You know the old saying: You spend ages teaching your kids how to talk then the rest of your lives telling them to ‘shut up’. But my son, Mat, at two-and-a-half years old, didn’t say very much at all and the few words he did use were unrecognisable.
I couldn’t understand it, because he’d been a real babbler as a baby. When he turned three, I wondered if he was just lazy, but he was really trying to say his words. We tested his hearing (it was fine) and we visited a private ENT consultant, a chiropractor (who discovered that his jaw was badly misaligned), a speech therapist and an osteopath.
When he was finally diagnosed as having Apraxia of Speech – an inability to position the articulators (face, tongue, lips, jaw) to produce speech sounds – I was relieved his problem had a label, but confused about what it actually meant. When I heard it was potentially a life-long condition, I thought our world had collapsed. Now Mat has weekly speech therapy sessions and osteopathy. It’s hard work. Some days are really difficult and I worry about school – if we can find one that will support his speech needs and whether he’ll make friends. But we know what we’re dealing with now and, with support and time, we hope he’ll learn to speak clearly.
What is Childhood Apraxia of Speech (CAS)?
Apraxia of Speech is a rare disorder, affecting around one in 1,000 children. The inability to position the face, tongue, lips and jaw to produce speech sounds interferes with a child’s ability to correctly pronounce and sequence sounds, syllables and words. Generally, there is nothing wrong with the muscles themselves and kids can cough, chew and swallow without problem. Instead the area of the brain that tells the muscles how to move and what to do to make a particular sound or series of sounds, is damaged or not fully developed.
What are the signs or symptoms?
Not all kids with CAS are the same. Many children with Down syndrome, autism or cerebral palsy are likely to have CAS, but it can equally occur in kids with no other disabilities. These symptoms may not all be found in every child, but things to look out for are:
• Little babbling in a baby
• First words coming late or missing certain sounds
• Using only a few different consonant or vowel sounds
• Problems combining sounds or long pauses between sounds
• Missing out difficult sounds or replacing them with easier ones
• Problems with eating or chewing
• Inconsistent pronunciation errors
• Understanding of language is much better than speech
• Difficulty imitating speech, but imitated speech is much clearer than spontaneous speech
• Appearing to have problems coordinating their lips, tongue and jaw
• Difficulty with longer words or complex phrases
• Difficulty when anxious or tired
• Sounds monotonous or stresses the wrong syllable or word in a phrase
• Difficulty with fine motor skills
• Problems reading, writing and basic spelling
• Over or under sensitivity to hot or cold foods
How early can a child be diagnosed with CAS?
Children as young as two can be diagnosed with CAS, but it may be difficult to pinpoint it as the main cause of speech problems. A qualified speech-language therapist with knowledge of CAS will be able to assess your child and rule out other causes of speech problems.
What can I do to help my child?
Stay calm! Your child will feel your anxiety and this in turn will further impede their speech. Speaking in clear and simple language yourself is essential, particularly when giving instructions or expecting a reply. Speech therapists will recommend specific exercises and games to help your child. It’s important that these are played regularly and involve the rest of the family to help your child feel positive and give them confidence. Try to avoid saying ‘no’ (unless, of course, they’re doing something they shouldn’t) and instead reinforce the correct word. For example, if your child says ‘camel’ when he’s shown a picture of a ‘cat’, you should reply: ‘Good try! But this animal has whiskers so it’s a… CAT.’ Sign language is also another tool to assist with communication. Remind family, teachers and friends that the treatment of CAS takes time and commitment and that kids with CAS need a supportive environment that will help them feel successful with their communication.
How will CAS affect my child?
A child diagnosed with Apraxia will probably always struggle with speech, although it will get easier as they get older. With the correct support in their early years, they will learn to choose words and phrases that they can say clearly over those they can’t. They will learn correct intonation and as adults, people may never really notice they are struggling with speech. They may shy away from loud noise, because this impedes their ability to hear and to make their speech understood, so don’t force them into situations where they feel uncomfortable.
Books: The Late Talker: What To Do if Your Child Isn’t Talking Yet, by Dr Marilyn C Agin, Lisa F Geng & Malcolm Nicholl
Speech therapists: Kids First (04 348 5437; www.kidsfirst.ae) or Rashid Hospital, Paediatric Therapy Centre (04 340 0005; www.rashidc.ae)
Support: If you would like to share your experiences or get support from other parents, contact email@example.com