Childhood Apraxia of Speech (CAS) is an enigmatic and severe expressive speech disorder of unknown etiology which has no cure, and is a lifelong challenge for those who are born with it. Up to 10% of the population is believed to suffer from some form of developmental apraxia, with approximately 70% of those affected being boys. While these children can perform the automatic (and subconscious) gross motor movements required for eating, the fine motor (and often automatic) movements involved with speech production require knowledge of representations of the movement that are neither automatic nor effortless, but are learned with protracted difficulty.

Speech – unlike reading – for persons with normalpraxis requires no learning, but is innate and inborn; only reading must be learned. This innate speaking ability is deficient in the child with CAS who requires early and very intensive therapeutic intervention to be able to speak and move normally – something taken for granted in the unaffected child.Praxis is mediated by a group of language genes (such as FOXP2) where - in the case of pathologicaldyspraxia - translocation is suspected result in atavatistic unmaskingof  an earlier genetic code so that the developing speech centers in the brain exhibit a neurodiversity due to suboptimal circuitry in gray &/or white matter. Similar to autism – another white matter neurodiversity characterized in some children by a regression of function, a red flag for many dyspraxic children is cued by used words which are then lost.

Primarily an inborn prenatal deficit of optimal function - knowns as praxis - of the brain's (cortical & subcortical) neural substrate for language, apraxia (- also known as dyspraxia) is an oral-motor disorder that does not permit voluntary motor planning because of poor motor engram genesis interfering with the planning, or programming of spatiotemporal parameters of movement sequences, organization, and/or coordinated execution required for the fine motor activities of speaking. Ideational in nature, and resulting in errors in speech-sound production and prosody, CAS is often accompanied by oral dyspraxia. Under the diagnostic umbrella of a broader developmental coordination disorder, childhood apraxia of speech is often accompanied by a host of gross & fine motor (e.g. dysgraphia) difficulties, balance & coordination challenges, adaptive problems, learning difficulties (e.g., dyscalculia), developmental delay, and social-emotional problems.

Often comorbid with other disorders such as attention deficit hyperactivity disorder (ADHD), & autism spectrum disorder (ASD), dyspraxia is preferably diagnosed by a speech language pathologist, whereas its concomitant developmental coordination disorder affecting fine, gross motor, and learning is best diagnosed by a pediatric neurologist or developmental pediatrician, who also rule out pathological post-natal brain insult. The resultant and often simultaneous delays across multiple domains for the child aged 0-3, especially with regard to motor output, balance, & equilibrium dysfunction that is best addressed by an interdisciplinary team of speech, physical, occupational therapists as well as special educators and social workers to counter the effects, as early and intensive treatment can vastly improve the outcome.

This primer is a MUST READ for all early intervention and pre-school therapists who service the professional needs of toddler, and child with Childhood Apraxia of Speech.

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Disclosure: Kristen O’Leary, SLP, has the following relevant financial relationships to disclose: she receives monetary compensation for the preparation of this course, in addition to a percentage of company sales, and has the following relevant non-financial relationships to disclose: EITTOC Board of Directors: volunteer member.Disclosure: David C Saidoff PT - course developer/presenter - has the following relevant financial relationships to disclose: he receives monetary compensation for the preparation of this course, in addition to a percentage of company sales, and has the following relevant non-financial relationships to disclose: EITTOC Board of Directors: volunteer member. Melissa Whelan, OTR - course developer/presenter -  has the following relevant financial relationships to disclose: she receives monetary compensation for the preparation of this course, in addition to a percentage of company sales, and has the following relevant non-financial relationships to disclose: EITTOC Board of Directors: volunteer member.Dr. Robert Koppel, M.D.,FAAP, Diplomate of the American Board of Pediatrics has the following relevant financial relationships to disclose: he receives monetary compensation for the preparation of this course, in addition to a percentage of company sales, and has the following relevant non-financial relationships to disclose: EITTOC Board of Directors: volunteer member. Declaration: Approval of this course does not necessarily imply that any of the governing bodies (e.g., West Virginian Board of Physical Therapy, or other such governmental or NGO’s supports the views of the presenter or sponsor. Information provided should be used within the scope of practice. No relevant financial or non-financial relationships exists between EITTOC or the products discussed any course; no such relationship or endorsement exists for any products mentioned in any courses sponsored by EITTOC, or in any of the items (such as specific AED or Epinephrine injection product) or any testing instrument used to evaluate children; the above course is specific to said-topic, and may not be extrapolated to any other course or topic outside the scope of this course. Course instructor(s) have no other financial or non-financial remuneration - whether prior to or following course delivery; the above advertisement is made available to all physical therapy (and other) licensee on a non-discriminatory basis. Ascend has approved this course and may be contacted about any concerns. Information provided should be used within scope of practice. AOTA does not endorse specific course content, products, or clinical procedures. The onus of responsibility for this course – granted contact hours by the AOTA – is for each OT professional to check with their State board of OT to see if this course meets licensure requirement for continuing education. AOTA does not endorse specific course content, products, or clinical procedures.