Updates on life and Spotlight on Childhood Apraxia of Speech

Wow, it's been a while since my last post! Time has flown and it is summer time! That means watermelon, lemonade, pool parties, and humidity (in St. Louis, MO anyway) .

I do not work in the school system, therefore I am still working away! I will be on maternity leave late July however. That's right! I am having a baby girl! I am nervous and excited and completely not ready to take care of another human. Feel free to leave me some words of wisdom!

I plan on going back to work after a few short months of recovery and being with baby girl because I really enjoy what I do and love to make a difference in others' lives through the gift of communication.

Today I wanted to post briefly on Childhood Apraxia of Speech. It is a rare diagnosis that can be challenging to work with, but with the right methodology, tools, patience, and work (from both the clinician, family, and the client) drastic improvement can be made!

What is childhood apraxia of speech?

According to the American Speech and Hearing Association, childhood apraxia of speech or CAS "is a neurological childhood (pediatric) 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 and 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, 2007b, Definitions of CAS section, para. 1).

Wait... what? Beneath all of the jargon, I typically like to explain to parents that CAS is essentially a brain to mouth wiring problem. It is a speech motor planning disorder. Your child may know exactly what she/he wants to say, but her/his mouth isn’t responding correctly. So when the message is "I want a cookie", that motor plan may be too motorically complex to program for your child's articulators (e.g. tongue, lips, cheeks, voice) The message may come out unintelligible and with many errors and substitutions. It’s as though the brain says speak, but the mouth doesn’t respond appropriately.

What causes CAS?

-CAS can be idiopathic, meaning an unknown origin.

-CAS may occur as a result of neurological impairment.

-CAS may occur as a result of complex neurobehavioral disorder including Fragile X, some forms of epilepsy, chromosome additions and deletions, and Autism Spectrum Disorder.

What are the symptoms of CAS?

The 3 key characteristics of CAS according to ASHA:

  • Inconsistent errors on consonants and vowels in repeated productions of syllables or words.

  • Lengthened and disrupted coarticulatory transitions between sounds and syllables.

  • Inappropriate prosody, especially in the realization of lexical or phrasal stress. (ASHA, 2007b)

Other characteristics may include:

-limited repertoire of consonants and vowels

-difficulty planning and sequencing the precise movements needed for speech production

-groping, facial grimacing, oral posturing- effortful speech

-multiple sound omissions and sound errors

How do we treat CAS?

CAS is a motor speech, movement disorder, therefore effective intervention should be based on the Principles of Motor Learning. The focus of apraxia treatment is not on accurate production of a particular speech sound ( e.g. "s" or "k"), rather the focus is on movement accuracy. Dr. Edythe Strand is a leading researcher in CAS and I incorporate her intervention methodologies into my treatment sessions with children exhibiting suspected childhood apraxia of speech and those who are formally diagnosed with CAS. Effective treatment should involve the following:

  • Therapy activities and reinforcements are structured to encourage the child to focus and attend to the movement of the targets

  • Conditions of practice are designed to promote quick skill development AND generalization over time

  • Feedback is carefully structured to encourage motor learning, provided as knowledge of performance and/or results.

  • Frequent visual, tactile, gestural and auditory cues are provided initially to help the child learn the movement then faded over time to promote generalization and motor learning.

  • To see a brief video of Dr. Strand discussing treatment of CAS and examples of therapy, click here

Well that's all for me now! I think I need a nap. Third trimester has definitely brought on extra yawns and daydreams of pillows! Please message me if you have any thoughts, comments, or questions. I love hearing from you!


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