Severe speech difficulties

Some children fail to develop speech sounds and their speech is unintelligible. In these extreme cases one pathology is called Child Apraxia of Speech.

What is Childhood Apraxia of Speech?

Childhood Apraxia of Speech (CAS) is a motor speech disorder that first becomes apparent as a young child is learning speech. For reasons not yet fully understood, children with apraxia of speech have great difficulty planning and producing the precise, highly refined and specific series of movements of the tongue, lips, jaw and palate that are necessary for intelligible speech.

How Does Speech “Happen”?

  • The act of speech begins with an intention to communicate.
  • Next, an idea forms, outlining what the speaker wants to say.
  • The words for the desired message are put in the correct order
  • Each word contains a specific sequence of sounds that must be correctly ordered together.
  • Then we coordinate the movements
  • The brain must tell the muscles of these “articulators” the exact order and timing of movements so that the words in the message are properly pronounced.
  • Finally, the muscles themselves must work properly with enough strength and muscle tone to perform the movements needed for speech.

Amazingly, all of this happens in the blink of an eye.

The child doesn’t have to think about how to say the word or phrase they want to say. At this point, speech motor plans and programs are stored in the brain and can be quickly accessed and put together effortlessly when they are needed.  Children with apraxia of speech have the most difficulty in this aspect of speech.  It is believed that children with CAS may not be able to form or reliably access speech motor plans and programs or that these plans and programs are faulty for some reason.  Unlike children developing typical speech, speech motor plans and programs for children with CAS fail to become automatic and easily accessed when they wish to speak.

How Is CAS Different Than a Speech Delay?

What is often seen in a child with apraxia of speech is a wide gap between their receptive language abilities and expressive abilities. In other words, the child’s ability to understand language (receptive ability) is broadly within normal limits, but his or her ability to use expressive language through speech is seriously deficient, absent, or severely unclear. This is an important factor and one indicator that the child may be experiencing more than “delayed” speech.  In the case of such a mismatch in skills, the child should be evaluated for the presence of a specific speech disorder such as apraxia.

What Causes Childhood Apraxia of Speech (CAS) and Is It Preventable?

First, it is important for parents to understand that:

  • Nothing that you did to “cause” your child’s speech difficulty.
  • It is not about how much you talked to your child
  • or whether your child went to nursery
  • Your child does not have apraxia because you separated from your spouse
  • or because you moved to a new city.
  • You are not responsible for causing your child’s speech problems.

Top Three Characteristics of Childhood Apraxia of Speech

The top three characteristics of Childhood Apraxia of Speech, as reported by the American Speech-Language-Hearing Association (ASHA) Technical Report on Childhood Apraxia of Speech, that can help the SLP make a differential diagnosis are:

  • Inconsistent errors with consonants and vowels on repeated productions of syllables and words (your child says the same word in different ways when asked to repeat it several times.  This might be more apparent in new words or longer more complex words.)
  • Difficulty moving from sound to sound or syllable to syllable, resulting in lengthened pauses between sounds and/or syllables
  • Inconsistent development of sounds and using a lot of vowels
  • Reduction in syllables
  • Inappropriate stress on syllables or words (such as all syllables are said with equal stress on each one causing the “melody” of speech to sound odd)

 

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