Childhood Apraxia of Speech (CAS) is a motor speech disorder presents itself when children are learning to speak. For reasons not yet fully understood, children with apraxia of speech have great difficulty planning and producing the precise, highly refined and specific series of movements of the tongue, lips, jaw and palate that are necessary for intelligible speech. Apraxia of speech is sometimes called verbal apraxia, developmental apraxia of speech, or verbal dyspraxia. To some degree or another, a child with the diagnosis of apraxia of speech has difficulty programming and planning speech movements. This difficulty in planning speech movements is the hallmark or “signature” of childhood apraxia of speech.
Often, children with apraxia of speech have a wide gap between their receptive language abilities and expressive abilities. Meaning, the child’s ability to understand language (receptive ability) is largely within normal limits, but his or her ability to use expressive language through speech is seriously deficient, absent, or severely unclear. This is an important factor and one indicator that the child may be experiencing more than “delayed” speech. In the case of such a mismatch in skills, the child should be evaluated for the presence of a specific speech disorder such as apraxia.
The top three characteristics of Childhood Apraxia of Speech, as reported by the American Speech-Language-Hearing Association (ASHA) Technical Report on Childhood Apraxia of Speech, that can help the SLP make a differential diagnosis are:
- Inconsistent errors with consonants and vowels on repeated productions of syllables and words (your child says the same word in different ways when asked to repeat it several times. This might be more apparent in new words or longer more complex words.)
- Difficulty moving from sound to sound or syllable to syllable, resulting in lengthened pauses between sounds and/or syllables
- Inappropriate stress on syllables or words (such as all syllables are said with equal stress on each one causing the “melody” of speech to sound odd)
Other possible signs of apraxia of speech are:
- Increased mistakes in longer or more difficult and complex syllables and words.
- Reduced vowel inventory (the number and assortment of vowel sounds that your child can produce), or errors when producing vowels, and
- Possible “groping” behaviors in which your child appears to struggle to achieve the correct oral posture to start or produce the syllable or word. (Not all children exhibit this at all times or situations. If your child does not demonstrate groping of their speech musculature, that alone is not enough to rule out apraxia of speech.)
It is very difficult and usually not possible to diagnose apraxia for children under the age of two (and up to age three). The reason being that young children are unable to follow the specific directions for the tasks asked of them that would be critical to making an accurate diagnosis.