Apraxia of Speech

Learn to identify a difficult childhood speech problem
Suzanne Koup-Larsen,

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. 

Apraxia & Autism

Though they are distinct diagnoses, there appear to be some similarities between autism and childhood apraxia, and sometimes the disorders do overlap. “There is a connection,” says Miro Lemonakis, “but it goes only one way.” Children with autism have a higher likelihood of having apraxia, she says. But children with apraxia do not have a higher likelihood of having autism.

“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

 

Conner’s apraxia story

Speech-Delay Definitions

Apraxia is a motor speech disorder, in which children have difficulty moving the muscles and structures necessary to form speech sounds to make spoken words.

Dyspraxia was formerly used interchangeably (though perhaps incorrectly) with apraxia. It isn’t used anymore in the speech field, says Unger.

Aphasia is a speech and language deficit caused by a neurological trauma, such as stroke or injury. 

With a phonological disorder, kids drop or delete certain consonant. This is normal under age 3.

With a speech delay, speech follows a developmental continuum, but children meet the milestones late. Receptive language and expressive language development are close. But with apraxia, speech does not follow a developmental continuum. There is a large gap between receptive language and expressive language.

Conner was not diagnosed with CAS until he was 4. From the age of 3, he was running somewhere for therapy almost every day of the week, as other issues necessitated speech, physical, occupational and vision therapies. His family also tried everything from nutritional therapies to chiropractor visits in an effort to help him speak. “We’ve tackled pretty much every approach possible,” reports mom Susan. “I wanted to look back and say I did everything I could.”

Now 11 and a 5th grader in a mainstream school in Haddon Heights, NJ, Conner is very clear and easy to understand speech-wise, Susan reports. She believes all those years of therapy paid off. “The more you get in early, when the brain is still developing, the more it helps later down the road,” she says. 

There are no medications for CAS, so speech therapy is the primary treatment. “You can’t go to just any speech pathologist,” says Unger, so make sure it’s a qualified therapist with experience treating apraxia. Speech therapy is a long, laborious process for kids with CAS. “You have to teach them every step of the way,” says Martin.

Like Conner, kids with apraxia can succeed in mainstream schools, but plenty of foundation work has to be in place first. “The goal is to get them to a point where they can be and keep up with their peers,” says Unger. Most kids with mild apraxia attend a regular classroom with supplemental therapy. In some cases, kids can use an augmentative system, such as sign language or an iPad, to help them communicate while they’re still learning to speak.

Moderate to severe apraxia can also affect reading, says Molly Miller, reading specialist and special education teacher at the TALK Institute. This is because the reading and speech parts of the brain overlap. Immediate retrieval of high-frequency words is difficult for apraxic kids. They also have issues with the normal rhythm and flow of words, says Miller.

“It is possible to speak fluently as an adult, but not everyone gets there,” says Martin. Kids with severe apraxia have a lifelong struggle with the disorder. But for those with mild to moderate apraxia, says Miro Lemonakis, after a couple years of therapy, “you might not know” there was ever a problem. 

Apraxia Web resources

For more on CAS, check out these vetted Web resources, as speech pathologists agree that most online info about apraxia is iffy:

Childhood Apraxia of Speech Association (See the Family Start Guide)

American Speech-Language Hearing Association

Suzanne Koup-Larsen is a contributing writer to MetroKids.

This article appears in the March 2015 issue of MetroKids.
Categories: Medical, Other Disabilities Research & Advice, Special Needs Parenting
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