Apraxia of Speech

What is apraxia of speech?

Apraxia is a motor disorder which happens sometimes when there is damage to the brain. It results in difficulty performing certain tasks or movements when you are asked, given that you understand what is asked of you and you want to perform these tasks. Apraxia may occur along with other speech disorders, such as dysarthria, during which muscles used in speech are damaged, paralysed or weakened. Another speech disorder is aphasia, an individual has difficulty communicating or understanding both verbal and written language. If you experience aphasia, you may also encounter troubles with reading and writing. 

There are various types of apraxia, but in this article we will focus specifically on apraxia affecting speech. This kind of apraxia affects 1 in 1000 [1] children but can also occur in adults.

If you have apraxia of speech (AOS), you will have trouble speaking correctly and consistently, although you might know exactly what you want to say.

How does having apraxia of speech affect me?

Social life. Although apraxia typically does not affect your intelligence, the inability to properly communicate with others may affect your day-to-day social interactions with others, thus potentially affecting your social life. 

Mental health. In addition, having apraxia may make you more prone to depression. This is because those with apraxia are usually unable to reap the full benefits of psychotherapy, one of the most effective treatments of depression and anxiety disorders which is based on the core idea of treating mental health problems by talking through problems with a mental health professional. 

So, although apraxia does not cause any serious or long-term health issues, it can be really hard to cope with every day and could cause major emotional distress if not managed properly.

What does having apraxia of speech feel like?

If you have AOS, you can experience a few symptoms when they speak. You might experience only one, or a few of the following symptoms:

Distorting sounds. You might have difficulty pronouncing words correctly, and vowels might often be distorted when you speak. You might also say the same word differently each time you pronounce it, because your speech muscles might behave in a different manner every time you say the word. Longer or more complex words will be more difficult for you to say.

Inaccurate intonation and stress on words. You might have difficulty with the rhythm and flow of language when you speak. You might use equal stress or syllables in the same word, or remove some syllables in words or phrases. You could also pause at inappropriate times when speaking.

Groping for sounds. You might appear to be searching for the right sound or word to say, or feel like you know exactly what to say but cannot coordinate your speech muscles to say it. You might try saying the word a few times before you can say it correctly.

Children with childhood AOS will usually understand language a lot better than their ability to speak. They might only say their first words and sounds later on in childhood than most, and have excessive movements of the mouth when speaking. Sounds might be omitted, switched or added into words.

What are the causes of apraxia of speech?

In order for us to be able to speak, our brains need to send the proper signals to our mouths. If you have AOS, the pathways in your brain that plan and coordinate the movements you need to speak (lip, jaw and tongue muscles) are affected, and the signals from your brain cannot reach these muscles properly. There are two types of AOS: 

Childhood AOS which is present from birth, and has an unknown cause. It is also known as developmental AOS. The symptoms can be noticed in early childhood. Children with AOS often have a family history of a communication disorder or a learning disabilities, and this affects more boys than girls [2]. In some cases, childhood AOS might happen as part of a more complex condition, like autism, epilepsy or cerebral palsy.

Acquired AOS can affect people at any age, but is most common in adults. This is the kind that is caused by brain damage. The kind and severity of brain damage will determine the degree of your AOS, so some people might only be affected saying certain syllables, but others might completely not be able to communicate properly. This can be caused by traumatic injuries to the brain, or a stroke or brain tumours. 

How is apraxia of speech diagnosed?

If you have symptoms of apraxia, your doctor might refer you to a speech-language pathologist (SLP) to run some tests to confirm your diagnosis of apraxia. You might also be referred to a neurologist who can help you to identify any underlying causes of apraxia. 

There is no single symptom or diagnostic test that can be used to diagnose AOS, so the SLP will probably evaluate your speech skills and language abilities, whilst gathering information about how you communicate in everyday life. This involves running speech tests like asking you to repeat a certain word a few times or reading given words that increase in complexity. You might be also checked for muscle weakness in your mouth, tongue and jaw to rule out any other conditions.

For acquired AOS, your ability to read and write might also be tested, as well as the sound and quality of your voice in speech.

How is apraxia treated?

For childhood AOS, the child will require treatment and speech therapy, because this type of AOS generally does not improve by itself. Treatment for childhood AOS may last for several years, based on the severity of the condition.

For both kinds of AOS, speech and language therapy will be used, which is customised to the needs of each individual, based on the severity of AOS they have, and the specific speech difficulties they are experiencing. These therapy sessions can be reduced if your symptoms improve after some time. In therapy, you might be asked to repeat certain words and phrases, with the help of visual cues such as watching yourself speak in a mirror. 

Children might be asked to communicate in other methods apart from speech, if they do not have a large vocabulary. Examples include sign language and picture communication tools. Your SLP might also recommend that you practise speaking regularly at home with family members.

Living With Apraxia of Speech

The early diagnosis and treatment of apraxia is the key to reducing the risk of long-term persistence of this condition. This condition might seem scary at first, especially if the symptoms you or your child experience are severe. 

However, with the right help and support, patients can make big improvements to their speech and communication skills.

References
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  1. Shriberg, L. D., Kwiatkowski, J., & Mabie, H. L. (2019). Estimates of the prevalence of motor speech disorders in children with idiopathic speech delay. Clinical Linguistics & Phonetics, 33(8), 679–706. https://doi.org/10.1080/02699206.2019.1595731
  2. Apraxia of Speech. (2015, August 18). NIDCD. https://www.nidcd.nih.gov/health/apraxia-speech
  3. Childhood Apraxia of Speech Causes, Symptoms and Treatment. Children’s Hospital of Philadelphia. https://www.chop.edu/conditions-diseases/childhood-apraxia-speech#:~:text=Childhood%20apraxia%20of%20speech%20(CAS
  4. Seladi-Schulman, J. (2019, February). Apraxia of Speech, Acquired and Childhood: What You Need to Know. Healthline; Healthline Media. https://www.healthline.com/health/apraxia-of-speech