What is Childhood Apraxia of Speech?

Childhood Apraxia of Speech (CAS) is a neurological childhood speech sound disorder. It causes problems with precision and consistency in the production of sounds, words and syllables and often continues into adulthood if not treated. Although a child with CAS knows what they want to say, the brain struggles to correctly move the lips, tongue and jaw so they can speak clearly.

CAS is a rare motor speech disorder and is different to more commonly presenting speech disorders like phonological disorders or articulation disorders. Most children memorise the steps involved with speaking and do not have to “plan” each new word they say, rather the plans are learned and “stored”. Children with CAS must continually plan and re-learn words and find it difficult to “store” words and phrases. They may think:

• Which sounds do I need?
• How do I move my lips, tongue and jaw to make the sound?
• What order do the sounds need to go in?
• What part of the word do I stress?

Children with CAS often experience a lot of frustration and it is often confusing for families to understand why their child is not speaking clearly, particularly if other family members or siblings did not have motor speech challenges.

The Impact of CAS

The impact of CAS is significant and often spans across the lifetime. Children who present with CAS are more likely to have other challenges, including:

• Language difficulties (including Developmental Language Delay)
• Developmental Coordination Disorder
• Literacy difficulties
• Psychosocial effects, e.g., social withdrawal, anxiety, depression
• Behavioural Problems

What Are The Signs of CAS?

CAS is challenging to diagnose and requires extensive assessment to differentially diagnose between CAS and other speech sound disorders. There are many different signs of CAS, and the condition itself may be mild, moderate or severe. In general, CAS consists of the following features:

• Inconsistent errors on consonants and vowels
• Timing and length issues on syllables (may sound robotic, nasal)
• Issues with prosody

These features will be identified during assessment with a speech pathologist.

Other features you might identify in your child that could indicate the presence of CAS are:

• Feeding difficulties
• Less babbling or playing with consonant sounds than other children
• Delayed first words and 2-word combinations
• Limited sounds when they do begin to talk
• Struggling to talk – groping, searching for sounds
• Very difficult to understand even by the immediate family
• Seems to understand well, but has a delay in expressive language.
• Difficulty with longer words or phrases
• Dropping or adding sounds to words

If your child displays any of these symptoms, it is recommended to seek assessment with a speech pathologist.

Treatment for CAS

After CAS has been identified, there are a number of research-based interventions with strong evidence that speech pathologists can implement with your child. The intervention that is selected is based on the child’s age and severity of CAS. The most common treatment approaches include:

• Dynamic Temporal Tactile Cueing (DTTC)
• Nuffield Dyspraxia Program
• Rapid Syllable Transition (ReST)
• Biofeedback with Speech Motor Chaining

Treatment for CAS is a big commitment and can take a long time (depending on severity), however the benefits to your child will be well worth the time and effort. Your speech pathologist will discuss the recommendations for therapy frequency with you (sessions per week, block therapy).

If you’re concerned, the best place to start is to get in touch with us at hello@superyou.org.au or to fill out an online referral form.