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Apraxia of Speech

Learn to identify a difficult childhood speech problem

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When it comes to speech disorders, childhood apraxia of speech (CAS) is particularly tricky to diagnose. “There are so many reasons a child might not be talking,” says Rizza Miro Lemonakis, MA, CCC-SLP, a Marlton, NJ-based speech language pathologist. As such, this neurologically based disorder, which impedes coordination of the complex oral movements needed to produce speech, tends to be off many pediatricians’ radars. 

“It is a disconnect between what your mind wants to say and the muscles doing it,” explains Miro Lemonakis. As a result, kids struggle to make their mouths form sounds and words, despite the fact that there is no weakness in the muscles used for speaking.

Unlike articulation disorders, which are rule-based and consistent, “The most consistent thing about apraxia is that it’s inconsistent,” says Maria Unger, CCC-SLP, a speech language pathologist at the TALK Institute in Newtown Square, PA, who describes CAS as an interruption in the brain’s speech motor plan. “It doesn’t follow rules and it doesn’t follow developmental sequence.” 

Evan’s apraxia story

“Evan wasn’t quiet, but he had no clear words,” remembers his mother Virginia, who first suspected a problem around the time he was 1 — the age flagged as a marker that something may be wrong by speech pathologist Loretta Martin, MS, CCC-SLP, of DuPont Pediatrics at Becks Woods in Bear, DE. It took a few years to finally get a definitive diagnosis, when Evan was 3½; after a few months of early intervention treatment, he really started talking by the age of 4. Now 5, Evan continues to receive speech therapy from his Marlton school district five days a week. “He’s not clear and still has a way to go,” Virginia says. “But he’s made a huge improvement.”

One of the biggest indicators of apraxia is a growing gap between expressive language and receptive language as the child gets older, says Miro Lemonakis. Other signs of CAS are:

  • Groping: The mouth gropes for the right movement to form a word. 
  • Vowel distortions 
  • Putting emphasis on the wrong syllables 
  • Difficulty making new word sounds or combinations 
  • Difficulty imitating sounds

By 2 or 3, if the child is not making a lot of sounds or sound combinations, seek a speech evaluation, recommends Martin. “Early therapy is key,” agrees Miro Lemonakis. 

Next page: Treatment and long-term implications of apraxia, plus Web-based resources

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