By: Jenny Lorince, M.S., CF-SLP
What is Childhood apraxia of speech (CAS)? According to the American Speech-Language-Hearing Association (ASHA), 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 complete neurobehavioral disorders of known and 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. (ASHA, 2007b, Definitions of CAS section, para.1).
To put it simply, CAS is a disconnection between the brain and the mouth. Before we speak, signals are sent to various areas in our brain that are responsible for word finding and speech production. Then, we are able to take those words/thoughts and voice them. Children with CAS generally have minimal problems generating thoughts and finding words; however, when they open their mouths to speak, they have difficulties coordinating the complex oral movements needed to turn sounds into syllables, syllables into words and words into phrases. Children with CAS make inconsistent errors, which makes it difficult for the communication partner to understand what the child is attempting to communicate. It can be quite frustrating.
What can we do to help these kiddos? Kiddos with CAS benefit immensely from frequent speech therapy sessions. Longer, more complex words and phrases are extremely difficult for a child with CAS, which is why it is so important that when we are providing speech therapy services we always initiate a hierarchy of tasks (i.e. begin working on sounds in isolation and slowly move to simple consonant-vowel combination words).
Repetition is key! Children with CAS require multiple repetitions in order to increase the coordination of the oral movements necessary for speech production. Repetition, repetition, repetition! Whether it is a single sound, syllable or word – REPEAT! The more the child repeats the word, the better their production will become.
Here are a few tools that I used with my CAS kiddos that you likely have at home:
· Mirror – Sit next to the child while looking in the mirror. Model what you want the child to say then ask the child to watch his/her mouth while he/she imitates. REPEAT.
· Sucker – Yes, you read that right! I love using Dum-Dum suckers in therapy. Kids work hard when they are motivated, so why not use a sucker during oral coordination exercises? This is useful for tongue lateralization, tongue elevation, tongue protrusion, puckering the lips and many more exercises that are beneficial for increasing coordination.
· Voice recording – Recording our voices for a few seconds during an imitation task will allow the child to listen to the speaker’s voice then his/her voice and compare the two.
· Children’s books – Children’s books that repeat the same words or phrases throughout the book are great for children with CAS. These books allow for multiple repetitions without the child realizing he/she is actually participating in a task that is addressing his/her speech skills.
Childhood Apraxia of Speech. (n.d.). Retrieved from https://www.asha.org/Practice-Portal/Clinical-Topics/Childhood-Apraxia-of-Speech/