Not only is May Better Hearing and Speech Month, but it is also Apraxia Awareness Month. Apraxia of Speech is a diagnosis that can affect both children and adults. There are two different types of Apraxia: Childhood Apraxia of Speech (CAS) and Acquired Apraxia of Speech (AOS) which affects adults. Both diagnoses and their differences will be outlined in this article.
Childhood Apraxia of Speech
According to the American Speech and Hearing Association,
“Childhood Apraxia of Speech, or CAS, is a neurological pediatric speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g. abnormal reflexes, abnormal tone). CAS may occur as a result of a known neurological impairment, in association with complex neurobehavioral disorders of known and unknown origin, or as an idiopathic neurogenic speech sound disorder. The core impairment in planning and/or programming spatiotemporal parameters of movement sequences results in errors in speech sound production and prosody” (ASHA, 2007b).
CAS occurs in every 1-2 children per 1,000 and is estimated to be more prevalent in males than females with a 2-3:1 ratio (Shriberg et al., 1997; Hall, Jordan, & Robinson, 1993). Children with CAS have a higher likelihood of having comorbid language, reading, and spelling disorders (Lewis et al., 2004). Unlike Acquired Apraxia of Speech, CAS is not the result of a brain injury or neurological infarct. CAS is a congenital disorder that is not apparent until children begin speaking or combining words. The major signs/symptoms of CAS are articulatory groping (mouth/face seem to be “searching” for how to produce the words/sounds), speech sound distortions, difficulty with smooth transitions between sounds and words, difficulty with longer, multisyllabic words, voicing errors, and vowel errors.
CAS cannot be treated in the same way a speech sound disorder is treated. Children with CAS benefit from an increased frequency of therapy sessions in short durations rather than long durations of therapy only a few times a week. Therapy targets should also focus on meaningful and functional words as well as motor planning and coordination for sound production rather than “correct” sound productions. In some cases where CAS is severe, Augmentative and Alternative Communication (AAC) devices may be introduced to aid in functional communication. It is important to remember that CAS is a frustrating and difficult disorder for children to have. Being positive and encouraging can make the biggest impact!
Acquired Apraxia of Speech
Acquired Apraxia of Speech (AOS) is defined by ASHA as: “a neurologic speech disorder that reflects an impaired capacity to plan or program sensorimotor commands necessary for directing movements that result in phonetically and prosodically normal speech” (Duffy, 2013). AOS is the result of a brain injury or neurological infarct such as a stroke. AOS often cooccurs with Aphasia in adults post neurologic events. The major signs/symptoms of AOS include sound distortions, reduced rate of speech, syllable segmentation, poor sequencing, and lack of stress or prosody in speech. Unlike in CAS where treatment is habilitative, AOS treatment is focused on rehabilitation and increasing patient independence. AAC devices may be introduced in the adult population, as well. Environmental modifications and consistent speech therapy are also beneficial for those with AOS.
Whether your loved one is diagnosed with CAS or AOS, a family-centered treatment plan is always considered most important. Having a strong support system around children and adults with this diagnosis is always beneficial.
If you or a loved one have been diagnosed with CAS/AOS, reach out to SPGCT to get more information about us and to schedule an evaluation to begin speech-language therapy services today.