Treating and Evaluating Childhood Apraxia of Speech

What Is Apraxia of Speech?

Childhood Apraxia of Speech (CAS) is a motor-planning disorder of speech production which impacts the message that the brain sends to the articulators (e.g., lips, jaw, tongue) to form and sequence speech sounds. Here we will discuss what treatment realistically looks like for children with CAS, both older and younger.  

What does an Evaluation Look like for CAS?

While assessment protocols differ across settings and clinicians, a general assessment for a child with suspected Childhood Apraxia of Speech would include a formal test of articulation, a motor speech assessment, and an oral-mechanism exam. Doing so allows us to identify any speech sound error patterns and assess the presence or absence of diagnostic criteria for childhood speech apraxia. This includes characteristics such as:  

• Limited phonetic inventory - a child only produces consonants /m/ and /g/ 
• Inconsistent errors 
• Atypical errors 
• Vowel distortion - less differentiation between vowel sounds, one vowel may be produced the same way as another vowel 
• Increased difficulty for multisyllabic words 
• Increased errors for self-initiated vs. voluntary utterances 
• Disturbed, irregular prosody - monotoned voice, “robotic” speech, choppy or increased rate of speech 

In an oral-mechanism exam, we look for disorganized movement sequences, effortful movement of the articulators, or inability to execute movements.  

Related Reading: Looking Beyond Articulation Scores 

What Does Therapy Look like for a Young Child With CAS?

The early stages of therapy with your child will focus on helping them plan and produce different consonant and vowel combinations. Sounds in your child’s inventory will then be used to shape their “best” approximations of adult word forms for vocabulary specific to your child's needs and interests. This may include their favorite items, words to request or manipulate their environment, or high-frequency words. These approximations will be targeted during play with your child’s highly preferred toys and activities! 

You may be thinking- “what if my child has minimal verbal output?” That is ok! For children with moderate-severe childhood apraxia of speech, sessions are focused on building imitative ability through use known words and increasing syllabic complexity. This means, that if your child cannot yet imitate novel consonants and word forms, we use a word that they already have, such as “go,” and use that within play to elicit imitation through completion of verbal routines, and modeling of increased syllabic complexity, such as “go-go,” or “go-go-go." 

As your child becomes more successful with their consonant-vowel sequencing skills, more advanced syllable structures will be targeted. An example of this could be introducing a vowel change (e.g., “puh-pee” vs “puh-puh” for “puppy”). In addition to more advanced syllable structures, the clinician will begin to expand your child’s productions by scripting language within play (e.g., “puppy eat,” “puppy ball”). Over time and as therapy progresses, cues will be reduced to support independence.  

What Does Therapy Look like for an Older Child With CAS?

For older, more advanced children with CAS, therapy will focus on the oral placement of later developing consonants (e.g., /l/, /r/, /th/), more complex syllable structures (e.g., multisyllabic words and consonant blends), and activities for improving their intonation and prosody (e.g., the rate and rhythm of their voice).  

Can You Use AAC in Apraxia Treatment?

Yes! Both low-tech (e.g., picture boards) and high-tech (e.g., Touch Chat) AAC devices are incorporated in therapy to supplement your child’s verbal communication skills. AAC devices may be used to repair a communication breakdown.  

Conclusion

If you suspect your child may have childhood apraxia of speech, we’re here to help. Stay tuned for more information on CAS and ways you can support your child across environments.