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childhood apraxia

Childhood Apraxia: The Facts

Childhood Apraxia of Speech (CAS)

Childhood apraxia of speech (CAS) is a neurologically-based motor speech disorder. Children with CASChildhood Apraxia: The Facts have difficulty producing speech sounds in the absence of muscle weakness or paralysis. Though a child with CAS knows what he/she wants to say, impairments in planning and/or coordinating lip, tongue, and jaw movement results in speech sound errors and differences in prosody (patterns of stress and intonation).

CAS is uncommon, occurring in 1-2 children per 1,000. It affects more boys than girls and occurs more frequently in children with galactosemia, fragile X syndrome, and Down Syndrome.

Acquired Apraxia of Speech versus CAS

There are two main types of apraxia of speech: acquired and developmental. Acquired apraxia of speech (AoS) is caused by damage to the parts of the brain involved in speech production and involves loss or impairment of existing speech skills. Causes of AoS include stroke, head injury, tumor, or illnesses affecting the brain. This disorder may occur with muscle weakness affecting speech production or language difficulties caused by brain damage. In contrast, CAS is present from birth and occurs in the absence of any muscle weakness or paralysis.

Cause of CAS

The cause of CAS is yet unknown. While some researchers believe that CAS is a disorder related to overall language development, others believe it is neurologically based and that it disrupts the brain’s ability to send signals to move muscles involved in speech production. Recent research also suggests a genetic component to this disorder, as children with CAS often have family members with a history of communication disorders or learning disabilities.

Diagnosing CAS

There is no universally agreed-upon list of diagnostic features that differentiates CAS from other childhood speech sound disorders such as phonological disorders or dysarthria. However, three characteristics of CAS are generally accepted by researchers and speech-language professionals:

  1. Inconsistent speech sound errors on consonants and vowels across repeated productions of syllables or words. While a child with an phonological or articulation disorder may make the same error each time he/she says a particular word, a child with CAS will not demonstrate a consistent pattern in his/her errors, even when repeating the same word.
  1. Longer and disrupted coarticulatory transitions between sounds and syllables. Children with CAS have difficulty combining sounds to form a word and may produce long pauses between sounds.
  1. Differences in prosody. Children with CAS produce speech that sounds choppy or monotonous, with stress on the wrong syllables.

Other Possible Signs/Characteristics of CAS

Young Children:

  • No cooing or babbling as an infant
  • Late development of first words
  • Production of limited set of consonant and vowel sounds

Older Children:

  • Numerous substitutions, deletions, and distortions of sounds
  • Understands language significantly more than can speak
  • Difficulty imitating speech, but imitated speech is more clear than spontaneous speech
  • Groping behavior when attempting to produce sounds
  • Saying longer words or phrases are more difficult to produce than shorter ones
  • Difficult for listeners to understand speech
  • Speech sounds choppy or monotonous or the wrong syllables are stressed
  • Distorted or inconsistent vowels

Possible Concomitant Conditions:

  • Language delay
  • Word finding or word order difficulties
  • Fine motor coordination difficulties
  • Oral hypersensitivity
  • Difficulty learning to read, spell, and write

Treatment of CAS:

Children with CAS receive frequent and intensive one-on-one therapy, tailored to their specific speech and language needs. Treatment focuses on improving speech imitation skills, speech-based motor sequences, length and complexity of producible syllable patterns, teaching rules of speech sound patterns, and, in severe cases, using augmentative communication systems (e.g., picture exchange communication system).

If you believe that your child shows signs of CAS or another speech sound disorder, do not hesitate to consult with a speech-language pathologist.

NSPT offers services in BucktownEvanstonHighland ParkLincolnwoodGlenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!

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Child speeking

Defining Speech-Language Diagnoses

 

 

 

Navigating the world of pediatric therapies can be a daunting and overwhelming challenge for many parents. Oftentimes, parents, caregivers, or even pediatricians notice changes in a child resulting in the need for an evaluation by a pediatric therapist. A pediatric speech-language evaluation is comprised of 3 parts: parent interview, assessments, and feedback following assessment.

 

SPEECH-LANGUAGE DIAGNOSES: WHAT DO THEY MEAN?

Following the initial evaluation, your child may receive a diagnosis from a licensed speech-language pathologist. Here’s a breakdown of many common diagnoses:

Language Disorder: A language disorder is characterized by difficulty with one or more aspects of language, including receptive, expressive, and pragmatic language. Children with a language disorder may have difficulty formulating sentences, following directions, using appropriate verb tenses, or asking/answering questions. The language disorder umbrella also can include late-talking toddlers.

Articulation Disorder: An articulation disorder occurs when a child has difficulty with place, manner, or voice of production for a given speech sound. Some errors in articulation are expected, Child speekingdepending on a child’s age and which sound he is trying to produce. For example, between two- and three-years-old, a typical child will master /p, b, m, n, h, d, t/ sounds; the same child, however, would not be expected to accurately produce an /r/ sound until closer to 7 years old. Common articulation errors include a “lisp” or other distortions with /s/ and /z/ sounds.

Phonological Disorder: A phonological disorder also pertains to speech sound production, however, these children substitute one sound for another. This predictable pattern of substitution occurs at different ages for many children, and may include substituting /w/ for /r/ sounds (e.g., “wabbit” for “rabbit”), or /f/ for /th/ sounds (e.g., “fumb” for “thumb”).

Fluency: Fluency disorders or “stuttering” commonly occur when an individual has whole and part-word repetitions (“can, can, can I have the iPad?”), prolongations (“s-s-s-s-s-sister”), or blocks, which are silent stops during connected speech. Some children will also demonstrate secondary behaviors including grimaces or tension in their face and/or neck.

Childhood Apraxia of Speech (CAS): This disorder also impacts how a child produces sounds. Children with CAS know what they want to say, but they have difficulty coordinating their muscles and articulators to accurately produce sounds. There is, in other words, a disconnect between a child’s brain and mouth to plan the movements for speech sounds.

Voice Disorder: A voice disorder is characterized by anything that disturbs or alters one’s regular voicing (talking). This may be the result of vocal abuse or misuse, including: yelling, gastro-esophageal reflux, or excessive coughing or throat clearing. Allergies and other environmental factors may also contribute to a voice disorder.

Depending on the severity of difficulties that your child is having, a Speech Language Pathologist might recommend one to two times per week for therapy, or even more.

 

Child speeking

Childhood Apraxia of Speech: What Is It?

What is it?

Apraxia of speech is a motor speech disorder caused by a disruption between the planning of muscle coordination in brain and the body parts needed for speech (e.g., lips, tongue, jaw). It is not due to muscle weakness or paralysis. A child with apraxia of speech knows what he wants to say, but their brain has difficulty coordinating the oral movements needed to produce and combine sounds to form syllables and words.

What does it looks like?

Childhood apraxia of speech can look different in each child. Not every child show all of the signs and symptoms of apraxia. The following is a list of potential indicators that your child may have apraxia of speech:

  • Little to no cooing or babbling as an infant
  • Limited imitation of syllables and/or words
  • First words occurring after 18 months of age
  • A two-year old who:

o   is non-verbal

o   uses non-speech sounds without any word approximations

o   uses gestures, rather than words, to communicate

o   becomes frustrated around communication

  • A child who is able to produce single words clearly, though becomes unintelligible in phrases or sentences
  • A child who deletes sounds from words after age three
  • A child who has previously said a word clearly, though cannot imitate it when asked
  • Family members often have to interpret for the child

How is it diagnosed?

An audiologist should complete a comprehensive hearing evaluation to rule out any potential hearing loss.

A certified speech-language pathologist will complete a comprehensive speech-language evaluation. This will assess your child’s oral-motor abilities, speech sound development, and language development.

Childhood apraxia of speech is a differential diagnosis, or a diagnosis that is made by examining all the possible causes for a set of symptoms in order to arrive at a conclusion. Due to this, an official diagnosis of apraxia may not be made right away. It is important to rule out other potential causes for your child’s speech difficulties before coming the apraxia diagnosis, such as phonological disorders. However, it should be noted that with or without a diagnosis your child will still receive effective therapy to improve their overall communication skills.

What treatments are available?

Research has shown that frequent (3-5 times per week) and intensive speech-language therapy yields more successful results. Furthermore, individual therapy is more successful than group therapy for children with apraxia. Improvement in the planning, sequencing, and coordination of oral muscle movements is the main focus in intervention. Visual and tactile cues, such as tapping on the arm or looking in the mirror, provide multi-sensory feedback which helps to improve the child’s coordination and production. The most important piece in therapy for apraxia is practice; both in therapy and at home. The treatment of apraxia takes time, patience, and commitment. A supportive environment is crucial so your child can feel successful in their communicative interactions.

If you have any questions regarding childhood apraxia of speech, contact one of our speech-language pathologists today!





Our 10 Favorite Speech and Language Apps for Kids

Apps can be a great way for kids to practice a variety of skills.  Read on for information on our top 10 choices for speech and language apps for children!

App Name

Focus

Age Group

Description

Purchase/Download Info

Peek-a-Boo Barn Lite
  • Spatial concepts (in, on, under, next to)
  • Animal sounds
  • Vocabulary (animals names, open/shut, barn)
  • Turn-taking
  • WH questions (what, where)
0-3 Listen to animal noises, then push barn doors to reveal the farm animal inside. Available in 10 languages. Free on iTunes for iPhone/iPad (full version, $1.99). $2.99 on Android

 

Toca Boca Kitchen Monsters
  • Verbs
  • Labeling (foods)
  • Language expansion (practice 2+ word phrases)
  • WH questions
  • Following directions
  • Environmental sounds
2-6 Choose and prepare various foods before feeding them to a Toca monster. Free on iTunes for iPhone/iPad
TallyTots
  • Verbs
  • Two-word combinations
  • Counting
  • Concepts (i.e. matching, size (big/little, on/off)
  • Following directions
2-6 Involves counting 1-20. Each number coordinates with an activity that illustrates language concepts $2.99 on iTunes for iPhone/iPad and  KindleFire/Android
Speech Tutor
  • Articulation
  • Visual cues (what mouth, lips, tongue, etc. are doing) for production
  • Tips for producing the sound
  • Other information about a selected sound
All Ages Watch a virtual mouth as it produces selected sounds. This application also provides tips for producing the sound and age for when we expect mastery of each sound. Free on iTunes for iPhone/iPad
My PlayHome Lite
  • Vocabulary (around the house)
  • Actions
  • Pronouns
  • Following directions
2-6 Manipulate people and things inside an interactive home (i.e. make Mom drink water, put Dad behind the couch, make the boy jump on a chair). Free on iTunes for iPad (full version, $3.99). $2.99 on Android
Articulation Station
  • Articulation
  • Matching
  • Labeling
All ages Speech sounds in words, sentences and stories in all positions of words (i.e. initial, medial and final). Choose from flashcards or matching games. Easy to keep track of accuracy and progress. Free to download on iTunes for iPhone/iPad (additional sounds $2.99 each).
iSequence
  • Sequencing
  • Expressive language (grammar, syntax)
  • Vocabulary
5-7 Put 3-4 picture sequences in the correct order. Includes 100 sequences. $2.99 on iTunes for iPhone/iPad
Blue Whale- NACD
  • Apraxia and articulation (CVC productions only)
1+ Imitate consonant-vowel-consonant (“CVC”) productions. 8 levels of complexity included. $4.99 on iTunes for iPad. Also available for $4.99 for Kindle, Android tablets and Nook.
Describe It to Me
  • Word-finding
  • Categories
  • Salient features
  • Object function
  • Parts
  • Location
5+ Complements EET program (Expanding Expression Tool). App can be used both expressively (e.g. to generate ideas), or receptively (e.g.  correctly select or point to various objects’ categories, function, parts). Customize  vocabulary given child’s needs, as well as skills targeted (categories, parts, etc). $9.99 on iTunes for iPad (free sample on iTunes).
Full Social Skills Builder
  • Understanding emotions
  • Perspective taking
  • Identifying appropriate responses (making comments, asking for information)
5-12 Videos are organized according to age group (school age, adolescent). Watch videos in different environments (school, community). Child answers 3-5 multiple choice questions following video. $14.99 on iTunes for iPhone/iPad (free sample on iTunes).

Click Here to View our Speech and Language Infographic!

*Co-written by Caitlin Brady

Imagine Being a Parent of a Child with Apraxia of Speech (CAS)

Guest post By: Leslie Lindsay, R.N., B.S.N. and a mother

At two years old, Kate was a beautiful, energetic, and happy toddler. With the exception of one word-hi-Kate was as quiet as a mouse. We wondered if something was wrong. Even as a baby, Kate rarely babbled and cried; she was beautiful and unique with red hair and bright blue eyes. She was, in a word, apraxia“perfect.” So why were we worried? After all, she could understand everything we said, even the big words. And what was so wrong with having a quiet, happy toddler?

But there were times my heart would sink. Gaggles of women who had all been in the same childbirth class a year or so earlier met up for our summer book discussion. They were chattering about how their children were saying new words every day. One mother proudly shared, “Oh, Maddie said elephant yesterday at daycare. I hate that I missed it.” I pulled my lips into a tight line and let out a sigh. If only my baby could say, ‘mama’ I thought.

Fast-forward a year or so. We learn Kate has Childhood Apraxia of Speech (CAS). Characterized by a child’s inability to express themselves verbally, CAS is a complex neurologically-based motor speech disorder. It is serious and requires intense and frequent speech therapy by a licensed speech-language pathologist (SLP). Part of me was relieved: now we know what to call this “reason” for Kate’s lack of verbal communication. But another part of me was overwhelmed, nervous, and anxious: now what and why?

It was time for me to put on my proactive parenting cape (forget Supermom), this diagnosis called for a little more. I started gathering any and all information I could on the subject of CAS. I joined listservs and read old text books on the subject. I picked my SLP’s brain. I worked with my daughter at home, in the car, and everywhere in between. I enrolled her in the special education preschool. And she improved. Yet in the meantime, we dealt with so many quizzical looks, unwanted advice, and clueless peers.

Imagine going to the grocery store with your toddler. The clerk makes small talk with you and your child. Your child can’t answer when asked, “What’s your name, cutie?” Instead, she grunts and smiles. The clerk turns to you, perplexed as if to say, “doesn’t your kid know her name?”

Try taking your 4-year old to see Santa at the mall. He can’t tell the big man in red what he wants for Christmas, even though you know he’d love a new bike with training wheels. Instead, he makes a spinning gesture with his hands and goes vroom, vroom. Santa chuckles, “Oh, a toy car!” But you know that’s not it. So does your son.

What will you tell the kind, grandmotherly babysitter who tells you, “Oh, don’t worry. Some kids are just late-to-talk. She’ll catch up. Maybe you aren’t reading and singing to her enough? Do you go to mommy-and-me classes so she can interact with other kids?”

How will you know what your child wants when he just stands and points to the top of the shelf at the many items it could be? You ask, “Do you want the blocks? No. Do you want the farm book? Oh, I know…you want your car!” But, instead he breaks down in tears and walks away.

How does your heart break when you overhear her peers say, “Julia can’t talk. Let’s not ask her to play with us.”

What’s a parent to do?

  • Love and accept your child for who he is. Of course you didn’t ask for your child to have CAS. Neither did your child. Focus on finding the resources your child needs the most-a qualified SLP.
  • Talk to your child. Speak with her as though you expect an answer. Just because she can’t speak back in a way you understand, she understands you. Make your communication with her matter.
  • Provide opportunities for your child to absorb speech and language. Read to him, study the illustrations; illuminate the details. Point out everything you can about the environment. “Look at the birds. Do you see the blue birds? Beautiful blue birds. Can you say bird?”
  • Be patient with your child. Having a child with CAS takes time to remediate. It’s not over in a matter of a couple of speech therapy sessions. It can take years to get your child speaking at developmentally-appropriate levels. Talk with your SLP about ways to monitor progress. It’s all about baby steps.
  • Be patient with yourself. Take a deep breath or a give yourself a time-out when you find yourself losing patience. Allow yourself to do other things besides parent a child with CAS. It’s important for your mental health.
  • Allow your child to be a “regular” kid. This may mean “coaching” social play. You may have to introduce your child to a group of peers, “This is Max. He’s a fun kid, but he’s still working on his words. Can he play with you?”
  • Bite your tongue or educate-diplomatically, of course. When someone asks you about why your child isn’t talking like every other child, you can grin and bear it, or you can simply tell them, “Brooke has Childhood Apraxia of Speech. She sees an SLP each week. We’re working on it.” Most folks don’t need or want more details than that.

Soon, you’ll be hearing things like, “Mom, can I have twelve bucks?” like I did the other day when my daughter with apraxia came home from school one day and wanted to go to Disney on Ice. You’ll be hearing words and phrases like, “Whatever,” and “I didn’t do it.” But the most touching of all, is when you hear these precious words: “I love you, mom.” Imagine being a parent of a child with CAS.

About the Author:

Leslie LindsayLeslie Lindsay is a former staff R.N. in child and adolescent psychiatry at the Mayo Clinic. She is the author of “Speaking of Apraxia: A Parent’s Guide to Childhood Apraxia of Speech,” available from Woodbine House, Inc. in March 2012. This is the first-ever book written by parents for parents specifically on CAS. Leslie blogs daily on apraxia, parenting, child development and more at www.leslie4kids.wordpress.com. She lives in Chicagoland with her two daughters Kate and Kelly, her husband Jim, and a basset hound named Sally where she writes full-time. Feel free to contact her at leslie_lindsay@hotmail.com

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