Most Effective Treatments for Apraxia
Childhood apraxia of speech (CAS) is a motor planning and programming disorder that affects oral motor movement, meaning there is a problem with communication between the brain and mouth.
This disorder can sometimes be referred to as developmental apraxia of speech, or developmental verbal dyspraxia. However, apraxia is not developmental because children do not grow out of it. This is a lifelong condition that needs treatment in order to improve.
The clearest indicator of apraxia is that a child will have trouble with the movements required to make consistent, correct sounds and speech. Apraxia is not a problem with the oral muscles. Before diagnosing apraxia, other factors should be looked at, such as muscle tone or hearing problems, both of which can affect a child’s speech.
Common signs include:
· Trouble pronouncing words
· Language delay
· Inconsistent mistakes on sounds, syllables, vowels, consonants, and consonant-vowel combinations
· Applying stress in the wrong place
· Trouble pronouncing longer words and with transitions between words
· Off-target movements (such as wrong mouth position)
· Movements that distort sound
Treatment
Apraxia treatment involves:
· Motor programming interventions include the repetitive exercise of proper speech movements.
· Linguistic interventions focus on speech function and the rules and sounds of language.
· Rhythmic interventions involve using songs, rhymes, and chants in a fun way to help with memorization
· Sensory cueing approaches
· A combination of motor and linguistic interventions
Although all of these approaches have not been extensively studied to be able to properly compare all of them, it does seem from the literature that the most evidence supports motor planning approaches.1 This, however, does not mean that other interventions are not effective.
Motor planning interventions such as Integral Stimulation (IS) and Dynamic Temporal and Tactical Cueing are proven to be especially effective for treating apraxia. Methods such as IS and DTTC involve first modeling by the therapist of proper movement which is followed by visual, auditory, and tactile cues, all of which are then imitated by the child.
Relationship Between Apraxia and Developmental Coordination Disorder
According to ASHA, there are some common co-occurring symptoms that are associated with apraxia of speech.2 These include gross and fine motor delays, motor clumsiness, and limb apraxia.
With that in mind, there is some preliminary evidence suggesting that there may be a co-occurrence between Developmental Coordination Disorder (DCD) and childhood apraxia of speech.3 This requires for SLPs to be able to help identify and advocate for multidisciplinary treatment.
Developmental Coordination Disorder, or dyspraxia, is a motor learning delay where an individual has trouble with motor planning and learning in regards to fine and gross motor skills. Similar to apraxia, there is trouble with communication between the brain and the planned executed movements.
A pilot study looking at 35 children found that there is a high probability that children with apraxia of speech may also have DCD, recommending that “a collaborative, multi-disciplinary (i.e., physical therapy, occupational therapy, speech-language pathology, therapy assistant) approach may be particularly important for early identification of DCD and for providing ongoing supports, treatment, and management of children identified as having sCAS and pDCD.”4
Although this was a small pilot study, the co-occurrence of gross and fine motor delays with childhood apraxia of speech is commonly known. This means that SLPs seeing children with apraxia can help with the early identification of any other motor delays.
Resources
The Canadian Journal of Speech-Language Pathology and Audiology also provides a suspected Childhood Apraxia of Speech Checklist. Feel free to check it out on pages 92-93 here.
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1. Koehlinger, Keegan M. “Improving Speech Intelligibility in Children with Childhood Apraxia of Speech: Employing Evidence-Based Practice,” EBP briefs. 9, no. 5 (2015): 6, http://images.pearsonclinical.com/images/assets/ebp/pdfs/EBPV9A5.pdf.
2. “Childhood Apraxia of Speech (Practice Portal),” American Speech-Language-Hearing Association, accessed 15 June 2022, www.asha.org/Practice-Portal/Clinical-Topics/Childhood-Apraxia-of-Speech/.
3. Duchow, Holly, et al. “The Co-Occurrence of Possible Developmental Coordination Disorder and Suspected Childhood Apraxia of Speech,” Canadian Journal of Speech-Language Pathology and Audiology. 43, no. 2 (2019): 81-93. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjmlNmOmLL4AhUqJUQIHVGSBNkQFnoECA4QAw&url=https%3A%2F%2Fwww.cjslpa.ca%2Fdownload.php%3Ffile%3D%2F2019_CJSLPA_Vol_43%2FNo_2%2FCJSLPA_Vol_43_No_2_2019_MS_1159.pdf&usg=AOvVaw3AIvcfFLO94MYXCyqE9sr9.
4. Duchow, Holly et al, “The Co-Occurrence of,” 89.
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“Childhood Apraxia of Speech,” American Speech-Language-Hearing Association, accessed 15 June 2022, https://www.asha.org/public/speech/disorders/childhood-apraxia-of-speech/.
“Childhood Apraxia of Speech (Practice Portal),” American Speech-Language-Hearing Association, accessed 15 June 2022, www.asha.org/Practice-Portal/Clinical-Topics/Childhood-Apraxia-of-Speech/.
Duchow, Holly, et al. “The Co-Occurrence of Possible Developmental Coordination Disorder and Suspected Childhood Apraxia of Speech,” Canadian Journal of Speech-Language Pathology and Audiology. 43, no. 2 (2019): 81-93. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjmlNmOmLL4AhUqJUQIHVGSBNkQFnoECA4QAw&url=https%3A%2F%2Fwww.cjslpa.ca%2Fdownload.php%3Ffile%3D%2F2019_CJSLPA_Vol_43%2FNo_2%2FCJSLPA_Vol_43_No_2_2019_MS_1159.pdf&usg=AOvVaw3AIvcfFLO94MYXCyqE9sr9.
Koehlinger, Keegan M. “Improving Speech Intelligibility in Children with Childhood Apraxia of Speech: Employing Evidence-Based Practice,” EBP briefs. 9, no. 5 (2015): 1-10, http://images.pearsonclinical.com/images/assets/ebp/pdfs/EBPV9A5.pdf.