Family Learning Center

Dr. Pamela Cooper, M.A., MBA, PhD.

Educational Diagnostician, Learning Disabilities Teacher-Consultant

Childhood Apraxia of Speech

At times, parents become concerned when their child is not engaging verbally with family or peers in a clear and understandable manner. The child appears to mumble, groan, gesture, or at times make no vocal sounds. They may make vocalizations without moving their mouths. This condition is often considered Apraxia of Speech.

Childhood apraxia of speech is a motor speech disorder that affects the signals from a child’s brain to coordinate the rapid and precise movements of the mouth muscles for speech. It is not related to muscle weakness or intelligence.

Children with apraxia of speech know what they want to say but have a tough time coordinating the movements of their jaw, tongue, lips, and other parts of the mouth to say what they want.

A speech-language pathologist is the person who diagnoses apraxia of speech. Apraxia of speech is a medical reason for having difficulty talking. Speech therapists often state that it is a motor impairment. Apraxia does not mean the child is not smart. It does not mean that they cannot understand you. And it does not mean that they do not have anything to say. When diagnosing apraxia, the current standard is to hold off giving a child an official diagnosis until they are at least three years old. This is because normal speech behaviors exhibited by one and two-year-olds look apraxic. Often, a speech therapist will wait to give an apraxia diagnosis until they have worked with the child. This is because sometimes children are shy during their evaluation and the speech therapist wants to make sure that they see how the child speaks and communicates when they are comfortable. In other instances, the child has another diagnosis (such as receptive/expressive language disorder, autism, etc.) and the additional diagnosis of apraxia is identified later.

Childhood apraxia of speech is one reason it might be hard to understand what the child says. Children with childhood apraxia of speech benefit from the support of a speech therapist to learn how to move their mouth for talking. Example: When we talk, we get an idea in the brain of the word we want to say. Then the idea travels a pathway from the brain to the mouth, getting the mouth prepared to move the lips, tongue, and jaw to properly say the word. For children without apraxia, the pathway between the mouth and brain is smooth and easy to travel, messages from brain to mouth move quickly and easily. With childhood apraxia of speech, those pathways between the brain and mouth are not well established, i.e., one path splits incorrectly into lots of paths. In many instances, the pathway to the brain is not there at all, causing the words to not travel correctly or smoothly. At times, the word(s) might sound a little different: maybe a “D” instead of the “B” will come out, maybe the mouth won’t open, maybe the child accidentally stick the tongue out or the child thinks of the word ball, tell the mouth to say “ball,” and then nothing happens. 

Apraxia can exist by itself, meaning the child’s development is typical in all other ways. Apraxia occurs more frequently in children who have diagnoses of autism or Down Syndrome. If a child has trouble with “articulation,” usually that means that they have difficulty correctly making one or two sounds in their mouths. The child may put their tongue in the wrong place when making an “R,” or their “SH” sound is made like an “S.” Articulation difficulties are consistent no matter what word the child is saying and limited to only a few consonant sounds. Articulation issues are typically related only to tongue movements.

For children with apraxia, they will have difficulties with other different unrelated sounds, including vowels. Sounds may be present in some words but not others, depending on how complicated the mouth movements in particular words are. In apraxia, letter sounds that require precise movement of the jaw, lips and tongue are all impacted. When children are born with apraxia it is called “childhood apraxia of speech” or “developmental apraxia of speech.” 

Another way children can develop apraxia is after a brain injury, i.e., an accident, football head injury or hitting the head seriously, etc. Treatment of apraxia involves creating or altering the pathways from the brain to the mouth. This is done through extensive repetition of words and sound patterns. The Therapist working with the family usually will start with words that are easy and useful to help motivate the child. The therapist and family may pick sounds to work first, adding on more sounds over time. They will target a particular mouth movement (like closing lips together or opening and shutting the jaw), practicing the skill. Example, instead of simply saying “mmm” by itself, they would practice saying “mmm” while smelling pretend food or handling an object. Introducing sounds with visual/motor experience gives the target sound/word meaning. The speech therapist will also work with the family to help create a communication system that they can use while the speech catches up. Some families will teach their child sign language to help communicate. Sometimes the child will be provided with a communication app on a tablet to help them tell people what they want to say. Childhood apraxia of speech can take a long time to treat. Depending on the severity, children often need many years of speech and language therapy, reason children might receive speech and language therapy throughout their entire school years.

Diagnosing apraxia is a process of elimination. Common behaviors often seen with apraxia:

• The child’s understanding is significantly better than their expression. Example, a 3-year-old who does not speak could follow complex multipart directions and questions without issue. 
• The child sometimes produces clever ways to communicate without using actual talking, speaking in sound effects, using a lot of gestures, or make up their own sign language. 
• The child has difficulty talking confrontationally. The parents show the child a ball and say, what is this? And the child sits silently. Shortly, when the child sees the ball, they say, bubbles!” without any hesitation at all. This behavior is interpreted as defiance when in fact the child is physically unable to speak.
• When the child speaks, many of the sounds are wrong for their age. Sometimes a child with apraxia can produce some later developing sounds before early developing sounds.
• Vowel sounds as well as consonant sounds might be wrong. For instance, a child might make the “eee” and “oh” sounds like “uh,” making beat sound like “but.” Technically the consonant in the word is okay, but the word is still wrong because of the vowel.
• The child may have limited or slow movement of their jaw. Sometimes the child’s mouth will be constantly open, and they drool. Or they may walk around with their mouth shut tight and seem to have difficulty opening it when asked.

Have the child imitate any sound effects or exclamations. They might try to copy the intonation for “uh oh!” Example, drop something, making a humming sound. When done in a fun and low-pressure way children will be more likely to make the sounds. If you tell a child, say “uh oh!” the child will not do it. But if you keep accidentally knocking something off the table while saying “uh oh” wait, and the child will hum “uh oh!” without saying anything. Set up silly and fun situations where the child can make sound effects to encourage talking.

Apraxia of Speech can be complicated. Contact the school child study team, explain your concerns, and request a speech and language evaluation. Understanding apraxia and working with an experienced speech therapist, you will see improvements and empower your child to communicate.