Childhood apraxia of speech
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Speech disorders like Childhood Apraxia of Speech (CAS) are relatively rare conditions. In individuals affected by CAS, there are difficulties in coordinating the precise movements of the lips, jaws, and tongue during speech.
In CAS, the brain encounters challenges in effectively directing the movements for speech. Even though the muscles involved in speech are not inherently weak, they struggle to form words correctly due to a problem in the brain’s ability to instruct them properly.
In order to speak fluently, the brain must generate intricate plans that guide the muscles responsible for moving the lips, jaw, and tongue. When executed correctly, these movements result in words and sounds being produced at the appropriate speed and rhythm. CAS interferes with this process.
A commonly employed approach for addressing CAS is speech therapy. Under the guidance of a speech–language pathologist, children with CAS learn and practice the correct pronunciation of words, syllables, and phrases during therapy sessions.
Symptoms
Speech symptoms in children with CAS might vary. The age of the kid and the severity of the speech issues affect the symptoms.
CAS may lead to:
- Babbling less or producing fewer vocal sounds than expected for a child between the ages of 7 and 12 months.
- Speaking for the first time later in life, usually after the ages of 12 to 18 months.
- Speak with fewer consonants and vowels.
- Making difficult–to–understand speech.
- Frequently omitting sounds during speaking.
Typically, these symptoms become noticeable in children between 18 months and 2 years of age. During this developmental stage, certain signs may suggest the presence of Childhood Apraxia of Speech (CAS). However, it’s crucial to recognize that a child initially suspected of having CAS may indeed have this speech disorder. Therefore, closely monitoring the child’s speech development is essential to determine the appropriate timing for initiating therapy.
Between the ages of two and four is often when children speak more. Symptoms that could point to CAS include:
- Mispronouncing words, like “pie” for “bye.”
- Distortions of consonant and vowels
- Pauses between syllables or words.
Many kids with CAS struggle to position their lips, tongues, and jaws in the right ways to produce sound. They might also find it difficult to transition fluidly to the following sound.
A lot of kids with CAS also struggle with language, like having a limited vocabulary or having issues with word order.
Certain symptoms might be specific to kids with CAS, which aids in the diagnosing process. But some CAS symptoms can also be found in other kinds of speech or language impairments. If a child only exhibits symptoms that are common to both CAS and other diseases, it might be challenging to diagnose CAS.
Certain characteristics aid in differentiating CAS from other kinds of speech impairments. People connected to CAS consist of:
- Trying to make the right motions for speech sounds by groping movements of the jaw, lips, or tongue.
- Vowel distortions, such as attempting to pronounce a vowel correctly yet mispronouncing it.
- Difficulty transitioning smoothly between sounds, syllables, or words.
- Difficulty mimicking simple words
- Varying in pronunciation errors when attempting to pronounce the same word twice.
- Mispronouncing words, such as saying “down” when you mean “town.”
- Stressing a word incorrectly—for example, saying “banana” as “BUH–nan–uh” rather than “buh–NAN–uh.”
- Stressing each syllable equally, for example, when saying “BUH–NAN–UH.”
- Syllable division, such as adding a pause or space between syllables.
Other speech problems that are occasionally mistaken for CAS
As there is often an overlap in symptoms between speech sound issues and Childhood Apraxia of Speech (CAS), they are frequently confused. These speech sound problems encompass conditions such as dysarthria, phonological problems, and articulation disorders.
In the case of a child dealing with an articulation or phonological disorder, the primary challenge lies in acquiring and using specific sounds correctly. Unlike CAS, these children do not face difficulties in organizing or coordinating their speech movements. It’s worth noting that articulation and phonological disorders are more common than CAS.
Speech problems related to phonology or articulation can include:
- Omitting last consonants. “Duh” or “uh” may be used by a child with CAS in place of “duck” or “up.”
- Substituting the sounds. The youngster may substitute words such as “wabbit” for “rabbit,” “tup” for “cup,” or “fum” for “thumb.”
- Making sound combinations simpler. It is possible that the child will say “ting” instead of “string” or “fog” instead of “frog.”
- Cutting off the airflow. It is possible that the child will say “tun” instead of “sun” or “doo” instead of “zoo.”
Dysarthria is a speech disorder characterized by weakened speech muscles. In individuals with dysarthria, these muscles cannot move as far, as quickly, or as forcefully as required for typical speech production, resulting in difficulty in producing speech sounds. Additionally, dysarthria can manifest as a hoarse, soft, or strained voice, and individuals with this condition may also speak slowly or slur their words.
Diagnosing Childhood Apraxia of Speech (CAS) is generally more complex than diagnosing dysarthria. Distinguishing between CAS and dysarthria can be particularly challenging when CAS is caused by damage to brain regions that affect speech coordination.
Causes
A multitude of factors may contribute to CAS. However, a reason is frequently unknown. Typically, a kid diagnosed with CAS does not exhibit any problems in the brain.
On the other hand, injuries or illnesses of the brain might cause CAS. A stroke, infections, or traumatic brain injury are a few examples of them.
Moreover, CAS could be a symptom of a metabolic disease, syndrome, or genetic abnormality.
Another name for CAS is developmental apraxia. However, children with CAS do not outgrow CAS, nor do they produce typical developmental sound mistakes. This is not the case for kids who have developmental disorders or delayed speech, who usually develop speech and sound patterns at a slower rate than normal.
Risk factors
Variations in the FOXP2 gene appear to increase the risk of developing Childhood Apraxia of Speech (CAS) as well as other speech and language disorders. The FOXP2 gene may play a role in developing specific brain circuits and nerves related to speech and language. Researchers are actively exploring how mutations in the FOXP2 gene affect various aspects of speech, language processing, and motor coordination in the brain. Additionally, it is possible that other genes may also contribute to the development of motor speech disorders.
Diagnosis
A speech–language pathologist evaluates your child’s medical history and symptoms in order to assess your child’s condition. In addition, the speech–language pathologist examines your child’s ability to generate words, sounds, and phrases as well as the speech–language muscles.
The speech–language pathologist for your kid may also evaluate their language abilities, such as their vocabulary, sentence construction, and speech comprehension.
A single test or observation is not sufficient to make the diagnosis of CAS. Based on the observed pattern of issues, a diagnosis is formed. The particular tests used during the assessment are determined by the age, cooperativeness, and severity of the speech issue in your child.
When a kid speaks very little or struggles to communicate with the speech–language pathologist, it might be difficult to diagnose CAS.
Still, since CAS is treated differently from other speech problems, it’s critical to determine whether your child exhibits CAS symptoms. Even if the diagnosis is uncertain at first, your child’s speech–language pathologist might be able to advise you on the best course of action for your kid.
Tests could consist of:
- Hearing tests. To ascertain whether hearing issues could be a factor in your child’s speech issues, your doctor might prescribe hearing tests.
- Oral–motor assessment. The speech–language pathologist for your child will examine the lips, tongue, palate, and jaw to check for any structural issues, like cleft palates or tongue tie. In addition, the speech–language pathologist will search for additional issues like low muscle tone. Although low muscle tone is typically not linked to CAS, it can indicate other medical issues.
When your child blows, smiles, or kisses, the speech–language pathologist will observe how your child moves his or her lips, tongue, and jaw.
- Speech evaluation. It is possible to watch your child’s sound, word, and phrase production while they play or engage in other activities.
You might ask your child to name some pictures. This enables the speech–language pathologist to determine whether your child struggles with pronouncing certain words or syllables or creating particular sounds.
The speech–language pathologist for your child may also assess the coherence and fluidity of their speech movements. Your toddler might be asked to recite words like “buttercup” or repeat syllables like “pa–ta–ka.”
When your kid is able to form sentences, the speech–language pathologist listens to the rhythm and melody of their speech. You can tell melody and rhythm from the way your toddler emphasizes words and syllables.
A speech–language pathologist for your child could assist them by giving clues, such speaking a word or sound more slowly or applying touch cues to their face.
The speech–language pathologist can confirm the diagnosis of CAS with the assistance of a speech therapy trial to watch how your kid responds to CAS treatment.
Treatment
Childhood Apraxia of Speech (CAS) is a condition that children do not typically outgrow, but speech therapy can significantly aid in their improvement. Speech–language pathologists have a range of treatment options available for individuals with CAS.
Speech therapy
The speech–language pathologist working with your child typically emphasizes practice with words, phrases, and syllables as the central focus of therapy.
The frequency of your child’s speech therapy sessions may vary, ranging from three to five times a week, depending on the severity of their speech issues. As your child progresses, the frequency of these weekly sessions may be reduced.
Individual therapy is often highly beneficial for children with CAS. Through one–on–one therapy, your child can engage in more extensive speech practice during each session.
It is essential that children with CAS consistently practice pronouncing words and phrases throughout each speech therapy session. Learning the correct way to say words and phrases requires dedicated practice and patience.
Speech therapy frequently concentrates your child’s attention on the sound and feel of speech motions since children with CAS sometimes struggle with speech movements planning. In speech treatment, speech–language pathologists may employ a variety of cues. For instance, the speech–language pathologist for your child might ask them to pay close attention. Additionally, your child can be asked to watch the speech–language pathologist construct the word or phrase with their mouth.
The speech–language pathologist for your child might also make facial gestures in response to specific sounds or words. A speech–language pathologist, for instance, could assist your child with rounding their lips to say “oo.”
It has not been demonstrated that a single speech treatment strategy is the most successful in treating CAS. However, the following are some crucial tenets of speech therapy for CAS:
- Speech drills. During a therapy session, your child’s speech–language pathologist could urge them to repeat words or phrases multiple times.
- Sound and movement exercises. It’s possible that your child will be asked to watch the speech–language pathologist’s mouth while the professional speaks a word or phrase in addition to listening to them. Your child can see the mouth movements associated with the sounds by observing the speech–language pathologist’s mouth.
- Vowel practice. Vowel sounds are often distorted in children with CAS. Your child’s speech–language pathologist might select words for them to practice that have vowels in various syllable forms. Your toddler might be asked to say things like “hi,” “mine,” and “bite.” Or they might ask your child to say “down,” “out,” and “house.”
- Speaking practice. Instead of practicing individual sounds, your youngster will probably rehearse syllables, words, or phrases. Children diagnosed with CAS require experience transitioning between sounds.
- Progressive learning approach. Depending on the extent of your child’s speech disorder, the speech–language pathologist may initially employ a limited set of practice words. The quantity of words for practice is expected to expand gradually as your child’s skills improve.
