Childhood Apraxia of Speech

What is childhood apraxia of speech?

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

What is the 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 the same condition.

Apraxia means that you completely lose the ability to do something. Dyspraxia means that you partially lose the ability to do something with accuracy. The difference between the two terms is severity, with apraxia being the most severe.

You will see all three terms interchangeably used by different healthcare providers.

Who does childhood apraxia of speech affect?

Childhood apraxia of speech can affect any child. The cause of the condition is unknown.

Children may be more likely to have this condition if:

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

How common is childhood apraxia of speech?

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

How will childhood apraxia of speech affect my child?

Childhood apraxia of speech affects how your child communicates verbally. Children with CAS have trouble carrying out the movements of their mouth to produce 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 trouble coordinating the movement of their mouth, lips and tongue. Some children with CAS may have trouble eating, but for many children with CAS, only their speech is affected.

Treatment should address the movement patterns required to produce speech appropriately and help to improve communication. Treatment may also include using supportive techniques such as augmentative communication (the use of voice output devices) or gesture communication, depending on the severity of their diagnosis.

What causes childhood apraxia of speech?

Childhood apraxia of speech occurs because of difficulty programming the movements needed for articulation (speech) to occur. The exact cause is unknown.

Children who have CAS may have interruptions in certain nerve pathways in their brains. These nerve pathways are responsible for planning the movements that are necessary for speech. In children who have 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 CAS.

In some cases, CAS is the result of an acquired brain injury, like a stroke, which causes nerve pathway interruptions in a person’s brain.

There is also evidence that genetic conditions can lead to a CAS diagnosis. Studies show that a mutation of the FOXP2 gene leads to a severe form of CAS, along with other neurodevelopmental conditions like autism, attention-deficit/hyperactivity disorder and epilepsy. Research is ongoing to pinpoint the direct cause of CAS.

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

There are several red flags or signs that your child has apraxia of speech during early development. Red flags include:

• Limited inventory of consonants and vowels (how many sounds your child makes with specific letters) and gaps in types of sounds like saying “pie” instead of “bye.”
• Limited rise and 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” and vowels “V.” A simple syllable shape consists of words with one C and one V, like the words “me” or “up.”
• Words appear then disappear quickly.
• Your child leaves out sounds of words like saying “coo” instead of “school.”

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

• Saying their first consonant after 12 months. Consonant sounds are not vowels (A, E, I, O, U).
• Saying fewer than three consonants by 16 months.
• Saying fewer than five 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 part 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 months.

What are the symptoms of childhood apraxia of speech?

The symptoms of CAS vary from child to child. In general, children affected by CAS usually understand the language but have difficulty with speaking and communicating. Symptoms for children with CAS include:

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

Symptoms before 3 years of age

Signs and symptoms of CAS may appear at different stages of a child’s life. Children younger than 3 years may:

• Not make babbling or cooing sounds.
• Use only a few different sounds.
• Have trouble putting sounds together.
• Take long pauses between sounds.
• Say words differently each time.
• Say their first words later than expected.
• Have problems eating.

Symptoms after 3 years of age

Children diagnosed with childhood apraxia of speech who are older than 3 years may:

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

How is childhood apraxia of speech diagnosed?

Childhood apraxia of speech is usually diagnosed by a speech-language pathologist (SLP). SLPs have extensive training and skill in treating speech disorders.

To diagnose CAS, an SLP will learn about your child’s history, including any known medical problems. The SLP will also test your child’s hearing, oral-motor skills and intonation (pitch) and the way they say sounds.

The SLP will also test your child’s ability to speak by:

• Checking for signs of mouth muscle weakness.
• Checking how well your child makes consonant and vowel sounds.
• Looking at nonspeech oral motor skills such as blowing, smiling, rounding lips and how quickly your child can move their mouth.
• Observing how your child pauses or changes the pitch of their voice.
• Observing how well others can understand what your child is saying.

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

How is childhood apraxia of speech treated?

Treatment for CAS may require more intense treatment than other speech sound conditions. Some children will visit their speech-language pathologist three to five times per week so they can develop their speaking ability.

Children with severe CAS symptoms may need treatment for several years, especially if they miss language development milestones throughout early childhood.

Treatment for CAS includes:

• Enrolling in speech therapy to address syllables, words and phrases at a pace unique to fit the needs of your child.
• Learning alternative means of communication like sign language or using electronic communication devices.
• Practicing repetitive language exercises at home and outside of speech therapy.

How can I prevent childhood apraxia of speech?

There is no way to prevent childhood apraxia of speech. It's a neurological condition tied to brain development.

Since some cases of CAS link to genetic mutations, if you plan on becoming pregnant, ask your healthcare provider 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?

As your child grows, they may miss language development milestones, like saying their first words and using short sentences to express themselves. Developmental delays could prevent your child from learning in the classroom at the same level as their peers.

Children who have CAS do not outgrow the condition and there is no cure. Early treatment alleviates frustration that your child may show if they want to say something but are unable to communicate that message.

Your healthcare provider can make recommendations for treatment after 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?

Offering your child support as they grow is the best way you can take care of your child diagnosed with apraxia of speech. Your child will likely participate in one-on-one sessions with a speech-language pathologist (SLP). Your child’s SLP may offer homework for your child to practice in between visits. Just like homework from a math class, it is important to help your child complete their speech assignments at the same rate as their educational assignments.

Follow up with your child’s 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 CAS in your child, or if your child is missing language development milestones, like saying their first words or naming common objects, contact your healthcare provider for a referral to a speech-language pathologist.

If your child has trouble eating and coordinating movement with their mouth apart from speech, visit your healthcare provider immediately.

What questions should I ask my doctor?

• Does my child need to see a speech-language pathologist?
• What should I do if my child misses language development milestones?
• Does my child need any language communication devices to speak?

A note from Cleveland Clinic

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