Childhood apraxia of speech

Childhood Apraxia of Speech (CAS) is a rare, significant, and lifelong speech disorder. Other names for the disorder are Developmental Apraxia of Speech (DAS) or Developmental Verbal Dyspraxia (DVD).

CAS does not naturally resolve, and it is very different to other, more common speech problems children can experience.

Children with CAS know what they want to say and can move their face and mouth well for facial expressions and eating. Usually there is nothing wrong with the muscles used for speech.

However, CAS affects a child's ability to organise the movements of the muscles used in speech such as planning the movements of their jaw, lips, tongue, voice and back of the roof of their mouth. Children with CAS have trouble storing plans for new words, meaning they need to work out the movements for the same words over and over again.

Children with CAS can be very hard to understand as their ability to produce the sounds accurately and consistently for speech is variable. Speech can sound jumbled, contain lots of sound errors, have limited variety of speech sounds or can sound too loud or broken and robotic.

It is difficult to estimate how many people have CAS, because not all researchers and professionals agree on the features that make up this disorder. At this stage, there is no information available to tell us how many people have a diagnosis of CAS.

Causes of childhood apraxia of speech

Scientists are still determining what causes CAS. Some people with CAS have a genetic condition or variation, others a neurodevelopmental disorder or a brain injury. For most people, we do not know the cause yet.

Features of childhood apraxia of speech

A child with CAS may:

• pronounce the same word differently each time they say it
• have general difficulties moving the muscles of their mouth and throat – for example, they may have trouble chewing, sucking, blowing or making certain speech sounds
• look like they are searching or groping for the right sound
• have difficulty imitating sounds and words
• use a limited number of consonant sounds when speaking
• mix up the order of sounds in words
• have more difficulty saying longer words and sentences than shorter ones.

Signs of childhood apraxia of speech in young children

Some very young children show signs that they may be having difficulty planning movements of their tongue, lips and jaw.

Signs that may indicate a child is at risk of future speech difficulties include:

• babies who don't play with sounds – for example, coo or babble
• babies and young children who have difficulties sucking, swallowing and chewing
• young children who are not starting to speak like other children their age (remembering that there is enormous variation between children)
• young children who only use noises, gestures and vowel sounds to communicate.

Other problems associated with CAS

People who have a diagnosis of CAS may also experience:

• feelings of frustration because they can't get their message across
• oral language difficulties
• difficulties with reading and spelling
• sucking, chewing, and swallowing problems
• difficulty performing movements with their tongue and lips when asked
• clumsiness.

CAS impacts children expressing their needs and wants, social interaction, and connections with others. People with CAS are often able to understand others well but have difficulty expressing their own thoughts and ideas, meaning some people underestimate their skills.

Children with CAS may have additional communication difficulties including dysarthria, Developmental Language Disorder, social communication difficulties and stuttering or voice issues. They may also have sensory processing difficulties or Developmental Coordination Disorder. They can also experience anxiety, depression, difficulties coping or have general learning difficulties. This means they need more supports and holistic care across health professionals like paediatricians, occupational therapists, and psychologists.

Diagnosis of childhood apraxia of speech

If you are worried about your child’s speech development, talk to your GP or maternal and child health nurse. They will be able to refer you to a speech pathologist. You can also make an appointment or call a speech pathologist directly without a referral. A speech pathologist can assess whether your child has CAS or whether their speech difficulties are due to another cause.

Use Speech Pathology Australia’s ‘Find a speech pathologist’ service to find a speech pathologist in your area.

Support for people with childhood apraxia of speech

If your child has been diagnosed with CAS, the speech pathologist will then work with them to improve their speech and their reading, spelling and language abilities (if required).

Your child may be eligible for some support under the Chronic Disease Management (CDM) items that are available under Medicare to patients with a chronic medical condition. Ask your GP and speech pathologist for more information.

Children with CAS may be eligible for NDIS funding and supports.

Planning a childhood apraxia of speech support program

There are lots of things a speech pathologist will consider when planning a support program for a child with CAS.

Factors to consider include:

• the severity of the speech disorder
• the child's ability to concentrate on the program
• the child’s ability to understand what is expected
• the commitment of the child and their family to support the program
• the need to create a supportive environment.

Children with a diagnosis of CAS may take time to show improvements in their speech and language.

Treatment takes many years depending on the functional goals the person and family choose. Treatment works best in numerous, intensive blocks of individual therapy. There is evidence for CAS therapy working in intensive clinic or online sessions 2-5 days a week for periods of at least 12 sessions per block.

Speech pathology strategies for CAS

There are specialised, research-based assessment and treatment options available to help people with CAS communicate. The specific assessments and treatments depend on a person’s strengths and needs as they develop.

A speech pathologist working with a person with CAS may:

• ask the person to imitate sounds, syllables and words
• teach the person about sounds and explain the rules about when to use certain sounds in words
• use gestures or pictures or touch specific points on the face or neck to help the person make the right sound or sequence of sounds
• introduce other ways to communicate, such as communication boards, key word signing or voice output devices. This will also help to reduce some of the frustration that naturally occurs if a person has difficulty getting their message across.

Support from a team of professionals

Numerous people may make up the team of professionals who support a person with CAS. Speech pathologists are key members of this team. Other team members may include:

• teachers
• psychologists
• occupational therapists.

Children with CAS and their parents or carers are important members of the team and should be encouraged to contribute to goal setting and reviews of the treatment program.

Children with CAS can develop functional communication and clear speech with intensive, longer-term speech pathology treatment.

CAS – suggestions for parents, carers and family members

• The child with CAS will need to work through an intensive evidence-based therapy program with a speech pathologist for an extended period of time.
• Try to be supportive and allow the child time to communicate. Placing pressure on a child with CAS may make speaking more difficult for them.
• A child with CAS may be frustrated or withdraw from communication and social situations because they cannot express themselves clearly despite trying really hard to speak.

Where to get help

• Your GP (doctor)
• Speech pathologist
• Your local school or Department of Education speech pathologist (if available)
• Community health centre
• Speech Pathology Australia Find a Speech Pathologist service Tel. 1300 368 835 or (03) 9642 4899