Apraxia of Speech

In normal speech, the brain sends signals to the muscles in a person’s mouth (the lips, jaw, and tongue) in order to make accurate sounds and speak with normal speed and rhythm.

Apraxia is a neurological condition that disrupts this process. The person often has the language capacity to talk, but these signals between the brain and muscles are not sent correctly.

In other words, the brain knows what it wants to say, but cannot properly plan the required speech sound movements.

As a result, people with apraxia have difficulty coordinating the mouth movements needed to turn sounds into syllables, syllables into words, and words into phrases. It is often hard for people to communicate and formulate coherent sounds and sentences. Most commonly, people with apraxia are described as “difficult to understand”.

Apraxia of speech can be broken into two categories:

• Childhood Apraxia of Speech: Children with apraxia are born with the condition. For children with apraxia, the difficulty in planning speech movements is the hallmark of the condition. In fact, the root of the word, “praxis,” means “planned movement.”
• Acquired Apraxia of Speech: This can affect people at all ages, although it most commonly occurs in adults. Acquired apraxia is caused by damage to the parts of the brain that are involved in speaking, and it often involves the loss or impairment of existing speech abilities.

Apraxia often gets confused or mislabeled with other conditions. To truly understand what apraxia is, it’s important you understand what apraxia is not. Here are a few common misconceptions:

• Developmental Speech Delay: Childhood apraxia can often be confused with delay in speech, in which a child follows a “typical” path of speech development but at a much slower rate than normal. While many children may outgrow a speech delay, this is not the case for apraxia. Children with apraxia often will not make progress without treatment. You can find more information about speech delays here.
• Articulation and Phonological Disorders: A child who has trouble learning how to make specific sounds, but doesn't have trouble planning or coordinating the movements to speak, may have an articulation or phonological disorder.
• Dysarthria: Dysarthria is a seperate motor speech disorder characterized as a weakness or inability to control the speech muscles. People with dysarthria may have a hoarse, soft or even strained voice, or slurred or slow speech. While rare, some people can have both dysarthria and apraxia.
• Aphasia: Aphasia is a language disorder that affects the production and comprehension of speech, as well as the ability to read and write. Aphasia is the result of damage to portions of the brain involved in language - most often from a stroke or head injury.

Research is lacking on the prevalence of apraxia. According to Apraxia Kids, some estimates show that childhood apraxia of speech affects approximately 1 in 1,000 children. Other sources have indicated that the incidence of childhood apraxia may have increased in recent years.

Some factors that may be influencing the rise in diagnoses include:

• Increased awareness of childhood apraxia of speech.
• An increase in research being done on apraxia.
• More children being evaluated for apraxia at an earlier age.

Every person is different, and symptoms can vary pretty dramatically.

In some cases, it can be so mild that the person only has difficulty with a few speech sounds or is unable to pronounce multi-syllable words. In more severe cases, a person may not be able to communicate effectively by speaking.

However, people with apraxia often have some of the following symptoms or speech characteristics, including:

• Inconsistent Errors in Speech: A child with apraxia may pronounce the same word differently each time they say it. For example, one day they may say a difficult word correctly, but then soon after have trouble repeating it.
• Distorting Sounds: Because people with apraxia do not place the speech muscles in the right places, sounds often come out incorrectly. Pronouncing vowels can be especially difficult, as well as longer and more complex words.
• Groping for Sounds: People with apraxia can seem like they’re “groping” for words. They may try saying a word several times before they say it correctly.
• Inappropriate Intonation, Stress, or Rhythm of Words: Individuals may struggle with the rhythm and flow of speech. They may segment syllables in a word, omit syllables in words and phrases altogether, or pause inappropriately while speaking.

Some additional signs and symptoms parents should look for associated with childhood apraxia of speech include:

• Your child develops their first words or sounds later than typical.
• Limited babbling in children.
• Excessive movements of the mouth.
• Persistent or frequent regression in the number of words produced.
• They may use automatic words or phrases correctly (such as "hello" and "thank you") but have difficulty with voluntary speech.
• Errors in the order of sound production in words. This can include omitting, switching, or adding the sounds of words.

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.
• 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.

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 that may play a role. The condition may 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, or galactosemia.

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.

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 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.

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 children 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 with acquired apraxia, treatment 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.

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.

Expressable matches families with a certified speech therapist trained to effectively evaluate and treat apraxia. All therapy is delivered online via face-to-face video conferencing.

Your child’s age and development will influence how your speech therapist interacts with them through these video chat capabilities.

Ages 0-3: Parents work directly with their speech therapist to learn cues and at-home strategies so they can confidently practice with their child outside the session and improve their communication. For more information on the importance of parental involvement in their child’s speech therapy, click here.

Ages 3-6: Parents attend video sessions alongside their child so they both learn valuable skills from their speech therapist. Reinforcing these lessons outside the session will continue to promote at-home skill building.

Ages 7 and Up: Most children attend video sessions independently but parents are kept in the loop with updates and tips during each session.

Adults: Adults attend sessions by themselves, but are welcome to bring loved ones or family members as well.