Well, what is apraxia?

Apraxia is neurological motor planning disorder in which a child knows exactly what they want to say but does not have the ability to say it. It is not due to weak muscles in the mouth but more of a disconnect between the brain and the mouth. It has nothing to do with a lack of intelligence or comprehension. In fact, one of the hallmarks of apraxia is a very low score for expressive speech and a high or very high score for receptive. It is currently believed that apraxia occurs in every 1 or 2 :1000 children. Children can have acquired apraxia (meaning something happened that caused them to have apraxia -stroke, traumatic birth, etc) or idiopathic apraxia (meaning no known cause). I have listed the full details of “why” or the lack thereof below.

How I explain it to people - Personally, I always compare apraxia to when an adult has a stroke and loses the ability to speak. They undergo speech therapy to regain that skill, some adults are able to make full recoveries and some are not. Just as the adult knows exactly what they want to say, so does a child with apraxia. Although this is a very loose frame of reference it does seem to provide people with at least a general understanding. 

One of the things I have found most difficult to deal with is that there is no "guideline", nothing to say do X & Y and you will have Z as your outcome. Each child is truly unique in their progress but all of them must receive frequent, intense and appropriate therapy in order to be successful. With that being said, progress is not a constant upward trajectory. I call it our "ebb & flow." There will be days when you feel you've lost months of progress. For us, it has always returned to where we were before our "ebb", sometimes it takes longer than others. If your child is experiencing this, hang tight. I know, for me, it is one of the worst and most defeating feelings.

 

Who diagnosis apraxia?

This is something I am asked frequently and I hear responses that generally catch me off guard. CAS (apraxia) can and should ONLY be diagnosed by a certified speech pathologist (SLP). Not a Pediatrician, not a Developmental Pediatrician, not an Occupational Therapist, not an Ear, Nose and Throat (ENT) Doctor, and not a Neurologist. To find a list of SLP's look here first CASANA Recognized SLP's then you can always go to the ASHA Professionals to locate someone near you. You should also be aware most school based therapists will NOT diagnose a child with any specific disorders. I have heard that can vary slightly school district to school district but overall you will need to find a private speech therapy office to receive a true diagnosis. A private speech evaluation can also be very helpful during an IEP. To learn more about how to lay the foundation for a solid IEP and a successful meeting check out my tips here.

 

Who has apraxia and why?

The current knowledge that we have about Childhood Apraxia of Speech (CAS) is this. CAS occurs in the following 3 conditions:

  • Neurological impairment caused by infection, illness, or injury, before or after birth or a random abnormality or glitch in fetal development. This category includes children with positive findings on MRI’s of the brain.
  • Complex Neurodevelopmental Disorders – We know that CAS can occur as a secondary characteristic of other conditions such as genetic, metabolic, and/or mitochondrial disorders. In this category would be Childhood Apraxia of
    Speech that occurs with Autism, Fragile X, Galactosemia, some forms of Epilepsy, and Chromosome translocations involving duplications and deletions.
  • Idiopathic Speech Disorder (a disorder of “unknown” origin) – with this condition, we currently don’t know “why” the child may have CAS. Children do not have observable neurological abnormalities or easily observed neurodevelopmental conditions.

Cited from (What Causes Childhood Apraxia of Speech and Is It Preventable? Library : Understanding Apraxia. http://www.apraxia-kids.org/library/what-causes-childhood-apraxia-of-speech-and-is-it-preventable/ ) The following graphic is also from the CASANA website and part of the information I hand to speech pathology offices. I find it incredibly helpful & easy understand.

apraxia