Childhood Apraxia Of Speech: Symptoms Diagnosis, Prognosis, And Treatment

Childhood Apraxia Of Speech Symptoms Diagnosis, Prognosis, And Treatment-1

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Childhood apraxia of speech (CAS) is a neurological speech sound disorder that affects the ability of children to consistently and correctly express themselves.

CAS causes a child’s brain to have trouble coordinating the sequence of complex oral movements required to produce speech by converting sounds into syllables, words, and phrases. Although CAS is not caused by muscle weakness, a child with CAS might struggle with lip and tongue movement while producing speech sounds (1).

Read this post to learn more about the causes, symptoms, complications, prevention, and treatment for CAS.

How Common Is CAS?

CAS is not a common condition (1). While the exact prevalence of CAS is unknown and the available data is unreliable due to inconsistencies and inadequacies in the studies conducted, it is estimated to affect one or two in 1,000 children. In addition, it is more common in boys than girls (2).

Symptoms Of CAS

According to the American Speech-Language-Hearing Association (ASHA), the following are the three most common symptoms that help distinguish CAS from other speech disorders (2).

  • When repeatedly pronouncing some syllables or words, the child makes inconsistent errors in terms of vowel and consonant sounds—the child may say the same word differently every time they try to pronounce it.
  • Lengthened and disrupted coarticulatory transition between sounds and syllables—the child may speak in a disjointed manner since they struggle with transitioning between sounds or words.
  • The child may use inappropriate prosody, such as incorrect use of intonation, or they may stress the wrong syllables while speaking.

However, these symptoms are not conclusive, and their frequency may change with age, the severity of the symptom, or complexity of the task.

The following are some other symptoms of CAS (1).

  • Articulatory groping—the child may fumble for the right word or sound and may try producing it repeatedly before getting it right (3)
  • Consonant speech distortion
  • Difficulty in smoothly transitioning between sounds
  • Increased difficulty in pronouncing more complex constructions
  • Inserting a schwa (an unstressed vowel sound) between consonant clusters or at the end of words. For example, “plane” would be pronounced as “peh-lane” (4)
  • Talking at a slow speed
  • Pausing between sounds, syllables, or words that affect smooth transitions
  • Producing voiceless sounds instead of voiced sounds
  • Vowel distortion or substitution
  • Late development of speech skills
  • Limited sound inventory—lack of variety in the consonant and vowel sounds expected at a certain age
  • Frequent reduction in the number of words produced

Causes And Risk Factors For CAS

In most cases, the cause of CAS is unknown. However, impairment to the brain due to a genetic disorder, syndrome, stroke, or traumatic brain injury may be responsible for the occurrence of CAS (5). Additionally, a child may be at an increased risk of developing CAS if other family members have communication disorders or learning disabilities (6).

Diagnosis Of CAS

Diagnosing CAS can be challenging as it is a complex disorder with symptoms similar to several other speech and language disorders. Thus, a specialist, such as a speech-language pathologist (SLP), would be required to help you arrive at the right diagnosis.

The SLP will start by asking about the child’s medical history and the symptoms you notice in them. Then, the SLP may talk to the child and observe their speech patterns over several sessions. These sessions would typically involve the SLP asking your child to repeat the same word several times, or the child might be asked to repeat a list of words of increasing length. The child may also need language testing (6).

Treatment For Childhood Apraxia Of Speech

Speech-language therapy is the primary treatment for CAS. Your child’s SLP might use various methods such as (6)

  • Articulation or phonological therapy.
  • Adapted cueing technique.
  • Orofacial myofunctional therapy.
  • Prompt for restructuring oral muscular phonetic targets therapy (PROMPT system).
  • Biofeedback treatments.

Children with CAS may benefit from the following activities conducted during the treatment (1).

  • Repeated practice of sound sequences, words, and phrases
  • The use of visual prompt cards to exhibit how sounds are used to make words and sentences.
  • Encouragement and support to say the same word simultaneously with the caregiver or SLP.

Children with CAS need several one-on-one speech therapy sessions. A team of occupational therapists, developmental pediatricians, and special education specialists can help with the treatment. However, the progress and outcome of the treatment differ for each child. For children with severe symptoms, alternative modes of expression, also known as augmentative and alternative communication (AAC) systems, might be needed (5). The different AACs that are recommended for children include

  • Learning informal sign language
  • Communicating using picture boards
  • Using a portable computer to write and produce speech

It is important to note that the child may not depend on AAC forever, and their speech may improve with age and consistent treatment. These other modes of communication will help the child improve their communication skills and reduce their frustration.

The goal of the treatment is to help the child pronounce sounds, words, and sentences more clearly and easily. The treatment will help the child learn how and when to plan their oral movements to say the sounds they intend to (5).

Prognosis And Prevention Of CAS

It is not possible to prevent CAS because the exact cause of CAS is unknown (7). Thus, speech and language therapy should be relied on as a treatment method. Children may take a while to show improvement, but many improve substantially with regular and persistent speech and language therapy.

Since the treatment of CAS is extensive and lengthy, the child will need a lot of support. You may repeat the exercises done at the therapy sessions when at home. If you notice your child exhibiting any symptoms of CAS, contact your healthcare provider, as early intervention helps get better outcomes.


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Dr. Ritika Shah

Dr. Ritika Shah is a dental surgeon with more than seven years of clinical experience across various cities in India. During her clinical practice, pediatric dentistry was her particular area of interest, and she constantly thrived to inculcate the latest advancements in the field of dentistry into her practice. Dr. Shah's deep interest in the well-being of babies and children... more