Childhood Apraxia: Understanding It and Treating It

Childhood Apraxia of Speech (CAS) is a specific speech disorder which involves a difficulty in planning and consistently producing sequences of speech using the tongue, lips, jaw and palates. This difficulty can prevent a child from producing intelligible speech. It is not a weakness of these structures that produces this difficult; rather, the difficulty originates in the brain. A child with CAS has trouble putting these structures to use properly in order to form comprehensive statements or sounds.

When we communicate, an idea first forms in our brain as to what we want to say. Our brain thinks about the words it needs to recall and produce as well as the order in which these words should be produced to correctly verbalize our ideas. This information than translates into highly coordinated movements of the tongue, lips, jaw and soft palate, AKA the "articulators". The brain tells the muscles that control articulators the exact order and timing of movements to produce intelligible speech. Children with CAS may not be able to accurately and consistently produce these plans, due to neurological impairments or developmental disabilities.

When a child receives a diagnosis of CAS, he/she needs to begin speech therapy. This type of therapy varies for children according to the severity of their diagnosis. Experienced therapists may attempt different therapies, since there is no "one-size-fits-all" approach to treatment and all children are motivated differently. They may need frequent one-on-one therapy, lots of repetitive practice with sounds, sequences, and movement patterns in order to be able to automatically incorporate them into their speech normally and intelligibly. Overcoming apraxia of speech can be tedious, but it is well worth it. Practicing at home is crucial in just about any speech and language program; this one especially.

Many therapist recommend the use of sign language, picture communication systems, and other augmentative or alternative communications. Combined therapies (sign and vocal word attempt) may enhance the chance that the listener will be able to understand the child. This will help with their self-esteem, which will help with their motivation in speech therapy and overcoming apraxia.

Young children recognize their speech difficulties, and any successful communication experience will encourage them to work harder. This is why various therapies and a continuous aim is highly encouraged by therapists. For some children, visual cues (ie. pointing to lips to insinuate a "b" sound) can aid in learning to use their articulators to produce a desired word. When a word and sign are consistent, children begin to associate the visual image of the sign with the placement of the articulators.  It's a very complex form of treatment for a very complicated disorder, but it works if a child works it.

If you notice speech delays or difficulties with your child's production or problems with his/her communication skills, please contact your physician or consult a speech-language pathologist in your area.

Resources

Spivey, Becky, M.ED. Super Duper Handy Handouts (2001):  Tongue Thrust, Dental Problems and Lisps