We often have parents ask us if their child may have childhood apraxia of speech, aka CAS. They may have read about it or known another parent whose child has been diagnosed with CAS and felt it seems similar to their own child. Childhood apraxia of speech is less common than other speech and language diagnoses; as a matter of fact, research estimates only 3.4%-4.3% of the children referred for speech disorders have CAS.
Speech-language pathologists typically do additional training, continuing education, and receive certifications that will aide them in proper diagnosis and treatment of children with CAS. In addition, a background in several other speech disorders is equally important for differential diagnosis. Children who present with symptoms consistent with CAS are easier to diagnose when over the age of 3.
Why is this? Well, children under the age of 3 are often not behaviorally or emotionally ready to participate in the assessment process. They may have some symptoms of apraxia that lead the assessor to "jumping the gun," but as time goes by, you'll see the child's errors are a result of low muscle tone or general articulation/phonological delays. An assessor who has a lack of experience, or is not up to date on research, may not be knowledgeable in everything that is necessary to make a proper diagnosis. Improper diagnoses cause a parent added stress, worry, and fear of what is ahead for their child. According to Apraxia-Kids, "firm diagnosis should not be made in extremely young children or children who are unable to give an adequate speech sample or cooperate and understand the tasks being asked of them in an evaluation." In addition, there are other factors that may influence the diagnostic process for children under 3. According to the American Speech Language and Hearing Association, this includes the following:
the potential presence of developmental disabilities and/or co-morbid conditions;
the lack of a single validated list of diagnostic features that differentiates CAS from other types of childhood speech sound disorders (e.g., those due to phonological-level deficits or neuromuscular disorder);
the fact that some primary characteristics of CAS (e.g., word inconsistency, a predominant error pattern of omission, etc.) are characteristic of emerging speech in typically developing children under the age of 3 years;
the lack of a sufficient speech sample size for making a more definitive diagnosis;
the challenge of sorting out inability versus unwillingness to provide a speech sample or to attempt a speech target;
the possibility that changes occurring prior to age 3 (e.g., developmental maturation, social and linguistic peer exposure, and beneficial effects of therapy) may alter the diagnostic label.
"I Googled, and I think/know my child has CAS; what do I do?"
Seek out an SLP with experience in this area. If you already are working with one, ask her/him what their experience with CAS is, and for their recommendations. One reason, it is important to consult a trained professional is that what you observe in your child may also be consistent with another diagnosis. This is not a complete list, but may give you an idea of how symptoms may be similar to other disorders:
Your SLP, may refer to the child as having sCAS (suspected Childhood Apraxia of Speech) if unable to make a positive diagnosis. What is of utmost importance, with a young child experiencing a speech sound disorder, is that the speech therapy approach matches the child's speech difficulty. Some strategies that may help a child with CAS, may also help a child with difficulties that are not CAS; however strategies used for other speech sound disorders, will not necessarily be beneficial to the child with CAS. For a child with sCAS, the SLP may use CAS strategies that will help the child develop clear speech whether or not he/she has a firm diagnosis of CAS.
A child with CAS may also have other related difficulties, such as oral apraxia (moving the mouth for things other than speech), limb apraxia (in-coordination of limbs), feeding, and language disorders. Your SLP will monitor for other issues and make referrals as needed.
What does treatment look like?
The treatment process will change based on the child's ability to participate in therapy. In order to achieve clear speech, the child will need to practice various sequences over and over. Young children are often not yet able to endure this type of therapy and may become discouraged and have setbacks in progress if it is attempted. SLPs will typically incorporate a system of hand cues/visual-tactile cues, such as the Kaufman protocol, PROMPT, or Easy Does It, systems to help the child achieve proper placement of the articulators during speech attempts. These can easily be incorporated into a play-based therapy program. Additionally, these systems may be utilized at any age and some may be adapted to work with children with other speech disorders, or sCAS as well.
A skilled clinician will be able to read the child, and know what he/she is able to tolerate to have the most benefit from treatment. Not all children are ready to have someone putting their hands on their faces, or to be drilled with words, and the clinician must incorporate various strategies to have successful outcomes. Treatment for CAS, should not include non-speech practices, such as blowing bubbles in hopes to produce sounds, like "ooh." Much research has been done in this area, showing that non-speech exercises do NOT help a child produce speech, and is a waste of valuable therapeutic opportunities.
The child's parents and caregivers are truly the most important people in the therapeutic process. You will be given a home program and taught techniques that must be used consistently in order for your child to achieve his or her maximum potential. Open communication with the SLP is very important and you should always ask questions and discuss concerns.
Where can I find more information on Childhood Apraxia of Speech?
The best resource is ASHA. The American Speech Language and Hearing Association provides information and research, available to professionals and families. In addition, apraxia-kids.org has a plethora of resources available to families, and will mail you a folder of information you can share with teachers and family members!