Friday, May 7, 2010

What Causes Childhood Apraxia of Speech and Is It Preventable?

From CASANA

First, it is important for parents to understand that there is most likely nothing that you did to “cause” your child’s speech disability. It is not about how much you talked to your child or whether or not you had them in daycare, for example. Your child does not have apraxia because you separated from your spouse or because you moved to a new city. So while we know that parents have a strong role in healthy child development, unless there was abuse, neglect, or isolation, you are not responsible for causing your child’s speech disorder.

The current knowledge that we have about Childhood Apraxia of Speech (CAS) is this. CAS occurs in the following 3 conditions:

  • Neurological impairment caused by infection, illness, or injury, before or after birth or a random abnormality or glitch in fetal development. This category includes children with positive findings on MRI’s of the brain.
  • Complex Neurodevelopmental Disorders – We know that CAS can occur as a secondary characteristic of other conditions such as genetic, metabolic, and/or mitochondrial disorders. In this category would be Childhood Apraxia of Speech that occurs with Autism, Fragile X, Galactosemia, some forms of Epilepsy, and Chromosome translocations involving duplications and deletions.
  • Idiopathic Speech Disorder (a disorder of “unknown” origin) – with this condition, we currently don’t know “why” the child may have CAS. Children do not have observable neurological abnormalities or easily observed neurodevelopmental conditions.

Parents often ask if their child may have apraxia due to medical complications during pregnancy or childbirth. There are currently no studies that suggest a direct relationship between complications of pregnancy or childbirth and a specific increase in risk for apraxia of speech. For example, an umbilical cord wrapped around the neck of a fetus could theoretically cut off oxygen supply and possibly lead to neurological injury, eventually resulting in a CAS diagnosis. However, such a condition could also NOT result in CAS or even neurological injury. Some children are born just fine even though there was some complication during pregnancy or birth. So, while it is possible that a complication could result in neurological damage that might contribute toward a motor speech disorder like CAS, research has not told us when or how this would occur.

Some speculate that some forms of CAS and other childhood conditions may be a result, in part, of environmental conditions such as exposure to pollutants and toxins before or after birth. Others speculate that nutritional deficits or malabsorbtions cause CAS. We do know that, generally, toxins and nutritional deficits do cause some developmental problems, but to date these theories, as they relate specifically to CAS, are only speculations.

That said, a child’s positive health would contribute to their ability to benefit from their learning exposures and from therapy designed to help them. A child who is healthy is more fully capable of taking advantage of opportunities to learn. Children who are sick frequently with ear and sinus infections, enlarged tonsils and adenoids, asthma, allergies or have sleep disturbances, poor diets, attention and behavioral difficulties are going to find it much more difficult to benefit from the help provided. Helping your child be healthy and thus more “present” to the learning opportunities around them is one way parents can help.

Most likely in the future we will learn that CAS is caused by multiple factors and conditions, not one. To the extent that research evidence becomes available that CAS is caused by some factor(s) that can be manipulated to reduce or eliminate it, will determine whether or not it is preventable. Until then, we do know that appropriate speech therapy provided frequently and in consideration of motor-speech treatment principles offers the single most important opportunity for children with CAS to improve their speech capacity. Children who are able to maintain optimum health will most likely directly benefit the most from appropriate help.

13 comments:

  1. My grandson does not have a definite diagnosis of Apraxia but the SLP is leaning more and more to the diagnosis. He gets two days of slp at and two days with the Childrens Institute of Pittsburgh. My daughter had to fight with the pediatrician to have him evaluated but ended up changing doctors who was more understanding. She tested him for autism and said he is not autistic. He will be 3yrs old 5-16-10 and the speech is making a difference. He is progressing very well. Being a pediatric home care nurse I had never run across this. My daughter is a special education teacher and has the tools to work with things like this. All of us work with him constantly. The cord was wrapped around his neck and my daughter has been asked about that many times. Cognatively he is advanced as with other testings. We're glad he's improving. We've been told it will be a long process.

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  2. Thanks for sharing. Though I do question if Apraxia might be inherited? Just so happens that I have an uncle and nephew who did not talk until 3/4. My nephew is now in his teens and you would never know that either of them ever struggled with speech as young child. But the Apraxia diagnosis was not around back then. Anyway, I agree whole heartedly that the right therapy paired with a lot of love from caretakers, assures the child every opportunity to learn and is essential to progress.

    Katie
    www.warriortherapymom.blogspot.com

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  3. Thanks for sharing the lovely article...I am sure the mental emotional problems add up to the problem but with care they sometimes over come it.

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  4. i have a 9 yr old son that has apraxia we found out when he was two and not talking. he started with some sing but when he went to school they didn't want him to sing anymore and try to talk more and now he is going in 3ed grade and still cant talk that good. I only understand him half the time the other half he has to act it out. He gets so mad when i don't understand him. Sometime it hard on me too.

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  5. I have 4 daughters and my 2nd (now 7) and 4th (about to be 3) daughters have both had this and both are quite intelligent. I had taken my now 7 yr old since she was 2 for hearing tests, to an ENT, to a program for children with speech delays called "Baby's Can't Wait" where an entire panel told me there was "nothing wrong". When she turned 3 I took her to school to be evaluated but she passed the standard test no problem (saying individual words) and they were about to send us away when I asked if they could just listen to her try and say a full sentence. All of a sudden the SLP looked at me and said she needs a different test! She failed the other test with flying colors lol. By the end of Kindergarten she graduated out of the program and people can't believe she ever had a problem with speech. My now 2 1/2 yr old has a slightly more severe case but having already been through this I took her to get her evaluated and since they said there is no discernable benefit to doing speech therapy now as opposed toi waiting until she is 3 and using our same speech therapist there, that is what I am doing. Many people have voiced their opinions (mainly my mother lol) but after talking to the school SLP about it she reassured me that this was a good course of action and in the meantime we just work on one word at a time and I teach her a few signs a week to help her communicate. Although now I am well versed in the art of nonverbal communication and can pretty much understand what she needs without speech. Some told me I had caused it because their sisters and I just "didn't give them a chance to use their words" I knew that wasn't true because I always push them to use their words and not grunt or point. Don't let anyone make you feel as if you "caused" this somehow. Overly annunciating the words helps quite a bit when working on individual words.

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    1. You are a brave brave mommy. I just wanted to say thank you for your example of persistence. And for your sense of humor - for "failing with flying colors". :) Lol I've read some stories on here that are just so sad, where the system has failed them horribly. You are right - the whole "blame the parents" thing is an atrocity that's used for a lot of things to cover up the agency/ school's inadequacy and laziness. Your daughters will be very intelligent. Genetics usually gives us an advantage somehow, so it may be that nonverbal communication is her strength or increased time to learn communication skills will benefit her. Another "myth" is that they don't need any help, it's just late talking... you know as well as all mommies on here by now, they are missing out on crucial learning years and it causes problems with their self-esteem and healthy positive bonding with family and peers. But I have used the "she's just a late talker" comment to my advantage when someone obviously wants to blame it on the family. Meet stupid with stupid, I guess.

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  6. My son was diagnosed at age 3 having a vocabulaery of only 10 words at the time. We used sign language and it opened a whole new world of communication for him. He started speech therapy twice a week and slowly built up his verbal vocab, although no one else could understand what he was saying, we could and it was such a relief. Our school system has an incredible program for preschoolers who need intense therapy and he started the program at age 4. He went twice a week for 4 hours and the results were so amazing. He is now 6 and in 1st grade, still has speech therapy in school and is improving all the time. Our biggest struggle is learning to spell and read...how do you sound out a word if you can't say it? It is so frustrating because he is a very smart boy but no accomedations are made because he is not in special ed! I'm sure this too shall pass but he gets discouraged with his grades.

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  7. What is the best way to dealing with emotions with a child that has apraxia...It gets so hard to try and work with a child that is suffering with it.please any ideas...

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    1. Sign Language (ASL) has been a great gift for my son. He can fully express himself in a language that doesn't emphasize his weaknesses. I really think signing is the reason he is such a pleasant, joyful child. We simply haven't experienced the frustration and disappointment that I hear many parents of apraxic children talking about.

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  8. I have an 8 and 3 year old with speech delays. My 8 year old is now really struggling as all the over annunciating has slowed down his out loud reading making him test below where he should be. He tries too hard to say words correctly making him not only sound "different" but also slow him down reading aloud. Noone talks making sure to annunciate every sound. It is so frustrating! Not sure what to do as the school speech teacher doesn't know how to help a child like this. Any ideas would be greatly appreciated!

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  9. My son just turned 4 yrs old and has been evaluated twice and although both places said they thought he has CAS neither one of them properly diagnosed him. I know this is a hard thing to diagnose but still is quite annoying. I can understand about 30 to 50% of what he says, everyone else about 10%. He started in a program for disabled children about 7 months ago where he recieves group therapy including speech, language, and occupational therapys. I have cerainly seen progress but it is such a slow process. We are waiting for our HMO to authorize him going to one on one therapy. He is just starting to get frustrated when I can't understand him and it just breaks my heart. We do not know what caused this and their just don't seem to be enough research done to know what to expect. I am very scared that he will never be able to talk on his own without someone their to help him. He can not do sign language because he has issues with his fine motor skills. He also has sever allergies and sensory problems. He is absolutely terrified of loud noises. We can not even flush a toilet around him and trying to cut his hair is just impossible. I have an appointment coming up with a new doctor who is sapposed to be able to diagnose him. I don't understand what could have happened to him, he was just fine untill 18 months old when he swelled up one day and we took him to the ER and they said they did not see anything wrong with him. They looked at us like we were crazy when we told him that he was not holding his hands right and that he was not talking. well now 3 yrs later and he still can not even make a fist and has not talked correctly since that day. He could say grandmom, daddy, mommy, bottle, grandad all the normal words with the right syllables and then he went to gama and da, ma, all babble like an infant again. and then he started makking up words or adding different sounds to the words like bo for no and bamber for amber. He still does this and sometimes makes up words entirely. I am so scared that if I can not figure out what caused this I can not make sure it does not happen again and this will start all over. I don't think people talk about how it affects the parents. I am so paranoid when it comes to my kids now. I am constantly scared that something is going to happen to them. I can not even sleep at night I am so worried and the guilt just eats me alive. I should know what happened to him and I should have been able to prevent it. What do I tell him about why he is different and what do I say when I just can't seem to get what he is saying which is happening more and more now cuz his vocabulary is growing at such a more rapid rate than his speech. He is sever and what if he never can talk or communicate? He has never been to a friends house or anywhere without me cuz I will not put him in that situation of not being able to communicate with his caregivers. He sees his sister going places and wants to go and I just have to tell hi he can't. It is just not fair and my heart breaks for him everyday. I just want him to be normal and not have to go through all this stuff. He has such a hard life and he is only 4. and he is noticing now and I do not know what to say to him. I don't want him to be labeled. Any ideas or tips? I do the best I can but I find myself second guessing everything when it comes to him. i just want to do the right thing. and it makes it even harder when I don't have all the money to just send him to the best doctors all the time like he deserves. If i did not have to wait on HMO's and medicaid all the time and had the money to get him in one on one therapy a long time ago maybe he would have made more progress by now. It is just so hard cuz I love him so much and I want whats best for him.

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    1. we have struggled with getting proper speech treatment for our son. while effective TX is out there, government officials such as Obama, have publicly voiced their beluefs that disabled children are low on the totem pole, instead of equals to us. My son is disabled and I would not trade him for a normal child. I believe he deserves effective treatment and this will not happen unless the goverment supports grants to help with his condition or we come up with funds somehow. Meanwhile, I teach him to stand up for himself, let people know he has a harder time speeching, but he can and wants to do things the other kids do. No disabled child should feel ashamed of who they are. God does not make mistakes anf our children are no exception to that.

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  10. I went into preterm labor at 18 weeks with my son, who has apraxia. I will always believe that it was the various medicines they gave me to keep me pregnant that caused harm to him, thus causing the apraxia. Of course, if the medicines weren't given to me, he, most likely, would have been miscarried.

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