Childhood Apraxia of Speech
Evaluation and Therapy
Childhood apraxia of speech (CAS) is a relatively uncommon and misunderstood disorder of motor speech. Our speech-language pathologist at Tip of the Tongue has a thorough mastery of the disorder, with the knowledge and expertise to discriminate CAS from the more common articulation and phonological disorders. Over the years, Rhonda has participated in numerous workshops pertaining to CAS. Presenters at these workshops include Dr. Edythe Strand, Dr. Shelley Velleman, Pam Marshalla, Nancy Kaufman, David Hammer, Char Boshart, Diane Bahr, St. Louis University's own Julie Hoffman, and others. Additionally, Rhonda has taken Level 1 training in the PROMPT technique (PROMPTS for Restructuring Oral Muscular Phonetic Targets), the tactile cueing system.
While most speech-language pathologists have the knowledge and experience to diagnose typical articulation disorders, few have the skills to diagnose childhood apraxia of speech. Too often, children are misdiagnosed; the disorder goes undetected or children are erroneously assigned the diagnosis on the basis of poor speech or lack of speech. Sometimes children are given the diagnosis of CAS when they are non-verbal or have other complicating factors such as autism or muscle weakness. Other times they are assigned the diagnosis when they are very young, when other factors might better account for the difficulties they are having with their speech. Sometimes children receive the diagnosis of CAS when they actually have significant phonological delays. Even more problematic are the children whose CAS is missed and are given year after year of traditional speech therapy without making notable progress.
It takes training, experience, and skill to diagnose childhood apraxia of speech, and the speech-language pathologist at Tip of the Tongue has each of those qualities. Years of diagnostic experience combined with therapy experience, especially that gained while teaching unintelligible preschoolers at Rockwood School District and in private practice since then, make Rhonda uniquely qualified to diagnose and treat CAS, and to rule out CAS when the speech disorder is better accounted for by another diagnosis.
Therapy for CAS is unique and differs from traditional articulation therapy. At Tip of the Tongue, we have the tests, materials, and know-how to address the disorder. We utilize materials such as Kaufman Cards, Moving Across Syllables, Word Flips, and others in therapy. We encourage parents to sit in, watch, and even participate in the therapy session! That is the best way for parents to gain the skills they need to help their child's speech at home. Every child who participates in therapy at Tip of the Tongue has a homework notebook used for daily home practice and review. Therapy sessions at Tip of the Tongue combined with caregiver-assisted home practice is the most efficient way of ensuring that our clients make timely progress with their speech. Tip of the Tongue speech-language therapy enables children to improve the quality and quantity of their verbal communication.
While most speech-language pathologists have the knowledge and experience to diagnose typical articulation disorders, few have the skills to diagnose childhood apraxia of speech. Too often, children are misdiagnosed; the disorder goes undetected or children are erroneously assigned the diagnosis on the basis of poor speech or lack of speech. Sometimes children are given the diagnosis of CAS when they are non-verbal or have other complicating factors such as autism or muscle weakness. Other times they are assigned the diagnosis when they are very young, when other factors might better account for the difficulties they are having with their speech. Sometimes children receive the diagnosis of CAS when they actually have significant phonological delays. Even more problematic are the children whose CAS is missed and are given year after year of traditional speech therapy without making notable progress.
It takes training, experience, and skill to diagnose childhood apraxia of speech, and the speech-language pathologist at Tip of the Tongue has each of those qualities. Years of diagnostic experience combined with therapy experience, especially that gained while teaching unintelligible preschoolers at Rockwood School District and in private practice since then, make Rhonda uniquely qualified to diagnose and treat CAS, and to rule out CAS when the speech disorder is better accounted for by another diagnosis.
Therapy for CAS is unique and differs from traditional articulation therapy. At Tip of the Tongue, we have the tests, materials, and know-how to address the disorder. We utilize materials such as Kaufman Cards, Moving Across Syllables, Word Flips, and others in therapy. We encourage parents to sit in, watch, and even participate in the therapy session! That is the best way for parents to gain the skills they need to help their child's speech at home. Every child who participates in therapy at Tip of the Tongue has a homework notebook used for daily home practice and review. Therapy sessions at Tip of the Tongue combined with caregiver-assisted home practice is the most efficient way of ensuring that our clients make timely progress with their speech. Tip of the Tongue speech-language therapy enables children to improve the quality and quantity of their verbal communication.
Syntax and Morphology... a fancy way of saying sentence structure and grammar
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What do syntax and morphology have to do with childhood apraxia of speech? Studies have shown that as children with CAS become more verbal and intelligible, many of them struggle with putting together good sentences and questions. They may reverse the order of words, leave words out, or have difficulty using grammatical forms such as plurals and possessives or verb tenses. They leave out "is/am/are," as in "He outside." Sometimes they call themselves "Me" instead of "I," as in "Me go to school." They may have difficulty in reversing words from sentence formations to form questions, saying things such as "Where he is?" These are just a few examples of the many errors that some children with CAS tend to make.
At Tip of the Tongue, we encourage our young clients to speak in phrases and sentences as soon as they are able. We address errors of syntax and morphology as soon as they are ready. We use therapy cards and board games, as well as programs and games on the iPad, and lots and lots of positive reinforcement. Of course, these new skills also need to be reinforced at home, and we count on caregivers to follow-through with practice on the materials that we send home. Together, we make lasting, positive changes in speech and expressive language! Reading Readiness...What does this have to do with CAS? |
Grammar
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Did you know that a 2007 study published in the professional publication Seminars in Speech and Language (1) implicates children with childhood apraxia of speech as being at risk for persistent reading and spelling difficulties? Numerous articles (2, 3) have been written about the connection between significant speech sound disorders (including CAS) with reading and spelling. It is phonemic awareness, or lack thereof, that causes the difficulties, rather than comprehension. Phonemic awareness can be defined as the ability to hear the individual sounds that make up spoken words. It includes recognizing differences and finding relationships between sounds, being aware of the positions of sounds within words, and the ability to change and rearrange sounds to make new words. Some examples of these skills include rhyming, telling the beginning and ending sounds of words, telling the number of syllables within words and what each of the syllables sounds like individually, and blending sounds to form words. Children with significant speech difficulties often struggle with phonemic awareness, lacking in skills more commonly known as Reading Readiness.
Does this mean that every child with CAS will have trouble with reading and spelling? No, but many do. Therefore, it is incumbent upon the child's teachers, parents, and SLPs to address these potential difficulties at an early age. It is quite possible to address phonemic awareness in conjunction with speech therapy, and at Tip of the Tongue, that is exactly what we do. In fact, Rhonda has written a couple of articles about teaching reading skills that you can find on the web:
Of course, Rhonda's experience in teaching reading using the Dubard Association Method (4) comes in handy with her clients with CAS, but she also has a wealth of knowledge about phonemic awareness and plenty of materials and methods for teaching reading readiness skills to help budding readers and spellers. A child need not have CAS to benefit from learning phonemic awareness skills, as these skills are necessary for all readers, but it is especially important to train these skills in children who have speech sound difficulties.
Does this mean that every child with CAS will have trouble with reading and spelling? No, but many do. Therefore, it is incumbent upon the child's teachers, parents, and SLPs to address these potential difficulties at an early age. It is quite possible to address phonemic awareness in conjunction with speech therapy, and at Tip of the Tongue, that is exactly what we do. In fact, Rhonda has written a couple of articles about teaching reading skills that you can find on the web:
- Helping Children with Speech Disorders Learn to Read, http://special-ism.com/help-children-with-speech-disorders-learn-to-read/
- A book review on Sharing Stories to Promote Literacy (editor Anne Van Kleeck, PhD) , http://speech-language-pathology-audiology.advanceweb.com/Article/Sharing-Stories-to-Promote-Language-and-Literacy.aspx.
Of course, Rhonda's experience in teaching reading using the Dubard Association Method (4) comes in handy with her clients with CAS, but she also has a wealth of knowledge about phonemic awareness and plenty of materials and methods for teaching reading readiness skills to help budding readers and spellers. A child need not have CAS to benefit from learning phonemic awareness skills, as these skills are necessary for all readers, but it is especially important to train these skills in children who have speech sound difficulties.
Read and learn more about CAS at http://www.apraxia-kids.org/, the website
of the Childhood Apraxia of Speech of North America (Casana) organization.
References:
(1) http://www.ncbi.nlm.nih.gov/pubmed/17340382; Childhood apraxia of speech: children at risk for persistent reading and spelling disorder.
Semin Speech Lang. 2007 Feb;28(1):48-57.
(2) http://www.apraxia-kids.org/library/literacy-and-children-with-apraxia-of-speech/
(3) http://www.apraxia-kids.org/library/children-with-apraxia-and-reading-writing-and-spelling-difficulties/
(4) https://www.usm.edu/dubard/what-dubard-association-method
Tip of the Tongue Speech and Language
Chesterfield, MO
(636) 220-8200
rjb.slp@charter.net
www.gotospeech.com