I’m a speech and language pathologist, and also a mom of 2.  When my youngest son, Miles, wasn’t meeting speech milestones we started to explore contributing factors. It turns out he had a tongue tie, lip tie, and motor planning difficulties! This topic hits close to home as a mom AND a speech therapist, and I want to share my experience with you.

Many of you probably haven’t heard of Childhood Apraxia of Speech or motor speech disorders. Don’t worry! You’re not alone. Hopefully this article will help clear up what these are, how to spot them and how to get help for them.

Miles said his first word around 8-months-old: Dada. We had a feral cat in our neighborhood who lived under the couch on our porch last winter. My kids would get so excited when they saw the cat. Miles was about 12-months old and said “cat” a few times. My heart skipped a beat when I heard him say those words, clear as day. He was on track to be an early talker just like his older brother. Unfortunately, I never heard him say cat again.

He babbled a lot as a baby but mostly had the sound ‘ba.’ Everything was ba. He made many approximations towards words and at about 18-months he had about ten words: mama, dada, more, uh oh, dog, duck, book, bunny, no, yay. This was actually age appropriate but in my gut I felt like something was not right with his speech. I talked to his pediatrician and she said he was fine. She sees kids with speech delays all the time and, to her,  he was not delayed. I was thinking, I see kids with speech delays all the time too and something is not adding up. Miles was an early crawler (7-months), walker (10-months), and did most things early. He has great play, problem solving, and new learning skills. My older son was speaking full sentences by the time he was 18-months old. I never thought Miles would be delayed in anything, especially talking, as I am a speech therapist for goodness sakes! I thought he may have motor planning difficulties but I kept hoping that was not the case.

When Miles turned 19-months and was not showing any improvement I decided I was going to form a plan. I consulted with another speech therapist and she started seeing Miles. We both agreed that he had motor planning deficits, a phonological disorder, and that he needed intensive speech sessions if he was going overcome these challenges. I acted quickly and he is now receiving therapy 3-times a week. Miles does not have a childhood apraxia of speech diagnosis, but he does have motor planning weakness as well as an inconsistent phonological disorder. I felt so much better after forming a plan of action for Miles and I know I am doing the best I can for my child to help him succeed. 

 

What is Childhood Apraxia of Speech:

Childhood Apraxia of Speech (CAS) is considered a neurological speech disorder that affects a child’s ability to clearly and correctly produce syllables and words. The most obvious thing that others notice is that the child has significantly limited and/or unclear speech. (https://www.apraxia-kids.org/wp-content/uploads/2015/05/What-You-Should-Know.pdf)

 

Speaking is actually really complex!

Here is what happens when you speak:  Messages need to go from your brain to your mouth. These messages tell the muscles how and when to move to make sounds. If your child has apraxia of speech, the messages do not get through correctly. Your child might not be able to move his lips or tongue to the right place to say sounds, even though his muscles are not weak. Sometimes, he might not be able to say much at all.

Children with CAS know what they want to say, but the problem is the brain is not getting the mouth muscles to move. (https://www.asha.org/public/speech/disorders/childhood-apraxia-of-speech/)

Who can diagnose it?

A speech and language pathologist who is experienced in childhood apraxia of speech.

What Causes It?

Currently, the cause of CAS is unknown. Most often no specific cause is found. Some children may have CAS as a part of a larger neurological diagnosis or as part of a genetic, metabolic, or mitochondrial disorder.

Symptoms of Childhood Apraxia of Speech:

Your child is younger than 3 years old and:
Does not coo or babble as an infant.
Says her first words later than you think she should.
Says only a few different sounds.
Has problems putting sounds together.
Puts long pauses between sounds she says.
Does not always say a word the same way.
Has some problems eating.
Tendency to simplify and neutralize vowels to a schwa (uh sound).
Well rehearsed speech is easier than on demand speech.
Prosodic errors.
Can have significantly reduced intelligibility.
Errors include: substitutions, omissions, and/or distortions.

Your child is older than 3 years old and:
– Does not always say words the same way each time he says them.
Can understand what others say to him better than he can talk.
Has problems imitating what others say. If he can imitate, those words will sound better than words he says on his own.
Seems like he has to move his lips, tongue, or jaw a few times to make sounds. This is called groping.
Has more trouble saying longer words clearly than shorter ones.
Seems to have more trouble talking when he is nervous.
Is hard to understand, especially for someone who doesn’t know him well.
Prosodic errors: sounds choppy or flat. He may put the stress on the wrong syllable or word.
Tendency to simplify and neutralize vowels to a schwa (uh sound).
Well rehearsed speech is easier than on demand speech.
Can have significantly reduced intelligibility.
Errors include: substitutions, omissions, and/or distortions.

How can you treat Childhood Apraxia of Speech?

CAS is not a problem that children outgrow. A child with a developmental speech disorder learns sounds in a typical order, just at a slower pace. If your child has CAS, he will not follow typical patterns and will not make progress without treatment. It will take a lot of work, but your child’s speech can improve.

Frequent and intense speech therapy sessions by an experienced SLP is recommended for the best outcome. Speech therapy for children with CAS is focused on providing the child with a great number of opportunities to practice planning, programming and then producing accurate movements for speech.

 

References:

  1. What you Should Know. 2018. Apraxia Kids. 
  2. Childhood Apraxia of Speech. American Speech-Language-Hearing Association.