What is childhood apraxia?
Childhood apraxia of speech (CAS) is a speech disorder where a child has trouble saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. Children with CAS know what they want to say. But their brains have difficulty coordinating the muscle movements necessary to say those words.
What are the symptoms of childhood apraxia?
The main signs of childhood apraxia are:
- Problems forming words correctly
- Putting stresses on the wrong syllable
- Inconsistent speech errors
- Difficulty combining sounds
- Slow rate of speech
- Difficulty sequencing sounds
Children with apraxia of speech often have a hoarse, monotonous, or strained voice quality. Their speech may be more difficult to understand when they are trying to say longer sentences. It is common for speech to be easier to understand than expected based on how it sounds.
How common is childhood apraxia?
Childhood apraxia of speech is considered a rare disorder. Estimates of prevalence vary widely. Some research suggests CAS affects about 1 to 2 children per 1,000. However, many experts believe it may be more common. Some key points about the incidence of childhood apraxia include:
- Boys are 2 to 3 times more likely to have CAS than girls.
- The condition often occurs along with other developmental disorders like autism spectrum disorder.
- CAS is difficult to diagnose accurately in young children. Mild cases are likely underdiagnosed.
- Reported rates likely underestimate the true incidence.
Overall, a reasonable estimate is that at least 1% of children have some degree of CAS. That would mean over 70,000 children under age 5 in the United States alone. However, the number could be several times higher.
What causes childhood apraxia?
The exact causes of CAS are not well understood. Some possible factors include:
- Genetics – CAS seems to run in families, suggesting a genetic component.
- Neurological problems – Abnormalities in parts of the brain involved with speech and motor function have been found in some children with apraxia.
- Developmental issues – Problems with learning and executing coordinated mouth movements needed for speech sounds.
- Hearing problems – Difficulty hearing speech sounds properly in early childhood disrupts normal speech development.
- Brain injury – Damage to parts of the brain involved in coordinating speech motor movements.
In many cases, the cause is unknown. More research is needed to better understand what leads to CAS.
How is childhood apraxia diagnosed?
Diagnosing CAS involves a speech-language evaluation by a trained professional. They look for difficulties saying different speech sounds or inconsistencies saying the same word. Key aspects include:
- Detailed case history – When symptoms started, speech and language development, other conditions.
- Oral mechanism exam – Checks the structures used in speech.
- Speech sound assessment – Testing speech production abilities.
- Evaluating sensation, motor skills, hearing.
- Ruling out other conditions – Autism, dysarthria, hearing loss.
There are no definitive tests for CAS. Diagnosis relies on expert clinical judgement. Symptoms can vary widely. Milder cases in young children are often misdiagnosed initially.
How is childhood apraxia treated?
The main treatment for childhood apraxia of speech is speech therapy. Key components often include:
- Motor learning approaches – Target mouth positioning, sound production.
- Tactile and gestural cueing – Tools to help coordinate speech movements.
- Repeating syllable sequences – Improves planning and sequencing.
- Using visual aids – Mirrors, pictures, apps to supplement verbal cues.
- Feedback on speech accuracy – Helps improve awareness of errors.
- Family education – Strategies for home practice and carryover.
Treatment is tailored to the needs of each child. More severe cases require intensive speech therapy 2-3 times per week. Daily home practice is also very important. With appropriate therapy, most children with CAS make significant improvements in speech clarity over time.
What is the prognosis for childhood apraxia?
The long-term outlook depends on the severity of CAS and how early treatment begins. Key prognostic factors include:
- Age at diagnosis – Earlier diagnosis and treatment leads to better outcomes.
- Severity of symptoms – More severe apraxia is slower to improve.
- Co-occurring conditions – Autism or intellectual disability make prognosis poorer.
- Intensity of speech therapy – More frequent therapy yields quicker gains.
- Family support – A supportive home environment optimizes progress.
With appropriate treatment, most children with mild to moderate CAS are able to speak fairly clearly by school age. More severe cases may continue to have speech difficulties into adulthood. Early diagnosis and intervention provides the best chance for significant improvement.
Conclusion
Childhood apraxia of speech is estimated to affect at least 1% of children. However, mild cases are likely underdiagnosed, so the true incidence is uncertain but potentially much higher. Intensive speech therapy is the main treatment approach. While CAS can be challenging, most children make major strides with ongoing intervention and practice. Early diagnosis and treatment are key to achieving the best outcomes.
