Few things worry a parent more than a diagnosis they have never heard of.
Childhood apraxia of speech is one of those. The name sounds serious, and the explanations online can be hard going.
The good news is that once you understand what it is, it becomes much less frightening. And with the right help, children with apraxia can make real progress.
In Perth, the speech pathologists at Kid Speak work with children who have apraxia and other speech difficulties, at clinics across the metro area.
This guide covers what apraxia is, the signs to look for, and how therapy and home practice fit together.
What is childhood apraxia of speech?
Childhood apraxia of speech, often shortened to CAS, is a motor speech disorder.
That means the difficulty sits in planning and coordinating the movements needed for speech. It isn’t a problem with understanding language or knowing what to say.
A child with apraxia usually knows exactly what they want to tell you. The trouble is getting the lips, jaw and tongue to move in the right order, at the right time, to make the words come out.
You may also see it called developmental verbal dyspraxia or developmental apraxia of speech. These names describe the same thing. In Australia, CAS is the term most speech pathologists use.
The Royal Children’s Hospital Melbourne has a clear fact sheet on CAS if you would like more background.
How apraxia differs from other speech delays
Lots of young children have speech that is hard to understand. Most have what is called a speech sound delay, where certain sounds are simply late to arrive.
Apraxia is different. Children with a speech delay usually make the same errors each time, such as saying “tat” for “cat” every time.
Children with apraxia often make different errors on the same word. They might say a word clearly once, then struggle with it a minute later.
That inconsistency is one of the key things a speech pathologist looks for.
Signs parents tend to notice
Every child is different, and many signs overlap with other speech difficulties. Some of the more common ones include:
- speech errors that seem random and change from one attempt to the next
- a small range of consonant and vowel sounds
- vowel sounds that come out distorted
- trouble with longer words, especially those with several syllables
- speech that sounds choppy, with unusual rhythm or stress
- visible effort, with the child searching or “groping” for the right mouth position
Some children were also quiet babies who didn’t babble much. Others understand far more than they can say, which can be frustrating for them.
If any of this sounds familiar, it is worth talking to your GP or a speech pathologist.
What causes it?
Parents often worry that something they did caused their child’s apraxia. That is very unlikely.
In most cases, there is no single clear cause. Research suggests genetics can play a part, particularly where there is a family history of speech or language difficulties.
Apraxia is also seen more often alongside some other conditions, including certain genetic and neurological conditions.
What matters most is not the cause, but getting the right support in place.
How apraxia is diagnosed
There isn’t a single test for apraxia. A speech pathologist builds a picture over time.
They will listen to how your child says sounds, words and longer phrases. They may ask your child to repeat the same word several times to check for inconsistency.
They will also look at how the mouth moves during speech and during other tasks, like blowing or licking their lips.
For very young children, it can take a few sessions before a speech pathologist is confident about the diagnosis. That is normal, and it helps make sure therapy is aimed at the right problem.
Speech Pathology Australia explains what to expect from an assessment and how to find a speech pathologist near you.
What therapy looks like
Therapy for apraxia focuses on movement. The aim is to help your child plan and carry out the movements for speech until they become automatic.
Sessions usually involve lots of practice of carefully chosen words and sound patterns. The speech pathologist may use touch cues, visual prompts or rhythm to help your child find the right movements.
Children with apraxia generally do best with frequent sessions. Short, regular practice tends to work better than longer sessions spaced far apart.
The words practised are often ones that matter in your child’s day, such as family names, favourite foods or toys. That keeps practice meaningful and motivating.
The role parents play
Parents are a big part of progress.
Your speech pathologist will usually give you activities to practise at home between sessions. These are often short, simple and built into everyday routines.
A few general tips that many families find helpful:
- keep practice short and fun, a few minutes at a time
- praise effort, not just the correct word
- give your child time to answer without finishing their sentences
- use gestures, pictures or signs alongside speech, so your child can still get their message across
That last point surprises some parents. Using signs or pictures doesn’t hold speech back. It reduces frustration and keeps your child communicating while their speech catches up.
Apraxia and starting school
Starting school brings new demands. Children need to answer questions, join in group talk and begin learning to read and spell.
Some children with apraxia also find early literacy harder, because linking sounds to letters relies on the same planning skills.
It helps to share any speech pathology reports with your child’s teacher before the year starts. That way, the classroom can back up the work being done in therapy.
Looking after confidence
Children with apraxia can become frustrated when people don’t understand them. Some start to talk less, especially around new people.
Let teachers, grandparents and carers know what helps, so the same approach is used everywhere.
Celebrate small wins. A new sound or a word said clearly for the first time is real progress.
When to get help
If you are worried about your child’s speech, you don’t need to wait and see.
Early assessment means that if your child does have apraxia, therapy can start sooner. And if it turns out to be something else, you will have a clearer picture of what will help.
Trust your instincts. You know your child better than anyone.
