One of the questions that I receive related to diagnosing Childhood Apraxia of Speech (CAS) is: "My child / client has very few sounds. Can I make the diagnosis of CAS?" In order to diagnose a child with CAS, the child needs to be able to participate in a dynamic motor speech assessment. This means that the child needs to be able to imitate or attempt imitation of words and attend to cues, via the principles of motor learning, to improve the accuracy of the movements. This information allows the clinician to see how the child responds to cueing which helps us make a proper diagnosis and determine prognosis.
When the child attempts production of new words and movement patterns, we can usually see the discriminative characteristics of CAS. When a child only has a few sounds it will be difficult to engage them in a dynamic assessment and therefore will be difficult to give a definitive diagnosis of CAS.
A few myths about diagnosing Childhood Apraxia of Speech:
1) The child is too smart / not smart enough. Truth: Children at all cognitive levels can have CAS.
2) The child is under age 3 so we cannot diagnose with CAS. Truth: If a child can participate in a dynamic assessment, and we see discriminative characteristics, then we can make a diagnosis.
3) A child cannot have CAS and another speech sound disorder. Truth: A child can have a combination of speech sound disorders.
How does the therapy differ for children with a language based speech and language delay versus a child with a motor speech based speech delay?
A child with a developmental language delay benefits from repetition of words during daily routines. The repetition of the word helps the child learn the meaning, categorize it, produce the sounds accurately and use it to communicate. They learn the word through books, play and real life daily routines.
A child with a speech motor disorder, such as childhood apraxia of speech, does not benefit the same way. Through daily routines they learn the meaning of the word and can categorize it, but just hearing the word does not help the child repeat the sounds and combine them accurately in words. The child with a speech motor disorder needs to practice producing the sounds and words utilizing multi-sensory cueing techniques and principles of motor learning. For more in-depth information about the principles of motor learning, you can refer to instagram posts from @speechproductionlabssyr.
Suspected Childhood Apraxia of Speech
It is important to identify children who have childhood apraxia of speech or suspected apraxia, so that the child can receive effective treatment. For more information about suspected CAS, click here. Additionally, you can view an Instagram LIVE session that I did with Suzanne from @playingspeech where we discussed suspected apraxia in the early intervention population here.
Selection of Words for Apraxia Therapy
An important part of apraxia therapy is the careful selection of the words that you will practice with the child. You can receive a free target selection handout for children with Childhood Apraxia of Speech (CAS) by clicking here.
Treating Childhood Apraxia of Speech Course
A comprehensive course called "Treating Childhood Apraxia of Speech: A Step-by-Step Guide" has been created to teach you step by step how to develop a target word list, how to structure repetitive practice, and how to use multi-sensory cueing to teach new motor plans. Find out more about the course here. Use discount code APTUS20 for $20 off.
Author Bio: Alonna Bondar is a highly respected speech-language pathologist with a deep passion for Childhood Apraxia of Speech (CAS) education. With years of experience working with CAS clients and training fellow SLPs, Alonna is committed to making information about CAS easily accessible and implementable. Her mission as a guest blogger is to share valuable insights and practical tips that empower speech language pathologists to work effectively with CAS clients. You can follow Alonna on Instagram @bondarspeech