Speech Language Therapy for Childhood Apraxia of Speech (CAS)
DEFINITION: Childhood Apraxia of Speech is a neurologically-based disorder of speech motor control that impacts the ability to effectively plan and sequence the movements of the jaw, lips and tongue required for speech production. Speech sounds, words and phrases are not produced with the automaticity or the accuracy that occurs in normal development.
DIAGNOSIS is challenging, especially for children under the age of 3 years, and the gold standard remains the expert judgement of a Certified SLP based on key features described below:
Key features of Childhood Apraxia of Speech (ASHA, 2007)
- Inconsistent speech sound errors in repeated productions of the same word
- Difficulty with smooth movement from one speech sound or syllable to the next
- Inappropriate prosody (poor use of syllable stress; intonation)
Caveat: In young children who have limited attention and little ability to engage in speech imitation tasks, it is challenging to form clear diagnostic impressions.
CO-OCCURRING DISORDERS: Children with CAS are at increased risk for language impairment and non-speech sensory and motor impairments, including the following:
- neuromuscular difficulties (low muscle tone; postural and jaw instability)
- deficits in receptive and/or expressive language including word retrieval difficulties
- auditory processing disorder
- developmental coordination disorder
THERAPY FOR CAS: Effective treatment of Childhood Apraxia of Speech requires intensive intervention, begun as early as possible. Speech language therapy for children with Childhood Apraxia of Speech is different from approaches used with children with other articulation difficulties or language disorders. It is based on principles of motor learning:
- A high degree of repetition to develop and establish motor plans
- Extensive practice opportunities to maintain learned patterns
- Careful use of feedback during different stages of motor learning
- Use of relevant words and phrases as targets during therapy sessions
- Increased sensory feedback for control of movements and movement sequences, particularly tactile-kinesthetic feedback
PROMPT® Therapy for Childhood Apraxia of Speech
At Donna Lederman, SLP, P.C., we have had high levels of success in working with clients with Childhood Apraxia of Speech. We believe that our clinical interventions, utilizing PROMPT therapy are successful because:
- PROMPT provides a high level of sensory feedback about movements of the jaw, lips and tongue that are required for accurate and consistent production of speech sounds.
- PROMPT provides information about transitions between speech sounds and syllables, building motor sequencing ability.
- PROMPT provides feedback about timing of speech sound production, contributing to the ability to develop appropriate stress patterns.
- For children with co-occurring neuromuscular deficits, PROMPT therapy provides support to the jaw while guiding vertical movements within an appropriate range of motion.
- The PROMPT system of therapy emphasizes extensive practice opportunities, in which sounds, syllables and words are used in varied activities and settings. Varied practice is a key component in building motor planning skills.
- PROMPT treatment incorporates a high level of motor practice into words and phrases that are used in motivating play or social interaction routines.