What is Apraxia?

I’m so happy to welcome April Vogt to Mommy Speech Therapy! April is not only an incredibly talented Speech Language Pathologist she is also a mother of two darling children. She will be sharing her experience and knowledge on various speech related topics here on Mommy Speech Therapy as well as answering some of your questions. In this post she answers common questions about the motor speech disorder called Apraxia. Questions like, “What is apraxia, what are the signs and symptoms of apraxia and what does treatment for apraxia look like?” If you have a minute, join me in welcoming April to Mommy Speech Therapy. Hopefully together we will be able to continue to share insightful and helpful information on speech and language topics for all of you wonderful parents at home.

What is Apraxia of Speech?

For a moment I want you to imagine (though this may not be too far off from reality for some) that you are the parent of a young child whose speech is severely unintelligible. People unfamiliar with your child cannot understand him or her when they attempt to speak, and sometimes even you, as a parent, have trouble trying to make sense of your child’s attempts at communication. Your child seems to understand language, but expressively the sounds and syllables of their words seem to be off target. You consult a speech language pathologist (“SLP”), who uses the term “apraxia” as a possible reason for your child’s speech difficulties—but what is apraxia?

What is Apraxia?

Apraxia is a type of motor speech disorder that affects the way the body is able to produce speech. Motor speech disorders are neurological in nature, meaning a child’s brain has difficulty coordinating the different body parts needed to produce speech—the tongue, lips, and lower jaw. Due to this neurological difference, children with apraxia struggle with sequencing and articulating sounds, syllables, and words when they are trying to communicate. As a result of these struggles, children with apraxia can be difficult to understand. Apraxia is different from other motor speech disorders in that it is not caused by muscle weakness, a limited range of motion, or paralysis of any muscles.

Below, I have addressed some frequently asked questions that parents may have when faced with the possibility of apraxia. It is important to note that apraxia can go by many other labels, including its more formal name—childhood apraxia of speech (CAS). Other labels include: dyspraxia, developmental apraxia of speech, developmental verbal apraxia, or verbal dyspraxia. These different terms can be found throughout the span of literature devoted to the subject, but for simplicity’s sake, I will simply refer to the disorder as “apraxia” for the remainder of this post.

What Causes Apraxia?

Apraxia is most often caused by neurological damage due to infection, illness, injury, or trauma. Apraxia can also be a secondary characteristic of other conditions including some genetic disorders, degenerative disorders, metabolic disorders, and even seizure disorders; however, not all children with these types of disorders will exhibit apraxia. There are also instances when the cause of apraxia will be unknown and there will not be any apparent neurological indicators for why a child is exhibiting apraxia in speech.

What Are the Signs and Symptoms of Apraxia?

Apraxia can be a perplexing disorder for parents due to its complexity. Part of the confusion associated with the disorder is that not all children with apraxia will exhibit the same types of signs or symptoms. Symptoms can also vary in their severity from mild to profound. The most common characteristics of apraxia include:

Late talking
Though this symptom can be indicative of many other speech or language disorders, if your baby does not coo or babble, or if your toddler is considered a “late talker”, apraxia could be involved.

Articulatory groping
This is a type of searching or struggling behavior that a child attempts with their tongue, lips, or lower jaw when they are trying to communicate. Attempts at coordinating these body parts may appear “off target”.

Errors are inconsistent
Different kinds of errors will occur on the same word when repeated over and over again.

Imitated vs. Spontaneous speech
Automatic speech (i.e. counting, singing the alphabet, social greetings, etc.) and imitated speech will be less affected then spontaneous speech.

Multisyllabic words are harder
The frequency of errors will increase the more complex the word or utterance.

Prosody
Prosody can be affected by a reduced rate of speech, monotone speech with little pitch variance, or the child may stress the wrong syllable or word.

Reduced speech intelligibility
Due to the inconsistency and frequency of their errors in speech, children with apraxia will be difficult to understand to unfamiliar listeners.

What Does Treatment for Apraxia Involve?

If you have concerns that your child may be exhibiting signs or symptoms of apraxia, it is important to have the child evaluated by an SLP. An SLP may be able to exclude other speech disorders to help determine if your child does have apraxia; this will also aid in determining a course of treatment. It is important to note that the labels “developmental apraxia of speech” or “childhood apraxia of speech” can be misleading. This is not a disorder that a child will grow out of. Many children can become intelligible speakers, but it takes time and commitment.

There is not an easy fix for apraxia, and because apraxia can manifest itself differently in every child, SLPs may use a variety of techniques in therapy to achieve maximum results. Research does show that children with apraxia benefit most from receiving frequent treatment sessions. SLPs may also suggest alternative means of communication such as sign language, or augmentative communication systems that may be implemented if a child is severely impacted in his or her communication. These alternative means of communication can serve as a temporary means to establishing a less-frustrating way for children with apraxia to express themselves and communicate with those around them until their speech begins to improve with treatment.

Naturally, parents will wonder if their child will ever be able to communicate effectively. Treatment outcomes may depend on the severity of the child’s apraxia, as well as whether any other co-occurring problems are present, such as delayed language development, difficulties with fine motor movements, or sensory-related issues. Generally, with timely and appropriate treatment, children with apraxia can make some level of progress and attain certain levels of intelligible speech and effective communication.

What Can I Do to Help at Home?

SLPs will usually send home information and specific assignments for parents to complete at home with their child once a plan of treatment has been determined. Consistent practice and repetition are important and necessary keys to helping children with apraxia achieve their potential for intelligibility and communication. Though apraxia can be frustrating at times for both parents and children, providing a variety of opportunities for a child with apraxia to talk is vital. Parents can get creative and make practice time fun to help in breaking up the monotony of therapy. Speech practice can be done during story time, in the car, in the tub, or while playing a game—anything that encourages communication.

Most of all, children with apraxia will benefit from a supportive environment that will help them feel positive as they strive to increase their successful communication attempts. I hope this information has better helped you understand the components of apraxia and wish you the best of luck while helping your child with their speech.


April - Mommy Speech Therapy April Vogt, M.Ed. CCC/SLP is a speech-language pathologist who has worked with school-aged children through adults in educational, transitional, and medical settings for the past 8 years. She received both her Bachelor’s and Master’s degrees from Utah State University. April lives with her husband, Colby, and 2 daughters: Eleanor and Audriana. She enjoys skiing, watching movies, and riding motorcycles.

18 Responses to “What is Apraxia?”

  1. nick says:

    thank you so much…im dealing with my nephew who has some kind of speech disorder…and you have strengthened my resolve…and enlightened my ideas…tomorrow I will approach him with more games that involve repetition of familiar words…And more patience…TY

  2. Sanaz Amini says:

    Thanks for sharing! Great article and very informative :)

  3. Zia Mohiuddin says:

    My daughter is about 6years old & had fits 2nd time on Julyt 24 to August 05, 2013 after January 08th – 19th, 2011. Now she behave like a baby of 1 year & unablt to talk properly and also having issue with her vision. In 2011 she had fits at right sides & now mostly she had fits on left side.

    Now movement of her left side is effected & face part of left side is also effected. We are looking for the possible option for her fastest recovery as best as we could do.

    If there is anybody who can help us with usefull information for my daughter to be as normal as of a healty child or nearest.

    Her medical treatments are as follows:
    After 2011:
    Epival (3 to 5 ml twice a day)
    Lerace (1 to 1.25 ml twice a day)
    Phenobarbiton 30mg (1 tablet twice a day)

    After July 2013, having infection from epival (Liver effected joindace):
    Topamax 25mg tab (half tablet in morning & 1 tablet in night)
    Lerace (1.5 to 1.75 ml twice a day)
    Phenobarbiton 30mg (1 tablet twice a day)
    Folic Acid & Multi vitamin syrup for 30 days once a day

    Looking for better advice / help from expert medicen.

    • April says:

      Hi Zia,
      We’re sorry to hear about your daughter. It’s difficult for us to recommend specific courses of intervention without having the opportunity to see and evaluate your daughter, but it sounds like she has some underlying medical and neurological issues that would best be addressed by her doctor especially if she is having regression with her behavior and her ability to communicate. It would also be beneficial for you or your doctor to consult a speech pathologist to determine your daughter’s receptive and expressive language needs and whether or not she would benefit from alternative or augmentative modes of communication so that she can communicate her wants and needs with you and other people as effectively as possible. We wish you the best of luck through this difficult time.

  4. Tamara L. Kaur-Singh says:

    Can this disorder develop from speaking two different languages in the home??

    • April says:

      Hi Tamara,
      The research available doesn’t show a connection between children developing apraxia and learning other languages in the home. Apraxia is usually considered a disorder that is neurological in nature and not one usually attributed to language development.

  5. hi my daughters child is 5year old he was born 6 weeks to earily and is a little slow in speech .i work with special needs under 5s and want to help the wee man .he is very shy and plays alone at school .his 3year old sister is outgoing child and gets all the notice he is in her shadow. please advise

    • April says:

      Hi Margaret,
      When you say that your grandson is “slow in speech” do you mean that he has a slow speaking rate, or that he has difficulty pronouncing and sequencing his words when he speaks? If you feel that his speech is irregular and is impeding his communicating with adults and peers then I would think you might want to consult a speech-language pathologist (SLP) to evaluate his speech and language skills. In the meantime you can encourage good speech and language skills at home by providing opportunity for your grandson to speak and by modeling good speech and language in your own speech productions.

  6. Hello,

    I regularly check this website and really enjoy reading the articles and browsing through worksheets. I stumbled upon this site because one of my dyslexic students also has Apraxia. She was undiagnosed when younger and is awaiting assessment now. I really enjoyed reading your article because I was very confused initially on what Apraxia is, and a friend of mine who is an SLP informally diagnosed it in my student.

    I found the question and answer section on Apraxia very helpful and just wanted to thank you for the information you have provided.

    Najia Siddiqi

  7. Emmanuella says:

    Hi April, I was reading your article very impress; I have a 4 year old just start preschool this year he have a speech delay problem the school is concern his not responding to his name I did get a hearing test for him and his hearing is fine, but sometime you need to call him 3 to 4 time to get him respond to you, and he really forget thing fast, you can tell him a word or phrase he will say it but just not remember them and his mind most of the time far.

    I saw speech therapist with him twice, they require to have one and one base with him with a speech therapist, which is the country I am leaving is a island were we do not have Speech therapist.

    I don’t have a friend or family member who leave abroad to leave him to get the treatment.

    How can you help please and what can be done for him with his speech to able to help more at home.

    He was born premature 8 months, he does everything else except not want to talk.

    Example if he want use the bathroom he say bathroom, most he will said up to 4 words, if he want something to eat he will say food , he know his animal sound , alphabetical, colours,

    His problem not doing phrase and not remember things

    Emma

    • April says:

      Hi Emma,
      I’m sorry to hear that you are having a hard time getting your son treatment for his language delay. There are some things you can do at home to encourage him to expand his language. there are some general things you can do to help encourage expressive language. It may seem like common sense, but talking to your child and exposing them to language is very important. Talk when you’re in the car, talk when you’re at the grocery store, talk while you’re making dinner, sing songs etc. That exposure to language will help in encouraging your child’s expressive language. Reading to your child is also very important. You don’t have to finish a whole book, but look for age-appropriate board or picture books that encourage your child to look at the book while you name the pictures. You can ask questions while you read like asking your child “what will happen next?” Reading will help create a language rich environment in your home. Finally, As you’re doing activities with your child, talk about what you’re doing as you do it and “think” out loud asking and answering your own questions “Where does this piece go?” “Oh, it goes right here.” This type of modeling will help show demonstrate to your child how to ask and answer questions. Also, you can check out our blogpost on 8 Ways to get your child to speak and the American Speech and Hearing Association has some great ideas listed here
      Good luck and we wish you the best!

  8. Birendra Kumar Shastri says:

    Dear Mam,
    My son 2years and 10 months old showing the symptoms of apraxia, he is going daily to a speech therapy centre since from last 5 months. Previously he was not responding to his name at all, but now after calling 2/3 times he is responding. He is showing slow but steady improvement. He seems to be very intelligent, but we are very much worried to see this. Financially also I am not sound. Please guide me how I can cure him in home. If you have any literature please send me.

    Regards
    B.K.Shastri
    F-576, CDA, Sector-6, Cuttack, Odisha, India

    07873846716

    • April says:

      Hi B.K.
      We’re glad to hear that your son is making progress. Sometimes progress with a disorder such as apraxia can seem slow, but as long as steady improvement is being made you can know that the speech therapy is helping. There is no “cure” for apraxia. In fact, apraxia treatment will vary from child to child based upon how severe that child’s apraxia is in their speech, and other factors that may be affecting their communication. Obviously we don’t know your child personally, so we cannot tell you precisely what will help him, but we will give you some general information that is usually included as key components of apraxia therapy.
      Speech therapy for apraxia usually includes principles of motor learning to help children coordinate the different body parts needed for speech i.e. lips, jaw, etc. Children will need a lot of practice and a lot of repetition as they practice syllables, words, multisyllabic words, etc. while the SLP works to shape their speech attempts, and the movements underlying them, into speech that is more accurate. As a parent you can practice these same target syllables and words at home so that your child can get as much practice as possible.
      Use of rhythm may help pace speech and help with naturalness of intonation, syllable and word stress patterns – a particular problem for children with apraxia of speech. The rate, intonation, and stress in speech are called prosody. Examples of the use of rhythm in speech therapy for children with apraxia may be clapping or tapping for each syllable or clapping harder when saying the syllable that should be stressed in a word.
      We strongly suggest that you meet and discuss your son’s progress with the SLP that is seeing him at the speech center where he is going. Ask for specific suggestions that you can do at home. The SLP should be able to provide word lists, etc. that will help you carry on that progress at home.
      Good luck!

  9. Yvette Gutierrez says:

    Hi . I’m a mother of 3 boys. Ages 4 1/2 (Anthony) 3 yrs (Izack) & 1yr (Noah). My 2 oldest boys hve a problem with talking. However my oldest (Anthony) is talking but he’s not at the level were all kids his age should be. (As in talking). He is in school (transitional kindergarten). And his teacher is having difficulties with him sometimes. She understand him but not most of the time. Now my other son Izack is 3 and he isn’t talking at all. I want to get some help quick or at least give me some ideas because flash cards isn’t helping. They are both very smart and listen and understand. They just don’t talk. Please help a.s.a.p

    • April says:

      Hi Yvette,
      If you feel your boys aren’t using enough expressive language then you can do a few tips I can suggest for you to try to get your boys talking and initiating a little more. As speech therapists, we often use the phrase “environmental sabotage” for setting up the child’s environment so that they HAVE to talk to get a wanted item, or snack, or whatever is motivating for them. Sometimes as parents we are very good at anticipating our child’s needs and so we will go ahead and refill a cup, get more crackers, or find a special toy for a child before they even have the opportunity to ask for it. In doing so we might be eliminating a valuable opportunity for our child to talk. Whether it’s at mealtime, or at playtime put desired objects just out of reach so that your child has the opportunity to initiate communication in order to get what they want. Basically, you want them to ask or request. For some children with lower language capabilities it might just be pointing at the object, but for children that have a vocabulary you’re going to want to encourage them to use their words or model a short phrase or sentence for them and have them repeat after you. You can make it a game too. During playtime have them request a toy, let them play with it for awhile, and then you request the toy back from them and you play with it for awhile until they request it back from you. Anything that you can do to create situations where your child has to speak or has to initiate communication in order to engage with you or their environment will be beneficial. Of course, if you feel that your child’s communication skills are delayed you will want to look into having them evaluated by a licensed speech language pathologist so that they can get intervention they need.

  10. tiffany says:

    At the end of this month my son will be 4 he began saying mama and Dada at 9 months even said dog a few times, around 1 yes old he just stopped and was just mumbling. At 1 1\2 he began lashing out with loud hollars and kicking. I thought maybe he had autism since also had weird ocd issues. I seemed help from a speech therapist, during our appt. My sons father had closed the door to the room he didn’t like that so he started throwing horrible fits and hollaring this lasted 3 hours. During this time he would still point to things on the pictures the speech therapist was asking him to point to. After determining my son was not going to calm down his dad took him to the waiting room. Once he was out of the room I broke down in tears. The speech therapist asked me if this was a constant behavior. And it was the tantrums would go on for hours and happened every day at least 5 times a day if not more. I love my child and I understood and was as patient as anyone can be with a child who can’t tell u what is wrong or just simply that he wanted a drink or what show he wanted to watch. I know it must have been horrible for him to not be able to make the words sound the way he heard them when anyone else says them. So, she sent me down the hall to a behaviorist who put him on the top of the list for a program in my city called first steps. We had 3 amazing people come over 4 times a week just to interact with my son. They taught him the basic signs for the most common requests my child would have on a daily basis. After 3 weeks I saw a huge improvement on his attitude and fits. Since my son was potty trained before they even started coming over he was immediately placed on a list for early childhood development which is really just a school. He started the day after his 3rd birthday. Which I might add was sad day for this mommy. Also a happy day though! In class to communicate with others his 3 wonderful teachers made him a book. The front of the book had Velcro strips and inside were little laminated pics with words so he could form a sentence on the front. That worked very well. However this year they have hit it right on the spot. They have this electronic board he uses which have buttons and different sheets to slide in the board depending on the theme of the week. When he pushes the button the board says the word out loud. For example during snack he can press a button for I WANY and then pick the snack or drink he wants and the board will then have said the full sentence out loud. Since using this board my son has gone from under 100 words to over 1000 being understood without errors. Not only that but his confidence and slef esteem as well as his overall interaction with children has grown past what any of his teachers or daily people in his life would have ever dreamt about. Before when asked to say a word he would just look down and say no. Now he always makes an attempt. That’s all a parent could ask for in these circumstances. He does still struggle with the n sound and sometimes we have to tell him our ears aren’t working and ask him to say it again or if he can show us what he’s saying. As his mom I see how smart my child is and know he has the potential to be anything he wants when he grows up. I mean he is very smart he is above a 2nd grade level on what he knows and he even takes any plastic or cardboard out of the trash and puts it outside in the recycle bin. He has been doing that since he could walk, except now it comes with a “mom that’s not trash” lol. Also a helpful tip to all parents or others who interact with a child with apraxia, I have noticed that since I started to repeat what he’s saying back to him just basically letting him know I know what your saying, he has made an attempt to try all words and he even laughs at me and says haha mommy not what I said. Before he would get down about his words but between my repeating everything he says, and the new board at school, and his teachers he has learned to just try his hardest and laugh when he gets it wrong. I wish all younmparents the best of luck in hopping this small milestone in ur child’s journey of life. Just remember when u feel like ur getting frustrated because ur child’s frustrated walk away and remind yourself that they are trying the best they can and its way more frustrating for them than it is you! Thank you for reading my story and I hope something that has worked for me works for you as well!

    • April says:

      Tiffany,
      Thank you for sharing your experience with your son, and thank you for your helpful tips to parents that may be experiencing similar struggles with their children with apraxia. I’m so glad to hear that your son has made so much progress since you first started on this journey, and that he has become a functional communicator. Thank you again!

Leave a Reply