Speech Apraxia and Autism: Are They Related?
Today you'll learn about the signs, diagnosis and treatment of speech apraxia and autism.
It is no secret that some autistic children have difficulty with speech and communication. The signs range from late-talking toddlers to nonverbal children. However, your child may also have childhood apraxia of speech, which is also known as CAS.
What is Speech Apraxia?
Speech apraxia is a rare neurological motor speech disorder that can sometimes occur with autism. The disorder affects every one or two in 1,000 children in the United States.
While there are common symptoms of this disorder, the symptoms displayed vary per child. This is because each child's brain processes movements made by their lips, tongue, jaw and mouth differently.
The age range of a child also plays a role in which symptoms of speech apraxia are displayed.
Very Young Children
The following list features several signs of speech apraxia in very young children, including babies. Some of these signs may become more apparent as your child grows older.
- Baby does not make cooing or babbling sounds.
- There is a delay in speaking their first words.
- Once their first words are spoken, some sounds may be missing from those words.
- Their ability to form consonant or vowel sounds is limited.
- They may substitute difficult sounds or leave those sounds out altogether when learning to speak.
- They have difficulty eating because they cannot properly move their mouth, jaw, lips and tongue.
Older Children
Now, this list contains just a few of the signs that may show in older children with speech apraxia.
- They have difficulty communicating with spoken language, but they may understand what other people are saying.
- While they may have problems imitating speech, it may be easier for them to imitate than to speak on their own.
- They opt for shorter words and phrases because it is easier for them.
- Their speech and syllables may be broken, or they may choose the wrong words when speaking.
- Difficulty moving their lips, jaw, tongue and mouth when trying to speak or make sounds.
- It becomes harder for your child to speak when they are nervous.
The Severity Varies
The severity of speech apraxia is a spectrum in itself, and it can affect children in different ways.
For example, one child may have mild apraxia that allows them to say a full sentence with a little stuttering. Another child may have severe apraxia that causes them to repeat a word until they can say it correctly.
The various levels of severity mean children need different levels of support, but it is important to approach all levels with patience and compassion.
Symptoms of speech apraxia may not be as noticeable in autistic children because they may already display communication and vocalization problems. If this is the case for your child, they should be evaluated and diagnosed by a speech-language pathologist.
To help give you a better idea of your child's severity, here are several symptoms of autism and speech apraxia in more detail.
Atypical Vocalizations
Atypical vocalizations in children are conversational or communication skills that are different from other children in their age group.
One example is a child who speaks in a monotone or sing-song voice instead of speaking in a normal tone.
Another example is a late-talking child with a vocabulary of fewer than 50 words. This child may use limited word combinations, such as saying "more juice" instead of "I want more juice."
Atypical vocalizations go hand-in-hand with phonological difficulties in children with ASD and speech apraxia.
Phonological Difficulties
Autistic children with speech apraxia may show signs of phonological difficulties.
One example of phonological difficulties is repeating two syllables in a word, such as saying "baba" instead of "bottle."
Another example is changing certain consonant sounds, such as calling a cat a "tat."
A child with phonological difficulties may also leave out a consonant sound altogether, such as saying "ba" or "at" instead of "bat."
Studies Show Signs of Atypical Vocalizations or Phonological Difficulties
Schoen et al. conducted a study on 30 toddlers diagnosed with autism using various language tests. All the toddlers displayed signs of atypical vocalizations and phonological difficulties compared to a controlled group.
The good news is that most late-talking toddlers slowly catch up with other children during their first few years of school.
Distortion of Sounds
Many children with speech apraxia have difficulty initiating coordinated movement of their lips, tongue and jaw muscles. While they are attempting to make a specific sound, their words come out distorted. For instance, your child may have difficulty pronouncing vowels because they cannot move their mouth correctly.
Errors in Prosody of Speech
Children with speech apraxia are usually unable to use the same rhythm, tone or stress while repeating a word or sentence multiple times. Additionally, this is a symptom that can impact an autistic child's ability to communicate with others.
Sound Error Inconsistencies
When attempting to pronounce a specific sound or word, your child may say it correctly one day and incorrectly the next day. This is known as an inconsistent sound error, and this symptom is found in autistic children as well.
Groping For Sounds
Groping for sounds is when a child has to make multiple attempts to move their mouth correctly to produce a certain sound or word.
Children with speech apraxia but not ASD can understand language at their level of development. However, they have difficulty verbally communicating with others.
A child with both ASD and speech apraxia has difficulty understanding others and producing their own language skills.
Evaluating Apraxia In Children With Autism
A trained child psychologist can diagnose autistic children when they are as young as three years old.
As stated earlier, all children must be evaluated for speech apraxia by a speech-language pathologist.
If you suspect your autistic child has speech apraxia, they need to be evaluated by a speech-language pathologist who is also experienced in working with autistic children.
However, it can take over a year for some autistic children to receive a proper evaluation and diagnosis. The reason is some autistic children are nonverbal or also have a social communication disorder.
A speech-language pathologist evaluates a child's ability to say speech sounds alone and with other words and syllables. Therefore, children need to be able to say a few words during the evaluation to receive an accurate diagnosis.
Apraxia Can Be Misdiagnosed
Autism spectrum disorder is a complex condition with a wide range of signs. The signs may include speech issues, including atypical vocalizations and phonological difficulties.
This means it is possible for speech apraxia to be misdiagnosed as autism. There are even children who are misdiagnosed with ASD that are not actually on the autism spectrum.
If your child has speech problems, it is important to have them evaluated for autism, speech apraxia and underlying conditions such as hearing loss, injuries and genetic disorders. This way, your child can receive the proper diagnosis and appropriate treatment.
How To Treat Apraxia of Speech in Autistic Children
Children with autism and speech apraxia need to learn how to understand others, use expressive language and use appropriate expressive and receptive language skills.
Luckily, there are ways to treat speech apraxia in autistic children. The most effective solution is office-based or online speech therapy that focuses on comprehensibility and intelligibility.
A speech pathologist may offer the following approaches to improve your child's speech production.
1. Using linguistic methods to teach children the rules for specific sounds and speech sound sequences.
2. Motor programs that focus on repeating speech movements for automatically making sounds and sequences.
3. Rhythmic exercises that focus on the rhythm, melody and stress needed to create accurate intonation patterns.
4. Shaping and toning jaw muscles to help your child produce more accurate sounds.
5. Sensory cues that use touch, sight, hearing and proprioception to teach children the movement sequences necessary for producing sounds and words.
6. Dynamic temporal and tactile cueing, which is also known as DTTC. This approach uses direct imitation with input from a speech pathologist, which decreases as your child's speech improves.
Alternatives To Verbal Communication
Your child may also need alternatives to verbal communication if they are nonverbal. They can also use these alternatives as they work to improve their speech.
1. Manual sign language.
2. Basic hand gestures.
3. Communication boards.
4. Electronic voice devices.
5. Typing out words that show on a screen.
Additional Approaches
Other approaches to improving speech may include the following exercises.
1. Playing games that encourage verbal communication.
2. Modeling language skills, such as speech and facial expressions.
3. Practicing essential language skills, such as saying "hello" and "goodbye."
4. A reward method for children who use language or an alternative method to express themselves.
Your child's speech pathologist may combine a few approaches to create a treatment that improves your child's speech production and communication skills.
As a parent of an autistic child with speech problems, it is essential to have your child properly evaluated and diagnosed for speech apraxia. The goal is to improve your child's speech and help them communicate with others.
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