Childhood Apraxia of Speech
Childhood Apraxia of Speech (CAS) is a disorder that affects the way kids produce speech sounds. We often get questions about it from parents because they’re either worried their children may have it, or because they know they do, and they need advice. If that describes you, we hope this post will give you the information you need to ease your concerns while helping you identify the references, apraxia specialists, and potential next steps your family may need.
What Is Childhood Apraxia of Speech?
Childhood Apraxia of Speech (CAS) is a speech sound disorder where children have difficulty with the motor portion of speech production. That means they know what they want to say, but they have a hard time coordinating their lips, tongue, teeth, palate, and jaw to produce the words they want. Typically, children with CAS have a good understanding of language, but a hard time expressing their ideas effectively.
How Common is CAS?
CAS is not nearly as common as other speech disorders and delays, like being a late talker or having an expressive language delay. And while research on CAS is limited, estimates are that around 1 in everyone 1000 children are affected.
Signs of Childhood Apraxia
Common signs we would look for when diagnosing childhood apraxia of speech include the following (adapted from ApraxiaKids.org):
Limited babbling as a baby (Little ones described as “quiet” babies.)
Limited phonemic repertoire (Which is a fancy way of saying they use a limited amount of consonants and tend to use the ones they do have over and over.)
Difficulty producing vowels correctly
Difficulty imitating non-speech movements with their mouth (Like blowing out a candle.)
A limited number of words
The longer the word or longer the sentence, the more difficulty they have
Saying a word one way, then a different way at another time (Maybe they see a dog outside and say “da,” and later see a dog in a book and say “gu”.)
Might be able to say things that are more automated like “Hi,” or “ABC” but struggle with self-initiated words
Articulatory groping (Which looks like them trying really hard to figure out how to say the word they want to say.)
Disturbances of prosody (Speech that might sound slower, choppy, or monotone.)
If you notice your child demonstrating several of the above signs, it’s a great idea to talk to your pediatrician or to see a local speech-language pathologist. It might turn out to be nothing, but if your child does have apraxia, you’ll be glad you didn’t wait to find out!
Getting A Childhood Apraxia Diagnosis
Because CAS is a speech sound disorder, it must be diagnosed by a speech-language pathologist. To receive a diagnosis, your child would need to participate in a speech and language evaluation.
Getting a diagnosis of childhood apraxia can be tricky because when they’re young, it’s often hard to tell if a child is simply a late talker or if they have true CAS. As children develop, gain words, and communicate verbally more frequently, though, the characteristics of CAS often become easier to identify. For that reason, it’s common for a child to start early intervention therapy at a young age with a diagnosis of “late talker” or “expressive language delay,” and throughout therapy have their diagnosis be changed to CAS.
Related: The Importance of Early Intervention
Speech Therapy for Childhood Apraxia
All pediatric speech therapy is play-based, fun, and goal-oriented. But while it may look like your child is “just playing”, rest assured that it’s play with a purpose!
We use play in therapy because:
Play is how toddlers learn
Play helps toddlers make sense of new concepts and practice what they’ve learned
Play builds connection (an essential component between therapist and child)
Play helps accomplish certain speech and language goals
All speech therapy is also very individualized. No two sessions are the same, and there’s no such thing as a one-size-fits-all approach. Your therapist will target your child’s specific needs and build upon their strengths. It’s all very intentional!
With CAS, the goal of speech therapy with young children is to help them become “communication risk takers”, a phrase coined by apraxia specialist Cari Ebert. A child with CAS will need much more practice with sounds and words than a child with average communication development, so your speech therapist will want to keep communication as positive as possible, to keep them trying and avoid having them shut down. (We encourage you to do the same thing at home, too!) This is another reason why you can expect therapy to be play-based and engaging—but again, there will also be very intentional targets and strategies baked into that play.
When supporting your toddler with childhood apraxia, your therapist will likely also recommend utilizing what we refer to as ‘total communication’: combining a few different modalities to help your child communicate their wants, needs, feelings, and ideas as best they can.
Some communication modalities your child might use are:
Any words they have
Sounds and gestures
Pictures (Think about keeping a few pictures of preferred food items on the fridge, so they can point to what they want. Things like that!)
Augmentative and Alternative Communication (AAC) devices
If you’re considering using AAC with your child, there are a few free iPad apps that can be really helpful. We like GoTalk NOW LITE and ChatterBoards AAC. (Just note that AAC options are best determined by your speech-language pathologist through the assessment process!)
What To Do If You Think Your Child Has Apraxia
If you have a hunch that your child may have childhood apraxia, remember that your concerns are extremely valid. You know your child best, so don’t be deterred by anyone who tells you to “just wait and see”. As we mentioned above, it may turn out to be nothing. But if your child does have apraxia, you’ll be so glad you didn’t want to find out.
Here are the specific steps we recommend taking:
#1 Reach Out To A Speech-Language Pathologist
If you have access, we recommend that you seek out a speech-language pathologist who specializes in CAS. You can find a therapist via ApraxiaKids.org.
If you can’t find someone who specializes in apraxia in your area, an evaluation by any pediatric speech-language pathologist is great, too. They’ll still be able to help if they’re familiar with CAS and if not, they’ll help you figure out where to go next.
#2 Watch Cari Ebert’s CAS Webinar
Cari Ebert is a speech-language pathologist who specializes in CAS in toddlers. She offers a $10 webinar specifically for parents that you may find very helpful!
#3 Keep Communication Positive
The best thing you can do if you suspect apraxia of speech, whether you’re in speech therapy or waiting to start, is to keep communication as positive as possible. We want to avoid a communication shutdown for your child and keep them trying to communicate to the best of their ability.
Our Songs + Stories membership is a great place to start. It provides language opportunities for little ones who struggle with communication and helps them positively view communication through songs, rhymes, and stories.
#4 Remember That You Can Do This
We know that worrying about your child’s development is a really tough part of being a parent. We want you to know that if your child is struggling with speech and language right now, you’re not alone, it’s not your fault, and there is so much hope!
We wish we could hug you, look you in the eye, and tell you this face-to-face. Because while we know self-doubt and blame can be loud…we want the message that you are an incredible parent to be even louder!.
If you could use a little support for yourself right now, read the comments on this Instagram post, from other parents who’ve been where you are now 💛