Overview of Childhood Apraxia of Speech

What is Childhood Apraxia of Speech ?

Childhood Apraxia of Speech (CAS)/Developmental Verbal Dyspraxia (UK), is a motor speech disorder in which the child, although knowing what to say, can’t say it because the brain has a really hard time coordinating the movements necessary to produce sounds, syllables, words and sentences that make up usual conversational speech.  However, speech is not the only aspect of a child’s functioning that is affected. Childhood Apraxia of Speech is a spectrum disorder, no two children are alike in how they are affected or how they respond to treatment.  CAS affects motor programming, including gross and fine motor usage,  and can affect language, learning, literacy, memory and other aspects of a child’s life.  Children will not “just outgrow” Childhood Apraxia of Speech.  Without years of Speech Therapy children will possibly not speak intelligibly. Difficulties in communication can affect a child’s self esteem, social interactions, and other important aspects of life and can lead to anxiety and stress and have a huge adverse impact on a child’s quality of life.

What are some of the signs and symptoms  of (How can you tell) CAS?

Very Young Children:

  • May not babble or coo or make early sounds.
  • Delayed first words (after one year or later).
  • First words are simplified and not very easy to understand.
  • Can replace difficult sounds with easier sounds (common).
  • Can drool a lot more.

Older Children:

  • Make inconsistent errors when they talk (always make different mistakes even if they get a word right, can get it wrong another time)
  • Sound choppy, speech is not smooth and have difficulty making smooth transitions between different tones of speech.
  • Have language delays, though understand things a lot better than they can express themselves, even with writing.
  • Can have issues with Literacy and Learning.
  • Can have more difficulty when anxious or tired.
  • Will be difficult to understand by strangers.

Other problems:

  • Difficulty with fine and gross motor coordination.
  • Can be a part of a Syndrome (eg Autism/Developmental Coordination Disorder/William’s Syndrome, others) or occur on it’s own. (Idiopathic- unknown cause)
  • Difficulties with Literacy, Language and Learning.

How is Childhood Apraxia of Speech Diagnosed?

A Speech Language Pathologist (SLP) is the best person trained to make this diagnosis.  A hearing test should be done to rule out problems with hearing.  An examination of the mouth and tongue (Oral Motor Assessment) to rule out weakness causing other issues (dysarthria) will be done. Additionally the SLP will check pitch and tone, and Speech and Sounds (vowel/consonant sounds) and sequencing different sounds together, as well as language and the ability of a listener to understand what the child says.

How is CAS treated?

Studies have shown that frequent short and intensive  therapy sessions (3-5 x per week) are most effective.  After the initial treatment, sessions can become about 1-2 x per week as the child masters more sounds and words.  The treatment involves many practice opportunities, training the brain to make speech happen, by focusing on planning and programming the movements of speech. Once learned, it becomes easier, and the child is able to speak like everyone else, for the most part. Regular practice is essential. Feedback by different methods (Multi-sensory cues) are also important to let the child know what he or she is doing right, as is encouragement and support.

Its important for parents to know that living with Childhood Apraxia of Speech becomes a way of life initially. It takes commitment to go for so many treatment sessions and for so long, and these are expensive.  Also, parents will need to advocate for their children to get the appropriate services in school etc.

Alberta Health Services (AHS) has programs that are tailored to treat young children with Childhood Apraxia of Speech, though this is considered initial assessment and treatment, and they follow a step wise protocol. Your Local Public Health Center will be the first place to access these.  Parents will still need to find an SLP for private treatment once this is complete.

In School, Services are accessed either via the school, or in some cases in the Edmonton Zone, Children can still be seen at the local health Centre, though most of the treatment support is done through the school that either hires SLP’s themselves or through the local AHS Public Health Center. Policies and Services do seem to change from time to time, so always find out what the current situation is for access to services. In addition, while the School SLP in some cases may not have enough experience with the motor treatment aspects of Apraxia , they can still work on other issues such as Language development.  Private therapy will be the mainstay of treatment, and in many cases Private Insurance plans pay for some of this, in addition Family Support for Children with Disabilities (FSCD) can help offset some of the cost, as well as the Child Disability Tax Credit.