What is Childhood Apraxia of Speech?
I have a soft spot for the kids who come to see me for pediatric, speech therapy to treat Childhood Apraxia of Speech. These are children who are so anxious to communicate, but have physiological limitations that keep them from doing so. I've had amazing experiences with these children. While a challenging population, they are among the most rewarding. Let's talk about what exactly Childhood Apraxia of Speech (CAS) is.
CAS is a motor-speech disorder. This means that a child knows what s/he wants to say, but the message from the brain is lost on the way to the articulators (tongue, lips, jaw, palate). This leaves the articulators unable to plan, coordinate, and follow through with speech. It should be noted that the muscles of the mouth are not impaired. The muscles are not weak or paralyzed; they are, essentially, not receiving directions for how to form words from the brain.
This results in the following characteristics observed in children with CAS. Please note that not all of these characteristics are seen in every child with CAS. Sometimes a child demonstrates all errors, maybe a few, or sometimes they demonstrate characteristics of CAS but actually have a different speech disorder.
Did not babble or coo as a baby
Limited sound repertoire
Minimal to no words as a toddler
Loss of previously spoken words
Errors are inconsistent. For example, the word "milk" can sound like "mut, mek, uka" at different points.
Errors increase with length or complexity; multisyllabic words and phrases will likely exhibit increased errors compared to a single word
Great difficulty with imitation: a child may be able to produce a word on his own but cannot do so when modeled and subsequently prompted
Decreased errors in well-rehearsed words or phrases
Impaired melodic speech; a child has difficulty or inability to stress syllables or change pitch. For example, whether the child raises his or her pitch
Physical groping for sounds
Oral apraxia may be exhibited (inability to produce non speech movements such as movements like puckering lips or moving the tongue up and down)
As a result of the inconsistency of errors with CAS and the overlap with other speech and language disorders, pediatric speech-language pathologists must use caution and great clinical judgement when diagnosing. One speech sample is generally not enough to diagnosis CAS as speech patterns must be assessed over multiple sessions. At times in severe cases, Augmentative, Alternative Communication (AAC) is necessary such as sign language, speech generating devices, pictures, etc. in order to supplement language while verbal communication is being addressed.
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