Childhood Apraxia of Speech

What does a CAS evaluation include?

The evaluation will include a language assessment, articulation and phonological assessment, a motor speech assessment, and an oral mechanism exam. The evaluation should also include a spontaneous speech sample either taken at the clinic, or provided by the parent in a video.

You will receive a comprehensive report following the evaluation. In the report, I will include background/history, clinical observations, discussion of scores and performance on each test administered, a diagnostic summary, and my recommendations.

What are some possible signs and symptoms of CAS?

Signs of CAS vary depending on the age of the child and the severity of the disorder.

CAS can be associated with:

• Delayed onset of first words
• A limited number of spoken words
• The ability to form only a few consonant or vowel sounds

These symptoms are usually noticed between ages 18 months and 2 years, and may indicate suspected CAS, or a different speech disorder. As children produce more speech, usually between ages 2 and 4, characteristics that may more likely indicate CAS include:

• Vowel distortions
• Separation of syllables in or between words
• Voicing errors, such as “pie” sounding like “bye”
• Groping (difficulty getting jaws, lips and tongues to the correct positions to make a sound)
• Addition of the “schwa” sound within or at the beginning or end of words

Are there “key” characteristics of CAS?

Some characteristics, often called markers, help clinicians distinguish CAS from other types of speech disorders. Possible markers associated with CAS include:

• Difficulty moving smoothly from one sound, syllable or word to another
• Groping movements with the jaw, lips or tongue to make the correct movement for speech sounds
• Inconsistency, such as making different errors when trying to say the same word a second time
• Vowel distortions, such as attempting to use the correct vowel, but saying it incorrectly
• Using the wrong stress in a word, such as pronouncing “banana” as “BUH-nan-uh” instead of “buh-NAN-uh”
• Using equal emphasis on all syllables, such as saying “BUH-NAN-UH”
• Separation of syllables, such as putting a pause or gap between syllables
• Difficulty imitating simple words
• Inconsistent voicing errors, such as saying “down” instead of “town”

Other characteristics are seen in many children with more common speech problems and are NOT helpful in distinguishing CAS. Characteristics seen both in children with CAS and in children with other types of speech or language disorders include:

• Babbling less or making fewer vocal sounds than is typical between the ages of 7 to 12 months old
• Speaking first words late (after ages 12 to 18 months old)
• Using a limited number of consonants and vowels
• Frequently leaving out (omitting) sounds
• Using speech that is difficult to understand

What other speech disorders are sometimes confused with CAS?

Different types of speech sound disorders often get confused with CAS because some of the characteristics may overlap. These speech sound disorders include articulation disorders, phonological disorders and dysarthria.

Articulation & Phonological Disorders

A child who has trouble learning how to make specific sounds, but doesn’t have trouble planning or coordinating the movements to speak, may have an articulation or phonological disorder. Articulation and phonological disorders are more common than CAS. Articulation or phonological speech errors may include:

• Substituting sounds, such as saying “fum” instead of “thumb,” “wabbit” instead of “rabbit” or “tup” instead of “cup”
• Leaving out (omitting) final consonants, such as saying “duh” instead of “duck” or “uh” instead of “up”
• Stopping the airstream, such as saying “tun” instead of “sun” or “doo” instead of “zoo”
• Simplifying sound combinations, such as saying “ting” instead of “string” or “fog” instead of “frog”

Dysarthria

Dysarthria is a motor speech disorder that is due to weakness, spasticity or inability to control the speech muscles. Making speech sounds is difficult because the speech muscles can’t move as far, as quickly or with the same strength as normal. People with dysarthria may also have a hoarse, soft or even strained voice, or slurred or slow speech.

Dysarthria is often easier to identify than CAS. However, when dysarthria is caused by damage to certain areas of the brain that affect coordination, it can be difficult to determine the differences between CAS and dysarthria.

Is treatment for CAS different than treatment for other speech disorders?

Yes! Treatment for CAS should implement the principles of motor learning, including many repetitions of speech movements to help the child acquire skills to accurately, consistently, and automatically produce sequences of speech sounds. Therapists who work with children with CAS should have advanced training in motor speech disorders. Evidence-based interventions for CAS include (but are not limited to): DTTC (Dynamic Temporal and Tactile Cueing), REST (Rapid Syllable Transition Treatment) and PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets). Cheryl is trained in all of these interventions.