31 Days of Awareness: Apraxia Awareness
Childhood Apraxia of Speech
Awareness Color: White and blue through Apraxia-KIDS (no official color)
Awareness Month: May
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Childhood Apraxia of Speech (CAS) is a motor speech disorder. Children with CAS have problems 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. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words. CAS is a low incidence disorder. Best estimates suggest that about 1 in 1000 children (0.1%) of children are affected by CAS.
Currently, the causes of CAS fall into three known categories. First, CAS can be caused by known neurological injuries, ie., intrauterine stroke, infection, or trauma. Second, CAS can occur as a primary or secondary sign in children with specific and known genetic or metabolic disorders. Third, CAS can present as idiopathic; that is, not associated with any known neurological or complex neurobehavioral disorder. Essentially there is as yet no known cause for the disorder in this subgroup.
What are some signs or symptoms of childhood apraxia of speech?
Not all children with CAS are the same. All of the signs and symptoms listed below may not be present in every child. It is important to have your child evaluated by a speech-language pathologist (SLP) who has knowledge of CAS to rule out other causes of speech problems. General things to look for include the following:
A Very Young Child
- Does not coo or babble as an infant
- First words are late, and they may be missing sounds
- Only a few different consonant and vowel sounds
- Problems combining sounds; may show long pauses between sounds
- Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)
- May have problems eating
An Older Child
- Makes inconsistent sound errors that are not the result of immaturity
- Can understand language much better than he or she can talk
- Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
- May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
- Has more difficulty saying longer words or phrases clearly than shorter ones
- Appears to have more difficulty when he or she is anxious
- Is hard to understand, especially for an unfamiliar listener
- Sounds choppy, monotonous, or stresses the wrong syllable or word
Potential Other Problems
- Delayed language development
- Other expressive language problems like word order confusions and word recall
- Difficulties with fine motor movement/coordination
- Over sensitive (hypersensitive) or under sensitive (hyposensitive) in their mouths (e.g., may not like toothbrushing or crunchy foods, may not be able to identify an object in their mouth through touch)
- Children with CAS or other speech problems may have problems when learning to read, spell, and write
How is it treated?
In some cases, people with acquired apraxia of speech recover some or all of their speech abilities on their own. This is called spontaneous recovery. Children with developmental apraxia of speech will not outgrow the problem on their own. Speech-language therapy is often helpful for these children and for people with acquired apraxia who do not spontaneously recover all of their speech abilities.
Speech-language pathologists use different approaches to treat apraxia of speech, and no single approach has been proven to be the most effective. Therapy is tailored to the individual and is designed to treat other speech or language problems that may occur together with apraxia. Each person responds differently to therapy, and some people will make more progress than others. People with apraxia of speech usually need frequent and intensive one-on-one therapy. Support and encouragement from family members and friends are also important.
In severe cases, people with acquired or developmental apraxia of speech may need to use other ways to express themselves. These might include formal or informal sign language, a language notebook with pictures or written words that the person can show to other people, or an electronic communication device such as a portable computer that writes and produces speech.
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