Have you ever noticed that your little one has something in his head that he wants to say, but he struggles to get it out of his mouth? Maybe he tries to say the same word several times, says it one way or the other, or gets his words mixed up. At times like these, we think that the child is just bored or just being stubborn. But that's not always the case. This is not just something different, there may be a medical reason for this. That's what we're going to talk about today.
What exactly is Childhood Apraxia of Speech (CAS)?
Simply put, Childhood Apraxia of Speech (CAS) is a motor speech disorder that makes it difficult for children to speak. Imagine this: You're driving a car. You know you want to go straight. You know you need to keep the steering wheel straight. But your hands can't quite execute that command. That's what's happening here.
The child's brain knows what word he needs to say. The child knows that he needs to say "mama." However, the command to move the mouth, lips, and tongue to pronounce the word "mama" does not come from the brain. There is a slight disruption in the nerve pathways that carry messages from the brain to the muscles of the mouth. Because of this, the child has difficulty making the movements needed to say the words clearly and correctly.
The important thing is, this is not a cognitive problem with your child. He knows exactly what he wants to say. The problem is the brain telling the muscles in his mouth to move like this.
This condition is called by several other names.
- Developmental apraxia of speech
- Developmental verbal dyspraxia
There is no cure for this condition, but early diagnosis and specialized speech therapy can significantly improve the speech abilities of many children.
What are the early symptoms of this condition?
These early symptoms are usually seen in children under the age of 3. You may not have all of them, but if you have a few of them, you should be concerned.
| Characteristic | A simple explanation |
|---|---|
| Absence or decrease in babbling/cooing | Not making sounds like "gu-gu" or "ba-ba" as appropriate for their age, or if they do, only making a few of the same sounds. |
| Difficulty putting sounds together | Difficulty pronouncing "ma" by combining sounds like "m" and "ah". |
| Delay in speaking first words | Starting to speak words later than other children of the same age. |
| Saying words one by one | Pronouncing the word "ball" once as "ball", another time as "boba", and another time as "ole". There is no consistency. |
| Leaving large gaps between sounds | A long pause between letters when pronouncing a word. For example: "Um.....ma". |
| Limited use of sounds | The child's speech uses only a few consonants and vowels. |
| Difficulty eating | Problems with mouth muscle coordination can cause some children to have difficulty chewing and swallowing. |
Symptoms that can be seen in children over 3 years old
When the child gets a little older and starts speaking sentences, these characteristics can be seen more clearly.
- Difficulty understanding for others: It can be very difficult to understand what a child is saying, especially for someone who doesn't see the child often.
- Moving the mouth as if searching for words: Before saying a word, the mouth moves in different ways several times, as if preparing for it.
- Changes in speech pattern: Speech may sound monotonous, flat, or choppy.
- Difficulty pronouncing long words: The child struggles to pronounce a long word like "banana" clearly.
- Talking becomes more difficult when you are anxious: When a child is scared or anxious, it becomes even more difficult to talk.
- Difficulty imitating: When asked to repeat (imitate) something that others say, the child has difficulty doing so.
- Trying to say a word multiple times: Trying to say the same word multiple times until you can say it correctly.
Why do children have this condition?
The exact cause of this condition is not yet known . Researchers believe it is caused by a disruption in certain nerve pathways in the brain. These nerve pathways are responsible for planning the movements needed to speak. In children with CAS, the messages that need to go from the brain to the parts of the mouth are not sent correctly.
In some cases, these nerve pathways can be disrupted by acquired brain injury, such as a stroke. There is also evidence that genetic factors may play a role. Scientists have now identified more than 20 genes associated with the condition.
How to recognize this?
The only person who can accurately diagnose this condition is a person who has received special training. We call them a Speech-Language Pathologist (SLP) . Your doctor will refer you to someone like that if necessary.
An SLP does things like this to identify this condition:
1. We will look into your child's history: We will ask you about your child's medical records from birth, how your child has passed important developmental milestones, and more.
2. Oral-motor skills testing: Non-verbal mouth movements are tested. For example, they are tested for the ability to blow, smile, pursing the lips, and moving the tongue back and forth.
3. Speech sounds test: Checks how vowel and consonant sounds are pronounced.
4. Checking the melody and rhythm of the speech: Observe the intensity of the child's voice and the way it changes tone as he speaks.
5. Ability to understand others: The extent to which others can understand what the child is saying is also considered.
6. Genetic testing: In some cases, the doctor may also recommend a blood sample and genetic testing to find out if the cause is a genetic problem.
What are the treatments for this?
Treatment for CAS requires a little more attention and intense treatment than other speech disorders. The main part of the treatment is speech therapy .
- Need for frequent therapy: Some children may need to see a speech therapist three to five times a week to improve their speaking skills.
- Time-consuming: If symptoms are severe, treatment may take years, especially for children who missed language development milestones in childhood.
- Repetitive exercises: The therapist has the child practice letters, words, and sentences over and over again. These exercises are also allowed to be practiced at home with the parents.
- Alternative communication methods: If the child has difficulty speaking, they may be temporarily trained to use sign language or electronic communication devices to express themselves.
Remember, this is not something that will change overnight. This is a long journey. But with the right treatment and your support, your child can definitely improve.
When should I see a doctor?
If you think your child has any of the conditions below, be sure to see your doctor for advice.
- If your child shows the CAS symptoms we talked about.
- If language development milestones such as saying first words and naming common objects are missed .
- If a child becomes very frustrated when others do not understand what they are saying.
In particular, if your child has difficulty eating or coordinating mouth movements, in addition to talking, see a doctor immediately.
What can I do as a parent?
The greatest thing you can give your child on this journey is your love, support, and encouragement .
1. Work closely with the therapist: Stay in regular contact with your child's speech therapist (SLP). Talk about your child's progress. Make sure you understand the homework assignments.
2. Practice at home: Do the exercises that the therapist gives you with your child exactly. This is just as important as homework in school math. Setting aside 10-15 minutes a day to do these things is a big help.
3. Be patient: When your child is trying to say a word, give them time. Don't fuss, laugh, or try to complete the words for them.
4. Encourage your child: Praise your child even if they show little improvement. Encourage them by saying things like, "Now you've said that word very well."
Imagine the embarrassment you feel when you suddenly can't remember the name of someone you know well. A child feels the same way. He has the word he wants to say in his head, but he struggles to get it out of his mouth. Your support will be his greatest strength in winning that battle.
Take-Home Message
- Childhood Apraxia of Speech (CAS) is not a problem with a child's intelligence. It is a coordination problem in the way messages are transmitted from the brain to the mouth.
- Be concerned if your child is pronouncing words one at a time, is late in speaking, and seems to be searching for words while speaking.
- Although there is no complete cure for this, early detection and intensive speech therapy under the guidance of a speech and language therapist (SLP) can yield very good results.
- Parental support, patience, and encouragement are essential for a child's development.
- If you have any doubts about this, do not delay and consult your doctor for advice.
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