Apraxia of Speech is a developmental speech condition characterized by an inability to correctly position and sequence muscle movements necessary for speech production. It is not due to weakness, incoordination, sensory loss or inability to understand the instruction.

Apraxia of Speech is known by a number of different names including:
Childhood Apraxia of Speech (CAS) and Developmental Verbal Dyspraxia (DVD).

The child with Apraxia usually knows what they want to say! The breakdown occurs in the message from the brain to the speech mechanism (larynx, lips, tongue, palate and jaw) specifying the movements that need to occur for speech. As a result, the speech mechanism is unable to produce the precise movements required for intelligible speech.

Often, a child will attempt to say a particular word and something completely different or nothing at all will come out. The inconsistent nature of their speech can cause a child to feel very frustrated - a word might “pop out” correctly one minute and then be impossible to say the next.

There is no single test that can be used to diagnose apraxia of speech and parents and professionals may need to observe a child over a period of time. 

The person making the diagnosis generally looks for the presence of some, or many, of a group of symptoms:

• little or no babbling in infancy; few consonants
• first words (such as ‘dad’) may emerge on time, but the growth of vocabulary is slow or nonexistent
• the understanding of words and language is much better than the production of language
• slow, effortful, or halting speech; the child sometimes seems to struggle or ‘grope’ for words
• may be able to say a word, but is then unable to repeat it on command
• difficulty putting sounds and syllables together in the correct order to form words
• increased frustration and behaviour problems

Unlike ‘late talkers’ who have a simple delay in speech, children with apraxia will not just ‘grow out of it’.  However, with early intervention and appropriate therapy they can learn to talk and be understood.

The underlying causes of Apraxia are not yet fully understood. However, Speech Scientists are currently testing theories behind the causes of Apraxia through research.

Signs and Symptoms
The severity of Apraxia can vary. A child with severe Apraxia may not be able to speak or gesture at all. A child with less severe Apraxia may have a small repertoire of “automatic words” that are intelligible, for example “mum” and “no”. However, most other words are difficult to understand.

A Speech Pathologist must be involved to rule-out other disorders that may be responsible for causing the child’s speech difficulties. At Max’s House the Speech Pathologist will administer a detailed speech and language assessment. These assessments will examine the child’s speech sounds, speech movements and speech patterns. Characteristics of Apraxia include:

• Inconsistent Productions – the child may say words differently from one day to the next. The child may use particular sounds in one word, but not in others.
• Groping – this occurs when a child attempts to speak but struggles with the placement of lips, tongue, and jaw.
• Increased number of speech errors with increased length of utterance
  – The child may make more errors on longer words, phrases and sentences than shorter words, sentences and phrases.
• Difficulties Imitating Sounds – the child may find it difficult to copy
  sounds and words.
• Oral-Motor Difficulties – the child may find it difficult to move his or her lips, tongue and jaw.
  

• No history of/limited babbling.
  
• Late Talker.
  
• Over use of Non-verbal Communication (e.g., pointing and grunting”).
  
• Difficult to Understand.
  
• Receptive language (comprehension) appears stronger than xpressive language (verbal output).
  
• Use of mostly vowel sounds in speech.
  
• Other fine motor problems.

The biggest question usually asked by parents of children with Apraxia is “Will my child ever speak normally?” Clinical research and experienced Speech Pathologists have reported that most children with Apraxia eventually acquire intelligible speech with appropriate intervention and ongoing support. Although the nature of treatment for Apraxia can be intensive and long term, these children are very capable of making significant progress.

There are a small number of children who despite intensive therapy do not develop verbal communication as their primary means of communication. These children can communicate but they require augmentative or alternative methods of communication.

At Max’s House we offer a variety of highly effective treatments including:

PR0MPT
Developed by Deborah Hayden, PROMPT stands for Prompts for Restructuring Oral Muscular Phonetics Targets. PROMPT is a system of treatment designed to help children gain voluntary control of motor-speech systems. The technique uses surface tactile PROMPTs which are subtle manipulations of the structures involved in speech (e.g., lips, tongue, jaw, etc). The PROMPTs help to guide the child’s lips, tongue and jaw to undertake the various muscle movements required for speech.

The Kaufman Speech Praxis Treatment Technique
This assessment and treatment technique was devised by American Speech Pathologist Nancy Kaufman and is used to diagnose and treat preschool children with Apraxia of Speech.

The Kaufman technique involves teaching children with Apraxia the easiest way of saying words until motor-speech coordination has improved. This technique basically imitates the way children produce “first words”. Children are taught the “shell” of words. This means that not all the consonants and vowels are included so that the motor programming of words can be kept simple.

For example, for the word “bottle”, the Speech Pathologist would initially train the child to say “ba”. Then as motor skills improve, the word would extend to “baba”. Later the word might become “bado” and finally “bottle”.

Eclectic Approach by Dr David Hammer
Dr David Hammer is a Speech Pathologist and Coordinator of Speech and Language Services at the Children’s Hospital North in Pittsburgh, United States. He has had over 20 years experience in treating Apraxia and has lectured extensively on childhood Apraxia of speech.

Dr Hammer uses a multi-sensory, multi-modality communication therapy approach for children with Apraxia of Speech. The use of core language books, sign language, sensory integration approaches (such as touch cueing and physical prompting) are just some of the elements of the therapy approaches he recommends.


Parental involvement in the child’s therapy program is vital in encouraging the child to achieve communicative success. Individual treatment sessions will address specific speech or language problems and identify alternative strategies to assist with communication and reduce frustration. It is likely that the Speech Pathologist will provide exercises for practice at home.

For more detailed information on Apraxia of Speech, please see our resources section, or feel free to contact us