Apraxia is a misunderstood and confusing speech disorder, difficult to diagnose as expressive language impairment may cloud the issue: young children only use a few words at at time and it has been argued that delays in language expression can disrupt a child's ability to gain voluntary motor control over their speech muscles.

Causes

Apraxia can be 'acquired' during life time (acquired apraxia), or occur at birth (developmental apraxia). Acquired Apraxia happens as a result of a incident causing brain damage: stroke, head injury, brain tumors, toxins, or infections. It can be so severe that the individual is unable to initiate speech, or so mild that an individual only has occasional difficulties in conversation pronouncing words with many syllables.  

Developmental apraxia or developmental apraxia of speech (DAS) occurs in children and is present from birth.  No one currently knows exactly what causes developmental apraxia.  Although some children diagnosed with apraxia have had specific birth or prenatal  injuries or periods without oxygen, most have nothing in their birth or prenatal histories that would suggest a possible cause of the apraxia of speech.

Characteristics

Children with apraxia have extreme difficulty translating their thoughts into correct sequence of movements of their mouth, tongue, and lips. A child with apraxia of speech can have speech that is very limited and unclear, making it difficult for others to understand the child.

Infants with apraxia often exhibit:

• limited babbling & oral play

• late transition to solids, feeding difficulties

• drooling that exceeds typical expectations

• history of accompanying oral apraxia

• may have elaborate nonverbal or gestured communication

• first words may emerge on time, but vocabulary growth is slow

• increased frustration, behavior problems

Older children with apraxia often exhibit:

• limited speech sound repertoire: very few speech sounds  used automatically, so the child frequently uses a simple syllable (such as da) to stand for almost everything

• inconsistent speech errors and speech capability

• dropping all the ending sounds in longer word sequences

• the longer the sentence, the worse the speech accuracy: a child may be able to say syllables and short words fairly well, but be impossible to understand in phrases or sentences

• better imitation of speech than saying words spontaneously

• poor speech performance under anxiety: a child may be able to say a word or phrase well in a relaxed setting, but not under stress

•  "losing" words previously acquired 

Some children with apraxia may also have:

• difficulty accessing vocabulary as the child grows

• tendency to be aggressive with other children, born out of frustration when the child cannot think of words to use to enter into play (in older children frustration may show up as shyness or tendency to rely on "I don't know" as a response to questions)

• some children may choose one topic to be very good at discussing, forced to change the topic they'll get quiet.

• difficulty learning how to put things in sequence or in the right order and then later remembering what the right order was.

• problems learning to read and spell - often their difficulty with written language is similar to the problems they had with spoken language.

• motor planning difficulties with fine motor tasks such as cutting, coloring and writing.

Diagnostic terms

Some other terms or diagnoses for Developmental Apraxia of Speech include:

• Developmental Verbal Apraxia

• Childhood Apraxia of Speech

• Developmental Apraxia of Speech (DAS)

• Dyspraxia

• Dysarthria

Treatment

Childhood apraxia is not something the child will outgrow on their own, it requires intensive and frequent speech therapy, and sometimes involves therapy materials for related neurological speech and swallowing disorders (including Aphasia, Dysphagia and Dysarthria).

Some children respond well to multi-sensory therapy, including touch-cue system (PROMPT),  customized speech/music and occupational therapy.  Also, check with the child's doctor about dietary advice and consider teaching the child sign language or picture communication systems or assistive technology communication aids (for very severe apraxia).

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