Childhood Apraxia of Speech

About Childhood Apraxia of Speech (CAS)

To speak, messages need to go from your brain to your mouth. These messages tell the muscles how and when to move to make sounds. If your child has apraxia of speech, the messages do not get through correctly. Your child might not be able to move his lips or tongue to the right place to say sounds, even though his muscles are not weak. Sometimes, he might not be able to say much at all.

A child with CAS knows what she wants to say. CAS is a problem with her brain getting her mouth muscles to move, not with how well she thinks. You may hear CAS called verbal dyspraxia or developmental apraxia.

Even though you may hear the term “developmental,” CAS is not a problem that children simply outgrow. A child with a developmental speech disorder learns sounds in a typical order, just at a slower pace. If your child has CAS, he will not follow typical patterns and will not make progress without treatment. It will take a lot of work, but your child’s speech can improve.

Signs of Childhood Apraxia of Speech

Not all children with CAS are the same. Your child may show some or all of the signs below. You should talk to your doctor or see an SLP if:

Your child is younger than 3 years old and

Does not coo or babble as an infant.
Says her first words later than you think she should.
Says only a few different sounds.
Has problems putting sounds together.
Puts long pauses between sounds she says.
Does not always say a word the same way.
Has some problems eating.

Your child is older than 3 years old and

Does not always say words the same way each time he says them.
Can understand what others say to him better than he can talk.
Has problems imitating what others say. If he can imitate, those words will sound better than words he says on his own.
Seems like he has to move his lips, tongue, or jaw a few times to make sounds. This is called groping.
Has more trouble saying longer words clearly than shorter ones.
Seems to have more trouble talking when he is nervous.
Is hard to understand, especially for someone who doesn’t know him well.
Sounds choppy or flat. He may put the stress on the wrong syllable or word.

There are some other problems that your child may have that could put her at risk for CAS. These include:

Language delay.
Problems with fine motor skills, like drawing, writing, or picking up small things.
Problems with how she feels things in her mouth. She may be very sensitive and not like to have her teeth brushed or eat crunchy foods. Or, she may not be very sensitive and may not feel hot or cold very well.
Learning problems. Children with CAS or other speech problems may have problems learning to read, spell, and write.

If you have any concerns, talk to your doctor or see an SLP for help.

Causes of Childhood Apraxia of Speech

CAS is a motor speech disorder. Something in your child’s brain does not allow messages to get to his mouth. Most of the time, the cause is unknown. It is possible that nothing would show up if you had tests done, like an MRI or CT scan of your child’s brain. This can be frustrating as you look for a reason for your child’s speech problems.

In some cases, your child may have brain damage that causes CAS. Your child may have a genetic disorder or syndrome that causes brain damage. A stroke or brain injury can also cause CAS.

Testing for Childhood Apraxia of Speech

There is help available if you are worried about how your child talks. You should talk to your doctor, who can check for any medical problems. It is important to have your child’s hearing checked to make sure she does not have a hearing loss. A child with a hearing loss may have more trouble talking.

An SLP can test your child’s speech and language. The SLP will test how well your child understands what he hears, called receptive language. The SLP will also test

how well your child uses words to tell others what he is thinking, called expressive language. To test for CAS, the SLP will look at your child’s oral-motor skills, speech melody, and how he says different sounds.

To test oral-motor skills, the SLP will:

Check for signs of lip, jaw, or tongue weakness, called dysarthria. Most children with CAS do not have weakness, but it is important to check.
See how well your child can move her mouth. The SLP may ask her to copy movements like smiling, sticking out her tongue, and puckering her lips.
Test how well your child can make fast mouth movements. This tells the SLP how well she can coordinate her movements since our mouths move fast when we talk.
See how well your child can do “real-life” mouth movements like licking a lollipop. The SLP will compare that to how well she can do the same thing when pretending. A child with CAS may be able to do a movement when she doesn’t think about it but not when asked to do it.

To test your child’s speech melody, called intonation, the SLP will:

Listen to how your child puts stress on syllables and words in sentences. When you get a gift, you call it a “PREsent.” The stress is on the first syllable. When you give a speech, you “preSENT.” The stress is on the second syllable. Children with CAS may have trouble putting stress on the right syllables.
See if your child can change her pitch to ask questions or make statements. Think about how you say “Hello?” when you answer the phone. Your pitch goes up at the end of the word because you are asking a question. Now think about how you say “Hello” to someone who walks into a room. You say the same sounds, but your pitch changes. Children with CAS may have trouble changing pitch correctly.
See how your child uses pauses to mark different parts of a sentence. When you say, “We went to the store, then back home,” you pause after the word “store” to mark a change in the sentence. Children with CAS may put pauses in the wrong place or not use them at all.

To test how your child says sounds, the SLP will:

Test both vowel and consonant sounds. Vowels are sounds like A, E, I, O, U, and consonants are sounds like B, G, M, R, S.
Check how well your child says sounds alone and combined in syllables or words.
Check how well others can understand what your child says.

Treatment for Childhood Apraxia of Speech

Type of treatment A child with CAS should work with an SLP. Research shows that your child will do better with therapy 3–5 times per week. As she improves, she may need treatment less often. As your child works on learning to make sounds and words, it is better for her to be seen alone. A group may be good when she works on using sentences to talk with others.

Treatment Goals

The goal of treatment is to help your child say sounds, words, and sentences more clearly. Your child needs to learn how to plan the movements he needs to say sounds. Then he needs to learn how to make those movements the right way at the right time. Doing exercises to make his mouth muscles stronger will not help. His muscles are not weak if he has CAS. Working on how to move those muscles to say sounds will help.

Your child must practice speaking to get better at it. It helps to use all of her senses as she learns how to say sounds. She may use “touch” cues, like putting her finger on her lips when saying the “p” sound to remind her to close her lips. Or, she may use visual cues, like watching herself in a mirror. Hearing how she sounds on a recording can help, too. This sensory feedback can help your child repeat sounds and words and start using them in longer sentences.

Other Ways to Communicate

Some children with apraxia have a hard time saying anything at all. Your child may be taught sign language or may learn to use picture boards or computers that talk for him. This is called augmentative and alternative communication. Some parents are afraid that their child will want to use these systems and not try to talk. That is not why they are used—the goal is to have your child talk. These systems will help your child as he learns to talk. He will use them less as he talks more.

Family Support

CAS treatment takes time, and your child will need your support. Practicing what your child learns with the SLP will help her make progress. There may be times when you or your child get frustrated or upset. Taking breaks when your child is tired and making practice as fun as possible helps. Tell your child’s SLP what is happening at home so you can all work together to help your child succeed.