APRAXIA

childhood apraxia of speech

 
 

WHAT IS childhood apraxia of speech?

CHILDHOOD APRAXIA OF SPEECH (CAS) IS a specific LABEL FOR A type of SPEECH-SOUND DISORDER.  WE CONSIDER CAS TO BE extra-SPECIAL BECAUSE IT REQUIRES A special THERAPY APPROACH, following the motor learning principles (think challenging dance moves!).  It is a neurological issue, meaning that the root cause is in the brain. CAS is not due to muscle weakness, it is a motor planning issue, which means that the brain is having trouble sending the right messages to coordinate all of the actions and movements needed for speech.  We must realize that speech is actually a very complex process, much like a symphony of instruments, that involves multiple systems that must be coordinated seamlessly (breathing, phonation, articulation, and language).  

CAS is about planning the sequences of movement needed to produce words, and ultimately, complete sentences that convey ideas.  Often times, a child’s language is developing inside of them, but they are not able to share their thoughts because of this difficulty with motor planning and coordination.  It is not uncommon for children with CAS to appear to understand language well, but not be able to say their own name. It is important to not mistake a child’s inability to speak with their level of intelligence, although also important to note that CAS may exist with other difficulties or disorders.  

Children with apraxia of speech usually have limited verbal output or few words in their vocabulary. Their speech attempts may omit sounds or be inconsistent in their error patterns. They may misplace the stress on words (prosodic errors) and may appear to be struggling to organize their mouth to produce certain sounds (groping behaviors).  They have a hard time imitating speech models and may have few sounds in their phonetic repertoire. Sometimes, a child with CAS will have a few words or phrases that they say clearly and often; however, the majority of their speech attempts are limited and hard to understand.

Children with CAS are often at risk for language difficulties, as well as later reading and writing struggles due to their deficits in phonological awareness.  Most children with CAS will be verbal communicators, especially if they receive early and frequent speech therapy that focuses on movement accuracy.


How can speech therapy help?

Intervention for childhood apraxia of speech (CAS) is different than traditional treatment for other speech sound disorders, such as articulation and phonological disorders.  Speech therapy should focus on providing opportunities for frequent practice, and may best serve the child by practicing only a few targets at a time.

Research has shown that using multimodal cues, such as visual or auditory prompts, often supports the child’s learning of speech.  CAS therapy should focus on the movement of sounds in production, rather than practicing individual isolated sounds, as is done in therapy for articulation and phonological disorders.



Our approach at CloudSpeech

CAS therapy is different than traditional articulation and phonological therapy where we work on what’s missing in a child's repertoire, or what they can’t do yet. In CAS we begin where the child can, or what is already in their phonetic repertoire. 

We like to begin with the low hanging fruit following typical speech development patterns, which starts with the vowels. We believe in working at the child’s optimal challenge point, meaning the point where they have some success but still make errors, so that they can learn from direct feedback. We provide multisensory cues (auditory, visual) as needed, with the goal being to fade as quickly as possible and move the child to an independent production level.   We use functional words as speech therapy targets in order to help the child build vocabulary that is powerful and useful from the very beginning. Power words can be selected even at the early simple CV level, such as ‘no’, ‘go’, ‘me’, ‘bye’. 

We typically recommend more frequent therapy sessions for children with CAS. Ideally, children can do frequent therapy cycles of two to three times per week.  Therapy moves at the child’s unique rate of progress and advances in complexity as they improve their production and consistency. Sometimes we recommend and implement AAC (alternative and augmentative communication) options to support children with limited speech as they work toward their goals.

 
 

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