Sunday, October 16, 2011

Early Warning Signs of Childhood Apraxia of Speech

Childhood Apraxia of Speech (often abbreviated as CAS) is a somewhat rare speech disorder. It is estimated that 1 in 1,000 children will be diagnosed with apraxia. In comparison, 1 in 150 will be diagnosed with an Autism Spectrum Disorder. Many parents, and indeed doctors, are not aware of what apraxia is, and thus the early warning signs may go unnoticed. Like many other neurological disorders, early treatment is the key to helping your child overcome the difficulties this speech disorder can present.

In medical terms, Childhood Apraxia of Speech is a motor-planning disorder that is characterized by difficulty sequencing the speech movements necessary for volitional speech. In layman's terms, the messages sent by the brain to the muscles and nerves that control voluntary speech get scrambled and the muscles and nerves can't decode them to understand what to do. This is not a speech delay, but a true neurological disorder. It is unclear what causes apraxia, but it appears to be related to immature neurological development, rather than caused by an injury to the brain, such as is seen in stroke patients with apraxia. Though it has been named "childhood" apraxia of speech, it is not strictly a childhood disease. A child diagnosed with apraxia will struggle their entire lives with their speech, though it will probably get easier to speak as they get older.

Many children with Autism, Down Syndrome, and Cerebral Palsy have been diagnosed with CAS, though apraxia does appear in children who have no other disabilities. Common co-morbid conditions include hypotonia (low muscle tone), sensory integrations problems, and language delay. Many older children with apraxia have trouble with reading, writing, and spelling. Because of this, early intervention with speech therapy and occupational therapy is very important for a child's future at school.

While there are some warning signs that are commonly seen in apraxic children, many parents are told by well meaning friends, family, and even pediatricians to "just wait and see." If your child shows several of the warning signs listed below, don't take the wait it out approach. As your pediatrician to refer you to a speech-language pathologist for an evaluation. Early detection and intervention is key for a bright future for your apraxia child. If your child is older and has speech problems, it's never too late to get them evaluated.

Early warning signs:

  • little or no babbling during infancy
  • difficulty with nursing or feeding during infancy
  • few consonants
  • slow, effortful or halting speech
  • poor speech intelligibility
  • difficulty imitating sounds or words
  • late onset of first words (or "losing" words)
  • inconsistent or unpredictable speech errors
  • groping during speech attempts
  • high frequency of vowel and voicing errors
  • high receptive language, but low or no expressive language (child understand everything being said, but can't say anything back)
  • "soft" neurological signs, such as sensory problems, sensitivity to touch, fine motor problems
  • slow or no progress with traditional speech therapy (apraxic kids benefit from specialized, intensive therapy that isn't necessarily know by all speech-language pathologists)

As the mother of a severely apraxic child, I understand the fear that hearing such a diagnosis can bring. My son is not on the spectrum, nor does he have any other disability (well, he does have minor sensory issues and minor hypotonia). Unless you hear him talk, you would never know that he can't talk. My first thought upon hearing the diagnosis was "Will he ever speak?" You are probably wondering the same thing about your recently diagnosed child. The answer is yes, more than likely your child will speak, especially with early intervention. You child may not speak "normally," he may need to use ASL (as mine does) or a communication device, but he will be able to communicate and lead a pretty typical life. The most important thing a parent can do is recognize the early warnings signs, push your pediatrician or other professional for help, and get involved in your child's treatment. With hard work, and possibly years of therapy, most people will never even know that your child has childhood apraxia of speech.

When my son was diagnosed with Apraxia, he was also diagnosed with Sensory Processing Disorder. I found that having a variety of fidget toys on hand helps his attention and focus tremendously. I've reviewed a variety of sensory toys to help others pick the best fidgets for their kids.

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