Childhood Apraxia of Speech

“My child isn’t talking, but his/her friends speak in full sentences! What do I do?

This is a common statement early intervention Speech-Language Pathologists (SLPs) hear frequently. If your child is not talking, this can be a sign of a speech and language delay. As early intervention SLPs, we treat a variety of communication deficits. So if you have any concerns, I encourage you to speak to a professional.

According to the American Speech and Hearing Association, 7.7% of children have a communication or swallowing disorder.

 One communication disorder that only Speech-Language Pathologists can diagnosis is Childhood Apraxia of Speech. First, I want to provide you with some facts on this topic.

The Facts of Childhood Apraxia of Speech (CAS)

“Childhood Apraxia of Speech (CAS) is a speech disorder in which a child’s brain has difficulty coordinating the complex oral movements needed to create sounds into syllables, syllables into words, and words into phrases. Typically, muscle weakness is not to blame for this speech disorder” (Children’s Hospital of Philadelphia).

Is CAS common?

CAS is not very common, but data shows that CAS is rising (Nationwide Children’s Hospital). Older data states that 1-2 out of 1000 children have CAS, which is more common in boys (Shriberg et al., 1997).

As a caregiver, what can I look for if I am concerned? 

  • Little to no babbling as an infant
  • Uses gestures/pointing more often than words
  • Difficulty imitating sounds, words, unfamiliar words, multi-syllable words
  • Difficulty combining words
  • Inconsistent errors (i.e., the same word comes out in different ways)
  • Monotone speech / robotic speech
  • Difficulty with vowel sounds (i.e., hat sounds like hot)
  • Difficult to understand
  • Difficulty with singing
  • Tries to say something but nothing comes out

This list is not exhaustive, and most children will not have challenges with all of the above. Suppose you see a few or even one of these characteristics. In that case, it may be beneficial to seek further consultation or assessment from a professional as they can determine if it is CAS or another type of speech and language delay. Do note that CAS can look different in every child and range from mild to severe. Sometimes children with less severe characteristics may be described as having motor planning challenges versus CAS. 

What causes CAS?

Unfortunately, we do not know most of the time. In some situations, it may be caused by brain damage at birth or after birth (ASHA). 

Will my child ever be able to talk normally?

With early identification, early treatment, and parent carryover, we can expect that your child will make significant gains. All children develop differently – some make quick progress, while others may need speech support for several years. If your child has any underlying conditions or other speech and language deficits, progress may be slower.

Will this affect my child’s learning?

During childhood, these children often have delayed language skills. Some children with CAS or motor planning deficits may have trouble reading, writing, and spelling when they are school-aged (ASHA).

#ApraxiaAwareness

A Therapist’s Experience Working with CAS

I have worked with numerous children with symptoms of CAS and a few children with a proper CAS diagnosis. These children are some of the most motivated children to work. This is because children with CAS often have a strong understanding of language and have a strong desire to communicate. These children are often very skilled at using nonverbal communication to get their messages across to their communicators. While they are some of the most excellent communicators, they demonstrate some of the most significant verbal speech challenges.

Many people refer to CAS as Apraxia. I think it is important to remember the “Childhood” part. Just as children are ever-changing, so are their skills. With early detection and intervention, progress will be made!

As a therapist, I love working with children with CAS because they make some tremendous gains. 

I want to go back to my statement of working with children with symptoms of CAS and children with a proper diagnosis CAS. Many children display characteristics of CAS but do not meet the criteria for a proper diagnosis. I often refer to these children with CAS symptoms as children with speech motor planning deficits. Children with motor planning deficits, too, need similar intervention, but they are often “less severe” and may require less intervention.

The diagnosis of CAS can be frightening for many parents.  However, there are many resources available online, and your speech therapist is here to help! Do not be afraid to reach out. While there are many resources online, I would first check with your current speech therapist if the source and/or material is appropriate. 

On the other hand, parents may be frustrated if their child has CAS characteristics and does not receive a CAS diagnosis. This is often because many caregivers feel that more therapy means a faster “fix.” This is not always the case. Remember, these are little kiddos, and their brains are rapidly changing and developing. With intervention and parent carry over, we expect even more gains. Minor changes are significant changes for these kiddos.

CAS is a complex speech disorder, so it is “okay” and “normal” if you feel overwhelmed as a parent. I encourage you to seek an early assessment if you have any concerns! 

Haley Nelson, M.A. CCC-SLP

Haley Nelson, M.A. CCC-SLP

Haley is the author of this blog post and she is a talented speech-language pathologists who serves the pediatric population in a public school as well as with Walkie Talkie Speech Therapy Inc.

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