A rare speech disorder that causes problems with controlling the lips, jaw, and tongue when speaking is called childhood apraxia of speech (CAS). In people with this condition, the brain cannot plan for speech movement. In other words, the brain is not able to direct the movements needed for speech. As a result, the muscles do not form words in the correct way despite they are not weak.
In normal circumstances, the brain tells the speech muscles how to move the lips, jaw, and tongue when speaking. The process in which a person speaks accurate sounds and words at the proper speed and rhythm is negatively affected by CAS.
Commonly, the primary treatment for CAS is speech therapy during which specialists will teach you to practice the correct way to say syllables, words, and phrases.
Symptoms
CAS may cause multiple symptoms depending on your age, severity of the condition, and other factors. This speech disorder may cause:
- Make fewer vocal sounds or babble less that normally occurs between 7 to 12 months of age.
- Late speaking first words, which usually occurs after 12 to 18 months of age.
- Use a limited number of consonants and vowels
- The speech is hard to understand
- Leaving out sounds when speaking
Previous symptoms usually occur between 18 months and 2 years and may indicate CAS. It means your child may have a speech disorder and you should contact a healthcare professional. While children usually produce more sounds between 2 and 4 years, the following symptoms may indicate CAS. For example:
- Consonant and vowel distortions
- Specific pauses between words or syllables
- Voicing errors (including “pie” that sounds like “bye”)
A lot of children with this speech disorder cannot get their jaws, lips, and tongues correctly to make sounds and have language problems (including decreased vocabulary and problems with word order).
Sometimes, it is difficult to diagnose this condition because other speech disorders cause similar symptoms to CAS. However, there are some characteristics (also known as markers) that may help distinguish CAS from other disorders. These include:
- Difficulty moving from one sound, syllable, or word to another.
- Unusual movements of the lips, tongue, and jaw when trying to do correct ones for speech sounds.
- Vowel distortions
- Frequently using the wrong stress in a word
- Equal emphasis on all syllables
- Separation of syllables
- Making multiple errors when trying to say the same word one more time (also known as inconsistency)
- Difficulty imitating simple words
- Voicing errors (such as saying “down” instead of “town”)
What Are The Speech Disorders Sometimes Mistaken for CAS?
In some cases, speech sound disorders are confused with CAS because the symptoms may overlap. For example articulation disorders, phonological disorders, and dysarthria.
Children with articulation or phonological disorders have problems with learning how to make some sounds. However, previous speech disorders occur more frequently than CAS. Check below some errors that occur in children with phonological and articulation disorders:
- Substituting sounds
- Leaving out final consonants
- Stopping the airstream
- Simplifying sound combinations
A speech disorder that causes weakness of the speech muscles is called dysarthria. It causes problems with making speech sounds because of weak muscles that cannot move as far, quickly, and strongly as they should. People with dysarthria also have a hoarse, soft, or strained voice. In most cases, physicians diagnose dysarthria more easily than CAS.
Causes
There are multiple causes of CAS and in most cases, the exact cause cannot be identified. However, there are no brain problems in children with this speech disorder. Some children may develop this condition due to brain diseases or injuries. For example traumatic brain injury, infections, stroke, and others.
Sometimes, CAS may happen due to a genetic disorder, syndrome, or metabolic disease. Healthcare providers call this condition developmental apraxia.
Risk Factors
While not every time it is possible to determine the exact cause of CAS, physicians identified a gene that may increase the risk of developing it. This gene is called FOXP2 and it may increase the risk of other speech disorders too. While researchers continue studies on how FOXP2 changes negatively affect motor coordination, speech, and language in the brain, other genes also may contribute to motor speech development problems.
What Are The Possible Complications of CAS?
Commonly, people with CAS have also other problems that negatively affect their ability to communicate. However, the following problems usually are not caused by this speech disorder. Check below some examples:
- Reduced vocabulary
- Problems understanding speech
- Using wrong grammar when trying to make phrases or sentences
- Delayed intellectual and motor development
- Difficulty reading, spelling, and writing
- Problems with communication in social interactions, motor movement skills, and coordination.
How to Prevent CAS?
Early diagnosis and proper treatment may help prevent complications and long-term symptoms. If you notice your child has speech disorder symptoms, immediately visit a doctor for diagnosis.
Diagnosis
Usually, to diagnose CAS, a speech-language pathologist with perform an examination of the speech muscles and will look at how the child makes speech sounds, words, and phrases. They also may ask some questions about the child’s medical history.
However, the CAS diagnosis is not based only on a single observation or test. Thus, physicians may perform some tests to confirm the condition and rule out other speech disorders that cause similar symptoms. In addition, it is very important to confirm the disease because treatments for speech disorders are different. Check below some tests used in CAS diagnosis:
- Hearing tests – These tests are used to check for hearing problems that may contribute to CAS.
- Oral-motor assessment – During this test, physicians will check your child’s lips, tongue, and jaw for structural problems (including tongue tie or a cleft palate). They also will check speech muscles for abnormalities linked with speech disorders.
- Speech evaluation – Usually, to check your child’s ability to make sounds, words, and sentences you can play or engage in other activities. For example, your child may be asked to name pictures and others.
Furthermore, a trial of speech therapy also may help doctors confirm CAS.
Treatment
Commonly, children do not outgrow CAS, but specialists trained in speech disorders treatment may lessen the CAS symptoms with multiple therapies.
Speech Therapy
Physicians usually provide therapies that focus on practicing words, syllables, and phrases. The duration of the treatment is usually from a few weeks to years up to 5 times per week. It depends on the severity of the condition, overall health, and others.
Commonly, children notice improvements from individual therapy because it allows more time to practice speech during each session. Moreover, it is very important a lot of practice saying words and phrases to people with CAS.
While there are multiple speech therapies that have been shown to be effective in CAS treatment it often includes the following principles. For example:
- Speech drills – This involves repetitive words and phrases during the therapy.
- Sound and movement exercises – During this procedure, your child usually is asked to watch the speech-language pathologist’s mouth while pronouncing words or phrases.
- Speaking practice – This treatment part involves practicing syllables and words.
- Vowel practice – Usually, people with CAS are more likely to distort vowel sounds. Hence, doctors will choose to repeat words that contain vowels in multiple syllable types.
Frequently Asked Questions
What are the most common symptoms of CAS?
- Difficulty saying multisyllabic words
- Problems with imitating sounds or words
- Errors in speech rhythm
- Long pauses between sounds
If you notice that your child experiences any of the previous symptoms, it is advised to see a speech-language pathologist.
What is the prognosis for a child with apraxia of speech?
Usually, children with CAS experience significant improvement with treatment. To determine the best treatment for your child, it is advised to visit a doctor for diagnosis.
Is apraxia genetic?
While most of the time determining the exact cause of apraxia is not possible, it can be genetic. It also may occur due to brain injuries and other health problems. Check below some genetic causes:
- Single genes – For example, FOXP2, CDK13, and SETBP1 are linked to apraxia.
- Chromosomal disruptions – There are some chromosomal disruptions that are linked to apraxia. For example 16p11.2 deletion, Koolen de Vries syndrome, and others.
- Genetic mutations – Genes that may cause apraxia may be inherited from biological parents.
This article does not contain a complete list of CAS causes. If you have any other questions, ask your healthcare provider.
