Have you noticed unusual symptoms as your child enters the age of speech development? If he or she is not hitting the regular milestones of kids the same age, this could signal a speech disorder.
There are many possible diagnoses, and some speech difficulties come and go. One possible diagnosis, though rare, may be apraxia of speech. However, obtaining this particular diagnosis must be considered by several doctors as the condition can easily be confused with other similar disorders.
So in this article, we will discuss apraxia of speech and other similar disorders, as well as answer the question, “How rare is apraxia of speech?”
What is Apraxia of Speech?
Apraxia of speech, or verbal apraxia, is a rare speech disorder that involves difficulty moving the mouth to make sounds, syllables, and words. The brain has trouble directing the right signals or coordinating the movements of the mouth, lips, jaw, and tongue.
With this articulation disorder, the speech muscles aren’t weak necessarily, but they do not perform normally. Those affected by apraxia of speech know what they want to say, but are unable to get their motor function to work with their brain’s instructions.
There are two types of apraxia of speech:
Acquired apraxia of speech: Any age group can acquire apraxia of speech, though it is more likely to occur in adulthood. Those affected will have loss or impairment of their speaking ability.
This disorder is caused by damage to the parts of the brain that involve the motor function of speech. Stroke, traumatic brain injury, brain tumors, or other brain illnesses can specifically cause this disorder. Apraxia of speech is also linked to some disorders, like Down syndrome, autism spectrum disorder, Koolen de Vries syndrome, and Floating-Harbor syndrome.
This disorder has been known to occur with other conditions caused by nervous system damage. One is dysarthria, and another is aphasia, a language disorder.
Childhood apraxia of speech (CAS): The developmental type of apraxia speech is called childhood apraxia of speech. It is also called developmental apraxia of speech, developmental verbal apraxia, or articulatory apraxia. The disorder seems to affect boys more than girls.
Children who suffer from apraxia of speech are also likely to have reading difficulties, spelling difficulties, and learning disabilities. They may also have trouble controlling small and large muscle movements.
The cause of CAS is not well known. There has been known evidence that this developmental disorder is caused by brain damage or brain abnormalities. Oftentimes kids that suffer from CAS also have a family member who had a communication disorder or a learning disability. CAS also can coexist with epilepsy and other seizure disorders. Research suggests that CAS is a genetic disorder.
Symptoms of Apraxia of Speech
The symptoms of CAS may vary depending on the age and the severity of the condition. But if you are worried your child may suffer from apraxia of speech, there are some common symptoms to look out for. In children, symptoms may include:
Difficulties feeding as a baby
Less babbling than other babies
Language development is slower than other babies or children their age
Speech problems, such as difficulty forming words or sounds, even simple ones
Trouble moving from one sound, syllable, or word to the next
Struggling with intelligibility, including by their own family
Difficulty with moving their lips or tongue when making a sound emphasizing on the wrong part of a word (for example for the word banana, BA-nan-uh instead of ba-NAN-uh)
Adding or dropping sounds to a word (example for umbrella, saying “umbararella”)
Voicing errors (for example, saying “down” instead of “town”)
May have language problems such as a limited vocabulary or difficulty with word order
Inconsistency in pronunciations; making different errors on the same word
May speak in a monotone
Struggling with intonations
Straining of the jaw, lips, or tongue to make the correct sound
Equally stressing all syllables of a word (for example BA-NAN-UH)
Vowel distortions
Putting a pause between syllables
This disorder can be very hard to diagnose due to its rarity and its similarities with other conditions. If you suspect your child may suffer from this disorder, contact your child’s health care provider. He or she will then refer you to a certified speech-language pathologist (SLP) who should be familiar with rare diseases. Your SLP will have several tests for your child to assess his or her condition.
When it comes to CAS, the main symptoms to look out for include: the delayed onset of first words, a limited amount of spoken words, and limited ability to form consonants or vowels. These kinds of things are usually noticed around 18 months old to 2 years. Between 2 and 4, you will see your child experiencing vowel and consonant distortions, separating syllables, and voicing errors.
However, you may need to wait till your child is around age 3 or 4 to be diagnosed with childhood apraxia of speech. Some symptoms are unique to CAS, but some symptoms may be a sign of a different disorder. Many other possible diagnoses could easily be attributed to your child’s symptoms. For this reason, it can be difficult to diagnose CAS if your child is experiencing overlapping symptoms with another disorder.
Some overlapping symptoms include:
Between the ages of 7 months and 1 year old, the child babbles less and makes fewer sounds vocally than others their age
The child’s speech is difficult to understand
Not saying first words until after they are 1 year old
Only using a few select consonant and vowel sounds
Omitting sounds
Other Disorders Similar to Apraxia of Speech
Let’s explore similar disorders that can be confused with CAS. Getting the right health information on other possible disorders can make it easier to diagnose your child properly.
Other types of speech disorders with overlapping characteristics to apraxia of speech include:
Phonological disorders: Like articulation disorders, phonological disorders (aka phonemic disorders) involve being able to plan and coordinate speaking movements, but those affected will have trouble learning to make some sounds. Phonological disorders are more common than CAS.
Unlike CAS, children with phonological disorders can physically make the sounds, but cannot discern when to make the sound.
Dysarthria: Another disorder similar to CAS is dysarthria. It is typically easy to differentiate from CAS unless it is caused by brain damage that affects coordination. This motor speech disorder is characterized by muscle weakness, spasticity, or difficulty controlling speech muscles. This problem can occur because the muscles are limited by how far, how strongly, or how quickly they can move. You may be able to identify dysarthria by a hoarse, strained, or soft voice, and sometimes slow or slurred speech.
Autism: Apraxia of speech can get mistaken for autism because children may have difficulty with eye contact when talking and will have sensory issues. But those with CAS will have better receptive language skills than kids with autism. They will also be able to express their needs effectively when done in a nonverbal way, whereas autistic children generally struggle with this.
For more information on other disorders and a helpful resource directory, check out the National Institute on Deafness and Other Communication Disorders’ Directory of Organizations.
How Rare is Apraxia of Speech?
Now that we’ve discussed other possible disorders that are more common than CAS, let’s discuss the rarity of this disorder.
Apraxia of speech is very rare. It is only identified in 1 or 2 children in every 1,000 who visit a speech pathologist. However, it can occur at a higher rate when associated with other disorders, such as seizure disorders.
Typically a parent will notice the condition when a child is learning to talk. However, the condition can continue into adulthood.
Treatment for Apraxia of Speech
Unfortunately, CAS is a significant, lifelong speech disorder. It does not naturally resolve like some childhood speech disorders. While there is no cure, there are things that can be done to treat CAS, especially if the problem is assessed early on.
Once your child has been properly diagnosed by a medical professional, you will need to find some reliable treatment options. The goal of treatment for CAS is to help improve your child’s speech to be more clear. It will involve things like learning how to plan the movements needed to say sounds. Your child will also be learning to make the movements at the right time.
Treatment options include:
Speech therapy: It is best to find a speech therapist sooner rather than later. Working with an SLP 3-5 times a week, in the beginning, can make a difference with CAS and language skills. As your child's speech improves, the sessions can be less often. It can be helpful to do either individual or group therapy sessions. Speech pathology sessions may include speech drills, sound and movement exercises, speaking practice, vowel practice, and paced learning.
Make sure your SLP has been certified by the American Speech-Language-Hearing Association (ASHA). ASHA offers a certification that represents a nationally recognized professional, and ensures consumers essential protection. It also ensures the professional has been educated in the right practices and ethical standards for the industry. Violations in the code can mean they will be removed from practice.
Home practice: To get better, he or she must put a lot of practice into getting better at speaking. Your child’s SLP can give you some words or phrases for your child to practice at home.
Do a quick 5-minute session twice a day. To make it less frustrating and tiring for your child, have him or her practice in real-life situations. This can be done by creating situations where it is appropriate for your child to say the word or phrase.
Other communication alternatives: If your child has a severe case of CAS, it may be helpful to learn other communication methods, such as sign language. It will also be helpful to use natural gestures like pointing usinguse computers to help communicate. However, as their speech gets better, these methods can be abandoned.
Other therapies: Depending on your child’s condition, he or she may also benefit from the services of a counselor, psychologist, physiotherapist, or occupational therapist.
Support groups: Since CAS is pretty rare, it can be beneficial to know others going through the same things. Talking to and being around other kids with apraxia of speech can make it easier for your child to deal with. Join a support network online or find a support group near you. Apraxia Kids has a large community to help your child feel less alone. Are you in California? Come check us out!
As your child attends speech therapy and practices living with this disorder, he or she can move into what is called “residual CAS” or “resolved CAS”.
Residual CAS can occur when the child’s symptoms change into characteristics of a phonological disorder, language disorder, articulation disorder, auditory processing disorder, and/or stuttering speech impediment. They may still exhibit CAS symptoms, but these symptoms will be less apparent.
Children can also experience resolved CAS, which is when strangers wouldn’t even know they are diagnosed with a speech disorder. This is the result of the right therapy and support. However, some stressors like fatigue, emotional stress, or narcotics can still stir up some residual symptoms from time to time.
The time it will take to progress cannot be determined; it could take months or years. Get regular updates from your SLP as the prognosis can change as therapy continues.
Shooting For Residual Or Resolved CAS
Getting a diagnosis of apraxia of speech can be quite emotional for a parent. After all, we all want our children to live the most comfortable, healthy, and stress-free lives. But knowing what signs to look for and eliminating the possibilities of other disorders, you can focus on getting treatment for your child’s apraxia of speech.
Here at RiteCare Childhood Language Centers of California, we aim to give you the right resources that can greatly lessen the burden of your child’s speech disorder. We’ve got certified SLPs to help navigate apraxia of speech and shoot for “residual CAS” or “resolved CAS” diagnosis.