Childhood Apraxia of Speech
Childhood Apraxia of Speech, or CAS, is a motor speech disorder. It affects the way that the signals from the brain are relayed to the articulators (the tongue, jaw, lips, vocal folds, and soft palate), which in turn impacts the way kids are able to produce words and sounds. A child with CAS has difficulty planning and coordinating all of the movements needed for speech because the brain’s instructions regarding the exact timing and sequencing of the articulators’ movements are being disrupted. In other words, kids with CAS know what they want to say, they just “can’t get it out”.
Generally, CAS is not diagnosed before age three, although signs and symptoms may be present long before that. Currently, there are no set criteria for giving a child a diagnosis of Childhood Apraxia of Speech: experienced speech-language pathologists must use their clinical judgement to make the determination. CAS shares several characteristics with other speech disorders, which can make diagnosing it a complex process. Some key characteristics of CAS are:
- A limited consonant and vowel repertoire
- Minimal variation between different vowel sounds
- Vowel errors and distortions
- Inconsistent errors and idiosyncratic error patterns
- Reduced rate or accuracy on tasks with rapid articulator movement
- Oral groping behaviors
- Prosodic differences (reduced rate, excess or equal stress, “choppy” words and syllables, monotone speech)
- Increased errors with increased length or complexity of utterances
- More difficulty with spontaneous speech compared to modeled or automatic utterances
Only one or two children out of one thousand have Childhood Apraxia of Speech. Because it’s so rare, it can be difficult to find a speech-language pathologist who has experience treating the disorder. An accurate diagnosis and specialized treatment are essential in helping kids with CAS learn to communicate effectively, so it’s important to find a clinician with advanced training in this area.
Like with many speech disorders, there are a wide variety of treatment methods available for Childhood Apraxia of Speech. Unfortunately, many families gravitate towards the more widely known programs, regardless of the level of evidence shown through the research. In fact, some of the best marketed programs for CAS intervention have no supporting evidence!
As Childhood Apraxia of Speech does not include paralysis or weakness of the articulators, oral motor exercises are not a recommended treatment method. Activities such as chewing, blowing, etc. have not been proven to have a positive affect in children with CAS. Rather, in order to improve their speech production, these children have to practice speaking. Best practice for treating kids with CAS involves incorporating the principles of motor learning. In order to make long-lasting changes to a child’s motor planning for speech, your child’s therapist should consider the following variables:
The duration and frequency of sessions: Research supports shorter, more frequent sessions over less frequent, longer sessions. Currently, the best outcomes are reported for children who attend sessions between three and five times per week.
The amount of trials per session: In order to improve motor learning and increase the accuracy of the words produced, many trials of each target word need to be produced each session. To achieve this, focus on a small set of words (five might be a good place to start) rather than trying to tackle a large set.
The types of cues given: Children with CAS benefit greatly from modeling and cueing, especially as they are practicing a new word. This might include a physical cue, like touching their lips to promote roundness for /o/ or /u/, or giving a model, so children can see the proper movement of their therapist’s articulators as they are saying the word themselves.
Massed vs distributed practice: Massed practice involves practicing a target many times during a single session, while distributed practice entails spacing out the practice of the target word over several sessions. As you may have guessed, distributed practice more closely aligns with the principles of motor learning.
Blocked vs random practice: In blocked practice, each target word is addressed in a “block” of repetitive trials before moving on to the next target. This helps the child learn the motor movement. Next, random practice, or presenting the targets in a random order throughout the session, should be utilized to lead to increased generalization.
The types of feedback given: Specific feedback is much more beneficial to kids with CAS, especially as they are learning new sounds and words. Something along the lines of “make your lips rounder” or “open your jaw wider” will be more helpful to kids than a generic “good job”. As they become more proficient, feedback should transition from immediate to delayed.
Alternative communication methods: To help children communicate effectively while they are improving their verbal speech, they can use signs, pictures, or AAC devices. Some parents worry that this type of functional communication will impede speech production. However, research shows that actually it enhances language development, and can lead to a decrease in negative behaviors.
Interested in learning more about Childhood Apraxia of Speech and appropriate methods for diagnosis and treatment? Could The Speech Studio be a good fit for your child? Give us a call at (914) 893–2223 or visit our website for more information. A licensed and certified speech-language pathologist can recommend the best course of therapy for your child’s individual needs.
