Childhood apraxia of speech

Alternate names

CAS; Developmental apraxia of speech; Developmental verbal apraxia; Developmental verbal dyspraxia; DAS; Articulatory apraxia; Speech and language disorder with orofacial dyspraxia; Speech-language disorder type 1; Speech-language disorder-1

Definition

Childhood apraxia of speech occurs in children and is present from birth. It appears to be more common in boys than girls. Children with this condition have difficulty planning and producing the precise, refined, and specific movements of the tongue, lips, jaw, and palate that are necessary for intelligible speech.

Cause

• In many cases, the underlying cause of childhood apraxia of speech is unknown (idiopathic).
• Some cases are associated with a known neurological cause (such as intrauterine or early childhood stroke, infection, trauma, brain cancer or tumor resection, traumatic brain injury, etc.), and other cases occur as part of a complex neurobehavioral disorder (such as autism, epilepsy, fragile X syndrome, galactosemia, Rett syndrome, Prader-Willi syndrome or certain types of chromosome abnormalities).
• In some cases, researchers have found alterations (mutations) in the FOXP2 gene or loss of genetic material involving this gene.

Signs and symptoms

• People with either form of AOS may have a number of different speech characteristics, or symptoms:
• Distorting sounds. People with AOS may have difficulty pronouncing words correctly. Sounds, especially vowels, are often distorted. Because the speaker may not place the speech structures (e.g., tongue, jaw) quite in the right place, the sound comes out wrong. Longer or more complex words are usually harder to say than shorter or simpler words. Sound substitutions might also occur when AOS is accompanied by aphasia.
• Making inconsistent errors in speech. For example, someone with AOS may say a difficult word correctly but then have trouble repeating it, or may be able to say a particular sound one day and have trouble with the same sound the next day.
• Groping for sounds. People with AOS often appear to be groping for the right sound or word, and may try saying a word several times before they say it correctly.
• Making errors in tone, stress, or rhythm. Another common characteristic of AOS is the incorrect use of prosody. Prosody is the rhythm and inflection of speech that we use to help express meaning. Someone who has trouble with prosody might use equal stress, segment syllables in a word, omit syllables in words and phrases, or pause inappropriately while speaking.
• Children with AOS generally understand language much better than they are able to use it. Some children with the disorder may also have other speech problems, expressive language problems, or motor-skill problems.

Diagnosis

• Professionals known as speech-language pathologists play a key role in diagnosing and treating AOS.
• Because there is no single symptom or test that can be used to diagnose AOS, the person making the diagnosis generally looks for the presence of several of a group of symptoms, including those described earlier.
• Ruling out other conditions, such as muscle weakness or language production problems (e.g., aphasia), can help with the diagnostic process.
• In formal testing for both acquired and childhood AOS, a speech-language pathologist may ask the patient to perform speech tasks such as repeating a particular word several times or repeating a list of words of increasing length (for example, love, loving, lovingly). F
• or acquired AOS, a speech-language pathologist may also examine the patient’s ability to converse, read, write, and perform nonspeech movements.
• To diagnose childhood AOS, parents and professionals may need to observe a child’s speech over a period of time.

Treatment

• In some cases, people with acquired AOS recover some or all of their speech abilities on their own. This is called spontaneous recovery.
• Children with AOS will not outgrow the problem on their own.
• They also do not acquire the basics of speech just by being around other children, such as in a classroom.
• Therefore, speech-language therapy is necessary for children with AOS as well as for people with acquired AOS who do not spontaneously recover all of their speech abilities.
• Speech-language pathologists use different approaches to treat AOS, and no single approach has been proven to be the most effective.
• Therapy is tailored to the individual and is designed to treat other speech or language problems that may occur together with AOS.
• Frequent, intensive, one-on-one speech-language therapy sessions are needed for both children and adults with AOS. (The repetitive exercises and personal attention needed to improve AOS are difficult to deliver in group therapy.)
• Children with severe AOS may need intensive speech-language therapy for years, in parallel with normal schooling, to obtain adequate speech abilities.
• In severe cases, adults and children with AOS may need to find other ways to express themselves.
• These might include formal or informal sign language; a notebook with pictures or written words that can be pointed to and shown to other people; or an electronic communication device—such as a smartphone, tablet, or laptop computer—that can be used to write or produce speech.
• Such assistive communication methods can also help children with AOS learn to read and better understand spoken language by stimulating areas of the brain involved in language and literacy.
• Some adults and children will make more progress during treatment than others.
• Support and encouragement from family members and friends and extra practice in the home environment are important.

NIH genetic and rare disease info

• NIH info on Childhood apraxia of speech

Childhood apraxia of speech is a rare disease.

Childhood apraxia of speech Resources
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