What is Childhood Apraxia of Speech?
Childhood Apraxia of Speech or CAS is when there is an interruption in messaging of the brain to the mouth and lips to receive a clear signal to plan movements. This means that the mouth, lips and teeth have the ability to move but they are not getting the correct instruction from the brain to move. It can appear the child is frozen in response.
An example is one morning you might ask your child what do they want for breakfast, and they will give you a quick response however maybe the next day they won’t. You may be asking yourself “I don’t understand why they are not responding to me they just responded to me yesterday?!” That’s the complexity of CAS.
CAS is a motor based neurologic speech disorder. In short it is involved with the ability to plan and execute the movement of the facial structures for speech production. There are different motor speech therapy methods we use for CAS, including PROMPT therapy, Dynamic Temporal and Tactile Cueing (DTTC), Metrical Pacing Treatment (MPT), and others.
Cause of Childhood Apraxia of Speech
Because Childhood Apraxia of Speech is known as a motor speech disorder, most of the time the cause is unknown. An MRI or CT scan would allow a look into your child’s brain to expose a genetic disorder, syndrome, stroke or brain injury that may have maybe seen alongside Childhood Apraxia of Speech.
What are the signs of Childhood Apraxia of Speech via American Speech-Language-Hearing Association?
- Younger than 3
- Does not coo or babble as an infant.
- Says her first words later than you think she should.
- Says only a few different sounds.
- Has problems putting sounds together.
- Puts long pauses between sounds she says.
- Does not always say a word the same way.
- Has some problems eating.
- Older than 3
- Does not always say words the same way each time he says them.
- Can understand what others say to him better than he can talk.
- Has problems imitating what others say. If he can imitate, those words will sound better than words he says on his own.
- Seems like he has to move his lips, tongue, or jaw a few times to make sounds. This is called groping.
- Has more trouble saying longer words clearly than shorter ones.
- Seems to have more trouble talking when he is nervous.
- Is hard to understand, especially for someone who doesn’t know him well.
- Sounds choppy or flat. He may put the stress on the wrong syllable or word.
Treatment in general is focused on the movement versus the sound that is actually produced. Differences in therapy include more frequent sessions and motor learning.
The types of treatment we use in our practice are:
- Oral Motor activities: Though weakness of the lip, tongue, jaw are usually not accompanied with CAS, an SLP will evaluate them by having the child complete different speech motor tasks and might even use a lollipop!
- Speech Melody: Often children with CAS have a disconnect in the use of stress and tone and pauses in sentences, an SLP will evaluate this by asking them questions that allow for the productions of key words.
- Dynamic Temporal and Tactile Cueing (DTTC) was designed specifically for children with CAS. A primary difference is that the focus of treatment is on the movement, rather than an individual sound. A sound is never worked on in isolation. There is a hierarchy which we follow and model for the child and caregiver for carryover.
- PROMPTS for Restructuring Oral Muscular Phonetic Targets (PROMPT) is a multidimensional approach to speech production disorders has come to embrace not only the well-known physical-sensory aspects of motor performance, but also its cognitive-linguistic and social-emotional aspects.
- Metrical Pacing Treatment (MPT) a type of pacing technique that uses rhythmical sequences of tones that provide metrical templates to guide production of target sounds to simulate the natural stress patterns of speech.
References and Resources