What is Childhood Apraxia of Speech and How Is It Diagnosed?

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.

Are there other online resources I can read to learn more about Childhood Apraxia of Speech?

Definitely! If you like this article and would like to read more reference articles I've written they can be found on my Childhood Apraxia of Speech Reference Posts page. To find resources on other websites, check out my Childhood Apraxia of Speech Resource page for some places to start.

Perfection

I had this game when I was little and I grabbed it during the holidays for the kids. Then I forgot about it in the closet for four months. I pulled it out a few days ago to pass some time on a rainy morning. The children loved it. The funny part is how they play the game. They set the timer but stop the timer from running while they work together to fill in all the pieces. (Sometimes they work together nicely, sometimes lots of mediation from Mama is necessary to keep the peace.) Then they push the start button and run around excitedly shrieking until the timer finally goes off and the pieces pop out. Then they rush back over to the game to start all over again.

NutriiVeda for Childhood Apraxia of Speech: Information and Resources

What is NutriiVeda?

NutriiVeda is a powdered beverage being marketed primarily as a meal replacement shake to aid weight loss. You mix the powder into water, milk, or a smoothie. Nutriiveda has a proprietary blend of 7 Ayurvedic botanicals, 22 vitamins and minerals, high quality protein, soluble fiber, and essential amino acids. Each serving contains 153 calories, 3 grams of fiber, 20 grams of protein, 100% of many vitamins and minerals, and only 5 grams of sugar. It is available in chocolate and vanilla.

What does NutriiVeda have to do with Childhood Apraxia of Speech?

In December of 2009, parents of children with Childhood Apraxia of Speech began to try NutriiVeda with their children. Anecdotal reports began to surface of significant improvements in quantity and quality of speech production. The Cherab Foundation, a non-profit foundation trying to help families cope with their children’s communication impairments, began looking into NutriiVeda. They set up a sister site, Pursuit of Research to investigate the effect of taking NutriiVeda on children with communication impairments.

Here are a few web pages that discuss NutriiVeda and Childhood Apraxia.

• NutriiVeda Pursuit History: This article discusses the history of using NutriiVeda with children with apraxia and gives a detailed testimonial.
• Theories Based in Science to Support Whole Food Therapy for Autism, Apraxia, Traumatic Brain Injury, Seizure Disorders: This article discusses theories about why the ingredients in NutriiVeda may help children with apraxia and other special needs.
• Anecdotal SLP Children NutriiVeda Testimonials: This is essentially a long list of testimonials from parents of children with special needs who have seen improvement using NutriiVeda.

NutriiVeda for Childhood Apraxia: Review of Initial Product Purchase and First Impressions

I purchased a one month supply (at 2 scoops/day) of NutriiVeda from the Pursuit of Research website. I found it to be cheaper there than on other sites where it was being sold as a weight-loss product. When I read my confirmation email I was surprised to learn that when I made my purchase I had actually signed up for a monthly automatic shipment program. That was not clear to me during the checkout process. However, the number to call and cancel was clearly listed in the confirmation email and their customer service was excellent when I called.

The product was well packaged in an attractive box and arrived promptly. The individual containers are attractive and the product appeared to be in good condition. I’m using the product with my two year old daughter who has suspected Childhood Apraxia of Speech. I found that if I mix about half to 2/3 scoop (vanilla flavor) in with 4 ounces of yogurt, my daughter will eat it with no problem. Depending on how often she eats yogurt in a day she’ll get anywhere from half a scoop of NutriiVeda a day to two scoops per day. We’ve been using the product for about a week. At only one week, I cannot claim that I see clear signs of improvement in her speech that I definitely attribute to use of the NutriiVeda product. However, we haven’t been using it very long. I will update in the future. The product has a nice side benefit of adding a nutritional boost to the diet of a very picky two year old, so in that way it is a win either way.

Two-week Update: About two weeks into using NutriiVeda (average of one scoop daily) I feel like I am seeing definite improvement. We are hearing a lot more talking. She's even attempting to sing. She is listening to her own speech and self-correcting which we had never seen her do before. Could it be coincidence? Of course. Until someone completes a double-blind scientific study we won't have hard evidence. For now all we have is parent report. I'm reporting that I feel like I'm seeing improvements that I wasn't seeing before starting to give her NutriiVeda.

Six-week Update: At about six weeks after starting to supplement Ava with NutriiVeda we are giving her about 1.5 scoops a day on average. I believe that she is speaking much more often, her sentences are longer, and she is trying to string several sentences together to tell a single story. She has also learned a new sound (/f/) and some other new sounds are starting to emerge. She is occasionally putting a consonant at the end of some of her words (the /p/ at the end of "up" for example). All of this is new. As before, there is certainly no proof that these improvements are due to the NutriiVeda and wouldn't be happening anyway, but the coincidence is interesting and I'm not complaining. We will be continuing to use NutriiVeda in our household.

Are there other supplements that might help with Childhood Apraxia of Speech?

There is some evidence that supplementation with Omega-3 fatty acids can be helpful for children with Childhood Apraxia of Speech. You can read my Information and Resources page on Omega-3 fish oil supplementation for Childhood Apraxia of Speech here.