Apraxia is a rare speech disorder that occurs in children causing difficulty in speech. It affects the planning ability for making the right set of speech movement. The child’s brain will not make enough plans for making right movement of jaw or lips while talking resulting in slurred speech. The child with apraxia cannot make accurate movement of his lips or jaws while talking. It is commonly known as CAS (childhood apraxia of speech). Dyspraxia is the term given for mild forms of apraxia.
Types :
Basically there are 2 types of apraxia namely acquired and developmental.
- Acquired apraxia is the form that can affect people of any age group. It can affect the normal speaking ability of the person.
- Developmental apraxia is the type that occurs in children. Often, this condition is present from birth and the child with this problem will have struggle in making right movements of lips and jaws while talking. But these children can understand what others are talking. Most of the children will show considerable improvement by therapy.
Symptoms :
Depending on the severity of the disorder the symptoms of each child with apraxia will differ. Some of the common signs of childhood apraxia are limited number of words and producing only few sounds. Initial symptoms will appear anywhere from 1.5 to 2 years of the child. There can be voicing errors when the child tries to say some words. Most of the children with this problem will have struggle in making their jaw movements and retaining their lips in the right position while pronouncing a word or sound.
With parents support and speech therapy many children can make improved speech within a year or two. Some children will have difficulty in understanding speech or language. Sometimes there can be specific language problems for the child. The affected child will have reduced babbling when he was an infant and will have great difficulty in combining syllables together to form a word. There are children who can say few easy words but have problem while saying complex words.
Such children are tending to use non-verbal cues or gestures for communication rather than using language to express themselves. The same child will say some word correctly at times and may have problem when he/she is asked to repeat the same words. In some children apraxia can be associated along with other cognitive disorders also. The child may develop articulation disorder or phonologic disorder along with apraxia.
Causes :
Exact cause of apraxia is not known till now but there are many theories that explain the root cause of it. It can occur due to neurological disorder, head injury, stroke, brain infection or any other complications in the brain. It can develop due to genetic factor or due to certain syndromes like that of velocardiofacial syndrome. It cannot be said that all children affected with apraxia will have problems or delayed speech. Many children have outgrown this problem as they grow by speech therapy but there can be delay in learning it.
Any abnormality in the genes or gene mutation can increase the risk of developing apraxia in children. It can be due to FOXP2 gene which controls the nerves involved in speech and language. Complications due to apraxia are delayed development of speech, difficulty in understanding speech and reduced vocabulary. There can be reduced motor development and intellectual development and the child can face problems in reading and writing as it grows.
Tests :
The doctor can easily diagnose apraxia by observing the speech of the child. He may ask him to repeat few words as he says or use other means to test his vocabulary. He may refer the child to speech pathologist for assessing his language skills. Tests are developed in varying degrees as per the child’s age and his ability to cooperate. The doctor has to be specific that the child does not have any other speech disorders.
He may ask the child to undergo hearing tests to rule out any hearing problems. He will examine the muscle movement of the lips and jaws to find out if there is any structural abnormality. The speech problem can occur due to tongue tie or due to cleft palate also. The language pathologist will observe and evaluate his speech by paying more attention to the vowels, sounds he produces.
Treatment :
In some children the retarded speech will resolve after some years with the help of continued speech therapy. It is more common in the case of acquired apraxia but for apraxia due to developmental type it takes time to get resolved. The doctor and the speech therapist will devise individual plan for the child according to his age and intellectual capacity. The child will have to attend speech therapy classes almost each day and practice them at home with the help of his parents.
Speech therapist will ask the child to repeat certain words or sounds and will slowly teach the child to combine certain sounds to form a new word easily. They will use touch therapy and visual therapy while teaching. The child will be encouraged to take enough time to tell particular word so that he/she stays relaxed. Very often individual therapy is given to get the best result in each case. It is necessary for the child to get sufficient support from the parent to practice particular words and phrases each day so that he can be ready for the next session of therapy.
The child will be asked to observe carefully when the therapist makes particular sound and how he moves his muscles on the jaw and lips. Good practice is vital for achieving improvement in speech. After few sessions, therapist will gradually increase the number of words and move on to small sentences. Daily practice in real life situations can be easy for the child to learn fast.
In case the child is suffering from severe apraxia the therapist will use alterative communication methods like gestures or telling something through electronic devices. Some children who have associated language disorders with apraxia should be treated with effective approach based on the intensity of the disorder. The child may be asked to attend occupational therapy classes along with speech therapy in flexible timings.