How Can I Tell if My Child Has Apraxia of Speech?

Many children struggle with articulation, which means producing speech sounds correctly. But if a child’s speech is very difficult to understand, apraxia of speech may be the reason. Signs of apraxia include inconsistent pronunciation, difficulty producing vowels, and groping movements of the mouth.

Key takeaways

• Apraxia of speech is a motor-planning disorder. A person with apraxia knows what they want to say, but the signals between the brain and mouth muscles are not sent correctly, making clear speech difficult.
• Several signs may point to apraxia in children, including inconsistent word pronunciation, difficulty producing vowels, groping mouth movements, and finding “automatic” speech, such as counting to 10, easier to say.
• An articulation disorder is not the same as apraxia. Children with articulation difficulties have a pattern to their speech errors, such as consistently substituting a /b/ for a /v/ sound. They are also likely to have difficulty only with consonants.
• Apraxia usually will not resolve without speech therapy. Children with apraxia need frequent, consistent therapy to learn new motor patterns and strengthen speech-motor coordination.

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What is apraxia of speech?

Apraxia of speech is a motor-planning disorder. A person with apraxia has the language ability to talk, but the signals between the brain and mouth muscles are not sent correctly. This can be extremely frustrating. Speaking clearly, a task that may seem simple and that most of us perform every day, can be very challenging for someone with apraxia.

A person may be born with apraxia, which is known as childhood apraxia of speech, or CAS. Apraxia can also develop later in life after a stroke, traumatic brain injury, tumor, or progressive disease. This form is called acquired apraxia of speech. This article focuses on childhood apraxia of speech.

Signs of childhood apraxia of speech

Several characteristics may suggest that your child has apraxia:

Inconsistent word pronunciation. One of the first signs you may notice is that a person does not say words consistently. They might pronounce “caterpillar” clearly one time, then say it differently and be difficult to understand the next time. This inconsistency is one of the main symptoms of apraxia of speech.

Distorted speech sounds. Producing words in a distorted way is another symptom of apraxia. A child’s speech may not sound as crisp or precise as expected, or the child may simply be very difficult to understand. Some children with apraxia can clearly say a complex word while producing simpler words less clearly.

Apraxia can vary in severity, and no two people with the condition will have exactly the same speech characteristics.

Difficulty pronouncing vowels. Vowel errors can be another important clue. If a child cannot pronounce vowels correctly, it may be a sign of apraxia of speech. For example, they might say “shaw” instead of “shoe,” or “meh” instead of “me.” Even a very small difference in tongue or jaw movement can change how a vowel sounds, which is why children with apraxia often have this difficulty.

Groping movements of the mouth. This characteristic does not occur in everyone with apraxia, and it may not happen every time the person speaks. Still, it is a symptom to watch for. As a person starts to talk, they may try to position the mouth, tongue, teeth, and jaw correctly. They know what they want to say, but they cannot make their mouth muscles move in the needed way. As a result, their muscles move as if they are groping or searching for the right position.

This groping reflects the disconnect between the brain’s message about what to say and the muscles’ difficulty following that command.

Difficulty with speech intonation. Children with apraxia may also have trouble using natural speech intonation. Intonation is the natural rise and fall in tone and inflection that we use when speaking. When you ask a question, for example, your inflection rises slightly at the end of the sentence to signal that it is a question.

Automatic speech is easier than volitional speech. Children with apraxia may find automatic speech easier than volitional speech.

• Volitional speech is speech that a person initiates, such as asking a question, making a comment, or joining a conversation.
• Automatic speech includes stating your name or birthday, counting to 10, reciting the days of the week, or singing a song you know by heart. Because automatic speech is ingrained, it is likely to come out more smoothly than answers to questions or comments made during a conversation.

How does childhood apraxia of speech differ from an articulation disorder?

As noted above, many children find it difficult to pronounce certain sounds or speak clearly.

When a child has an articulation disorder, their speech errors follow a pattern. For example, they might consistently substitute a /b/ for a /v/ sound, so vacuum always sounds like bacuum. With apraxia, both the errors and the way words sound are inconsistent.

Children with an articulation disorder are likely to have difficulty only with consonants, such as /s/, /r/, /k/, or /l/. Trouble pronouncing vowels correctly may be a sign of childhood apraxia of speech.

Related guides

Childhood Apraxia of Speech: Causes, Signs, Diagnosis, and Treatment

Apraxia of Speech: Main Symptoms and Warning Signs

How Childhood Apraxia of Speech Is Diagnosed and Treated

How to Support and Advocate for a Child with Apraxia

Does childhood apraxia of speech require speech therapy?

A child is unlikely to outgrow apraxia without speech therapy. A licensed, trained speech therapist can evaluate speech sound production and determine whether a child has apraxia or an articulation delay.

During a speech and language evaluation, the speech therapist assesses the types of sound errors they hear and whether those errors occur in single words or connected speech. After identifying which disorder is present, the therapist can develop individualized treatment goals and a plan for your child.

A child is unlikely to outgrow apraxia without speech therapy.

Therapy goals are specific to each child and measurable, allowing the therapist to track progress. Here is one example of a therapy goal for a person with apraxia of speech:

The client will produce multisyllabic words with 80% accuracy, given moderate multimodal cues, in order to improve speech production to a more intelligible level.

Speech therapy for apraxia focuses on learning new motor patterns and improving speech-motor coordination. Children need frequent, consistent therapy to learn how to move their mouth muscles. For this reason, the frequency of speech therapy sessions is especially important when treating apraxia.

To make appropriate progress, children are recommended to have at least three sessions each week. Research supports shorter, more frequent therapy sessions. Three sessions of 30 minutes or less are effective. Some speech-language pathologists recommend 5 sessions per week, with each session lasting 15 minutes.

How to find a speech therapist who treats childhood apraxia of speech

There are several ways to find a speech therapist who treats apraxia in children. Start by asking people you know who have experience with speech therapy, since word-of-mouth recommendations can be helpful. You can also contact your child’s pediatrician, who likely has a list of recommended speech therapists.

For each therapist you are considering, call the office and ask about the therapist’s experience treating childhood apraxia of speech. Apraxia falls within every speech therapist’s scope of practice, but some therapists have more experience treating it than others. You can also search for online reviews of the therapist.

Many families find online speech therapy convenient, particularly for apraxia because treatment requires frequent sessions.

Apraxia Kids provides an online registry of speech therapists throughout the United States and Canada who have experience treating children with apraxia of speech. Search by location to find a speech therapist near you.

Consider the practical details of your child’s therapy sessions as well. How long is the commute? Do the available session times fit your schedule? Is there a wait list? Many families have found online speech therapy more convenient, especially for a condition such as apraxia that requires frequent sessions. Many studies have found that online speech therapy works just as well as in-person therapy.

After choosing a speech therapist, write down any questions you have. You can call before your child’s evaluation or bring your questions with you. Speech therapists understand that this can be an uncertain, anxious time for families. They will answer your questions and explain their plan for your child’s treatment.

If you are concerned about your child’s communication, do not wait to start the process of getting them into speech therapy. The sooner therapy begins, the sooner your child can start making progress. To learn how Astrel evaluates and treats apraxia of speech, read our treatment guide. Or, click here to be matched with a speech therapist.