What is Childhood Apraxia of Speech?

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). CAS may occur as a result of known neurological impairment, in association with complex neurobehavioral disorders of known or unknown origin, or as an idiopathic neurogenic speech sound disorder.  The core impairment in planning and/or programming spatiotemporal parameters of movement sequences results in errors in speech sound production and prosody (ASHA Ad Hoc Committee).

Characteristics often present but not discriminative of CAS:

  • Limited consonant and vowel repertoire
  • Use of simple syllable shapes
  • Frequent omission of sounds
  • Numerous errors: poor standard scores on articulation test
  • Poor intelligibility

Characteristics more likely to be discriminative for CAS:

  • Awkward movement from one articulatory configuration to another
  • Groping and/or trial-and-error behavior
  • Presence of vowel distortions
  • Prosodic errors (i.e., lexical stress errors, equal stress, segmentation)
  • Inconsistent voicing errors
  • Consonant distortions due to blending of manner (e.g., in between an /m/ and /b/)
  • Intrusive schwa
  • Inconsistency of word or phrase production over repeated trials

Some Early Signs of CAS 

  • Limited vocalizations
  • Decreased lack of babbling before 12 months
  • 5 or less consonants between 17-24 months
  • Simple syllable shapes (V and CV)
  • Ghost words – words appear then disappear

Treatment

Children with motor planning disorders need to build the muscle memory for new sounds so that they can combine them creatively into words and utterances.  When a person learns a new skill, such as playing the piano; at first the person has to think about how his fingers are moving, however, after practicing the piece of music many times he does not have to think about how his fingers are moving.  It is important to engage the child in repetitive, frequent practice of the target words.  We use the principles of motor learning to guide the way we structure practice and the kind of feedback we use. 

Treatment programs:

  1. PROMPT:  Is an acronym for PROMPTS for Restructuring Oral Muscular Phonetic Targets, is a multidimensional approach to speech production disorders has come to embrace not only the well-known physical-sensory aspects of motor performance, but also its cognitive-linguistic and social-emotional aspects. (Promptinstitute.com) 

This method focuses on use of specific tactile cues to the face and neck to provide information regarding place and manner of articulation.  It gives the child information on how to integrate the movements of the tongue, lips, and jaw, to create speech sounds and blend them together into words.  

  1. Dynamic Temporal and Tactile Cueing (DTTC): The program is a temporal hierarchy that is structured to slowly lengthen the amount of time between the clinician’s production and the child’s production of the word. Initially, the child will be cued to say the word simultaneously with the clinician and eventually be able to say the word as an answer to a question (Developed by Dr Edythe Strand).
  2. Nancy Kaufman approach: The program is designed to “Teach children to combine consonants and vowels to form words while controlling for speech motor coordination difficulty. Includes the syllable shapes children need to master to become effective vocal/verbal communicators.” (Northernspeechservices.com).

Dina has taken Dr Strand’s online training on the Diagnosis and Treatment of Dynamic Temporal and Tactile Cueing (DTTC).  She is also PROMPT trained.  She has taken:

  • Introduction to PROMPT: Technique 
  • Bridging PROMPT technique to intervention
  • PROMPT technique practicum project