Childhood Apraxia Of Speech
Childhood apraxia of speech is a motor speech disorder that affects the signals from a child’s brain to coordinate the rapid and precise movements of the mouth muscles for speech. It is not related to muscle weakness or intelligence.
Children with apraxia of speech know what they want to say but have a hard time coordinating the movements of their jaw, tongue, lips, and other parts of the mouth to say what they want.
Our goal in this post is to help explain childhood apraxia of speech in parent friendly terms and to explain how speech therapists help children learn to talk.
You can skip ahead to any of the sections by clicking the links below:
What is Childhood Apraxia of Speech?
Apraxia of speech is a medical reason for a person to have difficulty talking. A speech therapist will say that it is a motor impairment.
Apraxia does not mean that someone isn’t smart. It doesn’t mean that they can’t understand you. And it definitely doesn’t mean that they don’t have anything to say.
Childhood apraxia of speech is one reason it might be hard to understand what your child says. Children with childhood apraxia of speech benefit from the support of a speech therapist to learn how to move their mouth for talking.
Why does someone with apraxia have trouble talking?
I’m not a neurologist, but this is the best analogy I have come up with to summarize in a basic way what is happening: When you talk, you get an idea in your brain of the word you want to say. Then your idea travels on a little road from your brain to your mouth, getting your mouth prepared to move your lips, tongue, and jaw to properly say the word. When all the roads between your brain and mouth are well established, you think of the word ball and then your mouth simply says it. For people without apraxia, the roads between the mouth and brain are smooth and easy to travel, so messages from brain to mouth move quickly and easily.
With childhood apraxia of speech, those little roads between your brain and mouth are not well established. You can think of them as overgrown, or one path splits incorrectly into lots of paths. In many instances, the roads aren’t there at all. So what happens is this: you think of the word ball, but then your message runs down the wrong paths. Each time it might sound a little different: maybe a “D” instead of the “B” will come out, maybe your mouth won’t open, maybe you accidentally stick your tongue out. Or you think of ball, tell your mouth to say “ball,” and then nothing happens.
Have you ever had a dream where you are trying to do something, like scream or run away, but you can’t? Maybe when you try to run you move too slowly, or when you scream only a little sound comes out? In your dream you are frustrated. You know what you want to do, but you CAN’T. I imagine that this is similar to what apraxic people feel every day.
Who gets apraxia of speech?
Apraxia can exist all by itself, meaning that your child’s development is typical in all other ways.
In other instances, a person with another diagnosis may have apraxia also. For example, apraxia occurs more frequently in people who have diagnoses of autism or Down Syndrome.
What’s the difference between articulation and apraxia?
If a child has trouble with “articulation,” usually that means that they have difficulty correctly making one or two sounds in their mouths. So maybe they put their tongue in the wrong place when they make an “R,” or maybe their “SH” sound is made like an “S.” Articulation difficulties are consistent no matter what word the child is saying and limited to only a few consonant sounds. Articulation issues are typically related only to tongue movements.
For young kids with apraxia, they will have issues with lots of different unrelated sounds, including vowels. Sounds may be present in some words but not others, depending on how complicated the mouth movements in that particular word are. The child’s mouth movements will look imprecise and sometimes the errors will be inconsistent. In apraxia, letter sounds that require precise movement of the jaw, lips and tongue are all impacted.
What causes apraxia of speech?
In my job as a speech therapist, I encounter two ways that people get apraxia of speech.
Most commonly, you are born with it. It isn’t due to anything that the parents did or didn’t do, it is just a thing that happens. When children are born with apraxia it is called “childhood apraxia of speech” or “developmental apraxia of speech.”
The second way that people can become apraxic is after a brain injury. I see this in instances where adults and children have been in a severe accident (often with a coma) and then as they recover they have motor difficulty with their speech and other parts of their bodies. This doesn’t happen with a regular concussion like from football or falling out of your chair, I mean a serious life-threatening situation. You would know if this scenario applied to you.
Are there other types of apraxia?
Yes! We keep saying apraxia of speech but this same type of motor challenge can exist for other body movements.
Remember those little pathways that go from the brain to the mouth? Those pathways go all over the body to give messages to anything that you move.
So a person might also have apraxia affecting their walking/jumping, moving their hands, eating, etc.
When I diagnose a child with apraxia of speech I will often submit referrals to physical therapy and occupational therapy. This is because there is a higher likelihood for a person to have these other types of apraxia as well.
How does apraxia get treated?
Treatment of apraxia involves creating or altering the little pathways from the brain to the mouth. This is done through extensive repetition of words and sound patterns.
A good apraxia therapist will start with words that are easy and useful to help motivate your child. The therapist may pick particular sounds to work on first, adding on more and more sounds over time.
When I treat apraxia I like to target a particular mouth movement (like closing lips together, or opening and shutting the jaw) while making sure to always practice the skill in a real word. Like instead of simply saying “mmm” by itself, we will practice saying “mmm” while smelling pretend food. Or instead of drilling the syllable “ma,” the child’s mom will blow bubbles every time she is asked (who should blow bubbles? “Ma!”) In my experience, giving the target sound/word meaning is an important part of apraxia therapy.
In addition to treating a child’s speech, the speech therapist will also work with the family to help create a communication system that they can use while the speech catches up. Some families will teach their child sign language to help communicate. Sometimes the child will be provided with a communication app on a tablet to help them tell people what they want to say.
The therapist isn’t suggesting sign language or a tablet to replace speech, but rather to help ease a child’s frustration and give independence while their speech develops at a slower pace.
How long does speech therapy for apraxia take?
To be honest, childhood apraxia of speech can take a long time to treat. Depending on the severity, children often need many years of therapy. In addition, children might need therapy more frequently than for another diagnosis, sometimes as many as four times a week. A good therapist will involve the family and give “homework” to practice between sessions to help expedite the process.
I’m wondering if my child has childhood apraxia of speech. How do I get them tested?
A speech-language pathologist is the person who diagnoses apraxia of speech. For more information about how to schedule an evaluation for childhood apraxia of speech, continue reading here where we discuss how to find a speech therapist for your child.
Diagnosing apraxia is a slightly tricky process. The current standard is to hold off giving a child an official diagnosis until they are at least three years old. This is because many of the normal speech behaviors exhibited by one and two-year-olds look sort of apraxic. Often, a therapist will wait to give an apraxia diagnosis until they have treated the child for a few sessions. This is because sometimes kids are shy during their evaluation and the therapist wants to make sure that they see how the child speaks and communicates when they are comfortable. In other instances, the child has another diagnosis (such as receptive/expressive language disorder, autism, etc.) and the additional diagnosis of apraxia is identified later.
What are the symptoms of childhood apraxia of speech that the therapist is looking for?
Diagnosing apraxia is really a process of elimination. Basically, the SLP wants to rule out other speech/language issues before jumping to apraxia. That being said, here is my unofficial checklist if I suspect apraxia in a toddler or preschooler. The things on my list don’t apply to every child, they are just common behaviors I see with apraxia. This might get a little technical so please bear with me:
The child’s understanding is significantly better than their expression. This means that, for example, a 3-year-old who doesn’t speak could follow complex multipart directions and questions without issue.
The child sometimes comes up with clever ways to communicate without using actual talking. I’ve encountered kids who speak in sound effects, use a lot of gestures, or have made up their own sign language.
The child has more difficulty talking confrontationally. So the parent says, what’s your name? and the child sits there silently. However, just a few minutes later they see the therapist’s toy and say, “bubbles!” without any hesitation at all. This particular behavior is sometimes interpreted as being naughty when in fact the child is physically unable to speak.
When the child speaks, many of the sounds are wrong for their age (read here for more information about when sounds develop.) Sometimes kids can only make one or two sounds, or they come into the office tight-lipped and can’t say anything at all.
Sometimes a child with apraxia can produce some later developing sounds before early developing sounds. I once had a preschooler who could make a great “R” (a sound older kids learn) but couldn’t close his lips to make a “B” (a sound babies learn.)
Vowel sounds as well as consonant sounds might be wrong. For instance, a child might make the “eee” and “oh” sounds like “uh,” making beat and boat sound like “but.” Technically the consonants in those words are okay, but the words are still wrong because of the vowel.
The child may have limited or slow movement of their jaw. Sometimes the child’s mouth will be constantly open and they drool. Or they may walk around with their mouth shut right and seem to have difficulty opening it when asked.
What can I do at home?
My “at home plan” for families of young children with apraxia is always two-fold.
First, establish a communication system.
For many families this is most easily done through sign language for very young children. For preschoolers some families will use a tablet with a communication app.
Basically, I want a child to be able to approach a parent and say what they want. So if they can sign “FISH-CRACKER” or they can select a “Goldfish” icon on a tablet to ask for their snack, that is an excellent start. Most families rely on the parents guessing and the child nodding yes/no (do you want a snack?), but having the child be specific and independent (signs EAT-FISH-CRACKER) is key to alleviating frustration and encouraging normal language development.
The second thing I want families of kids who don’t talk to work on is having the child try to imitate any sounds.
For hesitant talkers, I have the most success having kids imitate sound effects or exclamations. They might try to copy the intonation for “uh oh!” when I drop something, making a humming sound while they push a toy truck, growl with a dinosaur, etc. If it is done in a fun and low-pressure way children will be more likely to make the sounds. If I tell a child, say “uh oh!” the child will most likely not do it. But if I keep accidentally knocking something off the table while saying “uh oh” myself, maybe on the tenth time I will knock it off, wait, and the child will hum “uh oh!” without me saying anything. I encourage families to set up silly and fun situations where the child can make sound effects to encourage talking.
Your SLP will guide you about what specific words/sounds you should be working on at home.
Childhood Apraxia of Speech can be complicated, difficult to diagnose, and slow to treat. But an experienced speech therapist will help you see improvements and empower your child to communicate.
Let’s Review What We’ve Learned:
apraxia of speech is difficulty coordinating the brain’s signals with mouth movements
apraxia of speech usually can’t be diagnosed until after the age of three
apraxia of speech is treated through extensive repetition of correct mouth movements in real words
sometimes kids with apraxia need to use sign language or a tablet to help them communicate while they learn to use speech
For more information, Apraxia Kids is a non-profit organization with resources for families and professionals: www.apraxia-kids.org
Parents Also Asked:
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Apraxia of speech is diagnosed by a speech language pathologist sometime after children turn 3 years old. It is typically not diagnosed before 3 years old because children’s speech systems are still developing quite significantly.
However, a good speech therapist should be able to identify signs of potential apraxia of speech and suggest strategies to support them before they turn 3.
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Developmental apraxia does not go away on its own. Children with developmental apraxia of speech require speech therapy to help them learn to talk.
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There is some evidence to suggest that childhood apraxia of speech may run in families. Read more here.
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No, apraxia of speech does not affect intelligence.
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Written By: Stephanie Burgener-Vader, MS CCC-SLP
Edited By: Stephanie Keffer, MS CCC-SLP
© 2020-2023. Stephanie Keffer, MS CCC-SLP. All Rights Reserved.
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