Childhood Apraxia of Speech (CAS)

Childhood Apraxia of Speech (CAS) is also commonly known as verbal apraxia, developmental apraxia of speech, or verbal dyspraxia. CAS is a severe permanent and lifelong disorder of speech motor programming and planning which is present from birth and does not naturally resolve .¹ This is very frustrating for the speaker as they know what they’re trying to say, but the motor program impacts their coordination impacting the clarity of speech. This is often initially described by parents as their kids jumbling up sounds, or having mumbly speech

There is currently no known cause for CAS, however it can co‐occur with other speech, language, literacy, and developmental disorders. The prevalence of CAS is low, generally affecting one to two children per thousand (0.1% of the child population).² CAS has increased frequency in children and adults with galactosaemia, epilepsy, or Down Syndrome but has no increased prevalence in autistic children.¹

Signs and Symptoms of Childhood Apraxia of Speech

For a child to receive a diagnosis of CAS, they must meet all three consensus‐based features of CAS: ³

• Inconsistency across words and syllables
• Lengthened and disrupted coarticulatory transitions
• Inappropriate prosody

Inconsistency across words and syllables refers to the difficulties of repeating words in the same way. In CAS, typically there are more errors in consistency with longer words compared to shorter words. For example, the word ‘caterpillar’ may be said as: “catepita, petakilla, patepilla.” This is different from other types of speech sound errors where a sound error is consistently said incorrectly. For example in a lisp the /s/ sound is articulated as /th/, sun→ ‘thun’, house →’ houth’. In CAS, the motor programing interferes with the correct articulation of the word leading to inconsistency errors.

Coarticulatory transitions refers to the ability to transition smoothly and in a timely manner between sounds in a word. This may look like pauses between syllables (e.g. butter…fly), pauses between sounds (e.g. caterp…illa), false starts, hesitations, repairs, repetitive attempts (groping) and lengthened sounds (e.g. mosssman). This often means that children’s speech can sound ‘choppy’ on certain vowels or consonants.

Prosody refers to the stress pattern within words (e.g. te-le-scope) and within sentences (e.g. the man had a blue shirt). The stress pattern for children with CAS may be altered or made equal. This also impacts their intonation which is the natural rise and fall of conversation.

Children with CAS can also experience social difficulties. Research states that their experiences of social learning and play is “made endlessly more complicated by early and ongoing communicative challenges impacting social experience and social encounters”⁵. As well as improving their speech and communication skills, supporting children with CAS in understanding and managing their emotions can be helpful for them in navigating their play and social experiences.

Apart from speech therapy, children with CAS may benefit from the following supports:

• Occupational Therapy – to help them with motor tasks, such as fine and gross motor skills, as well as emotional regulation
• Psychology – especially if their difficulties expressing themselves impact their confidence or self-perception

What happens in an assessment for Childhood Apraxia of Speech?

A comprehensive speech pathology assessment is needed in order to confirm a diagnosis of CAS.³, ⁶ During an assessment a Speech Pathologist will undertake:

• Case History: discussing with parents their concerns, the child’s developmental history, performance at school etc. is essential to the diagnostic journey for CAS
• Oral motor assessment: these non-speech activities observe how a child moves their lips, tongue and jaw in activities such as blowing, smiling and kissing.
• Speech production: the child’s ability to make sounds, words and sentences will be observed throughout the assessment. They may be asked to name pictures, to give a verbal recount or to copy the clinician’s words.
• Motor Planning: repeating sounds (e.g. p-p-p-p-p) and syllables (e.g. pa-ta-ka, pa-ta-ka) help to see if a child can quickly transition between sounds accurately and consistently,
• Prosody: observing their melody and rhythm of speech, such as how they stress syllables and words
• Language and Literacy skills: children with CAS may also have other language and/or literacy needs. Development of literacy skills can be impacted as children struggle with accurately sounding out words, equally or because the way they say a a word is not accurate impacts their spelling.
• Hearing: it is essential that children receive a hearing test prior to their speech pathology assessment to rule out any hearing impairment contributing to their speech difficulties

Once a child receives a diagnosis of CAS, they are elligible for National Disability Insurance Scheme (NDIS) funding. This is because CAS is a life-long condition that requires speech therapy treatment. Speech Pathology Assessment Reports can be an essential document to help secure this funding.

How is Childhood Apraxia of Speech assisted by Speech Therapy?

Speech Pathologists can choose from a range of evidence based treatment options for children with CAS. At Talkshop, the most common therapy choices include:

• The Nuffield Dyspraxia Programme⁷
• Rapid Syllable Transitioning Training (ReST)⁸

Speech Pathologists are trained to support children with CAS using these treatment options. Research shows that children with CAS typically require a minimum of 2x sessions a week in blocks ranging from 6-10 weeks, depending on the therapy program used.⁹

Nuffield: works to “build” accurate speech from single speech sounds (phonemes) and simple syllables. New motor programs are established using cues and feedback and through frequent practice and repetitive sequencing exercises. Phonological skills are incorporated into the treatment approach through the use of minimal word pairs.¹⁰

ReST: The ReST treatment uses nonsense words (words that sound and read like real words, but do not have any meaning). This allows children to concentrate on their movements, lessens the need for working on old words which already have errors and allows clinicians to make words specifically for each child’s needs. To find out more, check out Sydney University’s ReST Information for Parents page.

If you would like more information about Childhood Apraxia of Speech assessment or therapy options, please give us a call on (02) 7209 3838 or email us at hello@talkshop.com.au.