAS occur much more frequently together than once thought. It’s also been found that those with cerebral palsy may be at a higher risk for CAS. And, there can be other co-occurring speech, language, and/or motor difficulties as well. Some specific motor issues that could also be present include:

• Dyspraxia, which is difficulty with physical coordination and learning new skills

• Fine motor deficits, seen in such tasks as writing, buttoning clothes, or using utensils

• Gross motor deficits, noticed in activities like walking up stairs, climbing, or running

It’s important to find providers that can help diagnose any co-occurring conditions. These might include a developmental pediatrician, an occupational therapist, or a physical therapist. Having a team of professionals working together to address all of your child’s needs can make a big difference in the success of their therapy.