Childhood Apraxia of Speech (CAS)
Childhood Apraxia of Speech is a motor speech disorder characterized by an inability to initiate and sequence speech movements. The child knows what he or she wants to say, but is unable to coordinate the movements. It is not a disorder of muscle weakness; rather, the brain is unable to produce the required firing of the muscles in an organized fashion.
Apraxia can produce inconsistencies in speech sound production. A word may "pop out" clearly but be very difficult to produce when there is an intention to do so. Apraxic children often have a history of very little babbling or sound play, and even though these are the same muscles used for eating, eating is frequently not a problem. These children may have a history of delayed acquisition of speech and language milestones. Another issue that may occur in connected speech is distortion of vowels. Also, a lack of normal melody and inflection is not uncommon.
Adults may exhibit a similar disorder; however in their case it is not developmental. Apraxia in adults may be the result of a brain trauma, such as a stroke or a car accident.
Treatment for Apraxic children
First, an evaluation is conducted to make a differential diagnosis. Treatment should be frequent and intensive, at least three times per week. Home practice is essential for success. Treatment includes providing visual, auditory and tactile cues with intensive drilling.
The goal is to develop automaticity in speech, thereby bypassing the need for the brain to mediate speech movements. In some cases, CAS may be so severe that the child will require alternative augmentative communication (frequently referred to as AAC). However, when the focus in therapy is on planning, sequencing and coordination of the movements required for speech production, most children do well. The duration of treatment is generally several years and it is important that client and parent be aware of that and be active participants in the therapeutic process.