Childhood Apraxia Of Speech (CAS): Signs, Diagnosis, Prevention And Treatment

What is Apraxia of speech (AOS)? When to take medical advice? How does music therapy help children with apraxia of speech (AOS)?

Tavishi Dogra
Written by: Tavishi DograPublished at: Jan 26, 2021Updated at: Jan 26, 2021
Childhood Apraxia Of Speech (CAS): Signs, Diagnosis, Prevention And Treatment

What is apraxia of speech (AOS), and what are its causes? Apraxia of speech or verbal apraxia is a motor speech disorder. It’s like something in the child’s brain does not allow the information to get to the mouth, for accurate movements to produce speech correctly. It’s mainly the brain which has difficulty in developing the coordination of muscle movements. The cause of CAS (Childhood Apraxia of Speech) is unknown, and it’s not a disorder that overgrows. It’s just that the children with CAS won’t make any progress in their speech without the treatment (speech therapy). What is the prognosis of acquired apraxia of speech (AOS)? There is no guaranteed outcome for the apraxia of speech in children, but it will improve with continuous speech therapy. And the child will learn to speak well and be entirely verbal, and vocabulary will be intelligible.

What are the signs of acquired apraxia of speech (AOS)? 

acquired apraxia of speech

Audiologist Deepa Joseph (Bhatia Hospital, Mumbai) shares the early symptoms of AOS.

  • Delayed and abnormal babbling in the form of skipping consonants and preferring vowels. 
  • Difficulty in producing more prolonged and complicated words
  • Premature infant present with-feeding difficulties
  • Problem with timing, rhythm and flow of speech
  • Delayed onset cooing, sounds production
  • Inappropriate intonation
  • An older child with phonation disorder like articulation problems, making different pronunciation of same word every time, missing consonants and selecting vowels.

Symptoms of other associated developmental problems like cerebral palsy like clumsiness in body movement, delayed motor milestones etc. should also guide us for early diagnosis and intervention for acquired apraxia of speech (AOS).

apraxia of speech (AOS) in children

How to diagnose apraxia of speech (AOS) in children?

Dr Shiv N Gupta (SR in Pediatrics at ESIC and PGIMSR) states that "in the assessment for apraxia of speech, the Speech-Language Pathologist will assess the medical history, child’s symptoms and conduct an oral examination to identify the structure and function. An assessment will also be made on the child's pronunciation, speech sounds, words, and phrases." The SLP will also assess speech and language skills such as vocabulary, sentence structure, speech, articulation, and phonology. All this will be done by gathering information from the parents, like how they communicate at home and even in other situations. With proper assessment only, the SLP will develop the therapy goals to improve the apraxia, based on the child’s level.

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What is the expected duration of apraxia of speech (AOS)?

"AOS (verbal apraxia) duration depends on early detection, early education, early speech intervention. As AOS is not a self-limiting disorder - it needs to be diagnosed as early as possible and needs to be managed with interventions and associated cerebral problems. It will get improved with speech therapy. Sometimes, the therapy's effectiveness is enhanced to the extent that we cannot determine if the person has Apraxia. If not treated or managed early, then it becomes a permanent problem with lifelong articulation problem" says Speech Therapist Deepa Joseph (Bhatia Hospital, Mumbai). 

Apraxia Of Speech

Apraxia Of Speech: When to take medical advice?

  • For medical advice in AOS, parents or caregivers should be over suspicious like those with a significant family history of the language problem, high-risk pregnancy.
  • Whenever parents or caregivers feel there is a delay in early language development like cooing, babbling (compared with other siblings), they should meet up with their paediatrician for evaluation and referral.
  • When the parent feels that their child’s pronunciation is not correct at the word level or when the child is slow in pronouncing a word, you should take medical advice and consult an SLP.
  • Whenever parents feel that the infant is having early feeding difficulties or facial weakness ( by the asymmetry in facial expression)- they should visit the nearest paediatrician.
  • A little older age of say 5year if the child does not have more than 200 vocabularies or at any age if child pronounces mainly using vowels, e.g., aao, aai instead of goodbye skips consonants then medical attention is advisory.

How can one prevent and treat apraxia of speech (AOS)? Explains Audiologist Deepa Joseph

  • Speech and language interventions -with the help of speech pathologist for phonation, articulation practising and skill development
  • Avoiding or managing high-risk pregnancy, like those diagnosed with syndromes in early pregnancy,  polyhydramnios diag on antenatal USG.
  • Treatment of any associated neurological problem like physiotherapy in the cerebral palsy child should be started early.
  • Early intervention and special education -for those with early signs of speech and language disorder.
  • An early referral for detailed evaluation whenever necessary, to be done.

What environmental factors contribute to cause apraxia of speech (AOS)? Speech Therapist Deepa Joseph

  • Epigenetics has been an essential factor in regulating speech and language disorders.
  • Genetic disorders leading to different brain anomalies, heterotopias etc.
  • Maternal exposure to drugs and radiations during early pregnancy.
  • Maternal undernutrition leading to IUGR and small for gestational age babies.
  • Maternal polyhydramnios, multiple pregnancies.
  • Challenging perinatal course, difficult labour, severe perinatal asphyxia traumatic birth.
  • Some speculate that (childhood apraxia of speech) CAS can cause environmental conditions such as exposure to pollutants and toxins before or after birth. 
  • Other speculations are nutritional deficits can also cause CAS. While toxins and dietary deficiencies cause developmental problems, we relate it to (childhood apraxia of speech) CAS its only hypotheses with no research evidence that can support them.
music therapy

How does music therapy help children with apraxia of speech (AOS)? Explains Dr Shiv N Gupta

  • Music is a universal language. Not only can music breakdown barriers, but it can be a fun way to learn and enhance speech-language skills. Music therapy acts by strengthening and improving behaviour skills and phonation. It works as an addition to speech therapy by playing similar musical words several time and communicating the same to speech pathologists.
  • As in early stages of AOS Childs intelligence, understandings are intact, and child with music child listen and try to pronounce and articulate in similar fashion leading to clinical improvement and better acquisition of skills.
  • Except for music therapy, visual prompting shows how the speech sounds are made, and required repetitions of these speech sounds, words, and phrases are done until they grasp them properly.

Here are some FAQs related to Childhood Apraxia Of Speech (CAS) answered by Dr Shiv N Gupta 

Apraxia of speech comes from the motor disorder of speech where the infant has a language problem in articulation and subtle orofacial muscle movement. It present in early infantile age groups but need a lot of suspicions to pick up early. It’s a neurological condition which is tied to brain development.

How to spot apraxia of speech in children? The apraxia is the parents mainly notice speech at an early age as the child started to speak. They complain that the child is not talking; clearly, the parents do not understand what the child says (unclear speech). Also, the parent notices that the child is struggling to say words or when they try to speak.

How does the apraxia of speech affect communication?

  • It slows down the communication of the child. It can be mild/severe in disrupting a person’s ability to communicate.
  • It’s frustrating when you know what you want to speak, but you can’t even say it correctly. 
  • Also, in severe apraxia, people can’t even make sounds or words how much they even try.

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