Back when I was in graduate school, I worked for an Audiologist and conducted more than my fair share of hearing screenings.  Not only did I really enjoy it, but I learned an awful lot about hearing loss.  Did you know that hearing loss is one of the most common birth disorders in the United States?  According to the National Institute on Deafness and Other Communication Disorders, 1 in 1000 infants is born totally deaf and an additional 1-6 per 1,000 are born with less severe, but significant, hearing loss.  

Why is this important?

In the first 3 years of life, a child's auditory pathways and language cortex are developing at a rapid pace.  This neurological development happens in response to auditory (or visual) language. For families that are part of the deaf culture, parents begin signing from day one, so the baby is learning visual (sign) language.

But, it is estimated that 96% of children with hearing loss are actually born to hearing parents. So, it follows to reason that these children are at much greater risk for delays in speech and language skills, especially if their hearing loss goes undetected.  For example, even a child with a mild hearing loss may not hear "quiet" speech sounds such as /s/, /sh/, /f/, /t/ and /k/ and therefore would not include them in their speech. This can also affect their understanding and usage of vocabulary and grammar....  

Think about how often these "quiet" sounds pop up in this sentence...
"Seven cats sat on the fence shaking their tails".  
That's a lot of information missed if you aren't hearing those sounds. 

Newborn Hearing Screenings 

Thankfully, most babies born in hospitals in the U.S. are screened for hearing loss at birth using one of two tests:

1. Otoacoustic Emissions (OAE) is conducted by placing a sponge earphone/microphone in the infant's ear canal. The response (echo) of the outer hair cells of the cochlea (nerve pathways from the inner ear to the brain) is then measured by the microphone.
2. ​​Auditory Brainstem Response (ABR) is a more complex test that requires earphones be placed on the ears and electrodes placed on the infant's head and ears. The sound is emitted through the earphones while the electrodes measure how the baby's brain responds.

Both tests are painless, relatively quick, and can even be done while the baby is resting.

Can babies pass a newborn hearing screening and still have hearing loss or develop hearing loss later?

Yes!  It's important to remember that no screening is perfect and babies with mild hearing loss may even pass newborn hearing screenings. So, being aware of the signs of hearing loss as your child grows is crucial.  It's also possible that hearing loss may develop later on in a child's life for a variety of reasons, including chronic ear infections (acute otitis media), excessive earwax, congenital malformations, or a genetic hearing loss.

Here are some signs of hearing loss to watch for in children:

• Not being startled by sudden, loud noises
• Delays in speech or language
• Difficulty paying attention and behaving
• Difficulty with academic performance
• Lack of response to soft-level sounds or spoken language 
• Frequent use of "what?" or "huh?"
• Intently watching the faces of speakers
• Difficulty understanding speech when there is background noise
• Sitting close to the TV when the volume is loud enough for others
• Difficulty figuring out where a sound is coming from

If your child exhibits any of these symptoms, ask your pediatrician about a hearing screening.  They can often be done quickly at your pediatrician's office, once a child enters school, or by an Audiologist by request or referral.

Early detection is crucial.  Very often, depending on the type of loss (which is a post for another day), hearing loss can actually be corrected. But, even with a permanent hearing loss, research indicates that children who begin services early may be able to develop language (spoken and/or signed) on a par with their hearing peers.  So, don't delay if you suspect your child may have hearing loss!

​Click here or here to find an Audiologist near you.  

Was your child a late talker?.... Didn't babble as an infant?... Does he have difficulty imitating words?... Are her sound errors inconsistent?  These are just a few possible signs and symptoms of  Childhood Apraxia of Speech (CAS), but they can also be indicators of other speech or language disorders.  So, how can you tell if your child has CAS or not?

Let's start with some definitions...

Language vs. Speech:

When a child has difficulty understanding others (receptive language), or meaningfully using words and sentence to share thoughts and ideas (expressive language), then he or she may have a language delay or disorder.

When a child is unable to produce speech sounds to correctly form words,  then he or she may have a speech delay or disorder. CAS is one such speech disorder. However, there are several more common types of speech disorders that may also cause a child to have difficulty producing sounds.  Here are 3 main types of speech disorders that can sometimes be difficult to differentiate from one another:
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1. Articulation Delay: Young children often exhibit articulation errors by substituting,  omitting. or distorting particular sounds.  For example, making "w" for "r" sounds (e.g., "wun" for "run"), "d" for "th" (e.g., "dat" for "that"), and lisping of "s" (e.g., "thoup" for "soup") are errors of articulation.  If these errors continue past the expected age of acquisition, then the child may have an articulation delay. By the age of 8 all typically developing children should be able to pronounce all English sounds correctly.
2. Phonological Process Disorder: This type of speech disorder involves "patterns" of sound errors called "phonological processes", rather than errors specific to just one or two sounds.  Children with phonological disorders produce sound errors that are typically very consistent when they speak.  For example, they may consistently substitute sounds made in the back of the mouth, like "k" and "g", for sounds produced in the front of the mouth, like "t" and "d" (e.g., "tandaroo" for "kangaroo" or "tup" for "cup"). Typically developing children often use these "simplified" ways to produce speech when they're younger, but like articulation disorders, if these errors continue as they become older, the child may have a phonological disorder.
3. Childhood Apraxia of Speech is a much less common, neurologically based speech disorder. (Some sources indicate that CAS affects 1 – 10 in 1000 children or 3 – 5 % of speech-impaired preschoolers.) Children with CAS have problems saying sounds, syllables, and words, not because of muscle weakness or delayed development, but because the brain has problems planning the movements of the body parts needed for speech (e.g., lips, jaw, tongue).  Therefore, we call it a motor speech disorder. Children with CAS display errors that are typically inconsistent, the child may appear to be groping when attempting to produce sounds, he/she may have vowel sound errors, and have more difficulty upon imitating words.  Click here for more signs/symptoms of CAS.

So, how can you tell if your child has CAS?

The first step is finding a Speech Language Pathologist experienced with motor speech disorders.  In the U.S., SLPs are the most qualified professionals who can and should differentially diagnose CAS from other speech disorders.  I often hear of parents receiving an Apraxia diagnosis from their pediatricians or neurologists, but these professionals tend to use CAS as a "catch-all" term for children who have severe delays in speech or language and don't have the training or expertise to differentially diagnose.  

A comprehensive evaluation conducted by a Speech Pathologist experienced with CAS will include:

1. a thorough case history
2. oral motor/mechanism exam
3. assessment of receptive and expressive language abilities
4. in-depth speech sound assessment.  

It's important to note, however, that if only a limited speech sample can be obtained, a firm diagnosis will be challenging. In cases where children have very limited or no speech, especially with children younger than 3 years of age, SLPs often note "suspected" CAS until the child has enough speech to analyze. But, the provision of appropriate therapy should not be delayed.  Early intervention is critical, no matter the particular diagnosis.

Why is an accurate diagnosis important?  2 Reasons:

1. An accurate diagnosis will determine what type of intervention will be most effective.  There are numerous therapy approaches to treat different types of speech sound disorders. But, for example, using a phonological treatment approach to treat a motor speech disorder will not be as effective as those strategies and techniques that are designed to improve the motor planning aspects of speech.  
2. Children with CAS typically require individual, frequent and intensive therapy to make acceptable gains. For children with articulation or phonological deficits, receiving 1-2 speech therapy sessions a week may be sufficient.  However, the consensus among most experts is that frequent and direct intervention 3-5 times a week is most effective for children with CAS.

This is only a brief overview about differentiating CAS from other speech disorders. For more detailed information about Childhood Apraxia of Speech please visit these helpful sites: