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Childhood Apraxia of speech

Overview

Childhood apraxia of speech (CAS) is an uncommon speech disorder in which a child has difficulty making accurate movements when speaking. With this disorder, the speech muscles aren't weak, but they don't perform normally because the brain has difficulty directing or coordinating the movements.


Symptoms

Varies depending on their age and the severity of their speech problems.

CAS can be associated with delayed onset of first words, a limited number of spoken words, or the ability to form only a few consonant or vowel sounds. These symptoms usually may be noticed between ages 18 months and 2 years, and may indicate suspected CAS.

As children produce more speech, usually between ages 2 and 4, characteristics that likely indicate CAS include vowel and consonant distortions; separation of syllables in or between words; and voicing errors, such as "pie" sounding like "bye."

Many children have difficulty moving smoothly to the next sound.

Many children with CAS also have language problems, such as reduced vocabulary or difficulty with word order.

Some symptoms may primarily be seen in children with CAS and can be helpful to diagnose the problem.

Those particularly associated with CAS include:

  • Difficulty moving smoothly from one sound, syllable or word to another
  • Groping movements with the jaw, lips or tongue to make the correct movement for speech sounds
  • Vowel distortions, such as attempting to use the correct vowel, but saying it incorrectly
  • Using the wrong stress in a word, such as pronouncing "banana" as "BUH-nan-uh" instead of "buh-NAN-uh"
  • Using equal emphasis on all syllables, such as saying "BUH-NAN-UH"
  • Separation of syllables, such as putting a pause or gap between syllables
  • Inconsistency, such as making different errors when trying to say the same word a second time
  • Difficulty imitating simple words
  • Inconsistent voicing errors, such as saying "down" instead of "town," or "zoo" instead of "Sue"

A child who has trouble learning how to make specific sounds, but doesn't have trouble planning or coordinating the movements to speak, may have an articulation or phonologic disorder. Articulation and phonologic disorders are more common than CAS.

Articulation or phonologic speech errors may include:

  • Substituting sounds, such as saying "fum" instead of "thumb," "wabbit" instead of "rabbit" or "tup" instead of "cup"
  • Leaving out (omitting) final consonants, such as saying "duh" instead of "duck" or "uh" instead of "up"
  • Stopping the airstream, such as saying "tun" instead of "sun" or "doo" instead of "zoo"
  • Simplifying sound combinations, such as saying "ting" instead of "string" or "fog" instead of "frog"

Dysarthria is a motor speech disorder that is due to weakness, spasticity or inability to control the speech muscles. Making speech sounds is difficult because the speech muscles can't move as far, as quickly or as strongly as normal. People with dysarthria may also have a hoarse, soft or even strained voice, or slurred or slow speech.

Dysarthria is often easier to identify than CAS. However, when dysarthria is caused by damage to certain areas of the brain that affect coordination, it can be difficult to determine the differences between CAS and dysarthria.


Causes

Childhood apraxia of speech (CAS) has a number of possible causes, but in many cases a cause can't be determined. Doctors often don't observe a problem in the brain of a child with CAS.

  • CAS may be the result of brain (neurological) conditions or injury, such as a stroke, infections or traumatic brain injury.
  • CAS may also occur as a symptom of a genetic disorder, syndrome or metabolic condition. For example, CAS occurs more frequently in children with galactosemia.
  • CAS is sometimes referred to as developmental apraxia. However, children with CAS don't necessarily grow out of CAS as they develop. In many children with delayed speech or developmental disorders, children follow usual patterns in development of speech and sounds.
  • Children with CAS don't make typical developmental sound errors..

Complications

Symptoms or problems that are often present along with CAS include:

  • Delayed language, such as difficulty understanding speech, reduced vocabulary, or difficulty using correct grammar when putting words together in a phrase or sentence
  • Delays in intellectual and motor development and problems with reading, spelling and writing
  • Difficulties with gross and fine motor movement skills or coordination
  • Hypersensitivity, in which the child may not like some textures in clothing or the texture of certain foods, or the child may not like tooth brushing

Prevention

Diagnosing and treating childhood apraxia of speech at an early stage may reduce the risk of long-term persistence of the problem. If your child experiences speech problems, it's a good idea to have a speech-language pathologist evaluate your child as soon as you notice any speech problems.


Treatment

Speech-language pathologists may treat childhood apraxia of speech (CAS) with many therapies.


Speech therapy

Your child's speech-language therapist will usually provide therapy that focuses on practicing syllables, words and phrases. When CAS is relatively severe, your child may need frequent speech therapy, three to five times a week. As your child improves, the frequency of speech therapy may be reduced.

Children with CAS generally benefit from individual therapy. Individual therapy allows your child to have more time to practice speech during each session.

It's important that children with CAS get a significant amount of practice saying words and phrases during each speech therapy session. Learning to say words or phrases takes children with CAS time and practice.

Because children with CAS have difficulties planning movements for speech, speech therapy often focuses your child's attention to the sound and feel of speech movements.

Speech practice at home is also essential


Alternative communication methods

If your child has a severe speech disorder and can't effectively communicate, alternative communication methods can be very helpful.

Alternative communication methods may include sign language or natural gestures, such as pointing or pretending to eat or drink. For example, your child could use signs to communicate he or she wants a cookie. Sometimes electronic devices, such as electronic tablets, can be helpful in communication.

It's often important to use alternative communication methods early. Using these methods may help your child become less frustrated when trying to communicate. It may also help your child to develop language skills such as vocabulary and the ability to put words together in sentences.

As speech improves, these strategies and devices may no longer be necessary.


Therapies for coexisting problems

Children with CAS who have fine and gross motor movement difficulties in their arms or legs may need physical or occupational therapy.

If a child with CAS has another medical condition, then effective treatment for that condition may be important to improving the child's speech.

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