Episode 60: In this episode, Kim and Mary break down the definition of Childhood Apraxia of Speech (CAS), a speech disorder that affects the motor planning of language from the brain to the mouth, much like a glitch in computer coding. They discuss how parents and providers can be aware of the unique markers of apraxia, and the vital role of a speech therapist skilled in using a motor-based therapy approach. This episode is an invaluable resource for comprehensively understanding and managing Childhood Apraxia of Speech effectively.
Home - Apraxia Kids (apraxia-kids.org) is a wonderful resource and website for both parents and professionals. It also includes published articles and summaries of current research.
For more information on speech, language, feeding and play, visit The Speech Source, and follow us on Instagram @thespeechsource
If you liked this episode and found it to be a helpful resource, please leave a review and subscribe to our podcast!
Also, if you haven't done so already, follow our podcast! You will be the first to know when new episodes release. We would also love for you to leave a review and rate our show. The Speech Source appreciates your feedback and support! Follow here!
Episode 60: In this episode, Kim and Mary break down the definition of Childhood Apraxia of Speech (CAS), a speech disorder that affects the motor planning of language from the brain to the mouth, much like a glitch in computer coding. They discuss how parents and providers can be aware of the unique markers of apraxia, and the vital role of a speech therapist skilled in using a motor-based therapy approach. This episode is an invaluable resource for comprehensively understanding and managing Childhood Apraxia of Speech effectively.
Home - Apraxia Kids (apraxia-kids.org) is a wonderful resource and website for both parents and professionals. It also includes published articles and summaries of current research.
For more information on speech, language, feeding and play, visit The Speech Source, and follow us on Instagram @thespeechsource
If you liked this episode and found it to be a helpful resource, please leave a review and subscribe to our podcast!
Also, if you haven't done so already, follow our podcast! You will be the first to know when new episodes release. We would also love for you to leave a review and rate our show. The Speech Source appreciates your feedback and support! Follow here!
I think that there are so many great benefits of an apraxia approach that can help most children with speech sound disorders. And if you haven't taken this approach yet, you're spinning your wheels, and if you've been in therapy for a long time, this is exactly where I would be headed. Welcome to the Speech Source Podcast. My name is Mary Brezeek and I'm Kim Dillon.
Speaker 2:
We are two pediatric speech language pathologists with a combined 25 years of experience.
Speaker 1:
We are your source for speech, language, feeding, play and much more in between.
Speaker 2:
On today's episode we are talking all about apraxia. This is a question we hear a lot. What is apraxia? Because I think parents hear it, other providers hear it and sometimes it's hard to define. So we're going to talk a little bit about what apraxia is, how it's different than some of the other speech sound disorders that speech therapists treat, and the point of today's episode is to really be able to help parents or other providers get a better understanding of some characteristics of apraxia and how it's treated differently. Because at the end of the day, like we say with everything else, speech therapy can be a really broad area and if you think your child might have apraxia, you really want to find a therapist that is knowledgeable in treating apraxia.
Speaker 1:
I'm so excited about this episode and being able to just talk through a word that I think parents hear and, like you said, they just get confused or maybe a little worried because it is a name of a diagnosis. So, kim, let's start off by defining what is apraxia.
Speaker 2:
Apraxia is a motor speech disorder, so it's going to be difficulty with motor planning. There is a disconnect or a disruption in the signal from the brain to the mouth. So maybe a child knows a certain word, they understand the word, but there is a disconnect in being able to say the word and a lot of times you're going to hear it as childhood apraxia of speech, because we're talking about children, or you might see the acronym CAS.
Speaker 1:
Yeah, I think that the motor planning is really a key component of that. I really explain it like computer coding. It's this code that is the exact signal of cat or something, where it's these exact little blocks that have to go to the gather at and then that signal is supposed to be sent to the muscles. Well, if the code got messed up or there was a little glitch, it's going to come out wrong, but it doesn't mean that they somehow can't make a sound or they can't make a. It's just that by the time it comes out and that signal passes, it now sounds like a jumble.
Speaker 2:
That's a really great way to describe it, mary. We'll definitely talk about some of those specific characteristics that make apraxia different, but let's talk about what is it making it different from? What are some things we commonly see in speech therapy that kids are coming in for as far as their speech sounds?
Speaker 1:
Sure, as speech pathologists, whenever a child comes in and they have difficulty being understood, it's our job to figure out the why. Why are they being understood? Is it because they have apraxia, which might be one thing that we are looking at? But more than that, I think about four main things that I'm thinking about as a child is not understood. The first one is what most people think about as speech therapy, which would be traditional speech, sound therapy. Like you come in, you can't say your R. We teach you how to say er and then you can plug it in. Everything is good. The second area that we're looking for is really patterned base. It's things like chopping off the ends of words they're always taking out a syllable in words things that are really specific patterns that occur a lot of times in speech.
Speaker 2:
Mary, I was just going to say with both of those that you just talked about. I wanted to make a point that, for the specific speech, sound errors and then also those patterns that you're talking about, both of those are common in all kids until a certain age. So I would say with both of those, one of the big differences between those and apraxia is that apraxia is never age appropriate.
Speaker 1:
Those first two areas that we're looking at on a typical progression is that kids should be advancing along this pretty set continuum and pretty set kind of milestones and we're tracking where they're at on that progression. The other two things that we are ruling out would be the motor speech disorders, which, to your point, kim, these are never normal. These are patterns, but it's not a pattern that we expect. Oh, it's okay if you're one and you are showing apraxia. It doesn't work like that. The fourth area dysarthria.
Speaker 2:
Those are two areas that we are ruling out with every kid who comes in with speech and they're not common and I think a good thing lately about apraxia is that there has been more research being done that can really point to some of the earlier characteristics that help us do our job and determine whether it's apraxia or not, but also letting parents know or other providers of some red flags that could indicate that it's apraxia. So I'm going to break some of these characteristics up into more the baby, younger years and then what you might see as the child gets older. But really, looking at the baby and the younger years, you're going to see less babbling, maybe even no babbling or vocal play. Not having any of that might be an indication of apraxia. And again, when we talk about these characteristics, you need multiple of these characteristics for it to point to apraxia.
Speaker 1:
It's not going to be one of these characteristics that indicates apraxia, right, so these kids are oftentimes late talkers, so they don't talk until a little bit later they might struggle to say their first words and then they also might be a little bit quieter. You have moms that come in or parents that come in and just say, yeah, you know what? They just weren't really a noisy baby, they just weren't really interested and they weren't super chatty. So you're right, some of that can be a sign, one of the signs of apraxia.
Speaker 2:
And even thinking about it in terms of late talkers, a lot of times you're not even going to see many sounds by the time they're 18 months. So we're thinking like less than five sounds by the time a child is 18 months is another indicator that there might be some difficulty with some of that motor planning If we're not getting some of that sound practice and with this lack of sounds by a certain age. We also might see that a child has tried a sound. Maybe they tried for mommy or mom. Maybe they tried it one or two times and then stopped. So we're not seeing that consistently grow as far as trying some sounds and words.
Speaker 1:
One of the biggest hallmarks that I think about with apraxia is vowel distortions. What that means is you expect that a vowel, say a, would be pretty pure sounding and clear, but instead of a and an you would hear a different sound. Maybe sometimes it's a, maybe sometimes it sounds more like a or a. It's just a little bit again distorted from the sound that it should be. It might be a totally different vowel, it might be something somewhat close to it, but that that vowel changes because again it's this motor, mapping and planning, that can get disrupted. So the vowels are really easy for our ear to be able to perceive. Oh, wait a minute, that sounds different.
Speaker 2:
Because vowels really make a difference within words and speech. If you start taking vowels off or change them a little bit, a lot of times it really changes the whole way a word sounds or a sentence sounds. But it's interesting because kids with apraxia vowels are a lot of times what they're trying to use the most. You don't see a lot of consonants, but then those vowels are inconsistent. So inconsistent errors is one of the biggest indicators of apraxia.
Speaker 1:
Definitely.
Speaker 2:
So when we're talking about kids coming in for speech sound disorders, we know that we're working on the R sound or a certain pattern in speech, because they're consistently making that same error when they're talking. But with apraxia they might have a difficult time with the A sound or they might say a word a certain way one day but then it's a different error the next day. So even their difficulty with sounds, it's going to be inconsistent day to day and time to time that they're trying to say that word or sound. Another characteristic that you might see is as the word length increases, or if their phrase or sentence increases, you might see more errors happen. And so if a word is short and they have it, but then it becomes two or three syllables, you might see the errors increase as that word gets bigger.
Speaker 1:
Right, and so words like helicopter require so much motor planning to take all those vowels and consonants and say them at exactly the right time and in conjunction with each other. A word like that would be much more difficult for a child with apraxia than it would be if you were saying something like help. That would be a lot shorter and as speech pathologists, I do think if there's some of the speech pathologists that are listening now my preference for speech tests for children who I am kind of considering apraxia with, is the cap, just because it has those multisillible words. There's a few major speech tests, but there's one speech test in particular that really looks specifically at multisillible words and blends and I think that that test does a really good job of highlighting when this could be a problem. And then there is also the Kauffman. It's this other test that is very specific to apraxia. But I think, just if you're screening or even considering and you want kind of a more mainstream speech test to give the, the cap is definitely a great test to look at this.
Speaker 2:
I like both of those, mary, those are great. When we did our voice episode, we talked about intonation and stress and rhythm patterns and speech and how that is such a big factor in our overall communication where we're putting the stress on a word or that rise and fall of our voice, our intonation. Sometimes we see kids with apraxia have a difficult time with this. They might sound more monotone, their speech might sound choppier because they don't have that natural planning of that rise and fall, the breath support, whatever it is. It's that planning, that motor planning. You see it come across in those areas also.
Speaker 2:
And then also we talked about this with our stuttering episode is some of those physical features of groping. You might see some physical struggles whenever they're talking. A lot of times kids with apraxia don't just have difficulty with the motor planning for speech, but they might also have difficulty with some of their other motor planning, some of those gross motor or fine motor skills. You might see it in those areas also. So that's what's so great about being able to work with other professionals like OT or PT, especially with kids who are having motor planning difficulty, is that you can address the child as a whole Right and it is different than oral apraxia, which would be specifically difficulty with motor planning in your mouth on non-speech tasks.
Speaker 1:
So this would be stick out your tongue and being able to immediately stick it out, but you're tongue to your nose and you can immediately at least attempt to get your tongue to your nose. But it's when groping. It's like when you see all of a sudden the kid is trying to stick out their tongue but it's wagging and they're moving their jaw around and their head to try to figure out how to get their tongue out. That's not typical and that's what we're really looking for is to make sure that speech is effortless and it should never look like they have signs of struggle when they're trying to say words and so if you do see that kind of movement in their mouth, that is not going to be a typical way that children are going to figure out how to speak certain sounds.
Speaker 2:
That's a great way to describe it. So these are just some characteristics that if you see a lot of these happening, it might point to that. And let's talk about diagnosis for just a minute, because this gets tricky depending on who you're talking to. A speech therapist can diagnose childhood apraxia of speech. That is who you can come to and do a full evaluation for a diagnosis and a treatment plan. It might coexist with other language disorders or even what Mary and I were talking about earlier a specific sound or even a phonological process or a pattern. These can kind of overlap A lot of times. It's hard to get a good diagnosis until a child is at a certain age. I think three is what I read most in the research as far as being the number. But that doesn't mean that you can't treat it like childhood apraxia of speech before then, and I think the idea is that if you're treating it as that, it's not going to hurt if it ends up not being childhood apraxia of speech.
Speaker 1:
So I've only seen true apraxia of speech and a handful of kids. I would say it's few and far between that. I have seen apraxia in a kid who didn't have other things going on. It's not that it doesn't happen, it's just that I haven't seen a ton of them. What do you think, kim? What have you seen?
Speaker 2:
I agree with you. I think more often than not it's going to coexist with something else going on with a child. I think it's really important to one find someone who is knowledgeable about apraxia if you have those concerns. But then when we're talking about treatment, we can treat a child as if they have child apraxia of speech, even if that's maybe a little bit of what they have. But they also have some processes going on and there's also a language disorder going on, because it's going to help. So I think when you're talking about treatment, it's important for a child who has apraxia of speech to for sure have a motor based treatment plan, but I think those plans can also benefit all kids working on speech sounds.
Speaker 1:
Yes, I use an apraxia approach all the time, and so let's stop and kind of explain what an apraxia approach would be to our listeners.
Speaker 1:
An apraxia approach is basically saying you know what, if you have difficulty with the motor planning, then we need to do it again and again and again and we need to make that plan really repetitive and routine and this kind of repetition is going to make that pattern stronger and it's really going to be an effective way to communicate.
Speaker 1:
When you see this in kids conversation, it's going to mean that the words they have practiced all the time words like mama or milk or ball, all their favorite vocabulary should hypothetically be the clearest speech that they use because they've repeated it and used it over and over and over and they really strengthened that motor plan. But a child with apraxia, when they go to say a new word, especially when they're learning new vocabulary, that is a big struggle, especially if it has multiple syllables, like computer, where they're trying to put all these building blocks together. And so in a true apraxia approach, you're going to really solidify the building blocks of speech, the syllables, the vowels, the sounds themselves, so that, as the motor plan is strong in a unit, you can now put the units together. That's kind of how I explain an apraxia approach.
Speaker 2:
Right. What kid isn't going to benefit from lots of repetition? So, especially when you're working on getting a new sound, even if they don't have apraxia of speech, that's a great plan for speech therapy. Another great way that kids benefit is if you can give specific feedback so they're working on motor planning If you are able to say, oh, I love how you brought your lips together for that sound, strengthening that motor plan next time when they need to bring their lips together for the P. So specific feedback is always great to be able to give a child when you're working on sounds, especially for apraxia of speech.
Speaker 1:
And I kind of think about it as this approach. You're going all in right. You're saying we're going to really highlight how it feels, how it sounds, what it looks like. We're going to put a visual with it, we're going to put some kind of hand motion with it. We're going to do whatever it takes with our whole body to help that signal, make sure that that's clear and so it really is. You're using a lot of different tools in the toolbox to help really solidify this motor pattern.
Speaker 2:
In one other way. A big way that treatment is different for apraxia is you're working a lot on the syllable shapes and movement and sounds, versus a specific sound and isolation. So practicing how that MA for ma ma goes together, what's that pattern to get those shapes together, versus just pulling out those individual sounds, thank you. So I just wanted to recap. If you say you're a parent and you listen to this podcast and you think your child has some of these characteristics they're not talking yet or errors are inconsistent in words my advice would be if you're looking for a speech therapist, some things you want to look at as far as specific training is if they are prompt trained, that's P, r, o, m, p, t, or they have training in Kauffman protocol, or if they have training in D, t, t, c, that's dynamic, temporal and tactile queuing. In my experience those are kind of the top three training areas for having the correct approach for treating kids who truly have childhood apraxia of speech. Mary, would you add anything different into that?
Speaker 1:
Oh yeah, I think that's a good list. I think those are the ones you really want to be looking for, and you can just specifically ask, when you're looking for a speech therapist, say, do you have a therapist who has been trained in apraxia techniques? That's how I would phrase it.
Speaker 2:
Yeah, and I wouldn't say one is better than the other. My view is always use all of them together. That's always my approach is finding what works best for a child and what they respond to best and combining some of these approaches. Another really really good resource for families is apraxia kids and we'll link that website. But there are all types of trainings and information for parents and professionals on their page. A lot of support for parents once they get a diagnosis, so that's a really great website. It's also linked on our speech source website, so that's a great place to check out more detailed information of childhood apraxia of speech.
Speaker 1:
I think that apraxia is a really interesting area of speech and, even though it's not something, again, that I diagnose all the time or that we see all the time, a good provider is going to be very knowledgeable about apraxia. You're going to need to really know and understand it so that you can diagnose it when it's right for a child, because if you have spun your wheels in therapy for a long time, this is something that I would look at as well as just ask the question to say, hey, do you think you might have apraxia, or do you think an approach that is a little more geared towards apraxia might be beneficial? Like we've said, I think that there are so many great benefits of an apraxia approach that can help most children with speech sound disorders, and if you haven't taken this approach yet and again you're spinning your wheels and if you've been in therapy for a long time, this is exactly where I would be headed.
Speaker 2:
I completely agree, because if you have a child who truly has this diagnosis, they're not going to show progress with something that's not geared towards that. So that's why I think it's just really beneficial to use some of these treatments for all kids.
Speaker 1:
I think that also one of the things that I like about an apraxia approach is it's really focused, and so you're really focused on the child's world and their vocabulary, and I really love that idea. I love the idea that you're working on their name, you are working on their sibling's name, you're working on being able to say the name of their school or their teacher or the specific snacks that they like so that they're understood. And I love that functional approach to say, hey, this is a tricky word and we're going to practice it again and again and again, but not just rote repetition. We're going to do hand signs, we're going to use our body, we're going to use visuals, we're going to throw everything at making your specific words clearer to the people that you talk with. So I do think that, even with children who have speech sound only type of issues, I think that we can learn from this apraxia approach and take some of the best parts of this approach and really infuse it and mesh it together with just sounds themselves.
Speaker 2:
I think so too. It definitely makes the speech therapy process seem more meaningful and functional for that child. Thanks for listening. Make sure you subscribe to our podcast and check out our website, thespeechsourcecom Also check us out on Instagram for more ideas on speech, language, feeding and play.