What Is Childhood Apraxia of Speech, and What Causes It?
Leanne Sherred, M.S., CCC-SLP
If you are a parent or caregiver looking for information about childhood apraxia of speech, you’ve come to the right place. Apraxia isn’t an issue that children will outgrow on their own, but your child’s speech can improve with treatment from a qualified speech-language pathologist.
Here we cover what childhood apraxia of speech is, what causes it, what it sounds like, and how it differs from other speech and language disorders.
What is childhood apraxia of speech (CAS)?
Childhood apraxia of speech (CAS) is a motor-planning disorder. In fact, the root of the word, “praxis,” means “planned movement.” The person has the language capacity to talk, but the signals between their brain and mouth muscles aren’t sent correctly. A child with CAS may know exactly what they want to say, but their brain struggles to tell the muscles in their mouth how to move in order to make the right sounds.
People with apraxia have difficulty coordinating the mouth movements needed to turn sounds into syllables, syllables into words, and words into phrases. It’s often hard for people to communicate and form coherent sounds and sentences. People with apraxia are often described as “difficult to understand.”
Children who have apraxia are likely born with the condition. It’s referred to as childhood apraxia of speech because it begins in childhood and is not acquired later. Acquired apraxia of speech results from damage to the brain, such as from a stroke or some other kind of head injury.
What causes childhood apraxia of speech?
The causes of CAS are mostly unknown, with current knowledge pointing to some possibilities:
Genetics is widely considered to be a cause of CAS.
Neurological issues can also be a possible cause of CAS. An illness, injury, or seizure could cause neurological problems that then lead to CAS.
CAS can be idiopathic, meaning that there is no known cause and no other coexisting speech or motor issues.
While it can feel frustrating to not know an exact cause, one thing to keep in mind is that apraxia can be identified through its specific characteristics. Once it’s diagnosed, the right therapy can often make a huge difference for people with CAS. Let’s review some of the characteristics and symptoms of childhood apraxia.
What does childhood apraxia of speech look and sound like?
Every person is different, and symptoms can vary dramatically.
In some cases, apraxia can be so mild that the person only has difficulty with a few speech sounds, or is unable to pronounce multisyllable words. In more severe cases, a person may not be able to communicate effectively by speaking.
However, many people with apraxia have some of the following symptoms or speech characteristics:
Inconsistent errors in speech:
A child with apraxia may pronounce the same word differently each time they say it. For example, one day they may say a difficult word correctly, but soon after they have trouble repeating it.
Distorting sounds:
Because people with apraxia do not place their mouth muscles in the right position, sounds often come out incorrectly. Pronouncing vowels can be especially hard, as well as longer and more complex words.
Groping for sounds:
People with apraxia can seem like they’re “groping” or struggling for words. They may try saying a word several times before they say it correctly.
Inappropriate intonation, stress, or rhythm of words:
Kids with apraxia may struggle with the rhythm and flow of speech. They may segment syllables in a word, omit syllables in words and phrases altogether, or pause inappropriately while speaking.
Difficulty with volitional movements:
A person with apraxia may have a tough time initiating what they want to say, such as asking a question or making a comment, as compared to more automatic speech, such as counting or saying the alphabet.
How is childhood apraxia different from other speech and language issues?
If you think your child may have apraxia, it’s important to see a speech therapist for an evaluation. A speech therapist can determine if CAS or another speech and language disorder is present.
Childhood apraxia is a complex disorder, and it can be difficult to diagnose. Because there is no single symptom or test used to diagnose apraxia, your speech therapist will look for the presence of a group of symptoms, and work to rule out other conditions that may look similar to apraxia.
Some other disorders of speech that can initially appear similar to apraxia are articulation and phonological disorders.
Articulation disorders refers to a child’s inability to say specific sounds correctly. These can be errors with specific sounds like the /s/ sound or the “TH” sound.
Phonological disorders refer to a pattern of articulation issues, such as always leaving off final consonants at the end of words, or always producing sounds that are made in the back of the mouth (like /k/ and /g/) in the front of the mouth (as a /t/ or /d/ substitution).
Childhood apraxia also can be confused with a developmental delay in speech, in which a child follows a “typical” path of speech development but at a much slower rate than normal. While many children may outgrow a speech delay, this is not the case for apraxia. Children with apraxia often will not make progress without treatment.
How is childhood apraxia of speech diagnosed?
To make a diagnosis, the speech therapist will look closely at the types of speech errors present. They may give your child articulation tests in order to check for inconsistencies in the way they make their errors, which is a hallmark characteristic of apraxia of speech.
Because children with CAS can have a difficult time saying phrases and sentences, the speech therapist will also assess a child’s receptive and expressive language skills.
Sometimes, children with CAS will have age-appropriate receptive language skills, which refers to their ability to understand what's said to them. Their expressive language skills (the ability to communicate thoughts and ideas) will typically be delayed, likely due to their inability to form phrases and sentences. However, there can be expressive language issues present separate from the CAS diagnosis.
In other situations, children with CAS will be severely delayed in both receptive and expressive language.
Support for childhood apraxia of speech
You can see why a diagnosis of childhood apraxia of speech isn’t always an easy one to make. There are many different types of testing that should be completed before arriving at a diagnosis. It can take time and patience on everybody’s part–the child, the speech therapist, and especially the caregiver. Speech therapists know this can be an overwhelming time for families.
It’s encouraging to remember that there is effective treatment for CAS. While speech therapists cannot determine how much progress a child will make, speech therapy helps set children up for the most success possible.
