Apraxia of Speech: Understanding the Essentials
What Is It?
It's when the brain fails to plan and coordinate muscle movements for
Also referred to as...
- Developmental or childhood apraxia of speech (DAOS or CAS)
- Verbal (a)/(dys)praxia
- Developmental verbal dyspraxia (DVD)
- Dyspraxia of speech
- Motor dyspraxia
This disorder happens when the signal
from the brain is changed or broken
on it's way to
Every word that comes out of our mouth is planned by our brain before
we say it. Our brain works very fast to put sounds into words and words
When we use "filler words" such as "uh", or "um", or my least favorite
..."like", the brain is giving our mouth "time to catch up" with the
signal it is sending.
When that signal gets changed or broken, it makes voluntary
movements for sound and
word production difficult (see examples below).
Just to be clear, apraxia of speech does NOT
mean someone has weak mouth
You can read here about
one mother and daughters journey
What Is an Apraxia of Speech Disorder?
There are two types
involve Speech Pathologists:
- the person has problems
making voluntary movements of mouth muscles.
The person can randomly stick their tongue out at you, but if you ASK
them to do it... they can't.
(more common) - the
person has problems with their ability to plan and program voluntary
movements to say sounds and words.
If you ask the person to say banana 4 times, they might say...
Apraxia of speech can be
affects children from birth.
which can affect a
person at any age, but most often affects adults.
What Causes It?
Similar to some speech disorders
, SLPs are not sure what causes
it. Like adults, children can get acquired apraxia from a stroke,
tumor, or head injury. Apraxia of speech seems to affect more boys than
Caruso & Strand (1999) compiled some common factors they looked for
when evaluating a child who was thought to have developmental apraxia.
They suggested that apraxia of speech may be present if:
- a certain genetic syndrome existed (ex. Down, fragile X)
- a child had a history of neurological disease or damage
- it was suspected in a family member
- a child showed excessive motor activity and withdrawl
- a child had gross/fine motor incoordination
- abnormal feeding patterns were observed
- abnormalities were observed during imitative play with sounds or
- there was a family history of a communication and/or writing
disorder or learning disabilities
They also noted that young children with this disorder might have:
- feeding problems
- little vocal play or babbling
- shown little imitation in infancy
- delays in early language
- behavioral disorders, temper tantrums, and inflexibility in
- difficulty making normal progress in speech therapy
- to say a word many times before they say it right
- more errors as word length increases
- receptive language that exceeds expressive language
What Does It Affect?
A child can be mild
that they may only have one or two speech errors or occasionally
struggle with some multi-syllable words...
enough where a child
cannot communicate at all (only says vowel sounds) and
needs/uses another way to communicate such as sign language or a
If a child has a motor deficit it will more than likely influence the
development of phonology and other language abilities (Caruso &
Strand, 1999). Apraxia of speech may or may not affect:
- organization of spoken information
What Does an SLP Do to Help?
Speech-Language Pathologists have a variety of approaches they use with
children who have apraxia.
Different approaches focus on 4 types of cueing, such as:
- Tactile - touch, manipulation
- Auditory - hearing
- Kinesthetic - body movement
- Visual - pictures, watching mouth in mirror
Therapy should be frequent, intense, and focused
. Haynes (1985)
summarized the techniques she would use from her research on apraxia of
speech. She said she would use:
- concentrated drill (both imitative and on command) of isolated
movements of the tongue and lips
- imitation of sustained vowels and consonants
- imitation of syllables and words
- slow rate and facilitate self-monitoring
- introduce core vocabulary
- carrier phrases to provide a basis for increased meaningful
- rhythm, intonation, and stress, paired with arm and leg movements
to help a child understand speech motor sequencing
- tools that would develop and heighten perception and awareness in
a child's mouth
What Can I Do About It?
Shelley L. Velleman Ph.D., CCC-SLP offers some excellent tips for what
parents can do for their child when working with them at home.
She suggests that low-pressure verbal
are the most important thing parents can do to help.
Some examples are:
She encourages parents to turn everyday activities into verbal routines
by making up poems,
songs, or sayings about them:
When you are getting
ready to eat dinner you can say the following words to a tune of your
choice (nursery rhymes are easiest)
Eat, eat, eat, I like to eat, I like to eat, eat, eat, eat
This example can be repeated for just about any activity: swim, bathe,
walk, run, drive, shop, play, slide, brush (hair or teeth), climb,
wave, drink, crawl, etc.
She recommends labeling
instead of counting objects in books:
When reading a book and
you come across a picture of more than one thing(ex. 2 or more dogs).
Instead of saying "Two dogs"
Say: "Two dogs, (point to each
one and say) dog, dog"
Vebalizing repetitive activities
When setting the table
you can say
Plate, Plate, Plate, Plate, Plate, Plate
or Knife, Knife, Knife, Knife, Knife, Knife
As boring as it might sound, this is easy to do and easy to make fun.
So go ahead and act silly, be over dramatic, and repeat words 4-5 times
Is it overkill?... Yep
Will you feel weird?... Maybe
Will there be times that you don't want to do it?... You bet
Will it help your child?... Absolutely!
If you have seen some modern day cartoons, they
repeat things A LOT! That is because we learn by repetition.
I don't mean to promote specific TV shows but Dora
is excellent at doing this. They have
one song about Dora's Map.
The song has two very short verses and then the singer says "I'm the
map" 12 times straight! and the song is over.
Above all, and this is always easier said than done...exercise as
as possible. This disorder is very frustrating for
the individual and can be for the whole family.
If you suspect that your child has apraxia of speech, see a
Speech-Language Pathologist right away. They will be able to discuss
including the possibility of using sign language and/or a communication
Resources We Like
National Institute of Neurological Disorders and
National Institute on Deafness and Other Communication
Caruso, A.J., & Strand, E.A. (1999). Clinical management
or motor speech disorders in children. New
York, NY: Thieme Medical
Haynes, S. (1985). Developmental apraxia of speech: Symptoms and
treatment. In D. Johns
(ed.), Clinical Management of Neurogenic
Communication Disorders (pp. 259-266). Boston: Little, Brown