Apraxia Monday: Chapter 1

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By Leslie Lindsay

Welcome to the first installment of a series of excerpts of forthcoming, “Speaking of Apraxia: A Parent’s Guide to Childhood Apraxia of Speech” (Woodbine House, March 2012).  Here we begin at the beginning: chapter one.  You may have some suspicions that your child isn’t talking like he or she should; maybe you’ve heard of apraxia (CAS), but you just aren’t sure if that is why your little punkin isn’t chatting like all of the other children.

Consider these scenarios:

“Sarah, age 2, was a puzzle to her parents. She was obviously quite bright and alert. She knew the names of all the birds in her Big Book of Birds and would point to the cardinal, chickadee, etc. when asked. But she struggled to say even the simplest words.”

Jake was an active three-year-old who loved cause and effect, an engineer in the making.  He appeared to be a typically-developing child, with one exception: he was not talking. His grandmother kept saying, “Boys are late to talk–don’t worry.” But his parents were concerned. Could something else be going on?”

Do these stories sound familiar? Does your child remind you of  Sarah or Jake? If so, your child could have Childhood Apraxia of Speech (CAS).

I’ll admit, when I first heard of Childhood Apraxia of Speech, I was totally stumped. We hadn’t covered this in nursing school! So what is CAS, anyway? Like you, I had a ton of questions and concerns and little time to learn about it. But most of all—my child needed help. You may be feeling the same way.

Here’s some nitty-gritty details about CAS that may help steer you in the right direction for getting a diagnosis.  Remember, you need a qualifed speech-language pathologist (SLP) to make the diagnosis and provide treatment.

CAS is best defined by what it is not. Historically, it’s been one of the most debated disorders in the field of speech-language pathology. It took practitioners quite some time to find an easy, agreed-upon definition, list of symptoms, cause, and treatment. But they did!

The American Speech & Hearing Association (ASHA) offers the following 2007 definition of CAS*:

“A neurological childhood (pediatric) speech sound disorder in which precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits.”

Let’s break this down even more:

  • Neurological refers to the nervous system (brain and spinal cord to start with).
  • Childhood/pediatric generally refers to the ages of birth to adolescence.
  • Precision and consistency refer to the accuracy of speech sounds each and every time they are spoken.  
  • Movements underlying speech refers to the movements of the articulators (lips, jaw, tongue, soft palate, hard palate) in smooth, sequential, and overlapping gestures necessary for intelligible speech.
  •  The oral structures of the mouth are tongue, lips, jaw, and palate.
  • Neuromuscular deficits are things like abnormal reflexes and weakness and incoordination of the muscles that are controlled by the brain to produce speech movements.

In plain language, kids who have been diagnosed with “pure” CAS have completely normal facial tone and musculature. Their reflexes are typically normal, yet they still can’t coordinate their internal thoughts, shape them into verbal communication, and produce it in a manner we can all understand. (“Pure” refers to the fact that these children have no other diagnosis-able neuro-developmental conditions; they are struggling with only CAS).

Next week:  Chapter 2–All About Speech

You may also appreciate these artices, “Imagine Being a Parent of a Child with Apraxia of Speech” www.nspt4kids.com/therapy/imagine-being-a-parent-of-a-child-with-apraxia-of-speech-cas/

Or, “Speech-based Activities You Can do With Your Child with CAS,” www.specialneeds.com/children-and-parents/speech-or-communication-impairment/speech-based-activities-kids

For more information & additional resources on apraxia (CAS), see Apraxia-Kids at www.apraxia-kids.org

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