Childhood Apraxia of Speech


Childhood Apraxia of Speech (CAS)

CAS is a neurologically based difficulty with motor planning and programming for speech sounds. This results in difficulty for voluntarily produced and sequenced movements needed for speech. Children with CAS have difficulty producing sounds, syllables and words.  The brain has difficulty with planning and executing the fine motor movements needed for speech. CAS is not due to muscle weakness or paralysis, which is seen in another motor speech disorder, dysarthria.  The symptoms and characteristics of CAS present on a range from mild to more severe.

What causes Childhood Apraxia of Speech ?

In CAS the message from the brain to the muscles is incomplete. This causes problems with coordination and planning of the movements needed to make a sound or word. Some possible causes include genetic disorders, syndromes, stroke or brain injury.  Some children with CAS have had specific birth or prenatal injuries that have impacted brain functioning. But most of the time the cause is unknown.

What are the signs and symptoms of Childhood Apraxia of Speech?

Not all children with Childhood Apraxia of Speech will exhibit the same types of signs or symptoms. Additionally, symptoms can vary in severity from mild to profound. The most common characteristics include:

• Slow and late development of speech skills. Developmentally, there is a history of limited verbal output. Children with CAS are often reported to be quiet with little cooing, babbling or vocal play as infants and toddlers.

• May not say first words until the age of 2 or 2.5. Unintelligible speech due to high rates of sound errors on consonants and vowels, with difficulty sequencing sounds.

• Slow effortful or halting speech; groping during speech attempts

• Difficulty imitating sounds and words

• Errors are inconsistent. Different kinds of errors will occur on the same word when repeated over and over again.

• Prosody can be effected by a reduced rate of speech, monotone speech with little pitch variance

• Expressive language deficits; ability to put words together for communication is very weak.

• At risk for learning disabilities, especially reading, as well as spelling and writing

Who provides a diagnosis for Childhood Apraxia Speech?

A children’s speech therapist will diagnose CAS, and provide therapy based on the information derived from the evaluation. A child with CAS should begin speech therapy as soon as the disorder is identified, as it is not something a child will “grow out of”!  Evaluations for CAS are commonly provided at a children’s hospital. Most public schools do not provide a diagnosis for CAS.

What is the difference between Phonological Process Disorder and CAS?

Children with a Phonological Process Disorder are using phonological processes to simplify speech production, beyond the age when these processes typically disappear. (see link under the speech tab to phonological processes) Children with a phonological process disorder will be able to improve speech through the use of his/her auditory and visual senses. A child with CAS, also uses phonological processes to simplify speech, but will require much more to improve speech production, due to sensory-motor learning needs.

What is the treatment for Childhood Apraxia of Speech?

Because CAS may manifest itself differently in every child, the speech language pathologist may use a variety of techniques in therapy to achieve maximum results. Treatment approaches for CAS need to be based on the principles of motor learning structured in task hierarchies that gradually increase the complexity of the speech task, while providing repetitive drill, and a high level of multisensory cueing. Research does show that children with CAS benefit most from receiving frequent treatment sessions. For the new speech motor skill to become easy, a child with CAS will need to practice often between speech therapy sessions as well.  Parents can work with their child at home for short periods of time each day. Short frequent sessions are better than occasional long sessions. The more the child practices, the faster progress will be noticed and the sooner the child will be able to develop clear speech. Speech therapy will also focus on improving the expressive language system. Pre-literacy, and literacy skills may also be addressed.

What approach does Pathways to Speech and Reading use for treatment of CAS?

At Pathways to Speech and Reading, I provide intervention implementing different techniques, drawing from CAS specialists. Each child with CAS is different with regard to severity level, age, maturation, receptive and expressive language abilities, etc.  General principles of treatment include focus on movement performance, movement patterns, and sequencing of movement.  One CAS treatment approach that I implement, is the Kaufman Speech to Language Protocol, developed by Nancy Kaufman, a speech pathologist, who is known worldwide for her expertise in the area of CAS. She serves on the advisory board of the Childhood Apraxia of Speech Association of North America (CASNA). And, she is the owner and director of the Kaufman Children’s Center for Speech and Language.

The Kaufman Speech to Language Protocol is a systematic method of helping children with CAS become able to combine simple to complex consonants, and vowels so that they can become effective verbal communicators.  Children are taught the “shell” of words without including the most difficult motor movements. Their productions are then shaped toward the ability to say the word as a whole. For example, the word “bottle” may begin as “bah”, progresses to “bahbah”, later becoming “bahdo” and eventually becoming “bottle”. This method is based upon motor learning theory, and follows the current research in neurological development. Sound sequencing skills are further expanded, with a multi-sensory approach. I also  incorporate additional techniques such as PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets)  which I utilize when indicated or needed.

Children with moderate to more significant cases of CAS will initially need 3-5  speech therapy sessions per week, usually 30-45 minute sessions, when first diagnosed. As improvements are made, treatment frequency may be decreased. Those with milder CAS, will require at least 2 speech therapy treatment sessions per week.

Are there any factors that may effect treatment outcomes?

Yes. Outcomes for CAS are variable and will depend on a number of specific characteristics including: receptive language abilities (ability to understand spoken language), cognitive abilities, desire to communicate, age at which speech therapy is initiated, extent of other speech and language difficulties, extent of family participation and involvement in therapy, and follow through at home with speech and language exercises.

At Pathways to Speech and Reading, I will provide specific and manageable speech practice activities to complete at home. One of the most important things for the family to remember is that treatment of CAS takes time and commitment.

Please call for more information if you live in the following areas: Broomfield, Lafayette, Louisville, Superior, Boulder, Westminster, Thornton or Arvada. Call: 303-856-8817