The Apraxia Guide: What Every Parent Should Know About Childhood Apraxia

Apraxia is a motor disorder. The child is unable to transfer a speech messages from the brain to the mouth. This disorder can cause a child to be a “late talker” because of his/her inability to coordinate jaw, lip, and tongue movements.  In cases of Apraxia, the child’s speech intelligibility is unrelated to his/her language capacity; in other words, the child most likely understands more than what he/she can actually say. Apraxia is very different from a typical articulation disorder and so is the treatment approach to it.

What is Apraxia?
Apraxia is defined as a decreased ability to coordinate and initiate an imitated motor movement with the use of a body part. Apraxia can occur in the mouth and face, in the arms and legs, and more importantly in the speech muscles including those that are involved in respiration. A child with Apraxia will be able to produce involuntary or reflexive movements in a natural setting, such as waving goodbye, kissing your mother and using sporadic words; however when asked to imitate such movements or word the child will not be able to do so. The difficulty arises when the child is asked to imitate.

Parents will then ask: “Why then does my child not say words sporadically if the definition of Apraxia is limited to repetition and imitation?” This is because speech is learned and perfected through imitation.

It is also possible that a child with Apraxia is imitating words; however, the parent is unable to understand the word that the child is saying. As a result, the parent thinks the child is only making sounds and not using words/language when in actuality the child is developing language using unintelligible versions of words heard in their environment.

Keep in mind that in severe cases of Apraxia, the child may be non-verbal. It is therefore imperative that a speech-language pathologist be consulted in order to determine the correct diagnosis and develop a successful treatment plan for your child.

What is the difference between Oral Apraxia and Verbal Apraxia?
A child with Oral Apraxia will have difficulties using the mouth to initiate nonverbal movements such as, sticking their tongue out, blowing kisses, or making clicking sounds with the tongue.

A child with Verbal Apraxia will have difficulty with speech sounds at all levels (i.e., words, phrases, sentences and conversation). Difficulty can also be found with rhythm and rate of speech as well use of airflow.
Oral and verbal apraxia may also be referred to as Childhood Apraxia of Speech (CAS) in related articles.

Signs of Childhood Apraxia
It is important to note that not all children with Apraxia will experience the same symptoms. If you feel that your child is experiencing any of the following, please feel free to contact our office for further questioning.
•    During infancy, the child does not coo or babble
•    First words such as “mama” and “papa” are delayed
•    They have limited consonants and vowel sounds
•    They do not combine sounds, and when they do, there is a long pause between the two sounds.
•    Problems with feeding
•    Make constant inconsistent sound errors; use /k/ for /p/ and then the next time they use /b/ for /p/.
•    Strangers or unfamiliar listeners cannot understand what the child is saying (this is one of the major red flags; parents may feel the child has no difficulty due to the fact that they are familiar listeners and have become accustomed to the child’s misarticulations, therefore the stranger can better detect the child has a difficulty)

These signs or symptoms can be detrimental to a child’s development. Many children with Apraxia will develop expressive language skills in a delayed fashion due to decreased verbal practice and decreased language stimulation in some cases. These delayed language skills may affect how the child uses language for learning and thus manifest as a learning disorder. This impediment will especially become evident when learning to read, spell, and write. If the child produces sounds wrong, they will not be able to read correctly, and consequently, will not be able to spell or write properly.

The American Speech and Language Association (ASHA) states that because brain signals are “misinterpreted,” some children can experience sensations that others do not, and therefore, this will affect their behavior. It is important to keep in mind that behavioral outbursts are common with rising frustration in children with both Oral and Verbal Apraxia.

Important Facts about Apraxia
•    The cause of Apraxia is usually unknown but in some rare cases, it can co-occur with some genetic disorders or syndromes, Autism, and/or a brain injury.
•    There is no cure for Apraxia, but it can be managed with the intervention of an SLP, as well as parent support.
•    Apraxia is difficult to detect in ages less than 3 because of decreased cooperation with the evaluation.
•    Although a child with Apraxia will make an incredible progress with therapy, it may be with slow improvement. Every child is different and may progress at different rates.
•    If your child is diagnosed with Apraxia, you should avoid placing communication pressure on the child. Good tools for facilitating communication are singing songs, and reading poems and books.
•    If the Apraxia is severe, other methods of communication can be facilitated, such as Augmentative Alternative Communication and/or sign language. These two alternatives will ease the stress the child undergoes when trying to communicate verbally.
•    Verbal communication does not need to be ruled out, it may be integrated with the alternative means of communication.

Parents should be involved as much as possible in their child’s development and improvement. Childhood Apraxia of Speech is difficult disorder to cope with, and if suffering with this disorder, your child needs all the support he/she can get. They will often times feel frustrated, and isolated from the “typical” world, which is why it is important for you to make them feel welcomed in their environment. Remember that children with Apraxia are not less intelligent, and thus social and/or language exposure should not be limited.

For more information on Apraxia, here are some resourceful websites:

American Speech Language and Hearing Association
http://www.asha.org/

Apraxia Kids
http://www.apraxia-kids.org/

National Institute on Deafness and Other Communication Disorders
http://www.nidcd.nih.gov/

Speechville
http://www.speechville.com/

Cristine R. Jimenez
Language Stimulation Specialist
Speech Therapy Center, Inc.