Apraxia of Speech

What is Apraxia of Speech?

As stated above, apraxia of speech is a neurological condition which impacts a person’s ability to talk. They have the language ability and know what they want to say. Yes the signals between the brain and muscles are not working correctly. So the person (and their brain) knows what they want to say but the motor planning is working incorrectly. This is why apraxia of speech is considered a motor planning disorder. What does this look like in a person who has apraxia of speech? They often have difficulty coordinating movements in their mouth, tongue or lips to make the sounds into syllables, syllables into words, and words into phrases. They have a very difficult time communicating because  making the coherent sounds and sentences they know they can make just won’t come out correctly. This is very difficult and frustrating for the person trying to speak and very difficult to understand for the listener.

Different Types of Apraxia

There are two different types of Apraxia of speech: Childhood Apraxia of Speech: there are children who are born with apraxia for no known reason. They may develop normally in every other area like gross or fine motor as well as having appropriate communication milestones. Yet when they try to speak, it is very difficult to understand them. Acquired Apraxia of Speech: A person of any age can acquire apraxia – from children to adults. It is caused by damage to the part of the brain that is involved in speech motor planning . It will not affect a persons language abilities like vocabulary or grammar , but the way they sound will distorted depending on the severity of their apraxia. Therapy for apraxia of speech in adults may be similar to therapy for children.

Apraxia and Other Communication Disorders

Apraxia of speech in adults or childhood apraxia of speech may be confused with other communication disorder or conditions since the signs or symptoms may be similar and the fact that there is not much education or accurate information on it. Here are other Disorders and how they compare to apraxia: Speech Delay in Children: Childhood apraxia of speech may be mistaken with speech delay. A delay is when a child follows the typical development but at a slower than normal rate than other kids their age. Sometimes a child with a delay will outgrow it on their own but children with apraxia do not outgrow it and will often not make professs or improvements without specific types of speech therapy. There is more information about speech delays here. Articulation / Phonological Disorders: A child with this speech disorder will have trouble making specific sounds or have an issue with parts of a work (like dropping the final sound of words). Yet they have no issue with the planning or coordination of the movements needed to speak.  This is one of the most often misdiagnosed Disorders with apraxia. You can read about getting a critical differential diagnosis of apraxia of speech and a phonological disorder here. Dysarthria: Dysarthria is another motor speech disorder but is different in that it stems from a weakness or difficulty controlling the speech muscles. People with dysarthria might sound hoarsely have a soft, strained voice, or slurred or slow speech. People with dysarthria might also have a hard time smiling or puckering their lips while people with apraxia of speech (not oral apraxia) won’t have difficulty with these non speech movements of their mouth. Aphasia: People with Aphasia have a language disorder that impacts their ability to understand and use language (vocabulary, grammar etc) and can also affect the ability to read and write. This is not a speech disorder which is defined as how we sound when we talk. A person which aphasia may it know which word to use when they see a common object. Aphasia cam be the result of damage to the brain involved in language, for example a stroke or traumatic head injury. There are different types of aphasia you can read about here. 

Is Apraxia of Speech Common?

Apraxia is usually thought of as a rare disorder. Apraxia Kids, which is an excellent resource for the disorder, has reported that childhood apraxia of speech shows up in about 1 in 1,000 children. There could be a higher number of kids being diagnosed with the speech disorder for several reasons including :

• More people and parents are aware of childhood apraxia of speech.
• There is more research being done on apraxia. Dr. Edythe Strand provides for very reliable information on the disorder.

What Will a Person with Apraxia Sound Like?

People with any disorder will present differently and symptoms vary as well as severity.Sometimes a person with apraxia of speech will have mild symptoms so they would only have an issue with a few speech sounds or sound like they have a hard time with pronouncing multi-syllable words. If a person has more severe symptoms they may not be able to coherently produce more than a handful of words. People with apraxia often present with some or all of the symptoms below: Inconsistent Speech Errors: An adult with apraxia or a child may say the same word over and over but it sounds differently each time. They may be able to say a common word correctly one day but have difficulty the next day. This is a great way to  separate it out or get a differential diagnosis from an articulation or phonological disorder in which the errors are consistent. Sounds are Distorted:  Parts of the mouth are not correctly positioned when someone has apraxia of speech so the sounds come out sounding incorrect. Any vowel sounds may be especially hard to pronounce correctly. As words are longer and more complex, the distortions increase as well. Groping for Sounds: People who have apraxia might be observed as “groping” for the sounds  or words they are trying to say. They might seem like they are attempting to place their mouth in the right place. People might try to say a word a few times in an attempt to get it right. This does not happen in children with an articulation disorder. Intonation, Stress, Rhythm of Words is Incorrect: Those who have apraxia might break up syllables in a word, delete syllables in words and phrases, or pause while speaking in unnatural moments. The flow of speech just sounds off. Parents can also look for other signs and symptoms of apraxia that their child might have presented with when younger. This is great information to provide to a speech therapist during the intake process when providing history on speech or language development.

• A child develops first words/sounds later than typical
• Not much babbling as a baby
• Regression in the number of words used
• Use of automatic words/phrases like “bye-bye” or “thank you” sound ok but new words or voluntary speech is incorrect

According to the Mayo Clinic, apraxia in children has also been associated with other problems or complications that affect their ability to communicate. While these are not due to childhood apraxia of speech, in many cases they’ve been observed alongside apraxia, including: Delayed language development, such as difficulty understanding speech, having a reduced vocabulary, or using incorrect or inconsistent grammar when stringing words together in sentences and phrases. In addition, they may have difficulty with:

• Delays in reading, spelling, or writing.
• Difficulties with gross and fine motor skills and coordination.
• Hypersensitivity, in which your child may not like certain textures in clothing or food, or may not like brushing their teeth.

What Causes Apraxia of Speech?

In many cases, the exact cause of childhood apraxia is still unknown. Some researchers believe that apraxia may be related to a child’s language development, while others believe it has to do with problems in how the brain signals to speech muscles. Possible causes that researchers are still studying include:

• Abnormalities in the brain and other parts of the nervous system.
• Genetic factors can play a role. The condition could run in families, and many children with apraxia have a family member with a communication disorder or a learning disability.
• Other disorders your child may have, including: cerebral palsy, autism, epilepsy.

Acquired apraxia of speech, which often happens to adults, is when the part of the brain that controls coordinated muscle movement is damaged. Stroke is a common cause of apraxia. It may also be caused by head injury, brain tumors, dementia, or progressive neurological disorders.

How is Apraxia Diagnosed?

A speech-language pathologist (SLP), more commonly referred to as a speech therapist, is the most qualified professional to diagnose and treat apraxia. This begins with a comprehensive evaluation of your child’s condition. Childhood apraxia of speech is a very complex disorder and difficult to diagnose. Because there is no single symptom or test used to diagnose apraxia, your speech therapist will look for the presence of a group of symptoms, and work to rule out other possible conditions that may sometimes be confused with apraxia (such as those referenced above). This is an important step that can help confirm the diagnosis so your speech therapist can tailor treatment goals based on their individual needs. Your speech therapist will most likely evaluate a variety of factors, including your child’s speech skills, medical history, their use of expressive language (how they use words, sentences, and gestures to convey messages to others), and their receptive language (how they understand the words, sentences and meaning of what others say or what they read). They will also collect information about your family history, and how you’ve observed your child communicating at home and in other situations. In some cases, your speech therapist will perform a language test on your child. They may ask them to repeat a word several times, or repeat a list of words increasing in length.

What Does Speech Therapy for Apraxia of Speech Look Like?

As mentioned, children with apraxia will not outgrow it on their own, nor will they acquire the basics of speech by being around their peers. Apraxia often requires frequent, intensive, one-on-one speech-language therapy sessions, with lots of repetitive exercises and personal attention. Once your speech therapists better understands your child’s condition, they will design a treatment plan tailored to your child’s individual needs and speech abilities. Oftentimes, treatment may go on for years in addition to normal schooling. Many with childhood apraxia of speech benefit from:

• Practicing the repetition of sounds, words and phrases.
• Being shown visually how speech sounds are made by combining sounds into words.
• Having a child say a word at the same time as the speech therapist or parent/caregiver.

For adults, the apraxia of speech therapy works similarly. However, some people with acquired apraxia of speech do recover on their own. This is called spontaneous recovery. Just as individual symptoms vary, so does progress. What works for one child or adult may not work for another, and each person progresses at their own pace. As a parent, caregiver, or friend, one of the most important things you can do is be a constant source of encouragement and routinely practice at home. In severe cases, adults and children with apraxia of speech may need to find alternative ways for communicating and expressing their thoughts. These methods can include:

• The use of sign language.
• Using a notebook with pictures or written words.
• An alternative or augmentative communication device, such as a communication board or a portable tablet that writes and produces speech.

These assistive tools may not need to be used long-term. However, using these modes of communication while simultaneously working with your speech therapist can help promote speech production and verbal skills while also decreasing any frustration a person may be experiencing communicating.

Tips to Help Parents Support and Manage Their Child’s Apraxia

One of the most effective tools children have to manage their apraxia is you – their parents. Numerous studies show parents play an essential role in helping their child reach their speech and language goals. Parents spend the most time with their child, and there’s many simple techniques and exercises you can do everyday to help your child. While we’ve provided a few tips below, be sure your speech therapist empowers you with the tools and knowledge to take an active role in your child’s progress.

• Try not to pressure your child to speak if they’re uncomfortable or unwilling.
• Be patient when your child does want to speak and give them plenty of time to communicate.
• Use positive reinforcement, and try to be as supportive and encouraging as possible.
• Establish a topic, such as “what’s for dinner,” so you both know what you’re talking about.
• If you’re having difficulty understanding, ask simple, yes-or-no questions to clarify what you’ve heard is correct. Focus on the parts of the message that may still be unclear.
• Remember that kids with apraxia of speech and other communication issues may have sensory issues that they need to monitor and manage
• Remember that parents also need to take care of themselves; take time out and know that with consistency, your child can improve.

How Can Therapy Works Together Evaluate and Treat All Ages Online?

Therapy Works  Together helps families connect online with a licensed and certified speech therapist that is a trained expert in diagnosing and treating a variety of speech, language and communication issues. Speech therapy is delivered online at home with video conferencing applications. The age of our clients as well as their diagnosis and goals is important in determining how speech therapy online will be delivered. Speech therapy for babies and toddlers: For kids age 0-3, we usually work on early communication skills like joint attention, social communication, or increasing language skills in late talking toddlers. Parents work with their assigned speech language pathologist, usually in a parent coaching model, to learn tips and strategies that speech therapists use so they can be adept at practicing teaching their child after the session is over and at home. You can read more here about how important it is for parents to be involved in their child’s speech therapy at home. Speech therapy for preschoolers: For kids age 3-6, speech therapists target age appropriate articulation, language delays, reading readiness and more. Parents join in for online video sessions with the child so that both learn the speech strategies and skills from the speech therapist. Learning how to use these skills after the session helps kids improve. Speech therapy for school age kids: for children age 7 and up, speech therapists might work on academic skills, increasing vocabulary, social skills for kids with autism, stuttering and more. Children this age can come to online video sessions on their own. Our speech therapists keep parents informed by sharing tips and homework. Speech therapy for adults: Adults attend speech therapy sessions online after becoming stroke patients, for stuttering, for accent modification and more. They come to sessions on their own from the comfort of their home or office. Often, they bring a caregiver or family members to learn strategies if they will need help communicating with others.