• Childhood Apraxia of Speech
  • CAS
  • Verbal Dyspraxia

Apraxia

Childhood apraxia of speech (CAS), also known as developmental verbal dyspraxia (DVD), is a relatively rare speech disorder in which children have difficulty producing the sounds of speech. What makes CAS different from other speech disorders is that a child knows the sound she wishes to create, but is unable to do so due to a neurological abnormality. In CAS, a miscommunication exists between the brain and the muscles of speech. This leads to the production of sounds that are inaccurate and that appear to be produced at random. Over half of children with autism are thought to struggle with CAS.

In addition to getting speech signals crossed, children with CAS have great difficulty consistently and accurately making the sounds to form words. One minute, they may try to say “ma” and it sounds like “va.” The next, it sounds like “vo”. CAS is distinguished from other speech disorders such as difficulty in physically pronouncing certain sounds (e.g., “r”, “th”, “s”), which can be caused by muscle, lack of coordination, or an inability to accurately distinguish a sound. Instead, a child with CAS knows exactly which sound they wish to produce, but cannot get their muscles to produce that sound accurately or consistently. As a result, a child may wish to say “brother” but may instead produce the sounds “ma” or “my” or “fo”, seemingly at random. 

Whereas a child with a lisp or other speech problem may be unintelligible to strangers but not their parents, children with CAS may be even incomprehensible to their parents because of the randomness of their word-sounds. Lack of consistency in sound production for any particular word or sound is a hallmark of CAS. Children may also sound “choppy” or have a weird “melody” or “rhythm” to their speech pattern called inappropriate or disordered prosody. They may also “grope” for words, meaning that a child may struggle to form a sound before any sound is produced.

Although CAS is of neurological origin, it cannot yet be diagnosed with typical neurological brain scans. Children with CAS often have other language and developmental delays, and it is sometimes difficult to distinguish between ultimate causes. The disorder may be the result of a stroke or traumatic brain injury. Emerging research suggests that abnormalities in the FOXP2 gene may increase the risk of CAS. 

What makes apraxia different from other speech disorders is that a child knows what sound they wish to create, but is unable to make it due to a neurological abnormality.

Conventional Treatment

When a parent suspects CAS or another speech-language delay, they should share their concerns with their child’s doctor as soon as possible. The child’s physician can then make a referral to a trained speech-language pathologist who can diagnose and treat CAS through testing the child’s oral-motor skills and their ability to understand and express language. 

Early and intensive interventions are seen as the most effective approach. Because CAS occurs in less than 10% of children with speech and language disorders, many speech-language pathologists are not experienced in treating it. Make sure your practitioner has experience treating the disorder. Speech therapy is generally prescribed for half-hour to hour-long sessions three to five times per week. Speech therapists may also recommend visual/sensory reading programs to facilitate language development, which are discussed in more detail below. 

Support

At The Brain Possible, our goal is to empower you to take a holistic approach to your child’s treatment. Below are ways in which you can support several aspects of your child’s recovery; before embarking on any, be sure to discuss them with your trusted health care providers.

Physical

While many speech disorders are primarily treated through language-focused interventions, CAS requires attention to the development of motor skills (skills pertaining to the movement or action of muscles). The Once Upon a Time Foundation, which funds ChildhoodApraxiaTreatment.org, suggests ensuring that your speech-pathologist incorporate the Principles of Motor Learning into your child’s treatment. You can read their breakdown of the differences between motor and sound-based treatment.

Therapies such as craniosacral, which regulates the flow of cerebrospinal fluid, myofascial release, which helps release tissue trauma, and scalp acupuncture, which encourages the flow of energy through meridians in the head and body, have helped children with CAS find more relaxation and coordination when making speech. 

Emotional/Social

Caregivers should make sure their child’s therapy takes place in a comfortable and culturally-appropriate setting. Caregivers can motivate children by providing positive feedback on their child’s language progress. Speech-language pathologist Caroline Bowen, PhD has several recommendations on her website, such as creating a “Brag Book” of words the child can pronounce to motivate them to master more. Canine therapy and equine-assisted or hippotherapy can help children with CAS communicate better as they form bonds with animals and their therapeutic helpers.

Sensory

Integral stimulation therapy is commonly used to treat CAS. During sessions, the speech-language pathologist asks the patient to model sounds while also asking them to pay close visual attention to how the SLP’s face and body are producing the sounds. Dynamic Temporal and Tactile Cueing (DTTC) is a variation of integral stimulation therapy used for more severe cases. In it, the therapist supports the child further by initially making the sounds with her and cuing her production of them on her own.  Parents can further support the child at home by making sure the home environment is rich in sounds, words and music, and modeling the enjoyment of verbal communication.

Sensory integration therapies, such as the Wilbarger Protocol and Floortime, may include games, puzzles, and personal care or household tasks that help children regulate their states of sensory arousal. They also aid in building neuronal pathways for better integration of sensory input from multiple sources. 

Intellectual

There are several smartphone and tablet apps that can support children with CAS. The Speech Buddies website recommends the NACD Home Speech Therapist by Blue Whale and three apps by Smarty Ears: Articulation Scenes, Apraxia Ville, and Articulate It! 

Other ways to support the child’s intellectual development include creating “communication temptations,” such as putting desired videos and books on high shelves so children have to learn how to ask for them, and reinforcing new vocabulary words by placing pictures of objects in unusual places and saying the names aloud when they’re discovered. In addition, learning programs that help encourage cognitive and sensory processing such as Auditory processing therapies might be helpful in encouraging brain development.

Nutritional/Environmental

A study by the Children’s Hospital and Research Center in Oakland, California, found that children with CAS showed significant reduction in symptoms with vitamin E and omega 3 supplementation. The study found that many children exhibiting CAS symptoms exhibited carnitine deficiency, fat malabsorption, and gluten sensitivities. It is suggested that children with CAS undergo a full nutrition evaluation to identify the supplements that may benefit them. Success has also been reported with the Nemechek Protocol. The Nemechek Protocol inhibits bacterial overgrowth in the gut which can lead to improved absorption of necessary nutrients. 

Physiological

During your child’s assessment, your speech-language pathologist will likely conduct a physiological exam of your child and refer you to additional specialists if abnormalities are found. They’ll likely examine the oral cavity and sound producing structures and evaluate your child’s respiratory system to make sure they have the air capacity to produce sound.