Children with childhood apraxia of speech, or CAS, have difficulty planning and executing the physical aspects of speech. The brain of a child with CAS cannot properly coordinate the movements required for the child to speak. The child knows what he wants to say but cannot form the words. CAS is a motor speech disorder. The problems with speech do not result from developmental delays, cognitive limitations or muscle weakness. In children with CAS, the receptive language ability and the expressive language ability develop at different rates.
Childhood Apraxia of Speech
Childhood apraxia of speech also is called verbal dyspraxia, verbal apraxia and developmental apraxia of speech. The root word "praxis" in all of the terms means "planned movement." Doctors do not know the cause of childhood apraxia. Little is understood about the disconnect between planning and executing speech. Children with CAS have extreme difficulty with the complex and precise movements of the tongue, palate, lips and jaw required for proper speech. Children learn language programming and store the information in the brain. Speech-language professionals theorize that children with CAS have problems forming or accessing the information to speak intelligibly or that, for some children, the stored information is incorrect or damaged.
Symptoms
Children with childhood apraxia begin to exhibit symptoms of the disorder in infancy with the failure to coo and babble and the late appearance of first words. As the child ages, her expressive language is poor, absent or unclear. A young child with apraxia may have eating problems, speak a very limited number of sounds and have problems combining sounds or speaking difficult sounds. An older child with apraxia understands more language than she can speak. She may have difficulty speaking longer phrases, speak in a choppy monotone, incorrectly stress syllables and words and demonstrate confusion about word order. An older child's imitative speech may be more understandable than her spontaneous speech. Older children with apraxia often have delayed development in language and fine motor coordination.
Diagnosis
The first sign that testing for CAS might be required is a wide gap between a child's expressive and receptive language abilities. A child with developmental delays in speech will not have similar gap but instead will show an equal and recognized, if delayed, progression in the development of expressive and receptive language. A speech and language pathologist performs tests to diagnose childhood apraxia. An oral motor assessment evaluates muscle tone, movement and coordination. The melody of speech assessment evaluates the child's ability to properly stress syllables and use pitch and pauses correctly to enhance communication. The speech sound assessment evaluates the child's vowel and consonant sounds, sound combinations and the degree to which his speech is understood.
Treatment
The treatment for childhood apraxia includes frequent, intensive speech therapy with a trained speech and language professional. Therapy focuses on helping the child to improve her ability to plan and coordinate the muscle movements needed for speech. Children practice speech and use sensory feedback to provide cues for improvement. For instance, a mirror may help a child improve muscle coordination. Auditory feedback and computers also help children practice and improve speech. Some children use sign language or computer programs to communicate while treatment progresses. With proper treatment and a supportive home environment, most children eventually learn to speak clearly enough to be understood, according to Apraxia-KIDS, although there may be some lingering difficulties pronouncing certain sounds.
