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childhood apraxia of speechIn another article, What is Childhood Apraxia of Speech?, we discussed the difference between childhood apraxia of speech (CAS) and childhood dysarthria.

CAS, often referred to as verbal dyspraxia outside of the USA, must also be distinguished from a childhood phonological disorder and acquired apraxia of speech (AAS). These two are frequently confused with CAS. Additionally, some children can have a phonological disorder along with CAS.

Characteristics of a Language-Based Childhood Phonological Disorder

A language-based childhood phonological disorder is different from childhood apraxia of speech. Children with phonological disorders have difficulty internalizing speech sound production rules as part of the language system.

Children with phonological disorders (1, 2) tend to:

Ear Infections

Have a history of middle ear problems such as ear infections.

Improper Speech Sounds

Babble and say many speech sounds, but don’t use those speech sounds properly.

For example, a child with CAS may say “gog” instead of “dog” or “kak” instead of “cat” where both consonants are made at the back of the mouth.

They also tend to make consonant errors instead of vowel errors.

Spontaneous Speech

Have trouble saying speech sounds in spontaneous speech that they can imitate.

Typical Speech Rate

Have generally typical speech rate, rhythm, stress, and inflection.

Speech Sound Recall

Have difficulty identifying and remembering speech sounds.  For example,

What sounds do you hear in the word “dog?”

Tell me a word that begins with the “d” sound.

Reading & Spelling Impacts

Have difficulty with reading and spelling because they have not made adequate brain-level connections between speech and language.

Additional Language Isms

Have other specific language problems such as word-finding difficulties.

Neuro is Intact

Have no soft neurological signs.  There are no problems with gross or fine motor coordination used in activities such as tricycle riding or coloring.

Acquired Apraxia of Speech and How it Differs from Childhood Apraxia of Speech

AAS is usually found in adults who have had a stroke resulting in something called Broca’s aphasia.  While a similar area of the brain may be involved – the premotor cortex – children with CAS do not have specific brain damage or injury.

However, many people confuse the characteristics of AAS with CAS. While some characteristics of AAS may seem similar to CAS, the two disorders are qualitatively unique (3).

Let’s compare and contrast –

Sounds

Children with CAS often leave sounds out of words, particularly the beginning of a word.

Adults with AAS most frequently substitute one speech sound for another.

Voice

Children with CAS tend to turn voice on when they should turn voice off.

Adults with AAS do the opposite.

Voicing is further explained below.

Words & Phrases

Children with CAS may say an occasional word “out of the blue”.

Adults with AAS may say clear and complete phrases and sentences under certain circumstances.

Characteristics that Specifically Distinguish CAS from Other Speech Disorders

CAS affects the sequencing, coordination, and timing of speech. Children with CAS (3, 4) tend to:

Expressive Language

Have far greater understanding of language than they can express or say.

Limited Babbling

Have limited babbling and speech play as infants. They are often relatively quiet babies or only make a few speech sounds. They may gesture or grunt instead of using speech.

Limited Speech Sounds

Say a limited number of vowel and consonant sounds instead of a full range of speech sounds (5).

Mispronunciation

Mispronounce vowel sounds which significantly affects “understandability.”

Children may say “cot” instead of “cat”.

Speech Errors

Make many speech errors and frequently leave sounds out of of words.

A child with CAS may leave sounds out at the beginning, saying “_at” instead of “cat”.

Make consistent speech errors in spontaneous speech.

As above a child with CAS may say “_at” instead of “cat” consistently when commenting or responding.

Make inconsistent speech errors when attempting to imitate speech.

A child with CAS may say “gad,” “got,” “cad,” “cot,” “_at,” etc. instead of “cat” when given a speech model by another person.

Voicing

Turn their voices on or sometimes only partially on when they should turn their voices off during speech.

For example, a child with CAS may say something closer to “gad” instead of “cat”.

The “g” and “d” sounds use voice; the “k” and “t” sounds do not.

Children with phonological problems can also have voicing errors, but the sound of their errors is somewhat different from those of children with CAS.

Struggled Speech Attempts

Grope, struggle, and use trial and error during speech attempts.

You may note the mouth moving all over the place or getting stuck in place during speech attempts.

Telegraph Speech

Speak in short, telegraph-like words and phrases.

A child with CAS may say “_ant _oodie” instead of “I wanna cookie.” or “I want a cookie.”.

Out of Sync Speech

Have difficulty with speech rate, rhythm, stress, and intonation.

Speech often sounds “out-of sync” making it very difficult to understand.

“Out of the Blue” Speech

Say words “out of the blue” without being able to say them again.

For example, a child with CAS may say brother’s name “Alexander” perfectly without being able to repeat it.

Body Movement Isms

Have problems learning movement sequences throughout the body.

For example, a child with CAS may struggle with movements for bubble or horn blowing, gesturing, coloring, tricycle riding, etc.

However, children may have CAS without these additional issues.  The additional issues may be referred to as oral and limb dyspraxia.

In Summary

Now, you know many characteristics that can distinguish CAS from other speech disorders.  We invite you to explore resourceful websites on this topic.

References

(1) Strand, E. A. “Differential Diagnosis and Treatment of Childhood Apraxia of Speech.” The Childhood Apraxia of Speech Association. Nevada, Las Vegas. 2010. Workshop.

(2) Kamhi, Alan G., and Karen E. Pollock. Phonological Disorders in Children: Clinical Decision Making in Assessment and Intervention. Baltimore: Paul H. Brookes, 2005. Print.

(3)  Bahr, Diane Chapman., and Argye Elizabeth. Hillis. Oral Motor Assessment and Treatment: Ages and Stages. Boston: Allyn and Bacon, 2001. Print.

(4)  Lindsay, Leslie A. Speaking of Apraxia: A Parents’ Guide to Childhood Apraxia of Speech. Bethesda, MD: Woodbine House, 2012. Print.

(5) Bahr, Diane Chapman. Nobody Ever Told Me (or My Mother) That!: Everything from Bottles and Breathing to Healthy Speech Development. Arlington, TX: Sensory World, 2010. Print.