Children affected by childhood apraxia of speech (CAS) have problems in pronouncing sounds, syllables, and words. This condition doesn't arise due to muscle weakness or paralysis, but it's the brain that has problems in planning the movement of the body parts like lips, jaw, tongue, etc., which are needed for speech. The child knows what he wants to say, but his brain has difficulty in coordinating the muscle movements necessary to utter those words. In most cases the cause is unknown; however, genetic disorders, syndromes and strokes, or brain injuries may be some possible causes of CAS.
Signs and Symptoms
The signs and symptoms of CAS may not be same in all children. It is essential to get your child evaluated by a speech-language pathologist (SLP) who has knowledge about this condition. Some common symptoms which may be observed are:
In A Very Young Child
- Does not babble as an infant
- You can hear only a few different consonant and vowel sounds.
- There may be problems relating to sounds, like taking a long pause between sounds.
- Replacing difficult sounds with easier ones to simplify words, or sometimes deleting difficult sounds.
In An Older Child
- Makes inconsistent sound errors and has difficulty in saying longer words.
- Difficulty in imitating speech, but imitated speech is more clear than spontaneous speech.
- May appear to be fumbling while attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement.
- Speech can be hard to understand for an unknown listener, especially when the child is anxious.
Some Other Symptoms
- Weakness of the lips, jaw, and tongue.
- Delayed language development and other expressive language problems, like word order confusions and difficulty in recalling words.
- Hypersensitive or hyposensitive in their mouths, i.e. may not like to brush their teeth, eat crunchy food, and unable to identify an object in their mouth through touch.
- May experience problems while learning to read, spell, and write.
How is CAS Diagnosed?
An audiologist may perform a hearing evaluation to eliminate hearing loss as a possible cause of the child's speech difficulties. This evaluation will assess the child's oral-motor abilities, speech sound development, and melody of speech. This assessment involves:
- Checking for dysarthria, i.e., signs of weakness or low muscle tone in the lips, jaw, and tongue.
- Examining how well the child is able to coordinate the movement of the mouth - like moving the tongue from side to side, smiling, frowning, and puckering the lips.
- Assessing the coordination and sequencing of muscle movements for speech, while the child is performing tasks at diadochokinetic rate, that requires the child to repeat strings of sounds as fast as possible.
- Evaluating rote abilities by testing the child's skill in real-life situations like licking a lollipop, and comparing this to non-functional situations like pretending to lick a lollipop.
- Examining whether the child can use pitch and pauses to mark different types of sentences (e.g. questions vs. statements) and portions of the sentence (e.g. to pause between phrases and not in the middle of them).
- Assessing the child's receptive, expressive language, and literacy skills.
The focus of treatment is on improving the planning, sequencing, and coordination of mouth muscle movements for speech. Isolated exercises are designed to strengthen the oral muscles along with speech production. The child must practice speech and should be given feedback from a number of senses, such as tactile and visual cues (e.g. watching him in the mirror) as well as auditory feedback. With such a feedback, the child will find it easier to repeat syllables, words, sentences, and longer utterances to amend muscle coordination and sequencing for speech. Some kids may be taught to use sign language or an augmentative and alternative communication system, i.e., a portable computer that writes or produces speech. But, as the speech production improves, the need for these systems may lessen. Parents are often taught speech therapy related exercises to contribute in their child's progress and allow them to use new strategies outside the treatment room.
Childhood apraxia of speech may also be referred to as 'development apraxia', which has no cure, but with appropriate intensive intervention, significant progress can be made. The family should remember that the treatment takes time and commitment, and the child needs a supportive environment that makes him feel comfortable with the speech.