February 15, 2013

Apraxia of Speech

Today I have a guest post from Pamela Harnden. Pam has been recognized for Advanced Training and Clinical Expertise in Childhood Apraxia of Speech from CASANA (The Childhood Apraxia of Speech Association of North America). I am lucky enough to have Pam working in my city and we share a number of kiddos on our caseloads. She is my go-to lady for speech apraxia information, diagnosis, and treatment.

Have you ever had that child who comes in for an evaluation and after scoring the results you are left wondering where to begin your therapy? Do you have a child whose errors are just not responding to your typical therapy treatments? If so you may want to consider exploring whether this child has Childhood Apraxia of Speech.

In 2007, the ASHA Ad Hoc Committee on Childhood Apraxia of Speech recommended the following definition for CAS: Childhood apraxia of speech (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 or 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.

Some distinguishing characteristics of CAS include:

Inconsistent errors in production of consonants and vowels with repeated production of syllables and words

Lengthened and disrupted coarticulatory transitions between sounds and syllables

Inappropriate prosody, especially when lexical or phrasal stress is needed to precisely convey and idea

Other characteristics include:

Limited repertoire of vowels

Vowel errors, especially distortions

Variable and inconsistent errors

Difficulty with volitional, self-initiated utterances as compared to over-learned, automatic, or modeled utterances

Impaired rate/accuracy on diodochokinetic tasks

Suprasegmental differences including regulation of prosody, pitch, rate and volume

Receptive language skills exceeds expressive langauge

If you are seeing these characteristics, in addition to limited to no progress you might want to consider a more extensive evaluation to assess the child’s inventory of consonants, vowels and syllable structures. A few selected tests include:

Kaufman Speech Praxis Test for Children (KSPT;Kaufman 1995)

· Verbal Motor Production Assessment for Children (VMPAC;Hayden & Square, 1999) PROMPT

Apraxia Profile (Hickman, 1997)

If a child appears to have CAS then your treatment will be different than the traditional articulation/phonological process therapy. Therapy should be based on the principles of motor learning (increasing the number of practice trials to improve learning a motor plan) which employs specific and systematic graduated experiences with a targeted tasks, using selective feedback. This type of treatment approach includes:

greater Intensity of therapy (3-5, 20 minute sessions/week with severe CAS) to maximize motor learning

target selection based on syllable shapes combined with consonant and vowel inventories

target selection based on words that are functional and appropriate to the child’s environment as determined by the therapist, family, child and teachers

repeated practice of a small stimulus set

systematic use of multisensory cueing using visual, auditory, tactile, proprioceptive and cognitive cues

specific feedback regarding how the target was produced and the accuracy of the target words or phrases.

These resources can help you learn more about evaluating and treating Childhood Apraxia of Speech: www.apraxia-kids.org and the book by Margaret Fish Here’s How To Treat Childhood Apraxia of Speech.