Apraxia of speech is a motor speech disorder that makes it difficult for children to speak. It is caused by 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 does not affect a child’s ability to understand language, but it can greatly impact their ability to read out loud. So do kids with apraxia have trouble reading?
While apraxia itself does not directly cause reading difficulties, many children with apraxia experience challenges with reading skills. There are a few reasons for this:
Phonological processing issues
Many kids with apraxia struggle with phonological processing – the ability to detect, manipulate or analyze the sounds in words. They may have trouble distinguishing sounds, blending sounds into words, segmenting words into sounds or manipulating sounds within words. These phonological processing challenges make it hard to “sound out” words while reading.
Difficulty with sound-symbol correspondence
When learning to read, kids must understand that letters or letter patterns represent specific speech sounds. But for kids with apraxia who already struggle to produce speech sounds accurately and consistently, making these sound-symbol connections can be difficult.
Oral motor challenges
The oral motor planning and sequencing difficulties that are characteristic of apraxia can make reading out loud laborious. Kids may struggle to translate the words they are reading into fluent speech. This chops up the rhythm and flow of reading.
Impact on phonics skills
Many kids with apraxia have trouble mastering phonics rules and decoding words. Phonics relies heavily on blending sounds together, which requires solid phonological awareness skills. Weaknesses in this area impair phonics development.
Reduced reading practice
Kids with apraxia tend to avoid reading aloud because it is so frustrating. This means they miss out on valuable practice. Lack of reading experience can hinder overall reading abilities.
So in summary, while apraxia itself does not directly interfere with reading comprehension, the associated difficulties with speech sound production, phonological processing and oral motor planning can make reading a struggle for many kids with apraxia. Support in these areas is often necessary to help children with apraxia develop strong literacy skills.
What types of reading difficulties are common in kids with apraxia?
There are several distinct reading-related challenges that kids with apraxia are likely to experience:
Difficulty decoding and sounding out words
Because apraxia affects the ability to blend speech sounds smoothly, kids often struggle to blend letter sounds into words. This makes sounding out unfamiliar words very difficult.
Variable phonics skills
Children with apraxia tend to have an uneven phonics foundation. They may recognize some sound-symbol connections but consistently confuse others that are very similar. For example, a child may mix up /b/ and /d/ or /f/ and /v/.
Impaired word attack skills
Word attack skills allow readers to decipher new words by breaking them into smaller parts or chunks. Apraxia makes it hard for kids to segment words into individual sounds, which interferes with word attack abilities.
Challenges reading multisyllabic words
Longer words with multiple syllables are especially tough for children with apraxia to decode. This is due to both oral motor sequencing issues and phonological processing weaknesses.
Difficulty with automaticity and fluency
Fluent reading requires effortlessly translating print to speech. The labored speech of apraxia disrupts fluency. Readers with apraxia often read slowly, haltingly and with little expression. Building automaticity is challenging.
Reduced reading comprehension
All of the decoding issues that kids with apraxia face tend to hamper reading comprehension. So much effort goes into sounding out words that kids struggle to extract meaning from the text.
Avoidance of reading aloud
Many kids with apraxia resist reading out loud because their speech makes it so frustrating. But this also deprives them of practice that could improve their reading skills.
So in summary, the hallmark characteristics of apraxia such as difficulties with speech sound production, syllable sequencing, and oral motor coordination tend to negatively impact learning to decode, sound out unfamiliar words, develop fluency, and read with adequate speed and expression.
What aspects of reading are typically intact in children with apraxia?
Despite the decoding and fluency challenges associated with apraxia, some important reading abilities are usually preserved:
Intact receptive language skills
Apraxia does not affect receptive language – the ability to understand spoken language. Kids can generally comprehend text that is read to them.
Average to above average vocabulary knowledge
Vocabulary skills are usually in the normal range for kids with apraxia. When reading, vocabulary knowledge helps children unlock the meaning of unfamiliar words.
Age-appropriate listening comprehension
Listening comprehension tends to be an area of strength for children with apraxia. Solid listening comprehension abilities support reading comprehension.
Normal reading comprehension (when text is read to them)
If text is read aloud to them, kids with apraxia are typically able to understand it just as well as their peers. The mechanics of reading disrupt comprehension, not language comprehension itself.
Intact cognitive abilities
Apraxia does not affect cognition or thinking skills. Average or above average cognitive skills provide a strong foundation for reading comprehension.
Motivation to read
Despite struggles with reading mechanics, most kids with apraxia are eager to learn to read and enjoy being read to. This intrinsic motivation to read supports ongoing reading progress.
So while decoding skills may lag behind, foundational strengths like vocabulary knowledge, verbal reasoning abilities, listening comprehension and motivation to read can be leveraged to help kids with apraxia make steady progress in reading. Targeted instruction and accommodations are key.
What aspects of reading and literacy are important to address in therapy?
Speech-language therapy for children with apraxia should target the following literacy skills:
Phonological awareness
Phonemic awareness, rhyming, blending sounds, segmenting words – these phonological skills underpin decoding abilities and must be a priority. Games, songs and interactive activities make phonological awareness practice fun.
Sound-symbol correspondence
Linking speech sounds to letters or letter patterns is key. Sound-symbol knowledge can be built through multisensory techniques like tracing letter shapes while saying the sound.
Decoding and word attack skills
Practice sounding out and blending sounds, with a focus on difficult sound combinations. Teach kids to break longer words into more manageable chunks. Drills, word games and flashcards help.
Sight word recognition
Building a strong bank of sight words – common words recognized automatically – improves reading fluency. Flashcards, games and repeated practice boost sight word recognition.
Oral motor coordination
Exercises to improve oral motor planning and sequencing will support reading skills. Target lip, tongue, jaw and palate movements that correspond to speech sounds.
Reading fluency
Repeated reading of the same passage helps improve expression, pace, accuracy and prosody. Recording kids reading aloud helps them hear where fluency breaks down.
Comprehension strategies
Help kids make connections, visualize stories, ask questions and summarize key ideas. This boosts overall comprehension.
A therapy program that engages kids in fun, targeted literacy activities while also supporting their speech and language needs can help children with apraxia make excellent progress in reading.
What strategies and accommodations help kids with apraxia learn to read?
Here are some effective reading supports for children with apraxia:
Model slow, sequenced oral reading
Use slow, deliberate oral reading as kids follow along. This models the continuous blending they should strive for.
Focus initially on consonants when decoding
Since vowels are more challenging, begin by having kids sound out the consonants only. Then add the vowels.
Emphasize sound blending
Blending sounds and syllables smoothly is difficult with apraxia. Provide plenty of practice and model correct blending.
Use visual aids
Color code syllables, draw sound buttons under words, and provide letter tiles or magnetic letters to manipulate.
Allow extra time
Reading slowly is part of apraxia. Give kids ample time to decode words at their own pace.
Introduce sight words frequently
Building a bank of memorized sight words reduces decoding demands. Teach new sight words consistently.
Leverage multisensory techniques
Trace letters while saying sounds, use letter tiles to spell, and blend sounds using manipulatives. Making reading multisensory helps cement skills.
Read aloud together
Sit beside the child, point word by word as you read in unison. This provides decoding support.
Use books that highlight speech sounds
Books that emphasize alliterative sounds, rhymes or word families give lots of practice with sound connections.
Focus on comprehension, not just decoding
Gently correct decoding errors that don’t impede meaning, so kids don’t get bogged down in sound-by-sound reading.
The right mix of strategies, accommodations and encouragement can help kids with childhood apraxia of speech become capable, confident readers.
What professionals can help with reading difficulties in children with apraxia?
It takes a team to support the literacy needs of kids with apraxia. The following professionals play key roles:
Speech-language pathologists
SLPs assess reading abilities, target phonological awareness and decoding skills in therapy, and recommend strategies to develop fluency and comprehension.
Special education teachers
Special ed teachers provide specialized reading instruction tailored to each child’s needs. They monitor reading progress and adjust teaching strategies accordingly.
Reading specialists
Reading specialists have advanced training in research-based literacy instruction. They provide interventions to boost specific reading skills that are lagging.
Occupational therapists
OTs address sensory needs, visual-motor skills and oral motor control – all of which can impact reading for kids with apraxia.
School psychologists
Psychologists assess reading skills and identify specific areas of weakness to inform instruction. They ensure appropriate accommodations are utilized.
Parents
Parental involvement is key. Encouraging reading practice, reinforcing skills, and communicating with teachers maximizes reading outcomes.
With the expertise of these professionals and active parental support, children with apraxia can make remarkable progress in overcoming reading challenges. Implementing assistive technology tools as needed also helps level the playing field for kids with apraxia.
What assistive technology tools can help kids with apraxia read successfully?
Here are some useful technology tools and apps to build reading skills:
Text reading apps
Text reader apps allow kids to have digital texts read aloud with word highlighting. This promotes comprehension. Examples include Voice Dream Reader and ClaroScanPen.
Audiobooks
Services like Audible, Learning Ally and Bookshare provide digital audiobooks. Hearing books read aloud improves vocabulary, concepts and content knowledge.
Talking spellcheckers
Software programs like Ghotit provide auditory assistance with spelling. This allows kids to write independently.
Snapverter
Snapverter is an optical character recognition app. It instantly reads text from worksheets, books or other printed materials aloud.
Speech recognition
Speech-to-text tools like Dragon NaturallySpeaking allow students to dictate writing assignments and demonstrate comprehension through oral responses.
Word prediction
Word prediction apps like CoWriter reduce demands on spelling and typing. Kids can focus on content rather than mechanics.
When combined with strong instruction, assistive technology provides invaluable support to kids with apraxia learning to read.
What is the prognosis for reading difficulties in children with apraxia?
The prognosis for improving reading skills in kids with childhood apraxia of speech is generally quite promising, especially when targeted early. While literacy skills may develop at a slower pace, most children with apraxia can become fluid, proficient readers with the right supports in place.
Here are some key factors that affect reading prognosis for children with CAS:
Early intervention
When speech and reading weaknesses are addressed early through active therapy, outcomes are much better. Early gains make further progress more likely.
Intensity of speech therapy
More frequent therapy each week yields faster improvements in speech sound production. Clearer speech translates to better phonemic awareness and reading decoding skills.
Reading instruction methods
Systematic, multisensory reading instruction is most effective for kids with apraxia. Programs like Barton or Orton-Gillingham best meet their needs.
Consistency
Reading gains accumulate when instruction is consistent across settings and over time. Frequent gaps in services tend to prolong reading challenges.
Family support
Encouragement and reading practice at home reinforce classroom reading instruction. An involved family optimizes outcomes.
Cognitive abilities
Kids with strong cognitive, language and listening comprehension skills often overcome reading difficulties more rapidly.
While literacy skills may require specialized instruction, the outlook for children with apraxia learning to read successfully is very encouraging when evidence-based treatment is implemented early and consistently over time.
Conclusion
Childhood apraxia of speech can make learning to read more challenging for kids. Core characteristics of CAS like difficulties pronouncing speech sounds, problems with oral motor sequencing, and impaired phonological processing lead to weaknesses in decoding, sounding out words, and developing fluency. However, with targeted speech/language therapy, multisensory reading instruction, appropriate accommodations and supportive technology, children with apraxia can make tremendous strides in reading. Early intervention maximizes progress. A team approach involving SLPs, reading specialists, special education teachers, OTs, psychologists and parents offers the best hope for helping kids with apraxia overcome reading difficulties. While literacy skills may require more specialized instruction, the prognosis for children with childhood apraxia of speech becoming strong readers is excellent under optimal conditions. Maintaining high expectations and providing the necessary degree of support sets children with apraxia on a path to reading success.