Childhood Apraxia of speech (CAS)

• Childhood apraxia of speech (CAS) is a motor-speech neurological disorder that affects certain young children. Children with Childhood apraxia of speech (CAS) know what they want to say, but are unable to form the words. A speech-language pathologist will assist your child to improve their communication skills.

What is childhood apraxia of speech?

• Childhood apraxia of speech (CAS) is a motor speech neurological (brain) condition that harms some young children as they learn to speak. Children with Childhood apraxia of speech (CAS) know what they want to say, but are unable to form the words.

Difference between childhood apraxia of speech, developmental verbal dyspraxia, and developmental apraxia of speech

• Childhood apraxia of speech, developmental verbal dyspraxia, and developmental apraxia of speech refer to a similar condition.
• Apraxia means that you completely leave the ability to do something. Dyspraxia means that you partially leave the ability to do something with accuracy. The difference between the 2 terms is severity, with apraxia being the most severe.
• You will see all 3 terms interchangeably used by different healthcare providers.

How does childhood apraxia of speech affect?

• Childhood apraxia of speech can harm any child. The cause of the condition is unspecified.

Children may be more such to have this condition if:

• A child’s language skills are more powerful than their expressive communication & speech skills or if a child has limited to no speech.
• A child has difficulties chewing foods, utilizing a straw, or drinking from a cup and processing what they feel in their mouth.
• A child has harm with the development of reading, writing, and spelling when they are school-aged.
• A child has difficulty with fine motor skills. For example, the child may have trouble drawing or picking up small things.

How common is childhood apraxia of speech?

• Childhood apraxia of speech is a rare condition that harms an estimated 1-2 out of every 1,000 children in the U.S.

How will childhood apraxia of speech harm my child?

• Childhood apraxia of speech harms how your child communicates verbally. Children with Childhood apraxia of speech (CAS) have trouble carrying out the movements of their mouth to create speech accurately even though the child knows what they want to say.
• Although your child’s inability to speak is the reason for their diagnosis, they may also have difficulty coordinating the movement of their mouth, lips, and tongue. Some children with Childhood apraxia of speech (CAS) may have trouble eating, but for many children with Childhood apraxia of speech (CAS), only their speech is affected.
• Treatment should address the movement patterns needed to produce speech appropriately and help to improve communication. Treatment may involve using supportive techniques such as augmentative communication (the use of voice output devices) or gesture communication, depending on the severity of the diagnosis.

What causes childhood apraxia of speech?

• Childhood apraxia of speech (CAS) happens because of difficulty programming the movements needed for articulation (speech) to occur. The required cause is unknown.
• Children who have Childhood apraxia of speech (CAS) may have interruptions in certain nerve pathways in their brains. These nerve pathways are responsible for planning the movements that are required for speech. In children who have Childhood apraxia of speech (CAS), the messages from their brain to the parts of their mouth used for speech are not being sent correctly.
• Weakness or paralysis of the muscles involved in speech, including those of the lips, jaw, and tongue, are not a cause of Childhood apraxia of speech (CAS).
• In some cases, Childhood apraxia of speech (CAS) is the result of an acquired brain injury, such as a stroke, which causes nerve pathway interruptions in a person’s brain.
• There is also evidence that genetic conditions can lead to a Childhood apraxia of speech (CAS) diagnosis. Studies show that a mutation of the FOXP2 gene leads to a severe form of Childhood apraxia of speech (CAS), along with other neurodevelopmental conditions such as autism, attention-deficit/hyperactivity disorder, and epilepsy. Research is ongoing to pinpoint the direct cause of Childhood apraxia of speech (CAS).

What are the red flags to understand if my child has childhood apraxia of speech?

• There are so many red flags or signs that your child has apraxia of speech during early development.

Red flags involve:

• Limited inventory of consonants & vowels (how many sounds your child makes with specific letters) and gaps in types of sounds such as saying “pie” instead of “bye.”
• Limited rise & fall of voice (pitch) when speaking (intonation).
• Only pronouncing words that have simple syllable shapes (part of a word that has one vowel sound), which are a combination of consonants “C” & vowels “V.” A simple syllable shape consists of words with one C and one V, such as the words “me” or “up.”
• Words appear and then disappear fast.
• Your child leaves out sounds of words such as saying “coo” instead of “school.”

Signs that your child has apraxia of speech between birth and two years involve:

• Saying their 1st consonant after 12 months. Continuous sounds are not vowels (A, E, I, O, U).
• Saying fewer than 3 consonants by 16 months.
• Saying fewer than 5 consonants between 17 and 24 months.
• Focusing on bilabial sounds of speech where the lips nearly close (P, B, M, W), alveolar sounds where the tongue connects with the upper area of the jaw (T, D, N, L, S), and nasal sounds where air passes through the nose for a sound that forms in the back of their mouth (M, N).
• No velar or posterior sounds where the tongue touches the roof of their mouth (K and D) by 24 (twenty-four) months.

What are the symptoms of childhood apraxia of speech?

• The symptoms of Childhood apraxia of speech (CAS) vary from child to child. In general, children affected by Childhood apraxia of speech (CAS) usually understand the language but have difficulty speaking and communicating.

Symptoms for children with Childhood apraxia of speech (CAS) include:

• Creating inconsistent errors in speech,
• Trouble coordinating the movement from one syllable of a word to the next syllable,
• Distorting sounds,
• Attempting to say a word several times previous saying it correctly,
• Creating errors in the tone, stress, or rhythm of speech.

Symptoms before three years of age

Signs and symptoms of Childhood apraxia of speech (CAS) may appear at different stages of a child’s life. Children younger than three years may:

• Not create babbling or cooing sounds,
• Use only a few various sounds,
• Have difficulty putting sounds together,
• Take long pauses in between sounds,
• Say words various each time,
• Say their 1st words later than expected,
• Have problems eating.

Symptoms after 3 years of age

Children diagnosed with childhood apraxia of speech who are older than three years may:

• Have trouble saying longer words clearly,
• Have difficulty imitating what other people say,
• Be hard to understand, especially for people who do not know the child,
• Have a flat or choppy speech pattern,
• Grope, or search, for words by moving their mouth a few times previous speaking,
• Have more difficulty speaking when nervous.

How is childhood apraxia of speech diagnosed?

• Childhood apraxia of speech (CAS) is usually diagnosed by a speech-language pathologist (SLP). A speech-language pathologist (SLPs) has extensive training and skill in treating speech disorders.
• To diagnose Childhood apraxia of speech (CAS), a speech-language pathologist (SLP) will learn about your child’s history, including any known medical problems. The speech-language pathologist (SLP) will also test your child’s hearing, oral-motor skills and intonation (pitch), and the way they say sounds.

The speech-language pathologist (SLP) will also test your child’s ability to speak by:

1. Detecting for signs of mouth muscle weakness.
2. Detecting how well your child makes consonant and vowel sounds.
3. Looking at nonspeech oral motor skills like blowing, smiling, rounding lips, and how quickly your child can move their mouth.
4. Observing how your child pauses or exchanges the pitch of their voice.
5. Observing how well others can understand what your child is saying.

• Genetic testing can determine if there is a genetic mutation that is responsible for causing symptoms of the condition. Your healthcare provider (doctor) will examine a sample of your child’s blood to identify any abnormalities in their genes.

How is childhood apraxia of speech treated?

• Treatment for Childhood apraxia of speech (CAS) may require more intense treatment than other speech-sound conditions. Certain children will visit their speech-language pathologist 3 to 5 times per week so they can develop their speaking ability.
• Children with severe Childhood apraxia of speech (CAS) symptoms may need treatment for several years, especially if they miss language development milestones throughout early childhood.

Treatment for Childhood apraxia of speech (CAS) includes:

• Enroll in speech therapy to address syllables, words, and phrases at a pace unique to fit the requirements of your child.
• Learning alternative means of communication such as sign language or using electronic communication devices.
• Practicing constant language exercises at home & outside of speech therapy.

Physiotherapy management

• Remedial approach: In the remediation of the apraxias, it is advised that the therapist speak slowly and utilize the shortest possible sentences. One command should be given at a time, and the second command should not be given until the 1st task is completed. When teaching the latest task, it should be broken down into smaller areas. One component is taught at a time, physically guiding the patient through the task if required. It should be completed in precisely a similar manner each time. When all the individual units are mastered, an attempt to combine them should be created. A great deal of repetition may be required. Family members must be advised to utilize the exact approach found to be successful in the clinic. Performing activities in as normal an environment as possible also assists. Butler provides a case example of a young woman relearning how to drink from a cup using this technique. Using the sensorimotor approach, multiple sensory inputs are used on the affected body areas to enhance the production of appropriate motor responses.
• Compensatory approach: Strategy training involves teaching the patient compensatory techniques to overcome the apraxia such as the utilization of pictures in the correct sequence to support ADL skills. his approach has been developed further and is now widely used to assist patients to overcome apraxia.
• Activities to increase coordination and balance can be incorporated.
• Strategy training for daily activities (i.e. teaching personal strategies to overcome the difficulties of patient experiences)
• Gesture training (i.e. relearning gestures)
• Direct ADL training (i.e. relearning – or learning the latest ways to perform – daily tasks).

How can I prevent childhood apraxia of speech?

• There is not any other way to prevent childhood apraxia of speech (CAS). It is a neurological condition tied to brain development.
• Since certain cases of Childhood apraxia of speech (CAS) link to genetic mutations, if you plan on becoming pregnant, ask your healthcare provider (doctor) about genetic testing to assess your risk of having a child with a genetic condition.

What can I expect if I have a child with childhood apraxia of speech (CAS)?

• As your child grows, they may miss language development milestones, such as saying their first words and using short sentences to express themselves. Developmental delays could cure your child from learning in the classroom at a similar level as their peers.
• Children who have Childhood apraxia of speech (CAS) do not outgrow the condition and there is no cure. The early treatment alleviates the frustration that your child may look at if they want to say something but are unable to communicate that message.
• Your healthcare provider (doctor) can make recommendations for treatment later in a diagnosis and refer your child to a speech-language pathologist who will address your child’s unique symptoms to improve their speech.

How do I take care of my child with childhood apraxia of speech (CAS)?

• Offering your child support as they grow is the better way you can take care of your child diagnosed with apraxia of speech. Your child will such as participate in one-on-one sessions with the speech-language pathologist (SLP). Your child’s speech-language pathologist (SLP) may offer homework for your child to practice in-between visits. Just such as homework from a math class, it is important to assist your child to complete their speech assignments at the same rate as their educational assignments.
• Follow up with your child’s speech-language pathologist (SLP) to keep track of how much your child is improving and offer encouragement along their journey.

When should I see my healthcare provider?

• If you notice symptoms or signs of Childhood apraxia of speech (CAS) in your child, or if your child is missing language development milestones, such as saying their first words or naming usual objects, contact your healthcare provider (doctor) for a referral to a speech-language pathologist (SLP).
• If your child has trouble eating and coordinating movement with their mouth separate from speech, visit your healthcare provider (doctor) immediately.

What questions should I ask my doctor?

• Does my child require to see a speech-language pathologist?
• How should I act if my child misses language development milestones?
• Does my child require any language communication devices to speak?

Conclusion

• You might feel frustrated if you can not remember the name of a person you’ve met several times. If your child has Childhood apraxia of speech (CAS), they may experience the same frustration when they know a person’s name but are unable to formulate the correct sounds to express i
• Your child’s speech therapy treatment will be long-term to assist them to communicate, and treatment significantly improves their symptoms. Offer support & encouragement as your child reaches different milestones for communication each day.

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