Childhood apraxia of speech (CAS) is a neurological childhood speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g. abnormal reflexes, abnormal tone.) The core impairment in planning results in errors in speech sound production and prosody (ASHA, 2007). Children with CAS have difficulties with motor planning as it relates to speech sound production.
They know what they want to say but have difficulty getting their message out.
First, let’s talk motor planning. Motor planning refers to the movements our bones, joints, and muscles make that allows our bodies to move. With each movement, our body and brain send messages back and forth to tell each other certain ways to move to accomplish tasks.
You can thank your ability to motor plan when you get on a bike for the first time in 5 years, pick up your toothbrush from the same spot on the counter each morning, and take the same walk in the morning on the way to school! So, what happens when we lose the ability to motor plan? Suddenly, riding a bike feels impossible, grabbing your toothbrush in the morning just got harder and the walk to school feels different every day.
Disruption to the motor movements can also occur orally. When kids are unable to plan motor movements to talk, this can be referred to as developmental dyspraxia of speech or childhood apraxia of speech (CAS). Each of these terms refer to the same condition and are often interchangeable.
So, what causes childhood apraxia of speech and how can I help? Studies have revealed CAS can be congenital (born with), or it can be acquired during speech development. Both congenital and acquired CAS can occur as an idiopathic neurogenic speech sound disorder (i.e., in children with no observable neurological abnormalities or neurobehavioral disorders or conditions); as primary or secondary signs within complex neurobehavioral disorders (e.g., autism, epilepsy, and syndromes, such as fragile X, Rett syndrome, and Prader–Willi syndrome; or in association with known neurological events (e.g., intrauterine or early childhood stroke, infection, trauma, brain cancer/tumor resection).
In order to implement functional treatment strategies, we must first identify signs and symptoms consistent with apraxia. Here are a few early signs of childhood apraxia of speech to be on the lookout for:
Treatment for CAS is rooted in the principles of motor learning. Factors related to motor learning include:
While traditional speech therapy targets specific speech sounds, our childhood apraxia of speech goals aim to establish new neural pathways or fix the existing ones. To achieve this goal, the child will require repetitive practice. Practice should target movement patterns in syllables known as co-articulation, rather than individual and specific speech sounds. The movement patterns targeted will increase in complexity as therapy progresses.
Your SLP will assist you in establishing appropriate, functional targets to progress your child’s expressive language skills. Repetition of target words and frequent practice is essential in establishing notable gains in skill.
How can you support your child who presents with a motor planning disorder? Kids learn best through repetition of functional and engaging tasks. First, start small with easy words. For example, we can start with the word “ma.” Once “ma” is consistently used, we can start shaping it into “mama.” As “mama” becomes more consistent maybe we choose the word “baba”, the same vowel sound, but a new consonant. As consistency increases, continued expansion of vowel sounds is encouraged; “ma” can turn into “me” then “my”, then “mo.” Kids also learn visually, so incorporating all our senses can help with increased acquisition of sounds.
Caregivers and family members play an integral role in treatment! There are plenty of ways to make learning fun while still getting lots of practice in at home! Children learn best during daily routines and during play. If you suspect your child may have CAS, here are some strategies for home practice.
Here is a fun list of books that you can read with your kids with fun repeating lines. Choose a word that repeats throughout the book and pair a fun action!
Did you know that May 14th is Apraxia Awareness Day and May is Apraxia Awareness Month? For more information and resources, visit www.apraxia-kids.org.
Alyssa Mignone is a pediatric speech language pathologist at NAPA Center Boston. Alyssa loves putting the “fun” in functional by using everyday routines to create meaningful language opportunities for children to grow. When she’s not at work, you can find her skiing, hiking, or relaxing at the beach!
Mikaela Eppard is a Denver native and has always had a passion for working with kids and knew she wanted to be a speech therapist since her freshman year in high school. On the weekends she enjoys spending time with her friends and family, hiking, exploring new places to eat and skiing in the winter.
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