Apraxia of speech, also known as verbal apraxia or dyspraxia, is a speech disorder where an individual has trouble saying what he or she wants to say correctly and consistently. This can affect a child’s ability to produce clear speech and be understood by others. Here is an overview of what you may notice when listening to a child with apraxia speak:
Difficulty with Speech Motor Planning
A core feature of apraxia is difficulty with coordinating and planning the movements necessary for speech. This results in several characteristics in how the child’s speech may sound:
- Groping for sounds – The child knows what he wants to say but struggles to form the words correctly. You may see lots of visible effort as he tries to produce sounds.
- Inconsistent errors – The child may say a word correctly sometimes but incorrectly other times. The errors are not consistent each time.
- Simplifying words – The child may omit certain sounds from words or replace harder sounds with easier ones. For example, saying “tat” for “cat” or “pin” for “spin”.
Distorted Speech Sounds
Because apraxia affects the motor coordination for speech, children often have difficulty making certain sounds clearly. Some examples of sound errors you may hear:
- Slurred or “mumbled” speech
- Omitting final sounds – saying “do” instead of “dog”
- Sound substitutions – saying “wabbit” instead of “rabbit”
- Vowel distortions – saying “tup” for “top”
Short, Simple Sentences
Stringing together longer, more complex sentences requires careful planning and coordination of speech movements. Children with apraxia often use short, simple phrases when they speak. You may notice:
- 2-4 word phrases or sentences
- Difficulty putting words together in novel ways
- Relies heavily on memorized words and phrases
Prosody Errors
Prosody refers to the rhythm, stress, and intonation of speech. Children with apraxia frequently have abnormalities in their prosody when speaking. For example:
- Excessive pauses between words or syllables
- Monotone speech, lacking normal inflection
- Irregular stress on words – EMPHasizing the wrong sylLAble
Difficulty with Speech Initiation
Some children with apraxia experience difficulty initiating speech movements or “getting started” to produce words. You may notice:
- Hesitations at the beginning of sentences
- Appearing to stutter or repeat initial sounds (“mmmmmy name is…”)
Inconsistency
One of the hallmarks of apraxia is inconsistency in speech production. The same word may be said correctly, incorrectly, or approximated differently each time it is attempted. The child may be understandable at times but difficult to understand at other times.
Other Language Difficulties
Apraxia most directly impacts speech motor planning and coordination. However, many children with apraxia also have some degree of weakness with other language skills such as:
- Small vocabulary for their age
- Difficulty understanding complex sentences
- Problems with word retrieval/remembering words
- Grammar errors like missing word endings
Coping Strategies
Children with apraxia develop their own ways to help make their speech more understandable. You may notice:
- Use of filler words like “um”, “like”, “you know”
- Gestures or pointing to objects
- Drawing pictures
- Leading you to the object they are requesting
Frustration and Behavior Issues
Because apraxia impairs a child’s ability to communicate with others, frustration, acting out behaviors, and social struggles are common. Signs of difficulty may include:
- Tantrums
- Hitting, kicking, screaming
- Crying or whining
- Withdrawal from social situations
- Disruption/acting out in groups
Difficulty with Oral Motor Skills
Along with speech difficulties, some children with apraxia have challenges with other oral motor skills needed for eating. This can include:
- Messy eating
- Gagging or choking on foods
- Difficulty moving food in mouth
- Poor lip closure when eating
What Causes Childhood Apraxia of Speech?
The exact causes of apraxia are not fully understood, but it appears to arise from impaired function or connectivity between parts of the brain involved in planning and coordinating speech movements. Possible causes and risk factors researchers have identified include:
- Genetics – Runs in families, suggesting inherited tendencies
- Neurological differences – May be associated with differences in the cortex and basal ganglia
- Premature birth
- Developmental differences and delays
- Hearing impairment
- Autism spectrum disorders
Much is still unknown about what goes wrong in the brain to cause apraxia of speech in children. Ongoing research aims to better understand the neurological and genetic factors underlying this disorder.
Getting an Apraxia Evaluation
If you suspect your child may have apraxia of speech, it is important to have him or her evaluated by a speech-language pathologist. The SLP will assess your child’s speech abilities and try to determine if apraxia is the cause of the difficulties. Some of the assessment tools may include:
- Hearing screening – To rule out hearing impairment
- Oral motor exam – Looks at the movement and coordination of lips, tongue, jaw, etc.
- Speech sample analysis – Records speech to analyze errors
- Testing speech motor planning – Ability to program speech movements
- Language tests – To assess vocabulary, grammar, comprehension
- Observation of communication skills
Based on the results of the evaluation, the SLP can provide a diagnosis and recommend a customized treatment plan if one is needed. Early intervention is important to help children with apraxia make progress with their communication skills.
Apraxia Treatment Approaches
If a child is diagnosed with apraxia of speech, intervention with a speech therapist is recommended. There are several different approaches that may be used in treating childhood apraxia. Some common techniques include:
- Motor programming – Helps establish correct speech movement patterns through repetition of sounds, syllables, and words.
- PROMPT method – Uses tactile cues and hand-over-hand guidance to physically assist with speech movements.
- Integral stimulation – Combines listening, speech production, and gesture to enhance learning.
- Linguistic approaches – Target improving vocabulary, sentence structure, grammar.
- AAC devices – Augmentative and alternative communication aids such as speech-generating devices.
Therapy focuses on improving speech motor skills while also building language abilities and functional communication. It may incorporate speech drills along with play, books, songs, or activities tailored to the child’s interests to maximize engagement and progress. Parental involvement in treatment is also key.
FAQ about Childhood Apraxia of Speech
Here are answers to some frequently asked questions about apraxia in children:
What age does apraxia usually start?
Signs of apraxia often emerge between ages 2-4 when children’s speech is expected to improve and combine words. However, milder apraxia may not be noticed until a child enters school.
Is apraxia the same as autism?
No, apraxia and autism are separate conditions. However, some children have both apraxia and autism. Autism impacts social skills and behavior, while apraxia mainly affects speech production.
Will my child outgrow apraxia?
With early, intensive speech therapy, many children can resolve speech difficulties or learn techniques to compensate for apraxia. However, it may persist into adulthood, especially if severe.
Can apraxia improve on its own without therapy?
Most children with apraxia need direct intervention to make significant gains. Relying on natural development is unlikely to adequately improve speech. Early therapy capitalizes on brain plasticity.
How can parents help children with apraxia?
Encourage any speech attempts, use gestures, slow down your own speech, read books together, sing songs, supplement with AAC if needed, and be patient as your child communicates.
Outlook for Children with Apraxia
With prompt, appropriate treatment, many children with apraxia can make good progress with their speech and language abilities, allowing them to communicate more successfully. However, the severity of apraxia can vary widely. Factors impacting the prognosis include:
- Severity of the speech disorder
- Age at diagnosis and treatment
- Presence of other developmental issues
- Intensity of speech therapy provided
- Supportiveness of child’s environment
- Motivation and participation of the child
Ongoing research continues to find new therapies to help treat childhood apraxia of speech. Increased awareness and earlier intervention offer hope for helping children overcome speech challenges. With time and support, children with apraxia can learn to express themselves more fluently.
Conclusion
Apraxia of speech can make it difficult for children to produce clear speech, resulting in various sound errors, simplified sentences, and other abnormalities. Key characteristics of how apraxia affects speech include inconsistent errors, difficulty planning speech movements, distorted sounds, short phrases, prosody problems, and difficulty getting started. With comprehensive evaluation and customized therapy from a speech-language pathologist, many children with apraxia can substantially improve their communication abilities. While apraxia presents challenges for children and their families, support, patience, and early intervention provide the best opportunity for overcoming speech difficulties.