Also known as CAS, childhood apraxia of speech is a motor speech disorder that can sometimes accompany autism. Children with apraxia often exhibit different symptoms since the brain of each child has different strengths and weaknesses that correspond to movements made by the mouth, lips, jaw, and tongue. Speech therapy can help children with apraxia of speech or apraxia and autism.
In this article we will discuss:
What is apraxia of speech in children?
The brain sends messages that are meant to tell the mouth and related structures how to move in order to make specific sounds, but when a child has apraxia, the brain has difficulty communicating with the muscles that control speech.
Sometimes children with apraxia are not able to move muscles that control vocalization correctly – and this makes it very difficult to create and modulate the sounds that form words. This can occur even when the muscles in the mouth area have sufficient strength. In addition, it happens even though children know what they want to say.
CAS is a motor speech disorder, not a thinking problem. Children with apraxia of speech often make inconsistent errors when they speak. Their inflection, tone, and speech rhythm might not sound right, and their speech sounds may seem distorted.
Get professional treatment for apraxia of speech
Signs and symptoms of apraxia in children
Signs of childhood apraxia may become evident as a child grows.
Common symptoms in very young children:
Babies may not coo or babble as expected
First words may be late
Some sounds may be missing from the first words the child says
The child may have difficulty eating
The child may be able to make just a few different sounds including a limited number of consonants and some vowels
As the child gradually learns to speak, difficult sounds may be swapped with easier ones or left out altogether
Common symptoms in older children:
May understand what others are saying while having difficulty speaking, themselves
Might make mistakes with speech sounds, but not, in the same way young children do
May make different speech sound errors instead of showing consistency in speech errors
Speech may be choppy, or the wrong words/syllables might be stressed during speech
Voice inflection may not go up and down
May have difficulty imitating speech, but may still find this easier than speaking on their own
May appear to have difficulty moving the mouth, jaw, lips, and tongue in a coordinated way when attempting to speak or make specific sounds
Might be very difficult to understand, particularly for newcomers
May choose short words and phrases instead of opting for longer words and sentences that are harder to say
The child may have even more difficulty speaking when anxious
Other signs of childhood apraxia of speech
There are some other signs that can indicate that CAS is present:
The child may forget words they have learned, or they might say words in the incorrect order
Children with CAS may have difficulty learning to do language-based tasks like reading, writing, or spelling
The child might show some difficulty with fine motor movements
In addition, the child’s mouth might be over- or under-sensitive, i.e. they might have an aversion to certain foods that cause intense sensations (crunchy or very cold items, for example). When this type of sensitivity is present, they might feel discomfort when brushing their teeth, and avoid this activity as a result.
Are apraxia and autism related?
Researchers at Penn State Milton S Hershey Medical Center report that there is often a connection between apraxia and autism.
A three-year study that was published in the Journal of Developmental and Behavioral Pediatrics showed that of the children participating, 63.6 percent (almost two-thirds) of those with autism diagnoses were also affected by apraxia.
Researchers used the Checklist for Autism Spectrum Disorder (CASD) during their work. They noted that CASD did not over-diagnose autism in children with apraxia.
Cheryl Tierney, associate professor of pediatrics, led the team that conducted the study. “CASD is used to diagnose autism, but it can also be used to rule out autism,” she says. “We wanted to make sure this tool came out negative in a child that just had apraxia and we found that it really does help us distinguish kids accurately.”
At the study’s conclusion, Tierney and her team noted the importance of monitoring all children diagnosed with apraxia for signs of autism as well, and vice-versa. This tactic can help identify children -particularly those who are non-verbal – in each category early on in their development. Working with a speech pathologist from an early age can make a major difference in the success of pediatric speech therapy.
Apraxia can be misdiagnosed
Because autism spectrum disorder (ASD) is a highly complex condition that encompasses a number of behavioral signs that might or might not include apraxia or other speech and language problems, misdiagnoses can and do occur.
In some cases, kids with apraxia are misdiagnosed with ASD, as their articulatory and phonological abilities can be severe. In other cases, children with phonological difficulties are misdiagnosed with ASD when in fact, they are not on the autism spectrum.
Even though it can be challenging to transcribe and analyze data when speech is unintelligible, a correct diagnosis is vital. Speech-language pathology experts stress the fact that not all children are the same, and that children with difficulty speaking should be tested for apraxia and autism as well as other underlying conditions that can cause speech impairment. Genetic disorders and syndromes, traumatic brain injuries, strokes, and hearing loss are sometimes present.
A qualified speech-language pathologist can test your child’s speech and language by checking your child’s ability to say speech sounds by themselves and combined with other syllables and words. In addition, the speech pathologist will determine how your child’s speech is perceived and understood by listeners.
How to treat apraxia of speech in autistic children
Speech therapy for kids with apraxia focuses on increasing both intelligibility and speech production; or teaching alternate methods of communication such as manual signs, gestures, context-specific communication boards, and voice output devices when necessary.
In-office and online speech therapy typically use a variety of approaches to improve speech production:
Motor programming, which focuses on repeating speech movements so that the child learns how to make different sounds and sound sequences with accuracy and consistency, with the goal of acquiring the skill needed to make these sounds and sequences automatically.
Shaping and toning muscles to help your child speak more accurately.
Linguistic approaches that teach children the rules for using specific sounds and speech sound sequences in language
Sensory cueing approaches that incorporate touch, hearing, sight, and proprioception to provide feedback that helps children learn specific movement sequences used in creating speech.
DTTC, or dynamic temporal and tactile cueing, essentially “Watch, listen, and do what I do.” DTTC begins with direct imitation, with input from the speech pathologist decreasing as the child achieves success.
Rhythmic approaches that focus on teaching melody, stress, and rhythm for creating intonation patterns that improve speech production
Most children respond best to a combined approach that takes all relevant factors into account. Your child’s speech pathologist will work toward improving verbal speech production and communication, with the goal of helping them achieve the best possible outcome in terms of comprehensibility and intelligibility. Autism and speech therapy often go hand in hand, especially if apraxia is involved!
More ways to help children with autism and apraxia learn language
Many children with autism spectrum disorder (ASD) find it harder to learn and use language than their typically developing peers do. Which is why autism and speech therapy are so commonly related. This happens because during their first year of life, children with ASD are more focused on things happening around them than they are on other people. This reduces their ability to develop crucial language skills from the very start.
Your child’s speech pathologist can help you with:
Playing games that encourage speech
Modelling language, including speaking, gestures, and facial expressions
Practicing essential language skills such as greeting others
Rewarding your child appropriately when they use language or express themselves in another way
Children with apraxia and autism may need help learning how to:
Understand what others are saying
Use expressive language that includes a combination of words and gestures
Use both expressive and receptive language skills in ways that are socially appropriate
Other disciplines can be extremely helpful to children with autism and apraxia. Along with speech therapy, occupational therapy can be helpful, as well as physical therapy in some cases and many more.
Speech therapy for kids can help your child learn how and when to communicate, and eventually, how to participate in conversations.
Speech therapy for autism at home
Many parents wonder if it’s possible to get speech therapy for autism at home. The answer is a resounding “yes” – in fact most children respond better to speech therapy when they are in comfortable, familiar surroundings.
The earlier you seek help for a child who may have apraxia and autism, the better. ASD is usually evident before children reach the age of three, and language delays can often be recognized even earlier – by the age of 18 months in many cases.
Speech therapy always has the potential to create an impact, but the earlier apraxia treatment begins, the sooner the child can begin to reap the benefits including reduced isolation, better communication skills, a stronger ability to form meaningful relationships with others, and greater ease in daily functioning as time passes.
In many cases, online speech therapy can have an incredible impact. Many techniques are easily adapted to online learning, and with help, children with apraxia and autism can learn how to develop conversational skills, articulate their words, communicate verbally as well as non-verbally, and benefit in many other ways. Even the simple act of communicating with peers and playing with other children can become easier when online speech therapy is utilized.
Whether your child receives speech therapy for autism at home or in a professional setting, you will find that family plays a leading role in practicing what’s learned during the sessions. The more repetition and the more interaction your child has, the better.
Regular visits with a speech pathologist can make a life-changing difference for children with apraxia and autism. With consistent speech therapy, it is often possible for children to gain the ability to communicate with peers, parents, family members, and teachers.
Speech-language pathology services might be available in your local area with a referral from your child’s physician. There is another option, though, which is convenient for everyone, particularly in areas where it might be difficult to access local help. Online speech therapy is available everywhere, on-demand from Better Speech. We often find children feel more relaxed from the comfort of their own, and treatment is effective and convenient.
Ready to learn more about how online speech therapy can help your child? Offering experienced, licensed, accredited speech therapists at a time that works for your schedule, wherever you may be, Better Speech offers professional online speech therapy for children with apraxia and autism, and more. At Better Speech, we offer online speech therapy services convenient for you and tailored to your child's individual needs. Our services are affordable and effective - get Better Speech now.
Frequently Asked Questions
Is apraxia associated with autism?
Apraxia is not always associated with autism, but it is possible for a child with autism to have childhood apraxia of speech. It has been observed that childhood apraxia of speech will sometimes accompany an autism diagnosis, though the reason for this is unknown. There is a high prevalence of dual diagnosis, even though they can exist independently of one another.
Can a child have apraxia and not be autistic?
About the Author
Cheri Gipson
I am a speech-language pathologist who specializes in language skills and pronunciation. I obtained my Master’s of Science degree in Speech-Language Pathology from Western Illinois University and I have worked in the field of speech pathology for over 20 years. One of the things I enjoy most is helping people learn.
In my spare time, I enjoy writing tips on how to improve online teaching for both the larger language schools and also as a private ESL teacher. Teaching is my passion, and I love seeing students make progress. Every day is a new adventure, and I am grateful for the opportunity to help people learn and grow!
