CAS: A rare speech disorder in children

As children grow and develop, it is helpful to be knowledgeable about their developmental stages and milestones. It will be easier to then detect when something is out of line and intervention can be sought early.

One area that is a significant marker of childhood development is speech development. Children, indeed, are different and will learn to speak at different paces. However there will be cases where a notable difference to the general path of speech development occurs and this can be caused by Childhood apraxia of Speech (CAS).

What is CAS

Childhood apraxia of speech (CAS) is an uncommon speech disorder in which a child has difficulty making accurate movements when speaking. To speak correctly, your child’s brain has to learn how to make plans that tell his or her speech muscles how to move the lips, jaw and tongue in ways that result in accurate sounds and words. Your child’s brain also plans these movements so that he or she speaks with normal speed and rhythm. In childhood apraxia of speech, the brain struggles to develop plans for speech movement. As a result, children with CAS don’t learn accurate movements for speech with normal ease. In CAS, the speech muscles aren’t weak, but they don’t perform normally because the brain has difficulty directing or coordinating the movements.

Causes of CAS

The cause of CAS has not yet been accurately determined. It can be associated with a range of brain or neurological conditions, brain injury or a genetic disorder, a syndrome or a metabolic condition. It is however more common in children with autism.

Symptoms of CAS

CAS occurs on a continuum, ranging from minor cases to more severe cases. Before going on to the symptoms characteristic of CAS, it is important to know that CAS shares symptoms with other types of speech or language disorders. These shared symptoms include:

  • Reduced amount of babbling or vocal sounds from ages 7 to 12 months old
  • Speaking first words late (after ages 12 to 18 months old)
  • Using a limited number of consonants and vowels
  • Frequently leaving out (omitting) sounds
  • Speech that is difficult to understand

The symptoms particularly associated with CAS include:

  • Difficulty moving smoothly from one sound, syllable or word to another
  • Groping movements with the jaw, lips or tongue to make the correct movement for speech sounds
  • Vowel distortions, such as attempting to use the correct vowel, but saying it incorrectly
  • Using the wrong stress in a word, such as pronouncing “banana” as “BUH-nan-uh” instead of “buh-NAN-uh”
  • Using equal emphasis on all syllables, such as saying “BUH-NAN-UH”
  • Separation of syllables, such as putting a pause or gap between syllables
  • Inconsistency, such as making different errors when trying to say the same word a second time
  • Difficulty imitating simple words
  • Inconsistent voicing errors, such as saying “down” instead of “town,” or “zoo” instead of “Sue”
Source: Military families learning network
Source: Military families learning network

Diagnosis and treatment of CAS

Because CAS is so closely related to other speech and language disorders, it is advisable to consult a paediatric neurologist, a child psychologist or a speech language therapist experienced in diagnosing CAS. The earlier the diagnosis is made, the sooner therapy can be started.

CAS is a chronic condition that requires early and intensive intervention. There is currently no research showing that oral administration such as medication, vitamins or supplements can help to improve speech in children affected by CAS. The current treatment involves regular exercises undertaken during speech and occupational therapy.

‘It’s important that speech, occupational and behavioral therapists, psychologists and even educators work together,’ says Dr Athena Pedro, a research psychologist at the University of Western Cape, who has a six year old son with apraxia. A lot of mothers with children with CAS are unanimous on best progress resulting from a combination of both speech and occupational therapy.

CAS is a chronic condition that requires early and intensive intervention.

Schooling for CAS children

Because CAS occurs in varying degrees some children may need to go to a special needs school, others to a remedial school whilst others can attend mainstream school. Dr. Pedro is currently researching inclusive education at schools in Capetown and she and Deidre (another mom whose child has CAS) are founder members of the fledgling Dyspraxia/Apraxia Foundation of South Africa (DAFSA), which is working to promote inclusive accessible education countrywide. Deidre, along with another mom, Lydia de Villiers, have also launched Apraxia Awareness SA, to raise awareness in parents and teachers and lobby government to provide appropriate schooling for CAS children.

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