What is Apraxia and How Can Pediatric Speech Therapy Help?
This speech diagnosis has a lot to do with coordination, but it can be tricky to identify. Let’s dive in.
What does the word apraxia mean?
Apraxia is something that can happen after a stroke or brain injury. But some children who are otherwise healthy are born with apraxia. It can range from mild, moderate or severe, and there is research which suggests that it is genetic to some extent, being more common in boys.
Apraxia can impact walking and fine motor movements. When someone is apraxic they have difficulty making their body do something that their brain intends. Apraxia of speech is when this difficulty specifically affects the mouth for articulation. Sometimes children with apraxia of speech experience apraxia in other parts of their body as well, but often the movement planning challenges are isolated to speech.
I have heard apraxia of speech likened to the experience of trying to pronounce words backwards (sdrawkcab….oof). To conceptualize movement, or motor planning, you can also think about how discoordinated you would feel should you be thrown into a dance class, trying to keep up without having learned any of the steps.
My child’s speech is unclear: Do they have apraxia?
Maybe, but there are a plethora of reasons for unclear speech in childhood. It is up to your speech therapist to don their detective hat to see if Childhood Apraxia of Speech (CAS), is the underlying cause. CAS shares symptoms with other speech-language diagnoses, and sometimes children have multiple speech diagnoses happening at once.
But if you would like a peek behind the diagnostic curtain, below is a list of some of the signs your SLP will be looking for to make a diagnosis of CAS. A note while reading: All of the symptoms listed below may not be present in every child with CAS, and you should rely on a professional’s evaluation to draw conclusions.
A Very Young Child
Does not coo or babble as an infant
Their first words are late, and they may be missing sounds
Produces only a few different consonant and vowel sounds
Struggles to combine sounds; may show long pauses between sounds
Simplifies words by replacing difficult sounds with easier ones, or by deleting difficult sounds (although all children do this, the child with Apraxia of speech does so more often)
May have problems eating
An Older Child
Makes inconsistent sound errors that are not age appropriate
Can understand language much better than he or she can talk
Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
Has more difficulty saying longer words or phrases clearly than shorter ones
Appears to have more difficulty when he or she is anxious
Is hard to understand, especially for an unfamiliar listener
Sounds choppy, monotonous, or stresses the wrong syllable or word
*The above lists come courtesy of Motor Speech Queen, Pam Marshalla’s workshop Improving Intelligibility in Apraxia and Dysarthria, 2011.The government program and its acronyms: EI, IFSP, CPSE.
What Will a Speech Therapist Do to Help?
After making a diagnosis, which may occur after a period of early regular therapy, your SLP will begin to help your child learn to coordinate their speech movements. A bit of jargon is often used to describe this process: Motor Learning. There are key principles of motor learning that must be integrated into therapy to ensure your child is successful in learning their new speech sound movements. These include:
Having variety in practice contexts
Reducing the number of errors during practice (we don’t want mistakes to stick in the brain)
Providing meaningful feedback in response to a sound attempt
DTTC
If you want to experience speech discoordination for yourself, try saying the long form of this acronym 10x fast: Dynamic Temporal and Tactile Cuing. Coined by another motor speech queen, Dr. Edythe Strand, DTTC is an intervention for CAS that is strongly backed by clinical evidence. Some therapists who have not been trained in DTTC, may be surprised to learn that it is quite intuitive. If you are one of those therapists, Dr. Strand offers free workshops on to learn about CAS and DTTC. Here is a link!
Back to you parents, who don’t have time to take workshops (would be nice right?). What you need to know is that a therapist using DTTC to help your child will by doing things like:
Saying target words at the same time as your child, then adding delays
Providing visual cues with their hands or body to help them remember what to do with their mouth
Providing touch cues (sort of like how a fitness instructor would)
Stretching out words to make them longer, and easier to repeat
How Do I Get Started Therapy for CAS?
The first step is to consult with a speech-language pathologist. Tell them about what you are observing, and ask questions about their experience treating CAS. From there you will have an evaluation. If you’re working with BKST, we conduct diagnostic therapy at the start of our programs, so that we are not relying on a single moment in your child’s week to get to know them! Regular therapy for CAS should be frequent and regular.
If you’re interested in discussing the concerns you have about your child’s speech, or want to chat about CAS, you can book a complimentary 30 minute phone consultation with us here!