Childhood Apraxia of Speech

What is childhood apraxia of speech?

Childhood apraxia of speech is a type of speech disorder. It's present from birth. A child with this condition has problems making sounds correctly and consistently. Apraxia is a problem with the motor coordination of speech. It's different from aphasia, which is a problem with the use of words.

The speech centers of the brain help plan and coordinate what a child would like to say. These parts of the brain send complex signals to the speech muscles of the face, tongue, lips, and soft palate. Normally, all this signaling works smoothly, and a child can make all the sounds they need.

With childhood apraxia of speech, something in this process goes wrong. The speech muscles seem to work correctly, and the child knows what they want to say. But the brain has trouble working with the muscles to create the movements needed for clear speech.

Childhood apraxia of speech is not the same as developmental delay of speech. Developmental delay is when a child follows a normal path of speech development, just at a slower rate.

Childhood apraxia of speech can range from mild to severe. It's not a common condition. It happens more often in boys than in girls.

What causes childhood apraxia of speech?

Researchers don't yet understand what might cause childhood apraxia of speech. Some think that it is related to a child’s overall language development. Others think of it as a problem with the brain’s signals to the muscles needed for speech. Imaging tests have not found any real differences in brain structure in children with the condition.

Childhood apraxia of speech may be a part of a larger disorder a child has, such as:

• Cerebral palsy

• Autism

• Epilepsy

• Galactosemia

• Certain mitochondrial disorders

• Neuromuscular disorders

• Other intellectual disability

The condition may run in families. Many children with the disorder have a family member with a communication disorder or a learning disability.

Which children are at risk for childhood apraxia of speech?

Your child may have a higher risk of the condition if other members of your family have had communication disorders or learning disabilities.

What are the symptoms of childhood apraxia of speech?

Not all children with childhood apraxia of speech have the same signs. Not all speech experts agree on the core signs of the condition. Some possible signs include:

• Trouble putting sounds and syllables together in the correct order

• Inconsistent errors in consonants and vowels when repeating sounds

• Long pauses between sounds

• Problems with "prosody," the varying rhythms and tones that help express meaning (the emotional content) of speech

• Understanding language much better than expressing it

Some children have additional signs, such as:

• Fine motor delays

• Sensory processing difficulties

• Overall delayed language development

• Problems with reading, writing, spelling, or math

• Chewing and swallowing difficulties

The signs may vary with a child’s age. They also may be mild to severe. A child with a mild case of apraxia may only have trouble with a few speech sounds. A child with very severe apraxia may not be able to communicate very well with speech at all.

How is childhood apraxia of speech diagnosed?

Many other speech and language disorders can cause limited or unclear speech. Childhood apraxia is a very complex disorder. It can be difficult to diagnose. Because of this, a speech language pathologist (SLP) may need to diagnose the condition. An SLP has a lot of experience with speech problems. This helps the SLP distinguish childhood apraxia from other kinds of speech conditions.

The SLP will ask about your child’s medical history. They will ask you about what signs of speech problems you note. The SLP may also need to rule out other possible causes. These may include muscle weakness, comprehension problems, or hearing problems.

A child’s parents and the SLP may need to observe a child’s speech over a long period of time. Your child may also need language testing. For example, the SLP may ask your child to repeat a word several times. Or your child might need to repeat a list of words of increasing length. No medical test can be used to diagnose childhood apraxia of speech.

How is childhood apraxia of speech treated?

Speech language therapy is the main treatment for apraxia of speech. SLPs often use a variety of methods to treat it. Your child’s SLP might try methods, such as:

• Articulation or phonological therapy

• Adapted cueing method

• Orofacial myofunctional therapy

• Prompts for restructuring oral muscular phonetic targets therapy (PROMPT system)

• Biofeedback treatments

Speech therapy is tailored to a child’s specific needs. The therapy can also address other language problems. Children with apraxia often need frequent, one-on-one speech therapy to start. The results of therapy are different for each child. Some children make more progress than others.

In severe cases, children may need to use other ways to express themselves for a while. For example, your child might need to use:

• An informal sign language

• A language notebook with pictures

• A portable computer that writes and produces speech

Your child may not need to use these tools long-term.

Some children may also be helped by working with other health professionals. These may include:

• Occupational therapists

• Developmental pediatricians

• Special education specialists

How can I help my child live with childhood apraxia of speech?

Family support is a key part of treatment for a child with apraxia of speech. Parents and caregivers can help children practice their speech. Your child’s speech therapist may assign exercises to practice with your child. This can help improve your child’s progress.

Apraxia of speech can make school difficult. Ask your school to have the speech-language therapist see your child. Each school has a process you need to follow to have your child seen. Your child may be referred to a screening team for testing. The speech-language therapist may be a part of this team, along with teachers, special education teachers, and a psychologist. Parents are included in the process. The team's goal is to develop a mutually acceptable plan that supports your child's success in school. This includes using appropriate support resources and coordinating with your medical providers. The Americans with Disability Act, a federal law that protects people with disabilities from discrimination, may also help your child.

You can also help by:

• Not pressuring your child to speak

• Showing patience when your child does want to speak

• Being positive about your child’s efforts

• Modeling to others how to be supportive of your child’s attempts to communicate

• Being generally supportive and encouraging to your child

• Working as your child's advocate in the school setting

You can find resources about apraxia from the nonprofit organization Apraxia Kids.

Key points about childhood apraxia of speech

Childhood apraxia of speech is a type of speech disorder. It is present from birth. A child with this condition has problems making sounds correctly and consistently. Apraxia is a problem with the motor coordination of speech.

• Researchers don’t yet understand what causes most cases of apraxia of speech.

• Some key signs include trouble putting sounds and syllables together and long pauses between sounds.

• Some children with apraxia of speech also have other language and motor problems.

• Speech therapy is the main treatment for the condition.

• Some children may need to use other methods of communication for a while.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are and when they should be reported.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s healthcare provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.