Parents Need the Right Diagnosis for Childhood Apraxia of Speech
Childhood Apraxia of Speech (CAS) is considered to be a rare speech problem in children. However, because it is rare and researchers believe that other types of problems may occur more often than this does – there has been less research into how common apraxia in kids really is for those with different levels on the severity scale. Apraxia kids has reported that there are estimates like: 3-5% of children on a speech therapist’s caseload could have apraxia of speech. Which is why parents need the right diagnosis from a speech therapist that is highly qualified and experienced with this communication disorder.
When there’s a misdiagnosis, children can lose out on needed accurate and correct speech therapy for apraxia as opposed to another speech issue like a phonological disorder or speech delay. It is also unfortunate to note that childhood apraxia of speech can be over diagnosed.
Speech therapists and other professionals should be more cautious when diagnosing apraxia in children, especially when they are so young and a proper evaluation cannot be completed. This can cause parents to be worried unnecessarily and as stated the wrong treatment type may be used.
What are the Characteristics of Apraxia of Speech in Children?
According to the American Speech-Language-Hearing Association (ASHA), here are the key characteristics of apraxia that can help a speech pathologist make the best diagnosis:
- A child may not always say words the same way every time; this may be more evident on words that are longer, more complex, or words that are new to the child
- Distortion of sounds and/or addition of sounds (watch the video to see how the addition of a “schwa” sound happens
- Hard time moving from sound to sound and to syllables which can create pausing between sounds that does not sound right
- Groping or moving their mouth/lips or other articulators around to try to find the right placement
What is a Phonological Disorder?
A phonological disorder is a speech sound disorder in which a child has difficulty with the speech patterns or rules of a language that they speak and the sounds the differentiate words.
For example, a child may say the ‘s’ sound in “sit” correctly but will pronounce the ‘s’ sound in “sing” like “shing” and the patterns, while sometimes complex and hard to determine, are fairly consistent.
The Language Skills of Children with Apraxia
Children with apraxia frequently have a delay in their expressive language skills (this is especially notable before speech therapy starts) and they do not have a similar vocabulary size as other kids that are their age. You can read about the differences between speech and language disorders here.
Children with a phonological disorder could have expressive language skills that are closer to the typical range of other children their age. They do their best to use many words and a variety of words as well as saying longer sentences even though parents, teachers and others may not be able to understand very much.
Which Characteristics Overlap Apraxia of Speech and a Phonological Disorder?
The characteristics of both disorders are very general and include poor intelligibility or not being understood, deleting or omitting sounds in words. For example, saying “dah” instead of “dog.” And, having a limited consonant repertoire (so using few consonants).
As you can see, there are few overlapping characteristics of the two disorders and to generalize the the signs and symptoms of the two is to risk the wrong diagnosis for a child and therfore not use the correct treatment.
What is the Treatment for Apraxia in Kids?
A child with an apraxia diagnosis should work closely with a speech therapist. They may begin speech therapy 3–5 times per week, but as speech improves and treatment becomes less frequent individual sessions might be appropriate for them at different stages in their recovery process too!
The speech therapists at Therapy Works Together often have parents asking if doing some exercises to make the mouth muscles stronger can help. This is not the problem for children with apraxia and stronger mouth muscles will not help them say sounds better.
A child with apraxia must have many opportunities to practice speaking to get better at it. Treatment for apraxia of speech has been better when therapists use the following in combination as needed for each child:
- Providing “touch” cues (like touching a child on the lips to say the “b” sound as a reminder to close the lips)
- Giving “visual” cues and reminding the child to look at your mouth as a model for how to produce a sound
Accurate Diagnosis of Apraxia in Kids – Video Transcript
Hi there, so today I want to talk about a differential diagnosis between apraxia of speech and phonological disorders or severe phonological disorders. this is important because parents oftentimes look for a specific diagnosis online for why their child is not sounding intelligible. why we can’t understand what the child is saying and they will find something called childhood apraxia of speech which is a motor planning disorder and it’s important to get the correct diagnosis between childhood apraxia of speech and a phonological disorder because each one is treated very differently.
So it’s very important so the overlap between the two of them is intelligibility meaning a child will be very difficult to understand they will omit sounds meaning they will delete certain sounds from words instead of saying dog they’ll say da for example and they’ll have a limited consonant repertoire.OK so they won’t have a lot of consonants that they use so those are typical for both
But now what’s very specific to apraxia that a child doesn’t have a phonological disorder so one of the things that they’re going to do is perhaps grope since this is a motor planning it has to do with how the child is positioning their articulators or the parts of their mouth for speech.
So their mouth their tongue their lips so where they actually placing them so they’re going to grope they might move around their articulators trying to find exactly where to position their mouth this is especially the case in vowel sounds so they’re going to have a lot of errors in vowel sounds inaccuracies in vowel sounds that’s one thing another thing that they’re going to have.
And I’m going to look at my notes so that I don’t miss anything. they’re going to do a lot of trial and error and sometimes that might be silent you might not hear them trying you know.
I supposed to say it like this or am I supposed to say it like that but they’ll be quiet and you’ll see them maybe again moving around their mouth trying to figure out exactly where to put their articulators.
Another thing they might have as an intrusive kind of neutral sound (“schwa”) in words so instead of saying for example “cat” they’re going to say “cateh.”
OK or instead of saying “bike” they’re going to say “biehk.” Right, they’re going to add a sort of extra sound that doesn’t happen in the phonological disorders even if it’s severe.
OK lot of times in a proxy of speech we hear that they have inconsistent errors now this is a tricky one because in regular everyday life they might not have those inconsistent errors because they’re using the same words that they’ve sort of practiced and gotten used to over and over again so where you’re going to see those inconsistencies is if you have them repeat a word maybe a new word that they don’t often use if you’re going to have them repeat that word over and over again, which is something that happens in the speech evaluation we have them repeat the words over and over again a child with a severe phonological disorder will just say the word over and over again with the error.
OK but they’re going to say it over and over again the same way with the same error over and over again the child with apraxia is going to say it but with a slightly different error every time so you’re not really listening for those inconsistencies in everyday life you’re listening for them in repeat what we call in speech therapy repeated trials.
Let’s see have I missed anything? I wanted to make sure that I covered vowels. They have a lot of errors in vowel sounds and of course one of the hallmarks of apraxia is groping. So what does that mean the child will sort of move their mouth around trying to figure out where exactly there articulators again their mouth their tongue their lips where exactly they should be placed for producing the word accurately.
So again I hope this helps and I hope that parents you know when they go out and get a diagnosis either for a phonological disorder or apraxia of speech that they go and they ask their speech therapist well what are the characteristics that you’re seeing that make it this versus that, OK ask for that differential diagnosis because again there are very specific and different treatment strategies that work for each one and if you end up getting misdiagnosed and going down that path of treatment that is for an incorrect diagnosis it won’t work as well it won’t work as effectively it won’t be as effective in a timely manner you might spend a lot more time in treatment where you didn’t need to because you got a misdiagnosis because you’re treating that you know a disorder that is not the true one that your child has.
So if you have any questions just let us know and we are happy to help thank you.
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