Apraxia of Speech
Causes, signs and symptoms, and treatment of apraxia of speech
If you're a parent or caregiver of a child with apraxia of speech, or an adult who has acquired apraxia later in life, you may be struggling with many emotions. This is completely normal, and you should know that you’re not alone.
Learning about this disorder is the first step toward helping yourself, your child, or a loved one. To offer education and support, we’ve put together this guide to answer your questions about apraxia, help you identify common signs and symptoms, and share expert information about treatment.
What is apraxia?
In normal speech, the brain sends signals to the muscles in a person’s mouth (the lips, jaw, and tongue) in order to make accurate sounds and speak with normal speed and rhythm.
Apraxia is a neurological condition that disrupts this process. The person often has the language capacity to talk, but these signals between the brain and muscles are not sent correctly.
In other words, the brain knows what it wants to say, but cannot properly plan the required speech sound movements.
As a result, people with apraxia have difficulty coordinating the mouth movements needed to turn sounds into syllables, syllables into words, and words into phrases. It is often hard for people with apraxia to communicate and form coherent sounds and sentences. Most commonly, people with apraxia are described as “difficult to understand."
Types of apraxia
Apraxia of speech can be broken into two categories:
Childhood apraxia of speech: Children with apraxia are born with the condition. For children with apraxia, difficulty in planning speech movements is the hallmark of the condition. In fact, the root of the word, “praxis,” means “planned movement.”
Acquired apraxia of speech: This can affect people at all ages, although it most commonly occurs in adults. Acquired apraxia is caused by damage to the parts of the brain that are involved in speaking. It often involves the loss or impairment of existing speech abilities.
Misconceptions about apraxia
Apraxia often gets mislabeled or confused with other conditions. To truly understand what apraxia is, it’s important to understand what apraxia is not. Here are a few common misconceptions:
Developmental speech Delay: Childhood apraxia can often be confused with delay in speech, in which a child follows a “typical” path of speech development but at a much slower rate than normal. While many children may outgrow a speech delay, this is not the case for apraxia. Children with apraxia often will not make progress without treatment.
Articulation and phonological disorders: A child who has trouble learning how to make specific sounds, but doesn't have trouble planning or coordinating the movements to speak, may have an articulation or phonological disorder.
Dysarthria: Dysarthria is a separate motor speech disorder characterized as a weakness or inability to control the speech muscles. People with dysarthria may have a hoarse, soft, or even strained voice, or slurred or slow speech. While rare, some people can have both dysarthria and apraxia.
Aphasia: Aphasia is a language disorder that affects the production and comprehension of speech, as well as the ability to read and write. Aphasia is the result of damage to portions of the brain involved in language, most often from a stroke or head injury.
How common is apraxia?
Research is lacking on the prevalence of apraxia. According to Apraxia Kids, some estimates show that childhood apraxia of speech affects about 1 in 1,000 children. Other sources indicate that the incidence of childhood apraxia may have increased in recent years.
Some factors that may be influencing the rise in diagnoses include:
Increased awareness of childhood apraxia of speech
An increase in research being done on apraxia
More children being evaluated for apraxia at an earlier age
What does apraxia sound like?
Every person with apraxia is different, and symptoms can vary dramatically.
In some cases, apraxia can be so mild that the person only has difficulty with a few speech sounds or is unable to pronounce multi-syllable words. In more severe cases, a person may not be able to communicate effectively by speaking.
However, people with apraxia often have some of the following symptoms or speech characteristics, including:
Inconsistent errors in speech: A child with apraxia may pronounce the same word differently each time they say it. For example, one day they may say a difficult word correctly, but then soon after have trouble repeating it.
Distorting sounds: Because people with apraxia do not place their speech muscles in the right places, sounds often come out incorrectly. Pronouncing vowels can be especially difficult, as can longer and more complex words.
Groping for sounds: People with apraxia can seem like they’re “groping” for words. They may try saying a word several times before they say it correctly.
Inappropriate intonation, stress, or rhythm of words: Individuals may struggle with the rhythm and flow of speech. They may segment syllables in a word, omit syllables in words and phrases altogether, or pause inappropriately while speaking.
Some additional signs and symptoms of childhood apraxia of speech that caregivers should look for include:
Your child develops their first words or sounds later than typical
Excessive movements of the mouth
Persistent or frequent regression in the number of words produced
Use of automatic words or phrases correctly (such as "hello" and "thank you") but difficulty with voluntary speech
Errors in the order of sound production in words, which can include omitting, switching, or adding to the sounds of words
According to the Mayo Clinic, apraxia in children has been associated with other problems or complications that affect the ability to communicate. While these are not due to childhood apraxia of speech, in many cases they’ve been observed alongside apraxia, including:
Delayed language development, such as difficulty understanding speech, having a reduced vocabulary, or using incorrect or inconsistent grammar when stringing words together in sentences and phrases
Delays in reading, spelling, or writing
Difficulties with gross and fine motor skills and coordination
Hypersensitivity, in which your child may not like certain textures in clothing or food, or may not like brushing their teeth
What causes apraxia?
In many cases, the exact cause of childhood apraxia is still unknown. Some researchers believe that apraxia may be related to a child’s language development, while others believe it has to do with problems in how the brain signals to the speech muscles.
Possible causes that researchers are still studying include:
Abnormalities in the brain and other parts of the nervous system
Genetic factors that may play a role: The condition may run in families, and many children with apraxia have a family member with a communication disorder or a learning disability
Other disorders your child may have, including cerebral palsy, autism, epilepsy, or galactosemia
Acquired apraxia of speech, which often happens to adults, is when the part of the brain that controls coordinated muscle movement is damaged. Stroke is a common cause of apraxia. It may also be caused by head injury, brain tumors, dementia, or progressive neurological disorders.
How is apraxia diagnosed?
A speech-language pathologist, more commonly referred to as a speech therapist, is the most qualified professional to diagnose and treat apraxia. This process begins with a comprehensive evaluation.
Childhood apraxia is a complex disorder and difficult to diagnose. Because there is no single symptom or test used to diagnose apraxia, your speech therapist will look for the presence of a group of symptoms, and work to rule out other possible conditions that may sometimes be confused with apraxia, such as a speech delay. This is an important step that can help confirm the diagnosis so your speech therapist can tailor treatment goals appropriately.
Your speech therapist will most likely evaluate a variety of factors, including your child’s speech skills, medical history, their use of expressive language (how they use words, sentences, and gestures to convey messages to others), and their receptive language (how they understand the words, sentences, and meaning of what others say or what they read). They will also collect information about your family history and how you’ve observed your child communicating at home and in other situations.
In some cases, your speech therapist will perform a language test on your child. They may ask your child to repeat a word several times, or repeat a list of words increasing in length.
What does apraxia treatment look like?
As mentioned, children with apraxia will not outgrow it on their own, nor will they acquire the basics of speech by being around their peers.
Apraxia often requires frequent, intensive, one-on-one speech-language therapy sessions, with lots of repetitive exercises and personal attention. Once your speech therapist better understands your child’s condition, they will design a treatment plan tailored to your child’s needs and speech abilities. Treatment may go on for years in addition to normal schooling.
Many children with childhood apraxia of speech benefit from:
Practicing the repetition of sounds, words and phrases
Being shown visually how speech sounds are made by combining sounds into words
Saying a word at the same time as the speech therapist or parent/caregiver
For adults with acquired apraxia, treatment works similarly. However, some people with acquired apraxia of speech do recover on their own. This is called spontaneous recovery.
Just as individual symptoms vary, so does progress. What works for one child or adult may not work for another, and each person progresses at their own pace. As a parent, caregiver, spouse, or friend, one of the most important things you can do is be a constant source of encouragement and routinely practice at home.
In severe cases, adults and children with apraxia of speech may need to find alternative ways for communicating and expressing their thoughts. These methods can include:
Using sign language
Using a notebook with pictures or written words
Using an alternative or augmentative communication (AAC) device, such as a communication board or a portable tablet that writes and produces speech
These assistive tools may not need to be used long-term. However, using these modes of communication while working with your speech therapist can help promote speech production and verbal skills. Using an AAC device can also help decrease any frustration a person may feel in trying to communicate.
Tips to help parents support their child with apraxia
One of the best tools children have to help manage their apraxia is you, their parent or caregiver. Many studies show that parents play an essential role in helping their child reach their speech and language goals. Caregivers spend the most time with their child, and there are many simple techniques and exercises you can do every day to help your child.
While we’ve provided a few tips below, be sure your speech therapist empowers you with the tools and knowledge you need to take an active role in your child’s progress.
Try not to pressure your child to speak if they’re uncomfortable or unwilling.
Be patient when your child does want to speak. Give them plenty of time to communicate.
Use positive reinforcement. Try to be as supportive and encouraging as possible.
Establish a topic, such as “what’s for dinner,” so you both know what you’re talking about.
If you’re having difficulty understanding, ask simple, yes-or-no questions to clarify what you’ve heard is correct. Focus on the parts of the message that may still be unclear.
How does Expressable evaluate and treat apraxia?
Expressable matches families with a certified speech therapist trained to evaluate and treat apraxia. All therapy is delivered online via face-to-face video conferencing.
Your child’s age and development will influence how your speech therapist interacts with them through these video chat capabilities.
Ages 0-3: Caregivers work directly with their child's speech therapist to learn cues and at-home strategies. That way they can confidently practice with their child outside of sessions to help improve their communication. Learn more about the importance of caregiver involvement in children’s speech therapy here.
Ages 3-6: Caregivers attend video sessions alongside their child so they both learn valuable skills from their speech therapist. Reinforcing these lessons outside the session will continue to promote at-home skill building.
Ages 7 and up: Most children attend video sessions independently, but parents are kept in the loop with updates and tips during each session.
Adults: Adults attend sessions by themselves, but they are welcome to bring loved ones or family members as well.