Childhood Apraxia of Speech

I used to work with a boy named Johnny ( not his real name ). He started working with me during my first year at the school district. He had begun speech therapy through the Early Intervention program and had entered his second year of Kindergarten when I met him (his mother chose to have him repeat the year).

Johnny was such a sweet young man. Like a little gentleman. He tried to offer “ladies first” through the doors, he let others go first in games, he rarely complained. He was, however, extremely difficult to understand. When he tried to say common, multi-syllabic words his mouth seemed to get all jarbled up. For example, his sister’s name was Bethany. He sometimes said it as “be-ti”, sometimes “pe-i”, and sometimes couldn’t say it at all.

I developed a simple communication book for him to wear on his belt loop. It included the names of common people (family, friends, teachers), survival words (bathroom), and requests. He used to periodically, but mostly wanted to fit in with his peers.

I worked with Johnny for 5 years before he moved into another school district. During that time he made great gains, but continued to be very difficult to understand, especially on long words and thoughts. In 3rd grade he was diagnosed with a learning disability and began receiving support in reading, writing, and math. He spent a good portion of his day getting specialized services and made slow, steady progress.

A speech delay is when a child is following a typical path of speech development, but doing so at a slower rate than expected. An articulation disorder is when a child has incorrectly “learned” the voicing, placement, or type of sound and incorrectly produces the sound in a consistent manner. Childhood Apraxia of Speech, however, involves the neurological motor planning of speech.

The information provided on this post is all from Apraxia-Kids, a fabulous resource for both families and Speech Pathologists.

“Children with apraxia of speech have great 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. ”

Many children with a speech delay seem to be prematurely diagnosed with Childhood Apraxia of Speech (CAS). If a child “outgrows” their speech difficulties, then CAS was not an accurate diagnosis. In fact, a child cannot get a true diagnosis until they can follow more complex directions and have enough speech that inconsistencies have be observed.

The estimates of some sources indicate that CAS is low incidence with perhaps 1 – 10 in 1000 children affected or 3 – 5 % of speech-impaired preschoolers. I have only worked with a few children with CAS, due to it’s rarety. Most of these children have other learning difficulties (although they are sometimes not observed until the child is in 2nd or 3rd grade).

Some Key Characteristics of Childhood Apraxia of Speech:

• Difficulty with vowel sounds
• Inconsistent speech errors
• Very unusual speech errors
• Increased number of errors with multi-syllabic words or complex utterances
• The child may be able to produce accurately the target utterance in one context but is unable to produce the same target accurately in a different context.
• More difficulty with volitional, self-initiated utterances as compared to over-learned, automatic, or modeled utterances (songs, ABCs, counting, etc)
• Disturbances of rate, inflection, pausing between syllables, and stress in words
• At some point in time, groping or observable physical struggle for articulatory position may be observed

If you have questions about your child’s speech, make sure to set up an appointment with a Speech Pathologist through your school, doctor, or Early Intervention program.