Apraxia? What’s That?

Today we’re talking about Childhood Apraxia of Speech.  This is one of many speech disorders that a child may exhibit. Before we get into the science of it, simply stated…

Apraxia of Speech is a motor speech disorder that originates from a person having difficulty completing the necessary physical movements needed to correctly produce sounds.  With Apraxia, difficulty speaking does not stem from any weakness or paralysis.  Instead, the origin of the issue is that the person’s brain has difficulty coordinating the muscle movements necessary to say those words.

Now, on with the impressive stuff!  Today’s blog was written by Meg Sprunger, our Director of Speech and Language Services.  Meg specializes in treatment of Childhood Apraxia of Speech (CAS).  She has completed over 80 hours of continuing education in the area of diagnosis and treatment of CAS, including the Intensive Training Institute offered by the Childhood Apraxia of Speech Association of North America (CASANA). Meg is recognized by CASANA for “Advanced Training and Expertise in Childhood Apraxia of Speech.”  She has 30 years of clinical experience and is the highest trained in the state in CAS.

Before we continue, we want to make sure you know about our next Parent Munch-N-Learn session on Wednesday, February 24th, from 9 am to 10 am.  Meg will discuss tips for working through Apraxia at home with your child.  The session will take place in our Conference Room, and a light breakfast will be provided.  This event is open to the public, so please invite any friends or family who may be interested in learning more about Childhood Apraxia!

What is Childhood Apraxia of Speech?
Childhood Apraxia of Speech (CAS) is a specific type of speech sound disorder in which a child has difficulty planning, sequencing and coordinating the many precise movements necessary to form words, phrases, and sentences.

We don’t give it much thought, but speech is an extremely complicated process. For every sound we produce, we access “automatic programs” or “motor plans” stored in our brain that tell us exactly how to shape or position our lips, tongue, teeth, and jaw; whether or not to close off our nasal passage by lifting our soft palate; exactly when to start the vibration of our vocal cords (or not); and how to coordinate all this with the release of our airflow/breath. All this to produce a single speech sound! But that’s just the beginning. Depending on what sound comes before or after, we automatically make small adjustments to each of those movements, so that the transition from one sound to another is smooth. This is called co-articulation. It makes the overall “flow” of our connected speech sound like one continuous, uninterrupted movement, rather than a robotic, disconnected sequence of sounds or words. Isn’t it a wonder that we learn to talk at all? And yet the majority of us talk effortlessly and without conscious thought about the highly-refined fine motor process involved.

Children with CAS, sometimes referred to as verbal apraxia, developmental apraxia of speech, or dyspraxia, have difficulty with exactly these “motor planning” aspects of speech. Their sound errors may be inconsistent, they may have difficulty making smooth transitions from sound to sound, and the “melody” of their speech may sound atypical. Their difficulties are not due to muscle weakness. If muscle weakness is present, the child may have another type of speech disorder (dysarthria), instead of or in addition to the apraxia. CAS is also distinct from more common speech delays (e.g. phonological delays) in which a child has consistent error patterns for certain sounds. These different types of speech sound disorders have overlapping characteristics, and they may in fact co-occur. But it’s important to tease out the appropriate diagnosis, since the treatment is different for each. This “teasing out” (called differential diagnosis) may need to happen over time, especially in very young children or children with limited speech.

What does therapy for CAS include?
Therapy for CAS will necessarily include a great deal of repetition and practice, which is how those missing or faulty “motor plans” are established or improved. A creative speech-language pathologist (SLP) will make this practice both fun and functional, embedding the repetition and “drill” into playful activities in order to motivate the child, but keeping the therapy direct and focused. Children with CAS also require a multitude of cueing strategies, often needing visual, verbal, tactile, and gestural prompting to be successful. The SLP will provide cues when needed and fade them as the child develops some independence, naturally bringing cues in and out of use based on the complexity of the task and the performance of the child.

The overall focus of therapy for CAS will be on the movements from one sound to another, starting small and gradually building to longer and more complex sequences of sounds. Although a child may need specific instruction on how to produce some individual sounds, in general the SLP will spend very little time working on isolated sounds. Instead, the SLP will focus on syllables as the smallest unit of practice. A syllable always has a vowel present, and we form different “syllable shapes” by putting consonant sounds before or after the vowel, or both. Early on, therapy may focus on short, functional words (often just one syllable), made up of sounds the child can already produce. However, as quickly as possible the SLP will push forward, remembering that movement (the ability to connect and sequence sounds) is the core deficit. Thus, those early syllables and words will quickly be used to build sequences of syllables, either to form longer words or to form short phrases, and new sounds will be added before the others are perfected. In this way, therapy is like a “dance,” moving forward to add more and then back to work on closer approximations or refinements, forward and back. This also allows the therapist to build important language skills, like simple sentence structures. Verbal language cannot progress without a speech sound system to support it, and a speech sound system is no use without language to give it meaning. Thus, speech and language development need to proceed hand-in-hand, in the same way that they do for typical toddlers learning how to talk.

Children with CAS will need frequent speech-language therapy, often 3-5 sessions per week depending on the severity. At The Emerge Center, we have an effective program which combines group and individual therapy for young children with CAS. This gives the child both the targeted individual practice needed, plus the opportunity to use and carry-over those skills in a structured group setting, where the constant facilitation of a skilled SLP fosters communication success across contexts and with peers.

Can parents help?
Absolutely. Your therapist will provide you with information specific to your child, but if you are interested in learning more about CAS and ways you can help your child at home, plan to come to our next parent education session on Wednesday, February 24.

What should I do if I suspect my child may have CAS or another speech sound disorder?
Ask your doctor for a referral for a speech-language evaluation. If your child is already enrolled in speech-language therapy, discuss your concerns with your child’s SLP. Parents can also access a whole library of trusted and helpful information via the Childhood Apraxia of Speech Association of North America (CASANA) at http://www.apraxia-kids.org/