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Name of Disability: Childhood Apraxia of Speech (CAS)
Definition of the impairment:
“Childhood apraxia of speech (CAS) is a neurological childhood speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g. abnormal reflexes, abnormal tone).” (American Speech-Language Hearing Association)
“Childhood Apraxia of Speech (CAS) is a motor speech disorder that first becomes apparent as a young child is learning speech. For reasons not yet fully understood, children with apraxia of speech have great difficulty planning and producing the precise, highly refined and specific series of movements of the tongue, lips, jaw and palate that are necessary for intelligible speech. Apraxia of speech is sometimes called verbal apraxia, developmental apraxia of speech, or verbal dyspraxia. No matter what name is used, the most important concept is the root word “praxis.” Praxis means planned movement. To some degree or another, a child with the diagnosis of apraxia of speech has difficulty programming and planning speech movements. Apraxia of speech is a specific speech disorder. This difficulty in planning speech movements is the hallmark or “signature” of childhood apraxia of speech.” (Apraxia Kids)
Signs and Symptoms:
Three segmental and suprasegmental features considered to be hallmarks of apraxia:
- inconsistent errors on consonants and vowels in repeated productions of syllables or words
- lengthened and disrupted coarticulatory transitions between sounds and syllables
- inappropriate prosody, especially in the realization of lexical or phrasal stress
Additional reported characteristics:
- high incidence of vowel distortions
- limited consonant and vowel phonetic inventory in young children
- frequent sound distortions and distorted consonant substitutions
- initial consonant deletions
- voicing errors
- schwa additions/insertions to consonant clusters, within words and on the ends of words
- predominant use of simple syllable shapes
- greater ease in producing automatic (e.g., frequently used phrases, such as "I love you") versus volitional utterances (e.g., novel phrase or sentence)
- difficulty with smooth, accurate movement gestures
- better performance on speaking tasks that require single postures versus sequences of postures (e.g., single sounds such as [a] vs. words such as [mama])
- difficulty achieving accurate articulatory movement gestures when trying to imitate words not yet mastered
- presence of groping behaviors when attempting to produce speech sounds or coordinate articulators for purposeful movement
- altered and/or inconsistent suprasegmental characteristics (rate, pitch, loudness)
- increased difficulty with longer or more complex syllable and word shapes (often resulting in omissions, including word-initial consonant deletion)
- predominant errors of consonant, vowel, syllable, and/or word omissions
- atypical levels of regression (e.g., words or sounds mastered, then lost)
- sequencing errors affecting sounds (e.g., metathesis, migration), syllables, morphemes, or words
How it may impact academics:
- Difficulties with expressive language
- Phonological awareness deficits
- Word order confusion and grammatical errors
- Difficulties with peer socialization
- Problems learning to read, write, and spell
- Possible co-morbid motor difficulties, impacting motor skills required for handwriting, activities of daily living, etc.
Ways it is diagnosed for academic needs (valid, EBP methods):
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Complete a comprehensive assessment including case history, oral mechanism evaluation, hearing screening, speech sound assessment, spoken language assessment, and literacy assessment, if needed
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Complete differential diagnosis tasks, including comparison of:
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Articulatory postures and sequences, versus speech sounds and words
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Automatic vs. volitional speech tasks
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Speaking tasks that require single postures versus tasks requiring sequences of postures
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Multiple levels of speech production, including syllable, single-syllable, bi-syllable, multi-syllable, phrase and sentence levels
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Sequential/alternating movement repetitions (ASHA,
Treatment options (current EBP with links):
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Motor-programming approaches: Numerous repetition of speech movements to increase accuracy, consistency, and automaticity of movements to produce sounds and sequences (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192721/)
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Linguistic approaches: Learning how to produce speech sounds and how sound sequences are used in language
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Sensory cueing: Use of child’s senses, as well as gestures, to cue an aspect of a targeted speech sound
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Rhythmic or prosodic approaches: Use of intonation patterns to improve functional speech production
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Augmentative and Alternative Communication: Support and enhancement of overall communication through the use of augmentative and alternative modes of communication
Service Delivery:
- Higher frequency of services is preferable
- Intensive and individualized therapy is often stressed
- Frequency and length of sessions may be adjusted for younger children; shorter, but more frequent
- Immediate intervention is recommended
- Naturalistic treatment environment facilitates generalization and carryover
- Home practice is essential for progress
Ideas for families:
- Keep communicating with your child!
- Don’t be afraid to communicate with signs or pictures
- Model words for your child
- Ask questions and expect answers
- Talk to your child’s SLP and help them choose target words/phrases
- Follow through on home activities provided by the SLP
- Work on phonological awareness activities (sound-letter relationships)
- Repeat target words or phrases again and again… and again…
- Play games to make speech practice fun!
- Make talking and speech practice fit into your lifestyle
- Involve siblings in sound practice and conversation
- Educate extended family about what it means to have apraxia
- Talk to your child’s classroom teacher too!
Ideas for teachers:
- Collaborate with the IEP team to determine communicative targets
- Ask your SLP how you might incorporate communicative targets in the classroom environment
- Utilize multisensory teaching techniques for literacy strategies
- Incorporate phonological awareness activities into your classroom routine
- Provide the means to engage the student with apraxia in group activities
- Understand that inconsistency is a hallmark of apraxia – each day is a new beginning
- Build students’ self-esteem by genuinely complimenting what they do well
- Learn about any AAC systems the child might be utilizing
Resources for additional information
Videos
Official websites
Dysarthria
Definition of the impairment
Dysarthria is motor-speech disorder characterized by weakness in the muscles used for talking and breathing, which can make it difficult to talk and be understood by others. Dysarthria is caused by damage to the brain or nervous system (e.g., stroke, brain tumors, head trauma, toxins, neuromuscular diseases, etc.). The exact symptoms and severity of dysarthria will vary and may accompany other speech and language problems.
How it may impact academics
Children who have dysarthria can be difficult to understand and may:
- Have “slurred” speech or mumble
- Speak too slow or too quickly
- Talk softly
- Have difficulty moving their lips, tongue, vellum, and jaw
- Sound hoarse or breathy
- Sound like they have a stuffy nose or are talking through their nose
Ways it is diagnosed for academic needs
Students with dysarthria who have difficulty with communication often have reduced levels of participation in social, educational and family activities. Speech-Language Pathologists (SLPs) evaluate a student’s speech to determine the nature and severity of the problem, then develop a plan for treatment or therapy, which may include strategies for helping to maximize their ability to be understood through speech or other forms of communication (e.g., gestures, facial expression, augmentative-alternative communication, etc.). A school-based SLP will evaluate needs and make suggestions that are relevant to the educational setting.
Treatment options
Planning appropriate treatment goals and methods are largely based on the results and information gathered through the assessment process. Typically, a combination of treatment approaches that address multiple levels of the student’s communication disorder, with interventions and goals that are selected to maximize the effectiveness, efficiency, and naturalness of speech. The SLP may work closely with school personnel, families and others to help make communication easier. Recommendations for therapy may be based on the type of dysarthria, how severe it is and their needs within the educational setting. This may include:
- Slowing down the rate of speech
- Using more breath to speak louder
- Increasing the strength of the muscles needed for speaking
- Moving lips and tongue more
- Saying sounds clearly, or with more emphasis, in words and sentences
- Introduce a topic with words or phrases that help provide context before saying longer sentences or messages (e.g., “For lunch, I would like…” or “My friend ____ said…”)
- Using other ways to communicate, like gestures, writing, or using pictures or computers (i.e., augmentative and alternative communication, or AAC)
Ideas for families
At home, it is important to work as a member of your child’s school team to help give them the whole picture, as well as to help your child practice what they are learning in school. Provide a good model of communication expectations by looking at your child and allowing plenty of time to talk without finishing their sentences. If your child is receiving speech therapy, regularly communicate with your child’s speech therapist regarding things you are doing at home, as well as what your child is learning or using at school to increase their ability to communicate effectively that you can practice at home. There is evidence that involvement by family members is critical to the success of any intervention program.
Ideas for teachers
If communication is difficult in the classroom, try to limit noise so it’s easier to hear or watch the student’s lips to help with understanding. Allow your student time to talk without finishing their sentence(s). When the student is not understood, let them know that you didn’t understand and repeat back what you heard, so they can repeat or reword what was missed rather than restate the entire message. Encourage the student to use other methods of communication or use strategies to help narrow the context, such as pointing to what they are talking about, using gestures, writing words or drawing pictures. If the student has speech therapy, find out from their speech therapist the alternative methods of communication that they are learning or using and what you can do to help.
Sources
https://www.asha.org/public/speech/disorders/dysarthria/
https://www.mayoclinic.org/diseases-conditions/dysarthria/symptoms-causes/syc-20371994
https://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=90:dysarthrias&catid=11:admin
Duffy, Josef R. Motor Speech Disorders. (1995) St. Louis, MO: Mosby
Caruso, Anthony J. and Strand Edyth A. Clinical Management of Motor Speech Disorders in Children. (1999) New York, NY: Thieme
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