Surprising Connections: Why Autism and Apraxia Share Common Ground

Is there a link between autism and apraxia? Researchers are checking.Autism and apraxia are two conditions that can profoundly affect communication and speech. While they share some common symptoms, researchers are still actively investigating if there is a definitive link between autism and apraxia of speech.  The shared symptoms have many individuals asking, “Is apraxia a form of autism?” 

What is Autism Spectrum Disorder?

Autism spectrum disorder refers to a range of developmental disabilities characterized by challenges with social skills, communication, and restrictive/repetitive behaviors. The term “spectrum” is used because the symptoms and characteristics of autism can present themselves in a wide variety of combinations, from mild to severe.

Some of the key features of autism spectrum disorder include:

  • Difficulty with verbal and nonverbal communication – this can include delayed language, monotone or atypical speech, limited ability to have back-and-forth conversations, and trouble understanding non-literal language like sarcasm.

    Learn more about nonverbal autism.

  • Struggles with social interaction and relationships – autistic individuals may have trouble making eye contact, reading social cues, making friends, and feeling empathy. They often have limited interests and may not enjoy sharing interests or achievements with others.

    Learn more about autism and friendships and eye contact avoidance.

  • Restrictive, repetitive patterns of behavior – these can include repetitive motor movements like hand flapping, inflexible adherence to routines, highly restricted interests, and sensitivity to certain sounds, textures or stimuli.

    Learn more about sensory sensitivities and stimming behaviors.

  • Cognitive and neurological differences – some (but not all) autistic individuals have intellectual disabilities, differences in learning patterns, or neurodiversity conditions that impact the brain and cognition.

    Learn more about top 10 autism stereotypes and the truth behind them.

About 1 in 36 children have been identified with diagnosed with autism spectrum disorder, according to latest government data. It occurs in all racial, ethnic, gender, and socioeconomic groups, and is nearly 4 times more common among boys than girls. However, that statistic of boys/girls may be changing as researching is showing that girls may better at masking/code switching their symptoms, making their diagnosis less clear initially.

Interestingly, there is a growing number of individuals who do not receive a diagnosis until later in life and the same holds true for apraxia of speech in adults. It isn’t that they haven’t always had the disorder, it’s that evaluations and resulting diagnoses are improving all the time.

There is a co-occurrence between autism and apraxia, but you can have one without the other. Autism is considered a spectrum disorder because its severity and combinations of symptoms can be very different from person to person.

For example, someone with high-functioning autism has average or above-average intelligence and sufficient language skills to conduct a conversation.

However, autistics often struggle to understand sarcasm or body language cues. They may also be able to live independently and have a fulfilled life. On the other end of the spectrum, someone with low-functioning autism may have very delayed or limited speech, or may even be non-verbal, and require much more assistance with activities of daily living.

What is Autism and Speech Apraxia?

Apraxia of speech in adults as well as children is a motor speech disorder that makes it difficult to accurately produce sounds, syllables, and words despite having the physical ability to speak.

It is caused by difficulty planning and coordinating the precise movements of the lips, jaw, and tongue needed for intelligible speech.

Primary signs and symptoms of autism and speech apraxia include:

  • Inconsistent errors pronouncing consonants and distorted vowel sounds.
  • Struggling to move the mouth accurately to produce specific speech sounds or words, but not having paralysis.
  • Improperly sequencing sounds and syllables in longer words or phrases.
  • Abnormal rhythm, stress, and intonation when speaking.
  • Difficulty speaking with proper rate, speed, and flow. Speech may sound choppy, disjointed or hesitant.
  • Appearing to grope when attempting certain words, especially longer or more complex words with several syllables.
  • Easier or clearer speech when singing, copying a rhythm, or using automatic learned phrases.
  • Being able to communicate better through means other than speech, like writing or typing.
  • Great effort and frustration when trying to speak.

Apraxia of speech in adults and children is caused by neurological dysfunction in the parts of the brain that control planned movements of the speech muscles.

Difficulties coordinating and sequencing the physical gestures required for speech sounds leads to the visible symptoms of apraxia.

Autism and apraxia of speech sometimes occur alongside one another, as apraxia may also co-occur with other conditions like apraxia, cerebral palsy, stroke, or neurological disorders. But for many people the exact cause is unknown and it occurs as an isolated developmental speech disorder starting in childhood.

Frequency is estimated at 1-2 kids per 1,000. It can range from mild to severe, but in all cases speech therapy is the main form of treatment and early intervention is key in apraxia of speech in adults and children.

The Possible Connection Between Autism and Apraxia

There are several reasons many researchers ask, “Is apraxia a form of autism,” because they believe there could be a strong link between autism and apraxia of speech.

5 Top Reasons for Connecting Autism and Apraxia

  1. Co-Occurring Rates:
    Multiple studies show very high rates of autism and apraxia together. These numbers range from 28% to as high as 94% of co-occurrences with autism and apraxia in different studies. This suggests a strong overlap for a significant portion of the ASD population.
  2. Shared Neurological Features:
    Brain imaging studies demonstrate that autism and apraxia both involve abnormalities in regions critical for planning and coordinating speech motor movements. The neurological underpinnings seem to show substantial overlap, although a specialist would need to confirm any link.
  3. Genetic Factors:
    Ongoing genetic studies have identified shared gene mutations and variants between some individuals diagnosed with ASD and AOS. Certain genetic links are emerging between the conditions.
  4. Communication Difficulties:
    Both autism and apraxia involve challenges using speech and language to communicate effectively with others. There are similarities in their difficulties with motor planning, initiation, coordination and sequencing of the complex mouth and tongue movements necessary for intelligible speech.
  5. Developmental Trajectory:
    Signs of apraxia often become more noticeable in the early toddler and preschool years as spoken language and speech movements become more complex.

    This mirrors the more obvious speech delays seen in autistic children around ages 2-4 as their peers acquire more advanced speech skills.

Despite this evidence, apraxia of speech in adults and children is still not formally considered a core feature or diagnostic criterion of autism spectrum disorder.

There are individuals with autism who do not appear to have apraxia as a co-occurring condition. And not everyone with apraxia has autism. More research is needed to determine the nuances of their neurological and genetic relationship.

Treatment and Prognosis When Autism and Apraxia Occur Together

When an individual has both autism and speech apraxia concurrently, it is critical that therapy addresses the needs of both conditions for the best outcome.

While the diagnosis of the co-occurring conditions most commonly occurs in childhood, it can sometimes be autism and apraxia of speech in adults. That’s because sometimes the diagnosis is delayed until later in life.

According to experts (and, as always, check with your personal doctor and/or therapist), the recommended treatment approach includes:

  • Early intensive behavioral interventions including speech therapy, occupational therapy, and applied behavior analysis that use play-based methods to improve communication, speech production, and life skills.
  • Speech-language therapy focused specifically on mouth and tongue coordination, sequencing speech gestures, rhythm and stress patterns, and transitioning between sounds and syllables when speaking.
  • Augmentative communication devices like picture boards and speech-generating devices to supplement or temporarily replace oral speech.
  • Social skills therapy and support to practice reading social cues and initiate conversations using new communication strategies.
  • Ongoing accommodations and support services in home and school settings to enable full participation and independence.

The prognosis for those with co-occurring autism and apraxia varies significantly depending on the severity of symptoms for each condition. With early and intensive therapy starting as young as ages 2-3, many children can make substantial improvements in their communication skills and ability to be understood by others.

Even if not diagnosed with autism and apraxia in childhood, autism and apraxia of speech in adults or teens can be improved with support from speech therapists, special education staff, and assistive technology as they can continue playing an important role in improving outcomes throughout the school years and beyond.

The Complexities of Diagnosing Autism and Apraxia

Given the still-unclear relationship between autism spectrum disorder and apraxia of speech, accurately diagnosing autism and apraxia as co-occurring conditions can pose a significant challenge.  Questions still continue of, “Is apraxia a form of autism?” There are several complicating factors in determining autism and speech apraxia:

  • Overlapping Characteristics:
    Many of the speech and communication difficulties seen in autism like repeating words, odd intonation, and limited speech can appear similar to signs of apraxia. Separating the root causes can be difficult.
  • Inconsistent Speech Errors:
    In autism, speech errors often follow consistent incorrect patterns that reflect challenges understanding grammar rules. But with apraxia, speech errors are inconsistent and more related to motor planning. Noticing the difference requires careful evaluation.
  • Cognitive Profiles:
    Some individuals with autism and apraxia also have intellectual disability or very uneven cognitive profiles that make following instructions and completing oral exams difficult. Their full speech abilities may be obscured.
  • Severity Levels:
    Distinguishing between severe apraxia versus limited speech common in low-functioning (or high-needs) autism is tricky. Lack of speech attempt doesn’t necessarily equal apraxia.
  • Age of Onset:
    Many young children with autism remain minimally verbal for a period before showing delays. Determining if early speech attempts reflect true apraxia versus general language delay is challenging.

According to speech therapists, the best practices for diagnosing autism and apraxia may include:

  • Conducting a comprehensive speech-language evaluation that uses both formal standardized tests and informal observations during play.
  • Looking for key markers of apraxia like groping, distorted sound substitutions, and vowel/prosody errors.
  • Comparing speech production when imitating, during automatic phrases, and on structured tasks. Apraxia often shows up most clearly in imitation.
  • Partnering with occupational therapy to assess oral-motor skills beyond just speech production.
  • Considering cognitive abilities to determine if a child can understand task directions and whether limitations reflect cognition vs. motor planning.
  • Using assessment tools tailored to autistic profiles and a child’s developmental level.
  • Tracking speech patterns over time rather than relying on a single evaluation.

Getting an accurate autism and apraxia diagnosis is essential to provide individuals on the spectrum with the speech therapy techniques that will be most helpful for their needs. Autism and apraxia have many similar symptoms. Increased awareness of how autism and apraxia can intersect can enable clinicians to disentangle symptoms and support improved communication outcomes.

Ongoing research efforts bring hope that clearer diagnostic markers and targeted treatments will soon emerge.

These conditions can be similar and many people can be diagnosed with both but they are different conditions and we need to understand them more to say definitively whether or not they are connected.

There are a lot of conditions in the world, both physical and mental, and some can be similar, so it’s easy to get them mixed up with each other but that is why it takes the community of doctors, therapists, caregivers, family, and self to work together so that individuals with autism and other possible co-occurring conditions to live their best lives.

My Personal Autism and Apraxia Story

My mother tells me that they considered my having apraxia in early childhood (aged 5-7), but that the tests were always inconclusive. Autism was not ever mentioned at that age or stage in my life, however.

Since I was a toddler, my parents noticed that I talked less than my two older siblings, which first was attributed to my older sister by 23 months “talking” for me. Since other milestones were being hit, and because my dad was also a man of few words, it wasn’t too concerning.

However, my mom felt something wasn’t quite right, and she had me assessed at age 3. Due to the lack of typical verbal skills, I qualified for the Early Childhood Special Education Program ( formerly known as PPCD).

While I was never given an official diagnosis of apraxia, it was suggested. But, instead, I was “undefined special needs.” It wasn’t until middle school, after I had some struggles with all the chaos of that age group and struggled with extremely noisy classrooms and shrieking students that impacted my focus in a math class in particular, that I received the diagnosis of Asperger’s syndrome. 

Of course, we all now know it has become part of the broader autism spectrum disorder.

But back to apraxia, I may or may not have it or I may have a more general language delay, but even as an adult my clarity in speech is sometimes difficult for some people to understand.

I am pretty much a typical verbal adult, but don’t always articulate well, and sometimes struggle with putting detailed thoughts into how I express myself. I was in speech therapy from age 3 until I entered middle school, however.

Luckily, I have been given support, encouragement, and understanding throughout my autism journey, and my hope is others receive the same.

Additional Challenges Individuals with Autism Face

Learn more about other issues that autistics face:

Picture of Connor McClure

Connor McClure

I'm a young adult navigating life with autism. By sharing my experiences and views, I hope to create a better awareness, understanding, and compassion for those on the spectrum. Let's connect!
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