Childhood Apraxia of Speech and Hearing Loss

Childhood Apraxia of Speech (sometimes referred to as apraxia, verbal apraxia and dyspraxia) is a neurological speech motor planning disorder. Motor planning is the ability to for the brain to tell your muscles what to do. In the case of CAS, there is a disconnect between the brain and the speech muscles. Even though the child has an idea of what he wants to say, the speech muscles do not get the message or the correct message from the brain.

In general, very young children with CAS don’t babble and their first words are delayed. One of the first signs of CAS is that the child “understands everything” but isn’t starting to talk. Then, when she does begin to speak, she uses mostly vowels and has limited use of consonants. As the child begins to gain some speech, she may also be observed to produce the same word differently each time.

So, what does this have to do with hearing loss? When diagnosing CAS, it is often suggested that hearing loss be ruled out to ensure that the issue is a neurological issue with motor planning rather than due to the hearing loss. Does that mean that a child with hearing loss can not have CAS as well? That doesn’t sound likely. It just becomes difficult to diagnosis. It is like the chicken and the egg. For CAS, we know the problem lies in the wiring of the nerves to the speech muscles. But when hearing loss is involved, is the problem lack of use of the muscles and sequencing motor movements due to early sound deprivation? It is difficult to determine. Yet, when a child is diagnosed early and aided properly, giving them access to sound, can we then say it is CAS? Or if diagnosed later and aided later, is it a true CAS or due to the lack of experience with sound, babbling and practice? The real question is……Does it really matter?

Ultimately, it doesn’t matter what the cause of the motor sequencing issues. It should be treated similarly. For motor sequencing issues or CAS, consistent and frequent speech therapy is required to work on speech motor movements. Repetition is the key. The sessions should not focus on strengthening the muscles, as this is not the issue with CAS, but, rather on coordination of movements. While oral-motor exercises can be done, they must immediately be translated into speech movements and into speech production. I have seen kids who have learned to coordinate non-speech movements in oral motor therapy, but without working in conjunction with speech production, the progress is not carried over.

Possible therapy techniques that I have seen that have been successful have been PROMPT (c) www.promptinstitute.com (PROMPTS for Restructuring Oral Muscular Phonetic Targets), Kaufman Speech to Language Protocol © kidspeech.com, and use of bod movements/verbotonal cues (i.e. Sounds in Motion © www.soundsinmotionprogram.com).