We are excited to welcome Caitlin to the blog today for a guest post. She is a pediatric speech-language pathologist who is currently pursuing her Ph.D. in Speech and Hearing Sciences at Arizona State University with a focus on the genetic bases and electrophysiology of severe speech disorders.
What is Childhood Apraxia of Speech?
In the world of childhood speech and language, the term “apraxia” can be daunting to both parents and speech pathologists. Childhood Apraxia of Speech (CAS) is considered one of the most misunderstood and difficult to diagnose of the speech disorders we see in young children. CAS is a rare motor speech disorder that becomes apparent as children learn to talk. From a parent’s point of view, the term “apraxia” sounds much more intimidating than “speech delay” or “articulation disorder”. So what exactly does this term mean and how is it different from other diagnoses?
First of all, it’s important to consider where the diagnosis of CAS is coming from. The diagnostic team may include several professionals including your child’s pediatrician, a developmental pediatrician, a neurologist, and hopefully, a speech-language pathologist (SLP). It is very important to make sure your child receives a comprehensive evaluation by an experienced SLP to ensure an accurate diagnosis has been made. Other professionals can provide helpful information by assessing additional areas of your child’s development, but when it comes to speech and language specifically, an SLP will be your primary source of information regarding CAS.
What does CAS look like?
CAS can first appear in many different forms. Often times we see children who initially appear to be “late talkers”. Somewhere between a child’s first and second birthday, parents may become concerned that he or she isn’t speaking yet, so they have been referred for a speech evaluation to see if this is typical. Receptive language skills are great, so the child understands nearly everything you say, but he or she can’t seem to get the words out to communicate. Most of the time, the child is presenting with an expressive language delay and will begin talking after a course of speech therapy and some parent training. There are occasions, however, when speech begins to emerge atypically. In this case, the child may have a very limited sound repertoire, consisting of only a few vowels. Or maybe the same target word is produced differently each time the child attempts to produce it. “Mama” may sound like “mama” once, and then come out as “baba” or just a single syllable, “a” in other productions. Typically as words get longer and more complex, the more difficult they are for children with CAS to produce. This can be extremely frustrating for not only the child, but parents as well.
The American Speech and Hearing Association has identified three main characteristics of CAS, they are:
“(a) inconsistent errors on consonants and vowels in repeated productions of syllables or words, (b) lengthened and disrupted coarticulatory transitions between sounds and syllables, and (c) inappropriate prosody, especially in the realization of lexical or phrasal stress” (ASHA, 2007).
This means that a child with CAS will most likely have difficulty with the rapid movements it takes to transition from one sound to another, as well as one syllable to another, causing noticeable inconsistencies in the words he or she is trying to produce. Unlike an articulation delay or phonological processing disorder, there are no apparent patterns in the child’s errors so the same word may come out differently each time. Prosody refers to the intonation and tone children use to communicate things like emotional state or whether or not they are asking a question. This can be an important component of speech and language development, particularly when your child reaches school age and adolescent years.
Another common feature of CAS is oral groping. Oral groping will look like your child is struggling to find the correct placement of the articulators (tongue, jaw, lips, etc.) during speech production, but can’t quite figure out where they are supposed to go. Parents often say it appears as though their child is “searching for sounds”. This is sometimes the characteristic parents notice first that distinguishes their child’s speech pattern from other children his or her age. Children with CAS may also present with deficits in other areas, including fine motor skills and feeding.
How is CAS diagnosed?
Unfortunately, there is currently no validated list of diagnostic features to differentiate CAS from other pediatric speech sound disorders. This means that the job of the SLP is to rule out all other (more common) speech sound disorders, including articulation and phonological processing disorders before reaching the diagnosis of CAS. Your SLP might also ask your child to complete non-speech oral-motor tasks, such as lateral tongue movement, elevating and lowering the tongue tip, repetitive syllables and syllable transitions. As mentioned above, children with CAS often have significant difficulty transitioning between different sounds and syllables, so deficits in this area will become apparent. A family history will also be taken, as well as information regarding other developmental areas (i.e., gross and fine motor, feeding). The majority of cases of CAS are idiopathic, or are of unknown origin. However, in some cases, CAS is secondary to a neurological impairment or a complex neurodevelopmental disorder.
What can parents do to help?
First of all, it is important to remember that you know your child better than anyone, and you should be a key component of therapy. Be as involved as possible! In some cases, your child will learn signs or use pictures to communicate in the initial stages of treatment. It is important that you learn how to use these as well so your child can practice at home. Help other family members to understand what your child is working on in speech therapy so they can participate and help your child learn to communicate. Your speech therapist will most likely send home practice activities every session to ensure carry-over of skills learned in therapy. This is especially important in the case of CAS, because repetition of target sounds and words is crucial. CAS is a motor speech disorder, so practice and repetition will help your child to recreate the motor pathways necessary for speech production. You might feel like a broken record, but that’s okay! Make practice fun. Use games, songs, or anything else that is motivating to your child. It may also be helpful to choose a few key phrases or words that your child uses often in his or her daily routines. With frequent repetition and modeling, these may be phrases that your child can use functionally to request and comment. Again, practice, practice, practice! With consistent speech therapy and home practice, children with CAS can achieve functional speech production and age appropriate communication skills.
If you are looking for more information about CAS, check out the Childhood Apraxia of Speech Association of North America’s website at www.apraxia-kids.org.
For anyone interested in participating in research in the area of CAS, additional information can be found at https://sites.google.com/a/asu.edu/peterspeechlanguagegenetics/. This is an ongoing research project investigating the genetic and neurological bases of CAS and other childhood speech sound disorders. Feel free to contact me at firstname.lastname@example.org with any additional questions!
Caitlin is a pediatric speech-language pathologist in the Phoenix area. Her clinical areas of interest include childhood apraxia of speech and pediatric voice disorders. Caitlin is currently working on her Ph.D. in Speech and Hearing Sciences at Arizona State University, focusing on the genetic bases and electrophysiology of severe speech disorders.