Apraxia

Apraxia has been all the rage lately! It has been in the news. More and more of my students are being diagnosed with it. Controversy surrounds it since some insurance companies do not even recognize it as a disorder.

I started wondering...what is going on here? So, I did some research and this is what I found.





Definition

First things first, the most accepted term now is Childhood Apraxia of Speech (CAS). So, that is what I will use here and professionally.  

CAS is a speech sound disorder which is neurologically based and present in childhood.  There is no presence of muscle weakness or decreased tone. The key characteristics below of CAS give a broader "definition" of what the disorder looks like.

Key Characteristics of CAS

There are some key characteristics of CAS that differentiate it from other articulation disorders.

Below I give the areas of speech and language to consider and how CAS differs from articulation or phonological speech disorders.

1. Motor difficulties

  • Groping of facial muscles during speech tasks
  • Difficulty voluntarily moving articulators or initiating speech
  • Reduced coordination of articulators, especially on diadochokinesis tasks “pa-ta-ka”

2. Speech Sounds Errors

  • Inconsistent errors - Children will produce some sounds correctly some of the time and incorrectly at other times.
  • The number of errors increase with longer and more complex syllables. This can be seen in some articulation disorders but not always.
  • Regression of previously learned sounds
  • Automatic speech tasks such as counting, singing, and yawning are easier

3. Prosody

  • May speak with an odd rate 
  • May use a monotone voice

4. Speech Perception

  • May have difficulty with auditory discrimination

5. Language

  • Expressive and receptive language deficits are VERY common in conjunction with CAS. This is not always true with other speech sounds disorders.

Assessment Options

At this time, I am not aware of any standardized measure for diagnosing CAS. This is a HUGE problem! 

My current suggestions for assessment:

  1. Complete an articulation standardized test
  2. Complete an expressive/receptive language standardized test 
  3. Take a language sample 

When evaluating the results, consider these following questions:

  1. Articulation: Are errors typical or atypical? Are speech errors consistent across speech tasks and/or setting? 
  2. Language: Is there a language delay?
  3. Coordination of articulators: Can the child complete diadochokinesis tasks appropriately? 
  4. Prosody: Does the child speak with an appropriate rate of speech?
  5. Volitional oral motor skills: Does the child have difficulty initiating speech? Is he or she better an automatic speech tasks?
  6. Motor delays, fine and gross:  Does the child have other gross or fine motor delays? Is the child seeing a physical or occupational therapist?

Treatment Options

Treatment, in general, is more intense (more and/or longer sessions) when compared to typical articulation therapy.

Again, after a literature review, I didn't find any 100% evidence based practice treatment approaches for children with CAS. 

The best options I could find:

1. Typical speech/articulation therapy using a motor learning approach.

What is motor learning?

  • Drill based with lots of practice
  • Fade cues as child improves
  • Encourage and teach self-monitoring
  • Consistent practice across settings

2. Use AAC devices for the most severe cases

3. No oral motor exercises

  • During my research review, I didn't find any evidence that working on non-speech tasks will improve speech production for CAS

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Bridget is an ASHA certified, practicing speech language pathologist. She is passionate about providing parents with information on child speech and language development as well as provide functional, easy activities to do at home! Parents have the power to make a real difference.

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› Apraxia

References

  1. American Speech-Language-Hearing Association. (n.d.).Retrieved on June 30, 2013 from http://www.asha.org/policy/TR2007-00278/#sec1.2.1
  2. The Childhood Apraxia of Speech Association of North America. (N.D.) Retrieved on August 1,2013 from http://www.apraxia-kids.org