Childhood Apraxia of Speech – Symptoms and Causes
Overview
Childhood apraxia of speech (CAS) is an uncommon speech disorder. It makes it difficult for children to control their mouth movements during speech.
This condition isn’t caused by muscle weakness but by a problem in the brain’s ability to coordinate speech movements.
When a child speaks, their brain must create plans that direct the lips, jaw, and tongue to move in specific ways. In children with CAS, this planning process doesn’t work correctly.
The brain struggles to send proper signals to the speech muscles, resulting in pronunciation difficulties.
Children with this condition know what they want to say, but their brain can’t properly coordinate the complex movements needed for clear speech. This affects their ability to produce sounds accurately and speak with normal rhythm and speed.
Speech therapy is the primary treatment for CAS. A speech-language pathologist works with the child to practice forming sounds, syllables, and words correctly through repeated exercises and techniques.
Speech Symptoms
Children with childhood apraxia of speech (CAS) may show various symptoms that change based on age and how severe their speech issues are.
Kids with CAS often:
- Make fewer babbling sounds than typical babies between 7-12 months
- Say their first words later than expected (after 12-18 months)
- Use a small range of consonants and vowels
- Skip sounds when talking
- Have speech that’s difficult to understand
Parents usually notice these signs between 18 months and 2 years old. At this stage, doctors might call it “suspected CAS” and recommend watching the child’s speech development.
As children grow from ages 2 to 4, CAS may show through:
- Distorted vowels and consonants
- Unusual pauses between syllables or words
- Sound mix-ups (saying “bye” instead of “pie”)
Many children with CAS struggle to position their mouth parts correctly for making sounds. Moving smoothly between sounds is also hard for them. They might have language problems too, like using fewer words or mixing up word order.
Some key markers that help identify CAS include:
- Difficulty transitioning between sounds, syllables, or words
- Groping movements with the jaw, lips, or tongue
- Vowel errors despite trying to use the right vowel
- Incorrect stress patterns (saying “BUH-nan-uh” for “banana”)
- Equal emphasis on all syllables
- Gaps between syllables
- Inconsistent errors when repeating the same word
- Trouble imitating simple words
- Voicing mistakes (saying “down” instead of “town”)
Speech Disorders That May Look Like CAS
Some speech problems share symptoms with CAS, making diagnosis tricky. These include:
Articulation and Phonological Disorders
These are more common than CAS. Unlike CAS, children with these disorders don’t struggle with planning or coordinating speech movements. They just have trouble learning specific sounds.
Common errors in these disorders include:
| Error Type | Examples |
|---|---|
| Sound substitutions | “fum” for “thumb”, “wabbit” for “rabbit” |
| Missing final consonants | “duh” for “duck”, “uh” for “up” |
| Airstream stopping | “tun” for “sun”, “doo” for “zoo” |
| Simplified sound groups | “ting” for “string”, “fog” for “frog” |
Dysarthria
This disorder happens because speech muscles are weak. Children with dysarthria find it hard to move their speech muscles as far, quickly, or strongly as needed for clear speech. Signs include:
- Hoarse, soft, or strained voice
- Slurred speech
- Slow talking pace
Dysarthria is usually easier to spot than CAS. However, when brain damage affects coordination, telling the difference between dysarthria and CAS becomes challenging.
Causes
Childhood apraxia of speech (CAS) often has no clear cause. In many cases, doctors cannot find any visible brain problems in children with this condition.
However, several factors may lead to CAS:
- Brain conditions or injuries such as strokes, infections, or traumatic injuries to the brain
- Genetic disorders where CAS appears as one symptom
- Syndromes or metabolic conditions that affect brain function
It’s important to understand that CAS differs from typical speech delays. While some people call it “developmental apraxia,” this term can be misleading. Children with CAS:
- Don’t make the same speech errors as those with normal delays
- Don’t simply outgrow the condition over time
- Don’t follow typical patterns of speech development at a slower pace
Unlike children with developmental speech delays who eventually catch up, CAS requires specific treatment approaches to improve speech abilities.
Risk Factors
Changes in the FOXP2 gene may raise the risk of childhood apraxia of speech and other language disorders. This gene plays a role in how brain pathways develop. Scientists are studying how FOXP2 changes affect:
- Motor coordination
- Speech processing
- Language development in the brain
Other genes may also affect how speech motor skills develop. Research continues to uncover the genetic factors behind speech difficulties in children.
Complications
Children with childhood apraxia of speech often face additional communication challenges. These issues are separate from apraxia but frequently occur alongside it.
Many children experience language delays, including difficulty understanding what others say, limited vocabulary, or problems forming grammatically correct sentences.
Some children show delays in thinking skills and motor development. They might struggle with reading, writing, and spelling tasks.
Physical coordination can be challenging. Both large movements (like jumping or running) and small movements (like buttoning clothes or using scissors) may be difficult.
Social communication is another common issue. Children might have trouble using language appropriately in social situations or understanding the back-and-forth nature of conversation.
These additional challenges can impact a child’s overall development and may require separate treatment approaches.
Prevention
Early action can reduce the risk of long-term speech issues in children with apraxia. If you notice any speech problems in your child, consult a speech-language pathologist immediately for evaluation.
Quick diagnosis and treatment are key factors in managing childhood apraxia of speech effectively. Professional intervention at the first sign of speech difficulties gives children the best chance for improvement.
