Proper diagnosis of a language concern is crucial to effective and appropriate treatment. Childhood apraxia of speech (aka developmental apraxia of speech/dyspraxia/verbal apraxia) is frequently both over, and under-diagnosed. Ineffective and inefficient treatment can result.
Childhood apraxia of speech (CAS) is a difficulty coordinating and planning out the production of sounds. It is a disorder of motor planning. The child knows what he or she wants to say, but can’t get his or her mouth to do what the brain wants.
Specific signs of CAS include, but are not limited to:
- Limited babbling/sentence production: In younger children, they may not babble much and sequencing of sounds may be limited. The older child may produce shorter sentences
- Groping: The child may have obvious difficulty putting sounds together. Groping may be noted, meaning that the child may move his mouth around in an attempt to find the correct place in which to make the desired sound.
- Difficulty with spontaneous speech: The child may have difficulty initiating speech, not because of lack of desire, but because of difficulty producing the sounds and “getting started”. The child may also simplify words.
- Difficulty with accurate imitation: The child with CAS may not imitate sounds or movements accurately. The child with CAS will have difficulty imitating oral posture (i.e. round lips, blow a kiss), and may have difficulty imitating sounds..
7 Common Myths of CAS
- An expressive language delay (insufficient language at the child’s age) must mean the child has CAS.
- CAS is life-long, and the child will never speak properly as a result
- CAS results from oral muscle weakness.
- A wait-and-see approach is a good option.
- Any speech pathologist can treat CAS.
- CAS requires hundreds of dollars spent on special programs and special therapy materials.
- One session per week is sufficient for a child diagnosed with CAS
Myth 1: An expressive language delay must mean a child has CAS.
An expressive language delay and CAS are NOT the same thing. An expressive language delay means that the child is demonstrating verbal behaviors similar to that of a child at a younger age. The child with CAS is demonstrating verbal behaviors that are not considered appropriate at any age. Just because the child isn’t speaking sufficiently for his or her age doesn't mean he or she has CAS.
Myth 2: CAS is life-long, and my child will never speak properly as a result.
While there are children who continue to demonstrate minor speech issues, as well as those that are more significantly affected, the majority of children with CAS go on to lead lives with average speech abilities. A diagnosis of CAS is not an indication that the child will not be able to communicate effectively as he ages.
Myth 3: CAS is a weakness.
CAS is not a weakness. CAS is a motor planning issue – a difficulty with coordination. Though at times there can be weakness present due to other factors, CAS is not due to a lack of oral strength.
Myth 4: A wait-and-see approach is a good option.
It is important to begin therapy as quickly and as efficiently as possible once CAS is suspected. In the case of any language delay or disorder, waiting does not help. But especially in the case of CAS, the child needs opportunities to “train his or her brain” and learn how sounds are placed. Effective and efficient therapy is crucial to a successful outcome.
Myth 5: Any speech pathologist can treat CAS
While it is within the scope of practice for a certified speech pathologist to treat CAS, it’s optimal to obtain services from a speech pathologist that treats CAS specifically, and does not treat it as though it is a language delay. A parent/caregiver should look for someone that is familiar with tactile prompting, drilling, and most of all efficient and patient therapy. The speech pathologist should provide specific examples of how they will treat, and how that treatment differs from that of other speech diagnosis.
Myth 6: CAS requires hundreds of dollars spent on special programs and special therapy materials.
Special programs are not necessary, and neither are specialized therapy materials. CAS can be successfully treated with no more than age-appropriate toys that the child and speech pathologist can interact with. Expensive cards, activities, whistles, horns…these may not be harmful, but they are certainly not necessary to have effective and efficient speech therapy. A therapy session for CAS most appropriately contains opportunities for repetition, tactile prompting, and modeling.
Myth 7: One session of therapy per week is enough
For a child with CAS, one session per week is not enough! CAS requires frequent, short sessions to have maximum impact. Repetition is important, and provides the child with the opportunity to create a muscle memory of the sound, which allows him or her to improve their ability to produce the sound. Like playing the piano or learning a new sport, practice is key. Having only one session per week just prolongs the difficulty.
The diagnosis and therapy for CAS is very specific. There are many factors that determine if CAS is present, and at times it can be very difficult to determine if it is. Nonetheless, if CAS is suspected, treatment, at least initially, should focus on therapy specifically for CAS issues. There are many options and methods of treatment, and each practitioner usually feels his or her way is the best. Elements of positive therapy are key: multiple opportunities to imitate developmentally appropriate sounds, tactile prompting, and modeling. In all cases, therapy should be gentle, fun, and effective!
Melanie Feller, M.A., CCC-SLP is a bilingual (English/Spanish) ASHA certified speech language pathologist/clinical supervisor licensed in Oregon and New Jersey. She specializes in pediatrics, with emphasis on those ages 0-3 who demonstrate verbal apraxia or language concerns. She has a strong background in pediatric language development, speech issues with sensory deficits, and speech deficits that relate to an Autism Spectrum Disorder. Much of the therapy provided to those on the Spectrum has been loosely based on the DIR/Floortime method, and she anticipates beginning the certification course in January 2013. She has provided assessments and therapy within multiple settings; including teletherapy (online video conferencing), private practice, early intervention, schools, and facilities.
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