What is Childhood Apraxia of Speech (CAS)?
Childhood Apraxia of Speech is a neurological speech disorder in which the accuracy and precision of speech-motor movements are impaired.
This means the brain knows what it wants to say but it has difficulty carrying out the sequence and plan required for accurate and consistent speech movements and production.
What causes Childhood Apraxia of Speech?
CAS may occur as a result of a known neurological impairment, such as a brain injury or stroke, as a result of a genetic condition, or may be idiopathic (unknown) in origin.
The core impairment of CAS is in learning and carrying out the necessary planning and programming for speech-motor movements that are required for accurate speech production.
CAS is not caused by weakness in the speech production system (tongue, jaw, lips). If weakness in the system is observed during speech production, this may be classified as a separate disorder, known as Dysarthria.
How do I know if my child has Childhood Apraxia of Speech?
Some characteristics and warning signs include:
Limited vowel repertoire, vowel errors, and vowel distortions
Variability in speech errors
Unusual speech errors
Errors increase as length and complexity increase (more errors on phonetically complex words, multi-syllabic words, word combinations, phrases, etc.)
Impaired rate and accuracy in connected speech
Difficulty with “smoothness” in connected speech (speech may sound choppy, may hear breaks or pauses between syllables)
Groping behaviors/observable struggle when initiating speech or during speech, at some point in development
The following are characteristics that may be present in children with CAS, but are less likely to contribute to a differential diagnosis:
Delayed onset of speech
Limited babbling as an infant/young child
Limited sound inventory
Loss of previously acquired words
Poor intelligibility of speech
Who diagnoses Childhood Apraxia of Speech?
CAS is a communication disorder and therefore the professional who is most appropriate to make this diagnosis, is a qualified SLP.
Other professionals such as physicians, pediatric neurologists, developmental pediatricians, or physiatrists sometimes make the diagnosis or suspect this diagnosis, but usually they refer to a speech-language pathologist on their team or to an SLP who has expertise in distinguishing between CAS and other types of speech disorders.
Diagnosis of CAS is not based on a single test or assessment. The experienced clinician systematically investigates a number of key characteristics during predetermined tasks.
It can be difficult to diagnose CAS if the child is very young, does not have the attention or focus to engage in formal assessment, or does not have enough speech-language to complete the tasks.
What kind of treatment is recommended for Childhood Apraxia of Speech?
There are a number of evidence-based treatment methods for the effective treatment of CAS; however, it is important to note that some approaches have higher quality evidence and research supporting them. It is important the clinician has at least some training in principles of speech-motor learning.
Because the main problem of CAS is speech-motor learning, planning, and programming, the therapy approach needs to focus on the actual sequenced movements of speech structures during speech attempts.
Dynamic Temporal and Tactile Cueing (DTTC): An Evidence-Based Approach
Programs and frameworks, such as Let’s Start Talking, Let’s Talk More, and Let’s Talk Clearly follow DTTC methods and SLPs trained in these programs have a deep understanding of applying speech-motor learning principles to their treatment. “The rationale for following an approach using DTTC and the key elements important to it’s administration are supported by models and theories of speech-motor control” (Strand, 2020). When using DTTC method, emphasis lies in the gradual shaping of accurate speech movements. This means that auditory, visual and sometimes tactile cues are used to help build movement accuracy at the syllable, word, word combination and sentence level (vs. isolated sounds). The focus of treatment using a DTTC approach is to develop (and over-learn) accurate speech-motor movement patterns and these movements must occur only within the context of carefully selected targets. This focus distinguishes itself from other treatments for speech sound disorders (including, but not limited to traditional articulation approaches or phonological approaches).
Clinicians trained in Let’s Start Talking, Let’s Talk More, and Let’s Talk Clearly are experienced in making clinical decisions regarding number of practice opportunities, number of targets, choosing and creating appropriate targets, providing appropriate cueing, and carefully considering type, frequency, and timing of feedback. These therapeutic decisions are made by exercising the clinician's understanding of speech-motor learning principles.
According to Strand (2020), when using DTTC approach, the clinician is working to improve the child’s inefficient neural processing of controlled or volitional movements for speech. The desired outcome when following this approach is the improved accuracy of speech-motor movements, including improved sound production.
Learn More About DTTC
If you are interested in knowing more about DTTC treatment method or in determining what to look for in speech-motor learning treatment, the following links from Apraxia Kids may be helpful.
Key Factors in Appropriate Therapy
Learn more about Let’s Start Talking, Let’s Talk More, and Let’s Talk Clearly intervention programs designed for children with suspected or confirmed CAS.
What other difficulties co-occur with Childhood Apraxia of Speech?
Co-existing difficulties are often seen in children with CAS. These problems are not caused by CAS, but rather are seen along-side CAS.
Some difficulties that are often seen co-occurring with CAS include:
Delays in understanding and using spoken language
Problems with reading, writing, and spelling
Difficulties with attention and executive function
Difficulties with development and coordination of fine and gross motor movements
Difficulties with sensory input (e.g. loud noises, feeling of clothing, food & texture aversions, etc.)
What resources are available for families and educators who know a child with CAS or suspect CAS?
Click here to see a video of Dr. Edythe Strand referencing resources available to families, including reference to Apraxia Kids (2019)
Learn more about Apraxia Kids.
References:
Strand, E.A. (2020). Dynamic temporal and tactile cueing: A treatment strategy for childhood apraxia of speech. American Journal of Speech-Language Pathology. (29) 1, 30-48.
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