Childhood Apraxia of Speech CAS: Why it’s Treated Differently

Childhood Apraxia of Speech (CAS) is distinctly different than articulation and phonological delays with regards to evaluation, diagnosis, and treatment. If you’re confused about your child’s speech delay, it’s best to consult an experienced speech pathologist in a timely manner. At the end of this post, I share some resources for finding that speech pathologist in your area.

The late Pam Marshalla, a renowned Speech Pathologist, said it best in the opening to her book, Apraxia Uncovered- Seven Stages of Phoneme Development, “Children with apraxia and dysarthria do not respond well to traditional speech therapy methods and procedures, rather they need a therapy that actually teaches them how to make their speech mechanism function correctly.”  Explore causes, theories, and defining characteristics of apraxia and how it differentiates from speech delays.

What is Apraxia?

Apraxia of speech is a condition that impacts one’s ability to plan sequential movements for speech productions.  According to a well-known researcher and diagnostician, Dr. Edythe A. Strand, “Apraxia is due to deficits in the planning and programming of movement gestures for speech production.”  Like dysarthria, apraxia can be acquired or developmental.  Probably the most frustrating thing about a developmental apraxia diagnosis for some families is that it’s cause is unknown.

In cases with unknown causes, experts theorize about issues like motor planning or breakdowns in language processing, but definitive answers are lacking. These theories suggest problems with language frameworks or sensory-motor integration affecting speech. Effective therapy targets individual needs.

Common Characteristics of Apraxia

In the video clip below, a young child with CAS uses vowel distortions and has difficulty producing multiple syllable words.

Below is a list of characteristics common to many clients with apraxia of speech. This information was adapted from an informative website, www.apraxia-kids.org:

•  Errors on vowel productions
•  Variety of errors for one sound target (For example, may produce “mat”, “sat” or “hat” for the word “cat”)
•  Awkward speech movements, sometimes with groping that makes speech look difficult
•  Productions that are difficult to understand or distorted
•  Increase in errors as length or complexity of words increases
• They may correctly say a target sound once but struggle to repeat it
•  More success with producing a word in a conversation, but cannot imitate the same  word when asked
• Slower rates/speeds when talking because sequencing sounds/words is such a struggle
• Awkward prosody with limited to no use of stress on words, making speech sound robotic
• Significant difficulty with repetitions
• Age appropriate receptive/comprehension ability.  Your child knows what he or she wants to say, but can’t sequence the complicated stages necessary for speech

How does CAS Differ from Dysarthria?

Dysarthria is an impairment in muscle movements for speech caused by damage in the central or peripheral nervous system. In many cases, dysarthria has a clear medical diagnosis, affecting muscle tone. Speech might sound weak, strained, or slurred, making it hard to understand. Therapy sessions focus on individual needs and may include oral motor exercises.

The common thread between dysarthria and apraxia is that both significantly impact a child’s ability to tell his articulators (lips, tongue, palate) how to move and sequence sounds. This delay is markedly different than that of an articulation or phonological impairment and it all comes down to movement. Therefore, it is imperative that speech therapy for motor speech disorders follow some kind of protocol that teaches muscle movements for speech. Research and my own personal experience have taught me that delivering therapy early and frequently is the most effective form.

What is the Difference Between CAS and Phonological Disorders?

A phonological delay happens when your child leaves out, swaps, or changes sounds in words. It’s common in kids but usually gets better by preschool. These mistakes happen because a child’s mouth muscles aren’t fully developed yet.

There are eight, phonological processes that we typically encounter in speech therapy: syllable reduction, syllable structure, cluster reduction, final consonant deletion, stopping, fronting, backing, and gliding. For more information and examples of each of these, you can read my article: What are Phonological Disorders and Processes?

The Child Apraxia Treatment- Once Upon a Time Foundation has parent friendly videos with examples of a child talking with a phonological disorder and some children who have dysarthria of speech. Be sure to look at the video titled: Childhood Apraxia of Speech: How CAS is Different from other Disorders.

Who can Diagnose Apraxia?

As speech pathologists we need to seek specialized training in diagnosing and treating apraxia, otherwise, we cannot ethically work with children with motor speech disorders.  These trainings require that we learn how to effectively use evaluation tools and therapy programs. Not all speech pathologists treat motor speech disorders. Parents have the right to seek professionals with appropriate credentials for their child. Rather than administer an articulation assessment, clinicians record children during play tasks to analyze speech motor movements.

Dynamic Assessment

Speech therapists use dynamic assessment as a specialized approach to evaluate and understand childhood apraxia of speech (CAS), a motor speech disorder in children. It’s designed to provide insights into a child’s speech abilities by observing how they respond to various prompts and cues during assessment. Unlike traditional assessments that simply measure what a child can or cannot do, dynamic assessment actively engages the child in tasks that gradually increase in complexity.

Dynamic assessment can be likened to a problem-solving session. Imagine your child is presented with different speech tasks, starting with simple ones like producing single sounds or syllables, and progressing to more complex tasks like forming words or sentences. Throughout this process, the assessor observes how the child approaches each task, noting strengths, weaknesses, and any patterns of difficulty.

What makes dynamic assessment valuable is its interactive nature. It allows the assessor to provide support and feedback tailored to the child’s responses. For instance, if a child struggles with a task, the assessor might offer additional cues or modeling to help them succeed. By observing how the child responds to these supports, the assessor gains insights into the underlying nature of the speech difficulties.

The Dynamic Evaluation of Motor Speech Skill (DEMSS)

The Dynamic Evaluation of Motor Speech Skill (DEMSS) assessment for apraxia provides a comprehensive evaluation framework that considers various dimensions of speech motor planning and execution. What sets the DEMSS assessment apart is its emphasis on providing tailored support and feedback. If your child struggles with a task, the SLP will offer cues, prompts, or modeling to help them succeed. By observing how your child responds to these supports, the SLP gains valuable insights into the underlying nature of the speech difficulties.

We may need to collect additional information, such as vocabulary, language, and social interaction assessments, depending on the child’s needs.  In addition to speech interventions, it is best practice to teach other effective means for communication, determine if there are comprehension needs, address social communicative concerns, and work at your child’s level.

Treatments

In severe to profound motor speech disorders, speech pathologists support functional, effective communication for a child by finding the appropriate augmentative communication (i.e., PECS, SGD) that assist in making a child’s needs known. Once identified, therapy involves teaching the child and caregivers effective communication with the new support system.

PROMPT and DTTC therapy are evidence-based options that may suitable for your child. A speech pathologist must have rigorous clinical training in these approaches and pass competency assessments before providing either. You can search for a speech pathologist who specializes in evaluating and treating children with motor speech disorders at the apraxia kids website and/or PROMPT Institute.

Navigating childhood apraxia of speech (CAS) requires a structured strategy, such as utilizing the Kaufman Speech to Language Protocol, to prioritize motor planning and language development. Using Kaufman materials for CAS involves a systematic approach that emphasizes motor planning, syllable shapes, and functional vocabulary.

Conclusions

In conclusion, understanding childhood apraxia of speech (CAS) is crucial for effective intervention. By recognizing its characteristics, diagnosing accurately, and exploring treatment options such as PROMPT, DTTC, Kaufman Programming, and others, we equip ourselves to provide the best support for children with CAS. Early identification and intervention are key, offering hope for improved communication and quality of life for these individuals. Let’s continue to raise awareness and advocate for resources that empower both professionals and families in addressing CAS effectively.