What is Childhood Apraxia of Speech (CAS)?Childhood Apraxia of Speech is a relatively uncommon speech disorder. It is a neurological disorder caused by problems with motor planning and programming of the movements necessary to produce speech. Its cause is unknown.
Children with Childhood Apraxia of Speech do not have a problem with the actual structures and muscles involved in speech production. There is no evidence of weakness in the muscles of the face, jaw, lips, or tongue. Children with CAS also generally do not have problems knowing what they want to say. They can formulate the message in their mind and the muscles are capable of producing speech. The message just doesn't travel from the brain to the mouth properly.
How is Childhood Apraxia of Speech Diagnosed?A Speech-Language Pathologist (SLP) is the professional who typically diagnoses Childhood Apraxia of Speech. Diagnosis of CAS is complicated because there is a spectrum of characteristics that show up in CAS. Each child will exhibit a different combination of these characteristics. Some of the key characteristics the SLP will look for are:
- Child makes more errors when attempting to produce longer words or phrases (multi-syllable words or multi-word sentences).
- Child has abnormal prosody (unusual stress patterns, intonation, volume control, and rate issues).
- Errors are inconsistent. If the child says the same multi-syllable word three times it will come out differently each time.
- Child has a reduced number of vowels and demonstrates vowel errors.
- Child has significant difficulty imitating words and phrases.
- Child uses predominantly simple syllable shapes (they substitute shorter, simpler words for longer, more complicated ones).
Why am I being told that my child is too young to diagnose? Why will they only diagnose "suspected Childhood Apraxia of Speech"?Childhood Apraxia of Speech is extremely difficult to diagnose in a young child for many reasons. First, most of the key characteristics described above are too advanced to test in a young child with very little language. Second, it is difficult to tell if the problems a young child is having communicating is due to apraxia or some other speech or language disorder. There are, however, certain red flags for younger children. If these things, or most of these things are present in a young child who is a late talker, it is much more likely that the child will go on to be diagnosed with Childhood Apraxia of Speech when they are older.
- Reduced or absent babbling as a baby.
- Extremely limited number of consonants (often only /b, m, p, t, d, h/ or fewer).
- Use of grunting and pointing as a main mode of communication beyond 18 months of age.
- Use of a single syllable or word universally. (For us it was “da”. Ava used it for pretty much everything.)
- Most vocal communication is in vowels only.
- May see groping or struggle behaviors when attempting more complex sounds or combinations of sounds.
- Use of a limited number of vowels.
- Vowel distortions present (the vowel sounds are not “pure”).
- A word will be used for a short while and then will completely disappear never to be heard again.
- May see signs of oral apraxia (child has difficulty imitating performing non-speech oral actions like sticking out the tongue, blowing kisses, making "raspberries", etc.).
What happens next?If you are reading this because you are worried that your late talking toddler might have Childhood Apraxia of Speech I have two recommendations. First, get in touch with a Speech-Language Pathologist or your state's early intervention program (if your child is under 3 years of age). Get an evaluation. Early intervention programs will often evaluate your child for free. At best, you'll find out that you're worried a little to early. Or you might find out you were right. Your child does have a speech delay. But in that case you're ahead of the game. You've found out early and can get your child the right kind of help as early as possible and you will be glad you didn't wait. Second, I recommend the book The Late Talker: What To Do If Your Child Isn't Talking Yet.
If you've been recently told that your child has Childhood Apraxia of Speech or suspected Childhood Apraxia of speech you will be working on setting up a treatment plan with a Speech-Language Pathologist you trust. You will want to be sure that your child is getting enough therapy and the right kind of therapy.