What is Apraxia of Speech? 

Apraxia of speech is an uncommon speech impairment in which it is difficult to move the mouth correctly to produce sounds and words. Speech pathologists frequently provide therapy to people with apraxia to help them improve their speech. The brain struggles to coordinate mouth, lips, jaw, and tongue movements in those with apraxia. Though they understand what they want to say, people with apraxia have difficulty pronouncing sounds, syllables, and words. This condition is typically noticed during a child’s early language development but can persist into adulthood, often caused by brain injuries or dementia in adults. Apraxia of speech goes by other names like dyspraxia, developmental verbal dyspraxia (DVD), or childhood apraxia of speech (CAS). Understanding these basics helps in recognizing and addressing this speech challenge.

Types and Causes of Apraxia of Speech

There are two main types of AOS: acquired apraxia of speech and childhood apraxia of speech.

1: Acquired Apraxia of Speech (AOS)

Acquired AOS can happen to anyone, but it usually affects adults. It occurs when there’s damage to the parts of the brain responsible for speaking, leading to the loss or difficulty in using existing speech skills. Causes include strokes, head injuries, tumours, or other illnesses affecting the brain. Acquired AOS might coexist with conditions like dysarthria or aphasia, a language disorder. Aphasia can impact how a person understands or expresses words. Understanding and treating acquired AOS often involves addressing the broader effects of brain damage.

2: Childhood Apraxia of Speech (COS)

Childhood AOS, also called developmental apraxia of speech, is present from birth. Unlike children with speech delays, children with AOS struggle with speech despite following a typical developmental path. The causes aren’t fully understood, but studies suggest a possible genetic link, as family members with communication disorders or learning disabilities are often observed—more boys than girls seem to be affected by childhood AOS. Imaging studies haven’t found clear evidence of brain damage in these cases. 

What are the Symptoms of Apraxia of Speech?

People with either form of AOS may exhibit a variety of speech traits or symptoms, including:

Distorting Sounds

Individuals suffering from apraxia of speech (AOS) frequently have trouble with exact pronunciation, particularly when distorting sounds such as vowels. The difficulty in synchronizing speaking structures, such as the tongue and jaw, leads to mistakes in sound production. Longer or more complicated words are more difficult to pronounce, and sound substitutions may occur, especially when AOS is combined with aphasia. The misalignment of speech patterns contributes to sound distortion, a distinguishing hallmark of apraxia of speech.

Inconsistent Errors in Speech

The second and most crucial symptom by which AOS manifests is the occurrence of inconsistent speech errors. Despite successfully pronouncing a challenging word on one occasion, individuals may struggle with its repetition or encounter difficulties with the same sound on another day. This inconsistency in speech production highlights the unpredictable nature of AOS and the varying challenges individuals face with the condition.

Groping for Sounds

A distinct characteristic of AOS is the apparent struggle to find the correct sounds or words during speech. Affected individuals may engage in repeated attempts at articulating a word, experiencing a sense of groping or searching, before successfully producing the desired sound. This behaviour reflects the motor planning difficulties associated with AOS and the effort to coordinate the precise movements necessary for accurate speech.

Errors in Tone, Stress, or Rhythm

AOS commonly involves prosody mistakes, including tone, stress, and rhythm in speech. Individuals may demonstrate faulty prosodic characteristics such as equal stress, divided syllables, deleted syllables, or inappropriate pauses. These departures from usual prosody impact the expression of meaning in speech, leading to the overall communication difficulties faced by people with AOS. AOS is distinguished as a complicated speech disorder by its reduced ability to transmit appropriate pitch and rhythm.

More Signs a Child May Have Apraxia of Speech

Feeding Difficulties as a Baby

Children with apraxia of speech may exhibit challenges with feeding during infancy. This can manifest as difficulties in coordinating the necessary oral movements for sucking, swallowing, and chewing, indicating potential motor coordination issues associated with apraxia.

Limited Babbling

Compared to their peers, children with apraxia may engage in less babbling during the early stages of language development. Babbling serves as a precursor to speech, and a reduction in this behavior may signify difficulties in planning and executing the motor movements required for verbal communication.

Delayed Language Acquisition

Apraxia is distinguished by a slower rate of language development compared to peers of the same age. Children with apraxia may take longer to acquire and express words, demonstrating difficulties coordinating the complex motor movements required for speaking.

Speech Difficulty Understandability

Children with apraxia may be challenging to understand, even within their own families. This difficulty arises from imprecise articulation and coordination issues, hindering the production of clear and intelligible speech.

Visible Struggle in Articulation

An observable sign of apraxia is the child’s struggle to move their lips, tongue, or other articulatory organs when attempting to produce sounds. This physical effort reflects the motor planning difficulties associated with apraxia.

Emphasis Errors in Speech

During speech, children with apraxia may emphasize the incorrect syllables or portions of words. Because it deviates from regular speech patterns, this misplacement of emphasis can contribute to additional challenges in intelligibility.

Sound Substitution in Words

Apraxia can lead to errors such as substituting, omitting, or adding sounds within words. For example, saying ‘umbararella’ instead of ‘umbrella.’ These inconsistencies highlight the challenges in coordinating precise movements for accurate speech production.

Slow Speech Rate

Children with apraxia often speak with others at a much slower speed than their siblings or friends. This reduced speed will increase effort and concentration to execute each speech sound accurately and fluently. 

Difficulty in Forming Words

Speaking of forming proper and accurate words for children who have apraxia, it is a challenging task. The difficulty is synchronizing the numerous muscle movements required for appropriate articulation, which affects overall speech clarity.

Intonation and Stress Challenges 

Apraxia can interfere with a child’s ability to use appropriate intonation and stress in speech. This may manifest as speaking in a monotone or placing stress on the wrong parts of words, further contributing to difficulties in communication and expression.

Diagnosing Apraxia of Speech, What to Expect?

If you suspect someone has apraxia of speech (AOS), speech-language pathologists are experts who can consult for diagnosis and treatment. Because AOS lacks a single distinct symptom, the diagnosis entails looking for various symptoms, such as difficulty saying words correctly. They also rule out other concerns, such as weak muscles or linguistic impairments (such as aphasia). 

Differential diagnosis for apraxia of speech requires careful assessment by a qualified speech-language pathologist who can evaluate the specific characteristics of the individual’s speech and language difficulties and consider relevant medical, developmental, and environmental factors. A comprehensive evaluation may include standardized assessments, speech and language sampling, and consideration of the individual’s developmental history and medical background.

During the testing, the pathologist may ask the person to repeat a word or speak a long list of words. They also assess the individual’s ability to communicate, read, write, and perform other tasks. Diagnosis of AOS in children may take some time, with parents and specialists studying the child’s speech over time. The purpose is to identify and comprehend the difficulties someone may have with their speech. 

Tests May Include

  1. Hearing Test

First and foremost, the doctor will check your child’s hearing to ensure it’s not causing speech issues. They will give them time to speak and assess how they’re talking to them. They’ll use some tests to see if there are any problems with how your child hears sounds.

  1. Oral-motor Test

During the speaking process, a speech expert will look at the lips, tongue, jaw, and palate. They’ll check for structural issues in the affected person, like a tongue tie or a cleft palate. They’ll also look for other concerns, such as low muscle tone, which might indicate different conditions. Although AOS isn’t usually linked to low muscle tone, it can send signals about other issues. The speech expert will observe how your child moves muscles during blowing, smiling, and kissing. This examination helps to identify any physical factors that could be affecting your child’s speech abilities.

  1. Talk Test

The speech expert will check how the affected person talks and makes sounds. They might ask them to say specific words, name pictures, or repeat certain sounds. This helps them see if your child has trouble with specific sounds or words. They’ll also check how smoothly an affected adult speaks and if there’s any rhythm or melody in their speech. They might try speech therapy to see how your child responds and confirm if there’s an issue called AOS

How can Apraxia of Speech be Effectively Addressed/Treated? 

Treatment for apraxia of speech includes working with a speech therapist to learn how to create sounds correctly. It is essential to begin therapy as soon as possible, and regular sessions, especially with an experienced therapist, produce the best outcomes. The need for therapy could decrease over time. There are many treatments available, depending on the age of the person with apraxia of speech. The idea is to teach them how to articulate specific sounds, words, or sentences more clearly. For example, they may learn to close their lips by placing a finger on them and saying the sound ‘p.’ 

Extensive practice is essential for improvement, but it can be demanding and unpleasant, especially for children. Seeking help from a therapist or counsellor may be beneficial. Individuals with apraxia may also benefit from the services of a physiotherapist or occupational therapist. In extreme circumstances, people with apraxia of speech may need to experiment with alternate communication modalities such as sign language, computer use, or pointing to a book. 

Some people’s apraxia of speech (AOS) improves on its own, although not always. Children with AOS do not spontaneously outgrow it. Thus, they require speech therapy. This is especially true for people with AOS who do not fully recover on their own. Speech therapists assist in various ways, depending on the individual. The therapy also addresses any additional speech or language difficulties that may arise as a result of AOS.

For both kids and adults, one-on-one speech therapy is essential. Group sessions also don’t work because AOS needs personalized attention and repetition. Kids with severe AOS might require years of treatment alongside regular schooling to improve their speech. In extreme cases, people with AOS may need to find different communication methods. This could be using sign language, a notebook with pictures or words, or electronic devices like smartphones or tablets. These methods can also help kids with AOS learn to read and understand spoken language better.

Supporting a child with Apraxia of Speech- Tips for Parents and Caregivers

Supporting a child with apraxia of speech can be a challenging task for parents and caregivers, but it is an essential part of helping them develop their communication skills. Apraxia of speech is a motor speech disorder that affects a child’s ability to coordinate the movements required for speech. As a result, children with apraxia of speech may have difficulty speaking clearly and effectively.

If you’re the parent or caregiver of a child with apraxia of speech, it’s important to remember that patience, understanding, and a collaborative approach involving various professionals and caregivers are key to supporting them. Here are some ways to support your child if they have apraxia of speech:

  1. Work with a speech-language pathologist: A speech-language pathologist (SLP) is a professional who specializes in diagnosing and treating speech and language disorders. Working with an SLP can help your child improve their speech skills and develop strategies to overcome the challenges of apraxia of speech.
  2. Practice at home: Consistent practice is essential for improving your child’s speech skills. Your child’s SLP can provide you with exercises and activities to practice at home, and you can also incorporate speech practice into everyday activities like reading books or playing games.
  3. Use visual aids: Visual aids like pictures, charts, and videos can be helpful for children with apraxia of speech. They can help your child understand and remember new words and phrases, and can also be used to practice speech sounds and movements.
  4. Be patient and encouraging: It’s important to be patient and understanding with your child as they work to overcome the challenges of apraxia of speech. Encourage them to keep trying and celebrate their successes, no matter how small they may seem.

Incorporating these strategies into your daily routine, you can help your child develop their speech skills and overcome the challenges of apraxia of speech. Remember, supporting a child with apraxia of speech is a team effort, and with patience and perseverance, your child can make progress towards clear and effective communication.

What Research is Currently Underway to Enhance Understanding of AOS?

Scientists are actively exploring the initial cause of childhood apraxia of speech (AOS), investigating potential links to brain or nervous system abnormalities. They’re also delving into the genetic factors that might contribute to childhood AOS. Additionally, research on childhood AOS aims to develop more precise diagnostic criteria and new methods to distinguish it from other communication disorders. Researchers are conducting studies on acquired AOS to identify the specific brain areas involved in the disorder. They’ll also check the effectiveness of various treatment approaches for both types, such as acquired and childhood AOS.

Bottom Line

From the above discussion, we conclude that understanding apraxia of speech involves recognizing its types, knowing the diagnostic process, and exploring available treatments. When we talk about it, the treatments include undergoing specific tests, such as speech assessments and neurological examinations, to understand the condition accurately. We learned that specific speech therapies also play a very important role in the communication or speaking skills of an affected child or an adult. Ongoing research sheds light on new insights, promising hope for better interventions. By fostering awareness and supporting those affected, we contribute to a more inclusive and compassionate community for individuals facing the challenges of apraxia of speech.