The best part of what I do as a speech-language pathologist (SLP) is teaming up with parents and caretakers to develop treatment ideas that help kids relieve the frustrations inherent in speech difficulty. This can be especially challenging with more complex diagnoses, unfortunately. Childhood apraxia of speech (CAS) is one of the main culprits.
CAS and its complicated nature can lead the most diligent parent on a wild goose chase — not to worry!
I’ve broken down everything you need to know if you suspect your little one may have childhood apraxia of speech, ideas on how to spot it, and what works as effective treatment. Hang in there on this one! It may seem bleak at first, but SLPs are trained to address these developmental barriers while simultaneously helping relieve the tension your little one has bottled up.
Explanation of Childhood Apraxia of Speech
Childhood apraxia of speech (CAS) is a speech disorder in which a child has difficulty making the appropriate movements for speech sounds. At first glance, you might recognize that this sounds like several other forms of speech disorders; and, unfortunately, you’re right. But CAS is a nuanced speech issue that differs from the more common speech disorders in several ways.
Childhood apraxia of speech clogs up the pathway from the mind to the mouth. This makes CAS especially difficult because your little one knows (on the inside) what the proper sound or word is, but the connection between the speech centers of the brain and the muscles in the jaw, tongue, and lips just won’t cooperate with each other.
This takes place even though the speech muscles are fully capable of mechanical function, and is what makes CAS different from dysarthria, a motor speech disorder that is caused by weak articulation muscles. With CAS, the sounds, words, and thoughts are just trapped inside.
Although it delays development, CAS differs from a true developmental delay. In a developmental delay, “the child is following the ‘typical path’ of childhood speech development, although at a slower rate than normal.” (1) But childhood apraxia of speech is a barrier that stops development — that is, until proper diagnosis and treatment — making parents and caretakers essential in spotting the signs and pursuing professional assistance.
As if that wasn’t enough, the cause of CAS “remains heavily debated,” (2) varies, and often goes unknown. Furthermore, children with CAS may also have impairments in other areas such as general motor function or a combination of other speech and language diagnoses. (3) Wrapped together, childhood apraxia of speech can be a formidable dragon to slay...
The great news is that CAS is treatable! Your kiddo can make some amazing progress with the right plan and family support. Early diagnosis helps this process and provides a significant advantage. Here is what to look for:
What are the Early Signs of Childhood Apraxia of Speech?
Knowing what to look for can help lead to an early treatment. According to the #1 ranked Mayo Clinic, “symptoms are usually noticed between ages 18 months and 2 years.” (4) Although, all children are unique and may present with symptoms differently.
You may notice several or all of these signs and symptoms:
- Your child may conduct big groping movements of the jaw, tongue, and lips. This indicates effort is being made to create the correct speech sounds, but it just isn’t working.
- Your child may have difficulty imitating certain words. For example, you may demonstrate the word “hat” (both visually and verbally), but the word proves too difficult to repeat back.
- Your child may produce inconsistent speech errors. For example, your kiddo may present with an error in the /c/ of “cat” and then next time with the /t/. This differs from an articulation disorder, in which the error presents the same each time.
- Your child may speak with separation of or inconsistent emphasis on syllables. For example, the /a/ sound in “dad” may be elongated separating the /d/ sound on either side, or the /a/ sound may be over emphasized.
- Your child may speak with low intelligibility (being difficult to understand) to both familiar and unfamiliar listeners. This is contrasted with more common speech disorders in which familiar listeners can still understand what is being said.
These signs and symptoms all have a commonality, though: they point to evidence that your little one is understanding language but that the connection from the mind to the mouth is interrupted. This is because CAS does not affect intelligence. And even with CAS, it is possible to successfully go to school with the right type of support.
What is the Treatment for Childhood Apraxia of Speech?
First, connect with a speech-language pathologist (SLP) or other qualified medical professional trained to recognize CAS. Remember, this can be a tricky one! And it is made even trickier if a dual occurring diagnosis is present.
Once working with a professional, both consistency and volume of treatment have shown to make the most progress. (5) The specific treatment I take at NYC Speech Club is called PROMPT. PROMPT is an impressive treatment because it is a solution that is as unique as the problem; it can be customized to the exact needs of your little one!
What is PROMPT Therapy?
PROMPT therapy is a holistic, tactile-kinesthetic (touch and feel) approach to speech and language challenges. PROMT stands for Prompts for Restructuring Oral Muscular Phonetic Targets. And it shows effectiveness against more demanding speech diagnoses, such as CAS. (6) And helps children speak normally.
The PROMPT method uses a unique assessment to develop an approach that goes beyond speech production alone. It focuses on the three-part conceptual framework of communication: social-emotional, physical-sensory, and cognitive-linguistic. (7) This is how an SLP customizes the treatment to the unique need and helps you dial in treatment specific to your child.
Childhood apraxia of speech is a serious challenge, but it does not have to block the goal to speak normally! However, steps need to be taken and time is of the essence. An SLP can help with this process and equip you with the tools you need.
As parents and caregivers, it may be difficult to determine when intervention is necessary for speech and/or language delays. Speech Club offers informal screenings and consultations to determine the need for a comprehensive evaluation and therapy. Please don’t hesitate to reach out if you suspect your child may be struggling with CAS.
Pretty soon this big monster will start looking...well, not so big after all. The ability to speak normally melts away the tension. Fair warning: It takes practice and patience to meet this goal. But when progress is made, tears of frustration turn into tears of joy — ahhh! — we’ll take that any day.
- Apraxiaadmin. “What Is the Difference between CAS and a Speech Delay?” Apraxia Kids, Apraxia Kids, 26 Nov. 1970, www.apraxia-kids.org/apraxia_kids_library/what-is-the-difference-between-cas-and-a-speech-delay/.
- Morgan, Angela, and Adam Vogel. “Intervention for Childhood Apraxia of Speech.” The Cochrane Database of Systematic Reviews, U.S. National Library of Medicine, 16 July 2008, pubmed.ncbi.nlm.nih.gov/18646142/.
- Morgan, Angela, et al. “Interventions for Childhood Apraxia of Speech.” The Cochrane Database of Systematic Reviews, U.S. National Library of Medicine, 30 May 2018, pubmed.ncbi.nlm.nih.gov/29845607/.
- “Childhood Apraxia of Speech.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 8 July 2021, www.mayoclinic.org/diseases-conditions/childhood-apraxia-of-speech/symptoms-causes/syc-20352045#:~:text=Childhood%20apraxia%20of%20speech%20(CAS,develop%20plans%20for%20speech%20movement.
- Apraxiaadmin. “Practice Amount and Distribution in Treatment for Childhood Apraxia of Speech.” Apraxia Kids, Apraxia Kids, 15 Sept. 2020, www.apraxia-kids.org/study-of-practice-amount-and-distribution-in-treatment-for-childhood-apraxia-of-speech/.
- Dale, Philip, and Deborah Hayden. “Treating Speech Subsystems in Childhood Apraxia of Speech with Tactual Input: the PROMPT Approach.” American Journal of Speech-Language Pathology, U.S. National Library of Medicine, 28 June 2013, pubmed.ncbi.nlm.nih.gov/23813194/.
The PROMPT Institute. “What is PROMPT?” The PROMPT Technique, The PROMPT Institute, https://promptinstitute.com/page/Families_What_is_PROMPT.