What is Apraxia? (Taken from Cari Ebert’s Parent Information handouts)
The root word of apraxia is praxis, which is a Latin word that means doing or acting.
Praxis is the neurological process by which cognition directs motor action (Jean Ayres, 1985). In other words, praxis is the brain telling the body what movements to make.
Apraxia is a disorder in which the person has difficulty planning motor actions (i.e. movements). Therefore, professionals say that apraxia is a motor planning disorder.
Childhood Apraxia of Speech (CAS) is one type of apraxia. CAS is a motor speech disorder that makes it difficult for children to learn to talk.
Children with CAS generally have a good understanding of language and know what they want to say. They have difficulty, however, carrying out the complex motor movements of the lips, tongue, jaw, and soft palate that are necessary for developing intelligible speech. In essence, CAS is a wiring problem in which the brain says speak but the mouth does not respond.
Childhood apraxia of speech is the preferred term for this disorder. The acronym CAS is often used by professionals because it is shorter and thus easier to say. It is important to know, however, that CAS may also be referred to as:
➢ Apraxia
➢ Verbal apraxia
➢ Verbal dyspraxia
➢ Developmental apraxia of speech
Concerns about CAS typically arise when a toddler is first learning to talk. Parents often report their concerns to the pediatrician when the child’s highly anticipated first spoken words are not coming as expected. When a child is struggling learning to talk, a referral to a speech-language pathologist (SLP) is indicated.
The SLP is the professional who assesses, diagnoses, and treats speech sound disorders. Each state has an early intervention program that is specifically designed to support children under age 3 and their families. It is never too soon to refer for a speech-language evaluation!
When a minimally verbal child cannot participate in a full speech evaluation, but shows signs of speech motor planning difficulties, a working diagnosis of suspected childhood apraxia of speech (sCAS) may be used by the speech-language pathologist.
What are the signs of Childhood Apraxia of Speech?
Not all children with CAS are the same. Your child may show some or all of the signs below:
- Does not coo or babble as an infant; has limited vocalizations in infancy
- Says first words later than you think she should
- Says only a few different sounds:
- may often use mainly vowels
- Lack of a consonant by 12 months of age
- Fewer than 3 consonants by 16 months of age
- Fewer than 5 consonants by 24 months of age
- Has problems putting sounds together to form syllables/simple words
- Little use of different syllable shapes [consonant + vowel (CV); vowel + consonant (VC); CVCV, VCV]
- Puts long pauses between sounds or syllables
- Does not always say a word the same way
- Has problems with eating (chewing and swallowing) or a history of this
- Understands speech and language better than they can produce speech.
- Has problems imitating what others say. If she can imitate, those words will sound better than words she says on her own.
- Groping behaviors
- More trouble saying longer words than shorter ones
- Difficult to understand, especially with those who don’t know the child well
- Speech may sound choppy, flat, or monotone. The child may put stress on the wrong syllable or word or have difficulty with continuous voicing across syllables or words.
How Can We Help?
Childhood Apraxia of Speech (CAS) is a speciality in the world of Speech Pathology. All of our Speech-Language Pathologists receive extensive training in CAS. These trainings include PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets), Dynamic Temporal and Tactile Cueing (DTTC), the Kaufman Speech to Language Protocol, and regular continuing education through Apraxia Kids.
We are experts in assessing children for CAS, as well as developing a holistic treatment plan. We do not believe in a “one size fits all” approach to evaluation and therapy. Rather, we use a combination of techniques, methods, and approaches to provide the most effective and efficient intervention for CAS and sCAS.
Helpful Resources:
ASHA – Childhood Apraxia of Speech