Childhood Apraxia Simplified
What is Childhood Apraxia of Speech (CAS)?
Childhood Apraxia of Speech (CAS) is a neurological disorder that disrupts a child’s ability to move their articulators- tongue, lips, and jaw- to form their speech sounds and words.
Who diagnoses Childhood Apraxia of Speech?
A trained speech-language pathologist diagnoses CAS.
Developmental Signs of CAS
0-12 months:
No babbling or cooing
Babbling is limited to a few sounds
Difficulty feeding or coordinating oral motor movements for feeding
12-24 months:
Few consonants in repertoire
Limited oral motor shaping for vowel sounds
Not using two words together
Shows frustration when prompted to communicate
24-36 months:
Consonant sounds consist mostly of stops (/p/, /b/, /t/, /d/) and does not use velars (/k/, /g/)
Not using 2-3 word phrases
Difficulty copying a direct model for oral motor movements
Attempts to communicate with elaborate gestures rather than with speech
36 months+:
Not using words or sentences to communicate
Speech is not understood by even familiar listeners or speech is only understood by familiar listeners
Key features of CAS
Groping with tongue when attempting to form sounds and words
saying words and sounds differently at each attempt
increased breakdown of speech intelligibility the longer the word/phrase
difficulty finding oral motor placements to produce sounds
prosody differences- speech may sound choppy or have atypical intonation
Apraxia should be diagnosed by a speech-language pathologist.
How your Speech Therapist may Approach Treatment and Diagnosis
Diagnosis
When a speech therapist evaluates a child for CAS they will likely collect information about the child’s gestational period and ask about birth complications, rule out hearing loss, and look at how the child currently communicates. An assessment would include an oral motor assessment.
The speech therapist may assess rate of speech for sound production in different areas (“puh” for front sounds, “tuh” for middle sounds, and “kuh” for back sounds, the “puhtuhkuh” together to assess coarticulation across multiple positions.
Prosody will likely be assessed, as the speech therapist may be looking at if and how the child uses intonation in connected speech to emphasize words.
Life Impact will likely be discussed, as the speech therapist will want to know how the CAS impacts the child’s ability to interact with peers and adults inside and outside the home. They may also ask the parents how the CAS is impacting family dynamics.
The assessment and diagnosis will include a connected language sample to measure percent of understood words and mean length of utterances.
Caregivers may want to provide a speech therapist with common phrases that the child would use to help speech sessions target personal and applicable phrases to the child’s life.
Example:
“I like mac and cheese.”
“I want to be a doctor.”
“My brother is Ben.”
Treatment
The goal of apraxia treatment will be to improve oral motor planning for speech sounds.
You can expect lots of visual cues and feedback during therapy, like the use of a mirror for visual feedback.
The therapist may use their hands to provide tactile cues for movements- think lightly closing child’s lips to demonstrate positioning for “mmmm”.
Kaufman Apraxia Treatment Method
One of the key features of this approach is cueing before failure (errorless teaching), gaining as many responses within a session to gain frequent practice, and focusing on treating the child’s speech at the area of breakdown. For example, if a child’s speech includes the natural phonological process of vowelization- when an /er/ or /l/ sound is replaces with an “o” (“appo” for “apple”)- this treatment approach may teach “apple” as an approximation- “appo”- for the purpose of simplifying the motor planning. Teaching the approximation is a temporary approach; as the child begins to develop more mastery of speech sounds, they will be challenged to increase their accuracy of the sounds in words.
Dynamic and Temporal Tactile Cueing is one treatment approach that focuses on movement rather than individual sounds with a cue hierarchy that is individualized to the child. Because this treatment approach emphasizes movements you may see your child’s speech therapist modeling oral motor movements to your child without vocalizations at times. The speech therapist may have the child simultaneously say a word while watching their mouth as the direct model can help to elicit the accurate movements required for speech production.
PROMPTS for Restructuring Oral Muscular Phonetic Targets (PROMPT) is a treatment approach used to develop speech and language skills through tactile cues. The PROMPT approach takes into account the three domains of social-emotional, cognitive-linguistic, and physical-sensory communication.
Your child’s speech therapist may use a mix of many approaches as each child and each session is unique.
In some cases of speech apraxia Augmented Alternative Communication may be recommended by a speech pathologist.
What to do as a parent?
Ask your child’s speech therapist for ideas to carryover practice at home. Sit in on therapy occasionally to see what’s being practiced and don’t be afraid to ask questions.
Keep practice light hearted, especially if your child is already attending speech multiple times a week! There is more to their life than their speech, but if every conversation is a correction it may not seem like it. If a word is extra hard that day model it once or twice and move on. Try to avoid nonsense syllables or sound practice to avoid reinforcement of errored learning.
Show your face to demonstrate oral motor movements. Our senses allow us to observe skills that are unnatural to us for learning purposes. Speaking within your child’s visual field can help to involve their visual senses improved motor movements.
Identify and attend quality speech therapy sessions. Oral motor learning occurs with frequent structured practice, and speech therapy for CAS is recommended for 30-minute sessions up to four times per week rather than one or two longer sessions.
Avoid practice of nonsense syllables. To avoid reinforcement of erred learning, try to practice meaningful words and syllables.
Resources for parents:
The Parent Portal on the Apraxia Kids site provides frequently updated research, tips to interview a speech-language pathologist prior to initiating treatment, information about support groups, and more.
Childhood Apraxia Treatment is a valuable resource for parents seeking information and support for children with childhood apraxia of speech. The website provides insights into the condition, offers practical strategies for parents, and connects them with a community of support. It aims to empower parents with knowledge and tools to effectively assist their children in overcoming childhood apraxia of speech.
The Prompt Institute provide parents with teaching from researchers and also serves as a resource for speech-language pathologists treating apraxia of speech.
