Childhood Apraxia of Speech

Childhood apraxia of speech (CAS) is a motor speech disorder that makes it difficult for your child to speak. The disorder affects the nerve pathways that send messages from your child’s brain to their mouth. Because of this, your child has trouble carrying out the movements their mouth needs to make to speak clearly and accurately.

CAS isn’t a cognitive (thinking) disorder — your child knows what they want to say. The problem is in how their brain tells their mouth muscles to move.

Other names for childhood apraxia of speech include:

• Developmental apraxia of speech
• Developmental verbal dyspraxia

There’s no cure for childhood apraxia of speech. But with early diagnosis and a special kind of speech therapy, many children make significant progress and learn to speak clearly.

What are the early signs of childhood apraxia of speech?

Early signs of apraxia of speech may clue you in that your child has a motor speech disorder. Children younger than 3 years old may:

• Not make babbling or cooing sounds, or make a limited variety of babbling sounds
• Have trouble putting sounds together
• Say their first words later than expected
• Say words differently each time
• Take long pauses between sounds
• Use only a few different sounds
• Have problems with eating

What are the symptoms of childhood apraxia of speech?

Childhood apraxia of speech symptoms vary from child to child. In general, children with CAS usually understand language but have difficulty with speaking and communicating. Symptoms of childhood apraxia of speech may include:

• Attempting to say a word several times before saying it correctly
• Difficulty coordinating the movement from one syllable of a word to the next syllable
• Distorting sounds or deleting sounds
• Making errors in the tone, stress or rhythm of speech
• Making inconsistent errors in speech

Children who are older than 3 years old may:

• Be hard to understand, especially for people who don’t know your child
• Grope, or search, for words by moving their mouth a few times before speaking
• Have a flat or choppy speech pattern
• Have difficulty saying longer words clearly
• Have more trouble speaking when nervous
• Have trouble imitating what other people say

Childhood apraxia of speech causes

Researchers don’t know the exact cause of childhood apraxia of speech. Children with CAS have interruptions in certain nerve pathways in their brains. These nerve pathways are responsible for planning the movements that are necessary for speech. In children with apraxia of speech, the messages from their brain to the parts of their mouth used for speech aren’t being sent correctly.

In some cases, CAS is the result of an acquired brain injury, like a stroke, which causes nerve pathway interruptions in a person’s brain. There’s also evidence that genetic factors may contribute to childhood apraxia of speech. Scientists have linked more than 20 different genes to the disorder.

How doctors diagnose childhood apraxia of speech

A speech-language pathologist (SLP) diagnoses childhood apraxia of speech. SLPs have extensive training and skills in treating speech disorders.

To diagnose CAS, an SLP will learn about your child’s history, including any known medical problems. The SLP may also test your child’s hearing, oral-motor skills, speech melody (pitch) and the way they say sounds.

The SLP will also test your child’s ability to speak by:

• Checking for signs of mouth muscle weakness
• Checking how well your child makes consonant and vowel sounds
• Looking at nonspeech oral motor skills like blowing, smiling, rounding lips and how quickly your child can move their mouth
• Observing how well others can understand what your child is saying
• Observing how your child pauses or changes the pitch of their voice

Genetic testing can also determine if there’s a genetic variant that’s responsible for causing symptoms of the disorder. A healthcare provider will take a sample of your child’s blood to identify any abnormalities in their genes.

How is childhood apraxia of speech treated?

Treatment for CAS may require more intense treatment than other speech sound conditions. Some children will visit their speech-language pathologist three to five times per week so they can develop their speaking ability.

If your child has severe CAS symptoms, they may need treatment for several years, especially if they miss language development milestones throughout early childhood.

Childhood apraxia of speech treatment includes:

• Enrolling in speech therapy to address syllables, words and phrases at a pace unique to the needs of your child
• Learning alternative means of communication, like sign language or using electronic communication devices
• Practicing repetitive language exercises at home and outside of speech therapy

When should my child see a healthcare provider?

Contact your child’s healthcare provider for a referral to a speech-language pathologist if:

• You notice symptoms or signs of apraxia of speech
• Your child is missing language development milestones, like saying their first words or naming common objects
• Your child is showing signs of frustration with their communication when someone doesn’t understand them

If your child has trouble eating and coordinating movement with their mouth apart from speech, visit their provider immediately.

How can I prevent childhood apraxia of speech?

There’s no way to prevent childhood apraxia of speech. But some cases of CAS link to genetic variants. So, if you plan on becoming pregnant, you may want to ask your provider about genetic counseling to assess your risk of having a child with a genetic condition.

What can I expect if my child has apraxia of speech?

As your child grows, they may miss language development milestones, like saying their first words and using short sentences to express themselves. Developmental delays could prevent your child from learning in the classroom at the same level as their peers.

But your child will be working with a speech-language pathologist. They’ll address your child’s unique symptoms and develop a plan to improve their speech over time.

Does childhood apraxia go away?

There’s no cure for CAS, but early treatment can relieve frustration that your child may show if they want to say something but are unable to communicate that message.

Many factors come into play, but with appropriate treatment, most children with the disorder will eventually be able to speak normally to some degree.

Is there anything I can do to help my child?

Offering your child support as they grow is the best way you can take care of your child. Your child will likely participate in one-on-one sessions with a speech-language pathologist. Your child’s SLP may offer homework for your child to practice between visits. Just like homework from a math class, it’s important to help your child complete their speech assignments at the same rate as their educational assignments.

Follow up with your child’s SLP to keep track of how much your child is improving and offer encouragement along their journey.