What is speech apraxia and how is it related to autism? Apraxia refers to motor speech disorders impacting the ability to produce speech sounds.
Maybe your child is struggling to develop speech or a speech therapist has diagnosed them with childhood apraxia of speech. Further, you’ve noticed signs of autism in your little one and are wondering if the two are related.
Today, let’s discuss the relationship between autism and apraxia and how to support your child’s speech production.
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What is Apraxia?
Apraxia is the umbrella term used to define motor speech disorders that impact a person’s ability to produce consistent speech sounds.
In other words, those with apraxia of speech have a hard time producing the speech that they want to communicate.
Two primary types of apraxia are:
- Acquired apraxia of speech
- This occurs later in life and is often related to traumatic brain injuries
- Childhood apraxia of speech
- Present at birth
Childhood apraxia of speech is considered a type of motor speech disorder. Some refer to it as a developmental disorder, but there is controversy about that designation.
It’s estimated that apraxia affects one to two per thousand children in the United States.
Neurological in Nature
To speak, the brain has to plan and coordinate the various muscles in the mouth to articulate our thoughts.
Children with apraxia of speech have challenges with this motor planning and, ultimately, the execution of speech. For example, a child may have difficulties controlling the use of:
- tongue,
- movements of the jaw,
- lips,
- and palate
Unfortunately, this leads to unintelligible speech. Ultimately, it’s not that the child doesn’t know what to say. Rather, the brain has difficulties coordinating the muscle movements to do so.
Symptoms of Apraxia
The symptoms of childhood apraxia include:
- inconsistent errors of speech sounds
- distorted sounds
- difficulties with prosody and rate of speech
- prosody refers to rhythm, sound variations, intonation, etc.
- clear struggles when attempting to get words out
- laborious attempts to produce words
In the end, if you notice these signs in your child, it’s important to address them as early as possible.
How is Apraxia Diagnosed?
Childhood apraxia of speech should be diagnosed by a speech pathologist. Further, it must be differentiated from other speech and language disorders.
For example, dysarthria is a speech disorder related to weaknesses in the muscles responsible for speech production.
Children with apraxia and those with dysarthria may produce similar distorted speech sounds. However, the muscles in an apraxic child’s mouth are healthy and strong.
- Apraxia:
- A neurological disorder where the brain has difficulties with the motor planning required to produce intelligible speech sounds.
So when young children show signs of language problems, early intervention is important.
Ultimately, it’s important that initial diagnostic screening be thorough in order to get proper treatment.
Signs of Autism
According to the Autism Self-Advocacy Network, Autism is a developmental disability. Additionally, it impacts how autistic people receive and process information from the world around them.
Specifically, autistic children and adults often have unique social skills and sensory experiences. Further, they communicate differently than non-autistic people.
The hallmark of an autism diagnosis is comorbid speech disorders and motor coordination challenges.
Relationship Between Autism and Apraxia
In 2015 a study led by associate professor of pediatrics, Dr. Cheryl Tierney, offered support regarding the relationship between autism and apraxia.
The study, published in the Journal of Developmental Behavioral Pediatrics, assessed the reliability of the Checklist for Autism Spectrum Disorder (CASD).
The CASD is a commonly used checklist used specifically for diagnostic purposes. Using the CASD, approximately 63% of the children diagnosed with autism also had apraxia.
As such, researchers recommend monitoring autistic children for signs of apraxia. On the other hand, children with apraxia should be monitored for autism.
Additional Research
Other developmental experts have done a significant amount of research on the relationship between autism and apraxia.
This is some of what we do know.
- Researchers note that motor delays in childhood are important predictors of autism.
- A relatively new study published in 2019 found early motor skills predict expressive language and autism diagnoses.
- Specifically, they found fine motor skills in the second year of life were correlated with a child’s speech and communication by 36 months of age.
- Additionally, a 2020 report concluded that an infant’s gross motor development is predictive of speech and language development.
- One study found that the age at which an infant sits is correlated with later communication skills.
While there are qualitative data, experts are far from a comprehensive and cohesive picture.
Bottom Line: Speech Apraxia and Autism
The bottom line?
There are overlapping traits with motor delays in autism and oral motor skills deficits in speech apraxia.
Studies are ongoing and according to a 2022 report, the study of this relationship is still a neglected area.
The good news is that once you suspect your child is struggling or has a potential speech delay, you can get them help.
How to Help an Autistic Child with Apraxia
As mentioned, the American Speech-Language-Hearing Association, ASHA, recommends getting an evaluation from an expert in speech pathology.
Depending on your child’s age, a PreK speech-language pathologist with the local school district can help get a proper initial diagnosis.
However, if your child is older, I highly recommend you seek a thorough evaluation with a PRIVATE SLP.
Find a recommended neurodiversity-affirming speech-language pathologist who will use proper evaluation measures to assess your child’s needs.
- Hint: Join a local Facebook Group and ask for parent recommendations
Once you have the correct diagnosis, your child will participate in speech therapy.
Speech Goals for Apraxia
Your child’s SLP will share the speech and language goals that your child will be working on. Such speech and language goals include:
- Planning the motor movements needed to make proper speech sounds
- Practicing the oral motor movements to articulate new words and sentences
The speech therapist will likely use multiple methods to support your child’s speech production skills. Additionally, a good speech therapist will be neurodiversity-affirming and guide you on what you can do to support your child at home.
Multisensory Support
As with any learning, children benefit from multi-sensory input when in speech therapy.
A child with weak motor skills may have strong visual skills. As such, a good SLP will lean into that strength by providing visual cues to help your child.
When working on specific sounds, the therapist may touch their own lips while producing speech to model to the child.
Additionally, your child may be offered a mirror and encouraged to touch their own lips if helpful.
Progression of Speech
Further, auditory cues can assist in prompting the child to use previously learned speech sounds. Slowly, kids incorporate mastered speech sounds into new words.
Progression will look something like this.
- sounds
- syllables
- words
- sentences
Additionally, depending on the severity of your child’s apraxia, the number of weekly speech therapy sessions will be between one and five times per week.
As your child makes progress, those sessions will lessen in frequency.
Interdisciplinary Approach
Because childhood apraxia is a movement disorder and not a language disorder, children may benefit from occupational therapy.
A private occupational therapist can work with your child’s speech-language pathologist to support speech goals with brain-integration exercises.
As mentioned in the earlier Mayo Clinic tutorial, speech is a motor planning skill that’s impacted by the proprioceptive sensory system. This is an area of occupational therapy expertise.
Again, a good team for your child, autistic or not, will include you in the plan for your child.
I recommend you take the role of CEO of your child’s team. In the end, you’re the expert on your child.
AAC Support for Autism and Apraxia
Augmentative and Alternative Communication is any tool that helps someone better communicate.
Many adult autistic-led groups advocate for AAC support for anyone with challenges speaking.
Even if a person can speak at times, there are often reasons that they cannot speak to others. Selective mutism is one example.
AAC tools for apraxia and autism include:
- Sign Language
- Ipad with specialized AAC apps
- CoughDrop app is one recommended AAC app
If you’re looking to add an AAC device to your child’s communication toolbox, an SLP can help you find the best tool for your child.
Recap: Speech Apraxia and Autism
In the end, there’s a relationship between childhood apraxia of speech and autism. However, the research is out as to the underlying mechanisms involved.
We know autistic children typically struggle with language. Further, up to 63% of autistic kids have an apraxia diagnosis.
Ultimately, if you’re concerned for your child, talk with your child’s pediatrician. On the other hand, if you don’t need a referral, schedule an appointment with a respected SLP in your area.
Additionally, support your child’s communication with Alternative Augmentative Communication (AAC) tools. These communication tools can help reduce frustration and help your child in both language and emotional regulation.
So, friend. Does your autistic child struggle with apraxia of speech? Would love to hear your thoughts.
In this together!
About the Author:
Lindsay is a trauma-informed educator with a Master’s Degree in Teaching. Her mission is to support moms to equip neurodivergent kids (ADHD, Autism, Dyslexia, Anxiety) to thrive as exactly who they’ve been created to be. Wait until you hear the story that led to it all…
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My child has Autism, is nonverbal (list Speech in early childhood), his speech Once Autism is diagnosed, unfortunately Apraxia is neglected and no intervention are available. We are in Australia, but now I have to consider to look for SLP in US or Canada as unfortunately no SLP is available in our region who supports interventions for Apraxia in Autism.
Hi Olena,
Have you reached out to the community at Reframing Autism? https://reframingautism.org.au/ They’re based out of Australia and will likely be a great resource for you and your kiddo. 🙂