Recently, I have been getting an influx of children with the diagnosis of Childhood Apraxia of Speech (CAS). Sometimes the child actually has Childhood Apraxia of Speech. However, most often they are wrongly diagnosed.
There have been several studies over the past few years that have shown that when evaluated by an expert in Childhood Apraxia of Speech roughly 75% of children with the diagnosis are found not to have the disorder. One study even reported that 7 out of 53 children previously diagnosed or suspected of having Childhood Apraxia of Speech, a full 87%, did not actually have the severe speech disorder.
Neurologists Should Not Diagnose Apraxia
It feels as if every time I turn around there is another non-verbal 2 year old getting this diagnosis from a well meaning Neurologist. There seems to be many Neurologists who will diagnose any child who has a normal neurological exam at age 2 and is not talking with Childhood Apraxia of Speech.
I am not blaming the Neurologists for this. Most of the time, they are put in this position by Speech Language Pathologists who don’t feel comfortable giving the diagnosis themselves.
Unfortunately diagnosing this severe speech disorder is not easy. In fact there is no one agreed upon assessment tool within the field to make the diagnosis. Because of this many Speech Language Pathologists do not feel as if it is their role to make this call when in fact it is.
Expertise Matters
Of course the Speech Language Pathologist should have extensive knowledge of childhood motor speech disorders to properly diagnose and to treat Childhood Apraxia of Speech. If they don’t, a referral to Speech Language Pathologist who does is the more appropriate next step.
While the person who makes the diagnosis may seem unimportant, it really is extremely important.
A neurologist can rule out any other neurological causes for a severe speech disorder; however they should not be asked to make the diagnosis of Childhood Apraxia of Speech. They are not experts in speech and language disorders, only Speech Language Pathologists are. Neurologists have plenty of other areas in which they are the experts; this is not one of them.
This scenario is contributing to the over-diagnosis of this disorder.
Age Of Diagnosis Also A Factor
Another factor contributing to this problem is the age of diagnosis. A child should be at least 3 before they can be accurately diagnosed. Prior to age 3 the disorder may be suspected, but it should not be diagnosed. A lot can change between the ages of two and three.
Childhood Apraxia of Speech is a speech disorder which involves motor planning deficits of volitional speech. Until a child makes an attempt to speak we have no idea what is going on. We can suspect motor planning is an issue due to some red flags we look for, however a diagnosis should not be made too early.
Important Red Flags
Some red flags in infants and toddlers include; little or no babbling, drooling and feeding difficulties, limited intonation, and words used and then lost.
While these characteristics are not enough to make a diagnosis they are reason to be concerned and take action. A child suspected to have Childhood Apraxia of Speech should be treated as though they have the disorder even without a diagnosis.
Just because there is over-diagnosis does not mean that therapy should be avoided. With any speech disorder the sooner therapy starts the better the outcome.
When a child has Childhood Apraxia of Speech he or she may need 3000 productions of a sound combination or word to learn a muscle memory for that combination. So I am a strong believer that the more therapy a child is able to get, and the sooner they get it, the better. I would add to that, that therapy must be fun and doable for everyone. If someone in the equation is miserable something must change.
Stop Searching and Take Action
So if you are a parent of a young child who is diagnosed with Childhood Apraxia of Speech and you are searching and searching for answers and opinions, stop now. Find yourself an excellent Speech Language Pathologist with the proper experience and start therapy immediately.
While finding answers is important, getting the right therapy for your child is a better use of your time.
Sources noting over-diagnosis of Childhood Apraxia of Speech:
Stoeckel R., (2008). Childhood Apraxia of Speech (CAS) Differential Diagnosis and Practical Treatment Strategies, 8-9. Rye, NY
Jakielski, K J., (2006) Childhood Apraxia of Speech (CAS) Assessment and Intervention, 12-13. White Plains, NY.
Shriberg L.D, Campbell T.F., (2002). Proceedings of the 2002 Childhood Apraxia of Speech Research Symposium, 38. Tucson, Arizona: The Hendrix Foundation
Davis, B.L., Jakielski, K J., & Marquqrdt, T.M. (1998). Deveopmental Apraxia of Speech: Determiners of Differential Diagnosis. Clinical Linguistics and Phonetics, 12, 25-45.
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Hi Jody,
Children with Childhood Apraxia of Speech often have other developmental delays and learning disabilities. I do not think that what you are describing is directly related to the Childhood Apraxia of Speech diagnosis; however I do believe that your son is struggling with some real serious issues and is not “just a brat”. I would strongly recommend seeing a Developmental Pediatrician to guide you in the right direction.
My son was misdiagnosed from birth with a chromosome condition he did not have. As it turned out, he was rediagnosed at almost age 4 as being mosaic for the condition (a lesser form of the condition), but continued to be treated for a mild speech delay associated with the original condition with which he had been misdiagnosed. He was well into his 5th year before he got diagnosed with apraxia and about 6 years-old before he started getting appropriate & intensive therapy for apraxia. It took just as long, almost 3 more years, to get his co-morbid diagnosis of aphasia. Relentlessly, I tried to get therapists and doctors, alike, to listen. One therapist and two doctors finally did listen. Although I do think that apraxia is grossly misdiagnosed, evidenced by miraculously recoveries of speech (apraxia is a lifelong diagnosis, which can be remediated to an extent), there is no harm in going for the gold and diagnosing apraxia in order to get the most intense speech therapy services; however, in noting this, if the trained SLP is going to diagnose apraxia of speech, then he/she should be well-trained with many CEU’s in apraxia remediation as well. If and when the SLP realizes that the child does not meet the criteria for AOS, then the diagnosis should be quickly retracted to reflect the true nature of the speech disorder. It should not take 8 and a half years to get a child with such profound speech disorders to get appropriately diagnosed and sometimes it takes a well-versed pediatric neurologist to diagnose neurological conditions such as apraxia and aphasia.
Charlie Hart’s Mom,
I am sorry to hear it took you so long to get a proper diagnosis for your son. I hope he is in good hands now and making progress with his motor speech.
“Seventy Five Percent Of Apraxia Cases Wrongly Diagnosed — Speech Language and Feeding”
ended up being a beneficial blog. If only there were alot more web blogs just like this amazing one in the world wide web.
Anyhow, thanks a lot for ur time, Stevie
I have a 3 1/2 year old son who has not received any specific diagnosis, but has been receiving speech therapy in blocks of 8 weeks (once weekly) 2 times per year. We have supplmented with private speech therapy once per week. In the past year he has moved from saying only ‘ah do’, to speaking in long sentences. He has most consonant sounds and all vowel sounds, but struggles with jaw control esspecially when he is excited. He learns very quickly and iss eager to communicate (bonus for us!). At this point he has begun basic reading, as well as singing and story telling. Does this sound like a typical developmental path for apraxia? And is an oral motor disorder always deemed apraxia? Regardless of any diagnosis, we are very happy with his progress to date and hope he continues to be engaged in learning!
Hello I wondering if it is possible for kids to not have other delays and still have apraxia? My son will be three next month and both his speech therapist think he might have apraxia. We recently went to get a third persons thoughts on the matter and this SLP said he couldn’t have apraxia because he was not delayed in any other areas. And had no issues with any motor function. I know usually kids who are apraxic do have other delays but want to know if there are cases where a child’s only symptom is the speech aspect.
Stevie,
Thanks! I am glad you enjoyed it.
Natasha,
It is rare, however it is possible. Children who have CAS are at risk for later learning and language disabilities and should be monitored.
Cathy,
Children with CAS do not always follow a neat path. The progress that you speak about is quick for a child with CAS. They usually progress at t much slower pace. There are children who have an oral motor apraxia which is different from CAS. The jaw control could be due to a weakness as well. What is your therapists opinion? Are they using PROMPT?
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