Childhood Apraxia of Speech (CAS) | Causes, Symptoms & Treatment - ASLPclick

CHILDHOOD APRAXIA of SPEECH 

Ø Apraxia –

-         Apraxia is a motor disorder caused by damage to the brain (specifically the posterior parietal cortex or corpus callosum) which causes difficulty with motor planning to perform tasks or movements.

-         The nature of the damage determines the disorder's severity, and the absence of sensory loss or paralysis helps to explain the level of difficulty.

-         Children may be born with apraxia; its cause is unknown, and symptoms are usually noticed in the early stages of development.

-         Apraxia occurring later in life, known as acquired apraxia, is typically caused by traumatic brain injury, stroke, dementia, Alzheimer's disease, brain tumor, or other neurodegenerative disorders. There are multiple types of apraxia, categorized by the specific ability and/or body part affected.

-         Inability to perform particular purposive actions as a result of brain damage.

-         Apraxia (also called “Dyspraxia” if mild) is a disorder of learned movement in which the difficulty with movement is not caused by paralysis, weakness or incoordination of the muscles and can not be accounted by sensory loss, comprehension deficits or inattention to commands.

Ø Childhood Apraxia of Speech (CAS) –

-         Childhood Apraxia of Speech is a speech disorder in which child’s brain had difficulty to coordinating the complex Oral movements needed to create sound into Syllable, syllable into words & words into phrases.

-         “Defects of articulation in children of good mental capacity…associated neither with mechanical conditions of the mouth, nor with disease of the articulatory apparatus, but most certainly dependent on some fault in the central nervous system.”                                                                                ( ~W.B. Hadden, 1891)

-         The failure or limited ability to control and direct the movements and coordination’s of the respiratory and oral muscles for articulation when muscle tone is otherwise accurate.”                                                                                          (~M. Morley, 1965)

-         “Difficulty executing and/or coordinating/sequencing the oral motor movements necessary to produce and combine consonants and vowels to form syllables, words, phrases and sentences on volitional control.”                                                            (~ Nancy R. Kaufman, M.A., CCC/SLP)

-         In order for speech to occur, messages need to go from your brain to your mouth. These messages tell the muscles how and when to move to make sounds. When a child has apraxia of speech, the messages do not get through correctly. The child might not be able to move their lips or tongue in the right ways, even though their muscles are not weak. Sometimes, the child might not be able to say much at all.

-         A child with CAS knows what they want to say. The problem is not how the child thinks but how the brain tells the mouth muscles to move.

-         CAS is sometimes called verbal dyspraxia or developmental apraxia. Even though the word “developmental" is used, CAS is not a problem that children outgrow. A child with CAS will not learn speech sounds in typical order and will not make progress without treatment. It can take a lot of work, but the child’s speech can improve.

Ø   Signs & Symptoms of Apraxia of Speech –

·        Lack of cooing and babbling as an infant

·        Phoneme (consonant or vowel) replacements or deletions occur in order to simplify oral-motor movements.

·        A child may have a limited repertoire of consonants.

·        A child may be able to produce all (or most) consonants in isolation but cannot easily combine consonants and vowels.

·        Oral scanning and groping may occur.

 

Not all children with CAS are the same. Your child may show some or all of the signs below. You should talk to your doctor and see an SLP if your child is older than 3 years and

• does not always say words the same way every time;
• tends to put the stress on the wrong syllable or word;
• distorts or changes sounds; or
• can say shorter words more clearly than longer words.

Children with CAS may have other problems, including

• difficulty with fine motor skills;
• delayed language; or
• problems with reading, spelling, and writing.

 

Ø Signs & Symptoms of Apraxia of Speech, continued –

• Pointing and grunting occurs beyond age 2 to convey thoughts
• One syllable is used to represent words such as da da da….
• The child may only speak in vowels.
• One real word may be used to convey many
• Single words may be articulated accurately but strings of words result in unintelligible speech.
• Assimilation errors may occur
• Anticipatory errors may occur

·        “Triggered” or “reflexive” words or phrases may “pop out” with total clarity and may never be heard again or cannot be elicited upon imitation.

* In “classic” Apraxia/Dyspraxia of speech in children, receptive language is generally significantly better than expressive language.

Ø Causes –

-         Most of the time, the cause of CAS is unknown. In some cases, damage to the brain causes CAS. Damage may be caused by a genetic disorder or syndrome, or by a stroke or traumatic brain injury. 

vSeeing a Professional

Ø Testing for CAS –

-         An SLP can test your child’s speech and language skills. Many children with speech sound disorders also have language disorders. Find an ASHA-certified SLP in your area by using.

 

-         To test for CAS, the SLP will look at your child’s oral–motor skills, speech melody (intonation), and how they say different sounds. To test how your child says sounds, the SLP will

• check how well your child says speech sounds alone and combined in syllables or words and
• check how well others can understand what your child says.

You should also talk to your doctor, who can check for any medical problems. It is important to have your child’s hearing checked by an audiologist. A child with a hearing loss may have more trouble learning to talk.

 

Ø Treatment for CAS –

A child with CAS should work with an SLP. Your child may begin with therapy 3–5 times per week. As speech improves, treatment may be less often. Individual or group therapy may be appropriate at different stages of treatment.

 

Ø Treatment Goals –

The goal of treatment is to help your child say sounds, words, and sentences more clearly. Your child will learn how to

• plan the movements needed to say sounds and
• make those movements the right way at the right time.

-         Doing exercises to make the mouth muscles stronger will not help. Mouth muscles are not weak in children with CAS. Working on how to move those muscles to say sounds will help.

Your child must practice speaking to get better at it. It helps to use all the senses when learning how to say sounds. Your child may use

• “touch” cues, like putting their finger on their lips when saying the “p” sound as a reminder to close the lips;
• “visual” cues, like looking into a mirror when making sounds; or
• “listening” cues, like practicing sounds with a recorder and then listening to hear if the sounds were made correctly.

Ø Other Ways to Communicate

In order to communicate, your child may learn sign language or may learn to use picture boards or computers that talk. This is called augmentative and alternative communication (AAC).

-         Some parents are afraid that their child will only want to use AAC systems and not try to talk. There is no evidence to support this idea. AAC systems support communication and help your child as they work on their speech with the SLP.

 

Ø Family Support –

CAS treatment takes time, and your child will need your support. Practice what your child learns with the SLP to help them make progress. Take breaks when your child is tired and make practice as much fun as possible. Tell your child’s SLP what happens at home so you can all work together to help your child succeed.