Apraxia and Autism

Some children with autism should undergo ongoing screenings for apraxia, a rare neurological speech disorder, because the two conditions often go hand-in-hand, according to researchers. It’s estimated that one in 68 children in the United States has autism and one to two in 1,000 have apraxia.

Please be aware that just because a child with autism is nonverbal does not mean that he has apraxia; apraxia is not necessarily the cause of a lack of speech in a child with autism.

How might you be able to tell if this child is nonverbal because of apraxia, as opposed to the child being nonverbal because of autism? I would look for signs of oral-motor and limb apraxia. If this child’s apraxia is so severe that he cannot generate phonation at will, then you likely will see apraxia in other motor systems.

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Childhood apraxia of speech (CAS) is a motor speech disorder. This condition is present from birth, and it affects a child’s ability to form sounds and words. 

Children with speech apraxia often have far greater abilities to understand speech than to express themselves with spoken words.

The majority of children with childhood apraxia of speech will experience significant improvement, if not complete recovery, with the correct treatment.

Apraxia refers to the difficulty someone has initiating and performing the movements needed to make speech. This difficulty arises despite the fact that there is no weakness in the necessary muscles.

Childhood apraxia of speech rarely occurs alone. It is often accompanied by other language or cognitive deficits, which may cause:

  • Limited vocabulary
  • Grammatical problems
  • Problems with coordination and fine motor skills
  • Difficulties chewing and swallowing
  • Clumsiness

Experts do not yet understand what causes childhood apraxia of speech. Some scientists believe that it results from signaling problems between the brain and the muscles used for speaking. Ongoing research is focusing on whether brain abnormalities that cause apraxia of speech can be identified. Other research is looking for genetic causes of apraxia. Some studies are trying to determine exactly which parts of the brain are linked to the condition.

Childhood apraxia of speech may be a part of a larger disorder a child has, such as:

  • Cerebral palsy
  • Autism
  • Epilepsy
  • Galactosemia
  • Certain mitochondrial disorders
  • Neuromuscular disorders
  • Other intellectual disability

There is not a single test or procedure that is used to diagnose childhood apraxia of speech. Diagnosis is complicated by the fact that speech-language pathologists have different opinions about which symptoms indicate the condition.

Most children with apraxia of speech benefit from meeting one on one with a speech-language pathologist three to five times a week. They may also need to work with their parents or guardians to practice the skills they are developing.

Therapy for childhood apraxia of speech aims to improve speech coordination. Exercises may include:

  • Repeatedly practicing the formation and pronunciation of sounds and words
  • Practicing stringing together sounds to make speech
  • Working with rhythms or melodies
  • Using multisensory approaches, such as watching in a mirror while trying to form words or touching the face while talking

Speech language therapy is the main treatment for apraxia of speech. SLPs often use a variety of methods to treat it. Your child’s SLP might try methods such as:

  • Articulation or phonological therapy
  • Adapted cueing technique
  • Orofacial myofunctional therapy
  • Prompts for restructuring oral muscular phonetic targets therapy (PROMPT system)
  • Biofeedback treatments

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Apraxia

Apraxia is a condition that interferes with an individual’s ability to develop, execute, and sequence motor movements. The neurological impairment has three forms:

  • Motor involves movements in the hands or the entire body.
  • Verbal involves the muscle movements necessary for speech.
  • Oral involves movements not associated with speech and articulation such as puckering the lips or sticking out the tongue.

Subdivisions of Apraxia

  • Apraxia, Buccofacial
  • Apraxia, Classic
  • Apraxia, Constructional
  • Apraxia, Ideational
  • Apraxia, Ideokinetic
  • Apraxia, Ideomotor
  • Apraxia, Motor
  • Apraxia, Oculomotor

Limb-kinetic apraxia is the inability to make precise or exact movements with a finger, an arm or a leg. An example is the inability to use a screwdriver notwithstanding that the person affected understands what is to be done and has done it in the past.

Ideomotor apraxia is the inability to carry out a command from the brain to mimic limb or head movements performed or suggested by others.

Conceptual apraxia is much like ideomotor ataxia but infers a more profound malfunctioning in which the function of tools is no longer understood.

Ideational apraxia is the inability to create a plan for a specific movement.

Buccofacial apraxia, (sometimes called facial-oral apraxia) is the inability to coordinate and carry out facial and lip movements such as whistling, winking, coughing etc on command. This form includes verbal or speech developmental apraxia, perhaps the most common form of the disorder.

Constructional apraxia affects the person’s ability to draw or copy simple diagrams or to construct simple figures.

Oculomotor apraxia is a condition in which patients find it difficult to move their eyes.

Apraxia is believed to be caused by a lesion in the neural pathways of the brain that contain the learned patterns of movement. It is often a symptom of neurological, metabolic, or other disorders that can involve the brain.

Apraxia is caused by a defect in the brain pathways that contain memory of learned patterns of movement. The lesion may be the result of certain metabolic, neurological or other disorders that involve the brain, particularly the frontal lobe (inferior parietal lobule) of the left hemisphere of the brain. In this region, complex, 3-dimensional representations of previously learned patterns and movements are stored. Patients with apraxia cannot retrieve these models of stored skilled movements.

Oculomotor apraxia is a dominant genetic trait. The gene for this condition has been mapped to chromosome 2p13. Each chromosome has a short arm designated “p” and a long arm designated “q”. Chromosomes are further sub-divided into many bands that are numbered. For example, “chromosome 2p13” refers to band 13 on the short arm of chromosome 2. The numbered bands specify the location of the thousands of genes that are present on each chromosome.

Genetic diseases are determined by two genes, one received from the father and one from the mother.

Dominant genetic disorders occur when only a single copy of an abnormal gene is necessary for the appearance of the disease. The abnormal gene can be inherited from either parent, or can be the result of a new mutation (gene change) in the affected individual. The risk of passing the abnormal gene from affected parent to offspring is 50% for each pregnancy regardless of the sex of the resulting child.

Some cases of apraxia are congenital. When a child is born with apraxia it is usually the result of malformations of the central nervous system.

Treatments

  • Behavioral: ASSIST

Integral stimulation based treatment (“watch me, listen to me, say what I say”) for CAS that is based on principles of motor learning and neuroplasticity and includes a systematic approach to adaptive practice. Treatment includes a focus on prosody, use of visual, tactile, auditory cues, slowing speech rate, and large amounts of practice.

  • Therapy is delivered in a face-to-face format. The therapist uses picture stimuli, verbal modeling, feedback, reinforcement, forward-chaining to increase verbal production. For speech errors that occur, the therapist uses modeling, feedback, reinforcement, simultaneous production, articulatory instruction, and repeated practice to improve articulation.
  • Transcranial Magnetic Stimulation (TMS) Non-invasive brain stimulation, high frequency repetitive TMS delivered in 10 sessions over a 2-week period.
  • All patients will see a Neurologist for a neuro exam and consult, see a Speech Pathologist for assessment of speech and language skills, see the Study Coordinator for neuropsych testing (brief tests of thinking, memory, visual spatial skills, etc), undergo an MRI of the brain and a DaTscan of the brain.

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