Childhood Apraxia of Speech and Treatment Approaches

Childhood Apraxia of Speech is a type of motor speech disorder. In this case, the brain fails to plan the correct movement of oral muscles for speech. Thus, a child with CAS faces difficulty in speaking correct sounds or words.

Remember, there is no muscle weakness or abnormal tone in this disorder as in Dysarthria. Instead, it has a relation with motor planning. A client knows what he/she wants to say but fails to coordinate the required muscle movements.

Other names for CAS include the following.

• Developmental Apraxia of Speech (DAS) 
• Developmental Verbal Dyspraxia (DVD)

DSM-5 also calls it Verbal Dyspraxia. 

Childhood Apraxia of Speech Symptoms

CAS may have the following signs or symptoms.

• Sound errors are inconsistent i.e., the client may speak the same sound with a different error. This is true for both vowels and consonants. 
• Problem with a smooth transition from one sound to another. Pauses between syllables or sounds. 
• Inappropriate prosodic features i.e., rhythm, stress, and intonation. 
• More difficulty in longer words than shorter ones. 
• The slow rate of speech. 
• Disturbance in coarticulation. 
• Distortion Errors.
• Groping for articulatory movements. 
• Language Delay.
• Difficulty in reading or writing. 
• Voiceless cognates instead of voiced sounds or vice versa. 

Clients may have other problems. These are as follows. 

• Oral Apraxia.
• Problems with fine motor skills. 
• Limb Apraxia.
• Disturbed oral sensory perception. 
• Feeding problems. 

Apraxia and Autism: Apraxia and autism are different conditions. Autism comprises of repetitive or restrictive behaviors, difficulty in communication and social interaction. While Apraxia is a motor speech disorder. 

Assessment and Diagnosis

Speech Pathologist handles the screening and diagnosis of the disorder. Sometimes Assessment may consist of formal or informal methods. It may consist of different tasks.

• Oral motor skills like tongue movement, lip movement, etc. 
• Automatic vs Spontaneous Speech.
• Imitation vs elicited responses.
• Sounds in isolation followed by syllables.
• The task of Phrases, words, and sentences. 

A clinician may observe different aspects including; 

• Accuracy of oral movements
• Accuracy in different conditions. For instance, the repetition of the same sound or elicited speech
• Errors in pronunciation and inconsistency in errors. 
• Rate of speech
• Diadokokinetic Rate
• Effortfulness or smoothness
• Response on simple and complex words
• Response when an SLP  helps with Cues. 
• Prosodic features
• Intelligibility & comprehensibility

The diagnosis of apraxia is not an easy task. Especially, if the child is under the age of three. One of the most important parts is the differential diagnosis. Other disorders may have similarities in presentation as dyspraxia of speech. 

Sometimes a clinician may take more than one session to reach conclusive remarks. Sometimes, disorders with similar symptoms may be indistinguishable from one another.

The clinician will start the treatment if there is a possibility of DVD. The progress in this process will lead to a conclusive diagnosis.

Read More: Speech Sound Development Chart / Letter sounds by age

SLP can also refer the patient to other professionals if necessary.

Definition of Childhood Apraxia of Speech ASHA

What Causes Childhood Apraxia of Speech

Well, the exact reason behind this not unknown. Some studies suggest brain injury and genetics behind this. Developmental apraxia of speech can be congenital or acquired.

Remember one thing, the origin of this speech sound disorder is neurological.

According to studies, male children seem to have a higher ratio of CAS than females. 

Treatment for Childhood Apraxia of Speech

It is necessary to consult for therapy in verbal dyspraxia. Children with this disorder can't overcome the problem on their own. Therefore, intervention is mandatory for the progress of the child. 

Usually, an intensive therapy plan is necessary in this case. SLPs may use different approaches in their plan. The selection of approaches or techniques depends on several factors.

Have a look at the following.

Linguistic Approach

A clinician can teach the clients about the correct production of the sounds. The child also learns the rules of how sounds work in a language. This is a Linguistic approach. It also focuses on the phonological aspect of the language. It may have the following forms.

• Development of phonological awareness in the children. It enhances the concept of sounds and their production. Different activities like rhymes, alphabet games are part of this method. We can call it Integrated Phonological Awareness (IPA). 
• Another method focuses on phonological pattern errors. A clinician will focus on one or more sound errors for a specific time. After that time, SLP will set another target with different patterns of errors. In this way, the process continues in cycles. These cycles continue until a child uses the target sounds practically. We can call it the Cycles Approach. 

A linguistic approach along with motor programming is helpful in managing verbal apraxia. 

Motor Programming

Another approach for speech apraxia is to enhance motor skills. Children have to learn and repeat target speech movements. The goal is to produce the target sounds correct.

This method includes intensive therapy to achieve accurate movements. A therapist may use a cueing strategy to help the client. It may have the following techniques.

• Another method includes the repetition of various syllables or non-words. It requires frequent or intensive training. It enhances the child's ability for motor planning. It increases the accuracy in articulation. It also helps the rapid transition of one sound to another. This is called Rapid Syllable Transition (ReST). 
• One of the techniques uses auditory, visual and tactile cueing. As the child progresses in a task, SLP will reduce the amount of support. So that a child attains the target in future without any facilitation. Imitation and cueing help the child with severe apraxia of speech. This technique is Dynamic Temporal and Tactile Cueing (DTTC). 
• Another approach is the Bottom-Up or Nuffield Dyspraxia Program (NDP). It helps to establish new motor programs in an intensive therapy plan. It comprises of repetition of phonemes or simple syllables. 

Prosodic Facilitation

One of the approaches consists of using prosodic patterns. One of the examples is Melodic Intonation Therapy. The use of stress, rhythm and intonation can help to produce functional speech. As progress continues, practice shifts to the next phase. That includes the minimum use of the intonation pattern.

Augmentative and Alternative Methods of Communication 

An SLP may use AAC in the case of Apraxia of Speech. These may include communication with the help of the following. 

• Gestures
• Drawing
• Pictures
• Electronic Devices
• Objects
• Language Symbols
• Finger Spellings

You can read some more information about CAS on the American Journal of Speech Pathology.

Facilitation Techniques

A therapist can use various techniques to help clients with developmental verbal dyspraxia. These techniques can facilitate in producing the target sound(s). For instance;

• Use of cues with the help of different senses like visual or tactile. Cueing is very helpful in teaching the movement of articulators. 
• SLP can explain the correct articulation and movement in a simple possible way. This is Auditory Cueing. For example, bring your lower lip under the front teeth. 
• A therapist may use tactile input. For example, pointing out the part of the tongue with the use of tongue depressor (Tactile). 
• A clinician can show tongue movements or gestures to explain the target movement. This is visual Cueing. 

Apraxia Speech Childhood

Childhood Speech Apraxia Prognosis

It is important for a client with CAS to consult a Therapist for therapy. Because SLP knows how to help a child with speech apraxia. Although, there is no cure for this disorder but speech therapy can help the client a lot. A large number of patients got improvement after intensive therapy.

Apraxia of Speech in Adults

Adults can also acquire this disorder i.e., Acquired Apraxia of Speech. Tumor, vascular lesion, progressive neurological disorders or trauma can result in AOS.

It is vital to start therapy after the diagnosis as early as possible. The most common cause of AOS is stroke.

Conclusion 

Clients with "Childhood Apraxia of Speech" should consult a professional for therapy. CAS requires an intensive therapy plan. Children with speech apraxia need full support from parents and other family members.

SLP needs to be very careful about differential diagnosis. This is true for both types of apraxia of speech i.e., CAS and AOS. Intervention should be commenced as early as possible.