Speech Apraxia & Autism: Understanding the Connection
Autism and speech apraxia are comorbid conditions that are closely related. Children with one condition should be screened for the other.
Children with autism may be diagnosed with this developmental condition at a young enough age that they do not have strong capabilities for forming words or sentences. It is important to work with your pediatrician to understand when you can know that your child needs help from a speech therapist.
Speech therapy will typically be given in addition to behavior therapy, which is the primary form of treatment for autism. Adding speech therapy to your child’s treatment regime can help them learn skills to communicate their needs to the rest of the world.
How Does Speech Apraxia Overlap With Autism?
Speech apraxia — also known as apraxia of speech, verbal apraxia, childhood apraxia of speech (CAS), or acquired apraxia of speech — is a disorder of sounds associated with using verbal language. Someone with this condition has difficulty saying what they want to say out loud, clearly, and consistently.
This difficulty is due to a neurological difference affecting brain pathways that are related to planning the mouth muscle movements required to produce spoken words. This is often described as the brain knowing language and sentence structure and creating what it wants to say, but being unable to properly plan out the sequence of words to make speech. Apraxia still involves the person having some level of spoken language rather than being nonverbal.
Apraxia’s severity occurs on a spectrum, so some people may be able to speak with a little stuttering, while others may need extensive support to complete sentences. Symptoms of apraxia include:
- Distorting sounds, especially vowels. The speaker struggles to put the structures for speech, like the tongue, in the right place. Longer and more complex words are more difficult than simple, short words.
- Inconsistent speech errors. This can manifest as saying a difficult word correctly the first time but then saying it incorrectly the second time, or having trouble with one sound one day but having no trouble with it the next day.
- Groping for sounds. The person may attempt to say a word multiple times before they get it right or struggle to find the right pronunciation for a word.
- Errors in rhythm, stress, and tone. This is called prosody. It occurs with inflection and rhythm, as the person is more likely to use equal stress on syllables, omit syllables in words or phrases, segment syllables in a word, or pause inappropriately.
Typically, children with speech apraxia understand language at the normal developmental level, but they are not able to use it at that level. They may also have problems with motor skills and expressive language like gestures.
Apraxia is diagnosed by speech-language pathologists. They look at the cluster of symptoms and rule out other underlying conditions, like muscle weakness, problems producing language (aphasia), or other underlying causes. A speech-language pathologist can also help to treat apraxia.
Formal testing for apraxia may include:
- Repeating a particular word several times.
- Repeating a list of words of increasing length, such as love, loving, and lovingly.
- Examining the ability to read, converse, write, or perform non-speech movements.
Apraxia and autism are both disorders that involve speech and communication, but they are not the same disorder. One recent scientific study suggests that as much as 65% of children with autism have speech apraxia. This suggests that children diagnosed with autism need to be screened for apraxia when they begin speaking.
Autism & Apraxia Are Closely Comorbid Conditions
About 1 in 54 children in the United States has autism, and about 1 in 1,000 children has apraxia.
Children with autism can be especially challenging to diagnose with apraxia, so the assessment with a speech-language pathologist may take a few sessions. Using more than one session with a child on the autism spectrum reduces their stress, so it may be easier to get an accurate diagnosis over multiple sessions.
It may also be a few years before you can get a proper assessment from a speech-language pathologist. Children are diagnosed with autism between 12 months (1 year) and 4 years old, with the average diagnosis age being 2.
However, at this young age, children are still acquiring language capabilities, and they may not speak well enough for a speech therapist to diagnose a speech disorder. The therapist may ask the child to imitate their sounds or repeat words, and this can take a higher level of understanding than a toddler has, especially one with a developmental disorder like autism.
The study finding a high rate of apraxia in children with autism set out to determine if the diagnostic criteria for autism were accidentally overemphasizing speech and language production, leading to several misdiagnoses of apraxia. The 2015 publication reported that data from the study showed 63.6% of children who originally received an autism diagnosis also had apraxia; 36.8% of children with apraxia also had autism; 23.3% of children had neither; and 23.3% of children had both and were diagnosed for both at the same time. Complete diagnostic precision for the autism test is 96.7%.
The study concluded that children with apraxia and children with autism were not misdiagnosed with the other condition. Better pediatric screening for these conditions would improve outcomes for children who experienced these concurrently.
Treating Apraxia in Children With Autism
Treating apraxia in children with autism will likely be separate from behavior therapy, but treatment can occur concurrently. The goals of apraxia treatment include:
- Teaching the child to plan the movements needed to say words.
- Teaching the child to make these movements the correct way.
Speech and occupational therapists will work with your child’s behavior therapist to create a treatment plan, which will include working with and supporting parents like you. Depending on the severity of your child’s apraxia and autism, the speech pathologist or therapist may work on building your child’s communication skills using:
- Visual supports and speech devices. If your child struggles to complete words or sentences to the point that they cannot speak clearly enough to communicate, other devices may be used. Picture cards or a voice-generating computer tablet can help your child or adolescent to communicate when they are not verbally able to do so.
- Gesture cuing. The parent or therapist touches their mouth while saying a sound, which cues the child to form their lips and tongue in certain ways when creating words. This type of visual cue can help children understand where sounds are formed if they cannot transfer what they hear into a shape for their mouth.
- Tools to build vocabulary. Children with autism who are somewhat verbal can learn basic words or phrases that will be important in their daily lives. Parents may work with the therapist to decide which words to use every day, like “mom” and “dad,” or phrases like “I’m hungry.” The specific words and phrases depend on the child’s age and skill level with speaking and remembering.
Speech therapists will use a combination of these approaches in combination with understanding the individual child’s needs. Treatment plans may be frequently adjusted as the child progresses in therapy and builds better verbal skills.
Support Groups for Families of Children With Apraxia & Autism
There are many resources for children with both autism and apraxia and their parents. Here are a few national options to help you get the support you need:
- Apraxia Kids: This organization offers their own support group, along with a resource page of dozens of other support groups.
- PennState Health Children’s Hospital: This hospital offers a page with information on their parent support group as well as links to books on apraxia, autism, and other conditions that are often comorbid with autism.
- Autism Speaks: This national advocacy organization keeps a page of current support groups for people with autism and their loved ones.
The Next Step
If you suspect your child may have co-occurring speech apraxia and autism, the first step is to get an accurate diagnosis. Talk to your child’s pediatrician about your concerns. They may refer you to specialists to get an official diagnosis.
Once you have a diagnosis in hand, you can begin getting your child the treatment they need. This most often includes both behavior therapy and speech therapy.
Apraxia of Speech. (October 2017). National Institute on Deafness and Other Communication Disorders (NIDCD).
Recognizing and Treating Apraxia of Speech in Kids With Autism. Autism Speaks.
Data & Statistics on Autism Spectrum Disorder. (March 2020). Centers for Disease Control and Prevention (CDC).
How Valid is the Checklist for Autism Spectrum Disorder When a Child Has Apraxia of Speech? (October 2015). Journal of Developmental and Behavioral Pediatrics.
Childhood Apraxia of Speech. American Speech-Language-Hearing Association (ASHA).