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Supporting Your Child with Childhood Apraxia of Speech

Apr 14th, 2022 | by Alyssa Mignone

Alyssa Mignone

April 14th, 2022

What is Childhood Apraxia of Speech? 

Childhood apraxia of speech (CAS) is a neurological childhood speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g. abnormal reflexes, abnormal tone.) The core impairment in planning results in errors in speech sound production and prosody (ASHA, 2007). Children with CAS have difficulties with motor planning as it relates to speech sound production.

They know what they want to say but have difficulty getting their message out.  

What is Motor Planning?

First, let’s talk motor planning. Motor planning refers to the movements our bones, joints, and muscles make that allows our bodies to move. With each movement, our body and brain send messages back and forth to tell each other certain ways to move to accomplish tasks.

You can thank your ability to motor plan when you get on a bike for the first time in 5 years, pick up your toothbrush from the same spot on the counter each morning, and take the same walk in the morning on the way to school! So, what happens when we lose the ability to motor plan? Suddenly, riding a bike feels impossible, grabbing your toothbrush in the morning just got harder and the walk to school feels different every day.

What is Dyspraxia?

Disruption to the motor movements can also occur orally. When kids are unable to plan motor movements to talk, this can be referred to as developmental dyspraxia of speech or childhood apraxia of speech (CAS). Each of these terms refer to the same condition and are often interchangeable.

What Causes Childhood Apraxia of Speech (CAS)?

So, what causes childhood apraxia of speech and how can I help? Studies have revealed CAS can be congenital (born with), or it can be acquired during speech development. Both congenital and acquired CAS can occur as an idiopathic neurogenic speech sound disorder (i.e., in children with no observable neurological abnormalities or neurobehavioural disorders or conditions); as primary or secondary signs within complex neurobehavioural disorders (e.g., autism, epilepsy, and syndromes, such as fragile X, Rett syndrome, and Prader–Willi syndrome; or in association with known neurological events (e.g., intrauterine or early childhood stroke, infection, trauma, brain cancer/tumor resection).

Early Signs of Childhood Apraxia of Speech

In order to implement functional treatment strategies, we must first identify signs and symptoms consistent with apraxia. Here are a few early signs of childhood apraxia of speech to be on the lookout for:

  • Limited vocal play and babbling 
  • Described as a “quiet baby” 
  • Difficulty imitating sounds or words 
  • Difficulty simplifying words to make them easier to say 
  • Not consistently adding new words to their vocabulary  
  • May demonstrate social avoidance due to awareness of communication difficulty 
  • Limited use of varied vowels and consonant sounds 
  • Inconsistent speech sound errors- child could say the same word 5x and it would sound differently each time the word was produced 
  • Understanding of language far exceeds production of language 
  • Articulatory groping—articulatory searching prior to phonating 
  • Consonant distortions 
  • Difficulty with smooth, accurate movement transitions from one sound to the next 
  • Inconsistent errors on consonants and vowels in repeated productions of syllables or words 
  • Slower than typical rate of speech 
  • Syllable segregation—pauses between sounds, syllables, or words that affect smooth transitions 
  • Voicing errors

How Does Childhood Apraxia of Speech Treatment Differ from Traditional Speech Therapy?

Treatment for CAS is rooted in the principles of motor learning. Factors related to motor learning include: 

  • Attaining and sustaining motivation 
  • Frequency of practice 
  • Targets must include: highly frequent, relevant, functional, and motivating words 
  • Providing specific feedback (e.g. I heard your popping ‘p’ sound that time!) rather than vague feedback (e.g. Great job!) *Your SLP can help you in providing meaningful feedback to your child during practice at home* (Maas et al 2008)

Childhood Apraxia of Speech Goals

While traditional speech therapy targets specific speech sounds, our childhood apraxia of speech goals aim to establish new neural pathways or fix the existing ones. To achieve this goal, the child will require repetitive practice. Practice should target movement patterns in syllables known as co-articulation, rather than individual and specific speech sounds. The movement patterns targeted will increase in complexity as therapy progresses.

Your SLP will assist you in establishing appropriate, functional targets to progress your child’s expressive language skills. Repetition of target words and frequent practice is essential in establishing notable gains in skill.  

Providing Support for Childhood Apraxia of Speech

How can you support your child who presents with a motor planning disorder? Kids learn best through repetition of functional and engaging tasks. First, start small with easy words. For example, we can start with the word “ma.” Once “ma” is consistently used, we can start shaping it into “mama.” As “mama” becomes more consistent maybe we choose the word “baba”, the same vowel sound, but a new consonant. As consistency increases, continued expansion of vowel sounds is encouraged; “ma” can turn into “me” then “my”, then “mo.” Kids also learn visually, so incorporating all our senses can help with increased acquisition of sounds.

Involving Caregivers and Family in Child Apraxia of Speech Therapy

Caregivers and family members play an integral role in treatment! There are plenty of ways to make learning fun while still getting lots of practice in at home! Children learn best during daily routines and during play. If you suspect your child may have CAS, here are some strategies for home practice.  

10 Suggested Activities for Repetitive Practice

1. Counting books 
  • Instead of counting 1-5, repeat the object name: bee, bee, bee, bee, bee 
2. Use lift the flap books to play “knock knock”

3. Read repetitive books such as Brown Bear Brown Bear
  • Have the child fill in expectant pauses – I see a red bird looking at ____. Have your child finish the sentence by verbalizing “me” 
4. Create picture book of family members
  • Have your child identify the people in her family and name them as they flip through the book 
5. Play peek-a-boo!
  • Pause before “boo” and see if your child will fill it in. This is a great game to elicit many repetitions of the same word while also maintaining their interest and engagement in the activity. 
6. Bubbles/popper toys  
  • Pop, pop, pop! 
7. Stacking cups/blocks
  • Practice words such as up, up, up, down, down, down 
8. Practice saying “bye bye” to all objects as you clean up an activity

9. Velcro playing food
  • Target words: cut, eat- on repeat 
10. Ball and hammer toys
  • Target words such as bang! boom! on repeat 

Speech Therapist Book Recommendations for Apraxia of Speech in Children

Here is a fun list of books that you can read with your kids with fun repeating lines. Choose a word that repeats throughout the book and pair a fun action!

May is Apraxia Awareness Month

Did you know that May 14th is Apraxia Awareness Day and May is Apraxia Awareness Month? For more information and resources, visit www.apraxia-kids.org

Find Additional Resources and Activities in the NAPA Speech Therapy Blog:

About the Authors

Alyssa Mignone is a paediatric speech language pathologist at NAPA Center Boston. Alyssa loves putting the “fun” in functional by using everyday routines to create meaningful language opportunities for children to grow. When she’s not at work, you can find her skiing, hiking, or relaxing at the beach! 

Mikaela Eppard is a Denver native and has always had a passion for working with kids and knew she wanted to be a speech therapist since her freshman year in high school. On the weekends she enjoys spending time with her friends and family, hiking, exploring new places to eat and skiing in the winter.

About NAPA Centre

NAPA Centre is a world-renowned paediatric therapy clinic, offering peadiatric therapy for children of all ages in traditional or intensive settings. With multiple clinic locations and intensive therapy pop-up sessions worldwide, NAPA is committed to helping children lead their happiest, healthiest lives. At NAPA, we take an individualised approach to therapy because we understand that each child is unique with very specific needs. For this reason, no two therapeutic programs are alike. If your child needs our services, we will work closely with you to select the best therapies for them, creating a customised program specific to your child’s needs and your family’s goals. Let your child’s journey begin today by contacting us to learn more.

TAGS: Blogs, SLP
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