10 Early Signs and Symptoms of Childhood Apraxia of Speech

By: Laura Smith

I was a practicing speech-language pathologist for five years before my daughter was born. I worked primarily at the elementary and middle-school levels. I took professional development workshops on childhood apraxia of speech (CAS) and treated it successfully in three kiddos from my caseload. Perhaps that’s why I was bewildered, angry and utterly devastated when I missed those very signs in my own child.
I hadn’t yet worked in early intervention, so I missed what seem like obvious signs to me now that I specialize in the disorder. I urge all SLPs to learn more about CAS, because the disorder requires a specialized approach different from other commonly used treatments for speech and language delays.
In addition, ASHA denotes that the qualified professional to diagnose CAS is an SLP with specialized knowledge in motor learning theory and skills with differential diagnosis in childhood motor speech disorder, not a neurologist or other medical practitioner. It’s important to know the signs, but also to refer your client to a qualified SLP for differential diagnosis if you suspect childhood apraxia of speech.
Here are 10 early signs and symptoms of childhood apraxia of speech:

• Limited babbling, or variation within babbling
• Limited phonetic diversity
• Inconsistent errors
• Increased errors or difficulty with longer or more complex syllable and word shapes
• Omissions, particularly in word initial syllable shapes
• Vowel errors/distortions
• Excessive, equal stress
• Loss of previously produced words
• More difficulty with volitional versus automatic speech responses
• Predominant use of simple syllable shapes

Other non-speech “soft signs” that may be present include:

• Impaired volitional oral movements (oral apraxia)
  • Difficulty with volitional “smiling” “kissing” “puckering”
• Delays with fine/gross motor skills
• Feeding difficulties that include choking and/or poor manipulation of food
• General awkwardness or clumsiness

These are early signs, but many overlap with other phonologic and language delays, so it’s important to keep in mind that differential diagnosis is critical, as over-diagnosis of CAS remains problematic. It’s still a relatively rare disorder; however, there are resources that can help if you suspect it.
You can tap the below resources to learn more about childhood apraxia of speech.

• Apraxia-kids.org (CASANA):
  • Offers a growing library of on-demand webinars for professionals and parents.
  • Maintains a list of SLPs nationwide who are CASANA-recognized with advanced training and expertise and who are available for consult.
• ASHA.org:
  • Recently developed a practice portal for childhood apraxia of speech.
  • Compiled a comprehensive technical report.

Laura Smith, MA, CCC-SLP, is a school-based and private clinician in the Denver metro area specializing in childhood apraxia of speech. She’s CASANA-certified for advanced training and clinical expertise in Childhood Apraxia of Speech and often speaks at conferences and consults for school districts or other professionals.
Original blog: http://blog.asha.org/2015/04/09/10-early-signs-and-symptoms-for-childhood-apraxia-of-speech/