As a pediatric speech-language pathologist who has been working in early intervention for more than 5 years, I have come across few children with true isolated, childhood apraxia of speech (CAS). There’s a reason for this, and a reason to be wary when you hear this diagnosis thrown at you as an explanation for child’s speech delay. Not all children who are late talkers have CAS.
CAS is a tricky condition because in order to accurately diagnose it, a child needs to have some speech--- but a speech delay/limited sound repertoire is usually a characteristic of children with CAS. Huh?! You can see how this is confusing to parents, and less experienced therapists alike. Many professionals are mis-diagnosing and over-diagnosing, and the purpose of this post is to clarify some things about Childhood Apraxia of speech. I will start with the definition as provided by the guru of CAS, Nancy Kaufman:
“Childhood Apraxia of Speech (CAS) is a motor-speech programming disorder resulting in difficultly producing and sequencing the oral motor movements necessary to produce and combine speech sounds to form syllables, words, phrases and sentences on a voluntary (rather than only reflexive) control.”
When you are working with children younger than 3-4 years of age, it is considered best practice to diagnose as suspected Childhood Apraxia of Speech (sCAS).
Children with CAS know what they want to say, understand what they hear, have the words, phrases, and even sentences inside of their head, but when they go to speak, something in their motor plan goes wrong and sounds cannot be sequenced appropriately, preventing accurate (or any) sound production. How frustrating is that?!
Clinically, the children I have treated with isolated sCAS have also presented with extremely challenging interfering behaviors. It sort of makes sense, doesn’t it? Imagine understanding everything in the world around you, knowing what you want to say, but either unintelligible jargon comes out or even worse – nothing. Of course this may result in challenging behavior until an SLP comes around and knows how to help the child communicate!
To reiterate, CAS is a motor planning disorder, completely independent of any oral-motor weaknesses, cognitive delays, and receptive language delays.
Let’s look at an example:
Joey loves playing farm. He knows all the animals by name and all of the sounds they make. During play, Joey can often be heard producing “moo” and “neigh!” while engaging in pretend play. When Mom joins the activity and in an attempt to make it interactive, asks “Joey, what does a cow say?” Joey may produce “oo” “doo” “boo” or he may not produce any audible sound. Mom may think that Joey does not know his animals and their sounds, and can you imagine how frustrating this is to Joey? Mom may then break down the “moo” into “mmm” and have Joey imitate it, which he does. Then ask him to copy the “oo” sound, which he does. Then, when asked to sequence the sounds (m…ooo), Joey produces “da!” Imagine how difficult and frustrating this must be for our children with CAS! This example is often what CAS looks like in a child who has emerging speech.
The specific population of children I work with mostly fall on the Autism Spectrum. Children with Autism Spectrum Disorder (ASD) can also present with CAS, just like they can also have a hearing loss or brown hair (read: not related). This is important for an SLP to recognize when planning appropriate treatment methods. Some of the current “hot” therapies for CAS (e.g. PROMPT) are sold as the gold standard of CAS therapies, based on their ability to effectively treat children with CAS (which they can do), but in my experience these therapies do not account for children on the Autism Spectrum with sensory processing differences, or any child with receptive language delays. Children with ASD or receptive language delays are potentially missing necessary skills to participate in this type of therapy. A general word of advice is never buy in to the “buzz word” therapy and that therapy alone. Parents love to ask “Are you PROMPT trained?” and I thankfully can answer “yes” but I would like to stress that a good SLP is educated and trained in all relevant and effective methods particular to a disorder, not just the latest buzz!
Check out Nancy Kaufman’s website for early signs and symptoms as I simply could not come up with a list as comprehensive and accurate as she has compiled on her website: www.kidspeech.com
If the signs and symptoms read a little too clinical or too technical, feel free to shoot us an email and we will be happy to further explain!
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