Is it Childhood Apraxia of Speech?

 "My child / client has very few sounds.  Can I diagnosis childhood apraxia of speech (CAS) or suspected childhood apraxia of speech?" 

Here is a link to an instagram post that lists red flags for CAS, and a list of characteristics that are more discriminative of CAS, from other speech sound disorders. Is it CAS?

Diagnosing apraxia requires that the child 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 production. 

This information allows the clinician who is assessing apraxia of speech 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 or symptoms of childhood apraxia of speech. 

What are discriminative characteristics or symptoms of CAS?

• Awkward movement from one articulatory configuration to another
• Groping and/or trial-and-error behavior
• Vowel distortions
• Prosodic errors 
• Inconsistent voicing errors
• Intrusive schwa
• Inconsistency of word or phrase production over repeated trials (Strand 2020)

A few myths about diagnosing apraxia of speech in children: 

1) Myth: The child is too smart / not smart enough.  Truth: Children at all cognitive levels can have CAS.

2) Myth: 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) Myth: A child cannot have CAS and another speech sound disorder. Truth: A child can have a combination of speech sound disorders.

If the child cannot participate in a dynamic assessment and CAS is suspected, there is no downside to treating the child using principles of motor learning. A child who has CAS and is treated with a language based approach, will not progress.  You can learn more about principles of motor learning by clicking here.

If a child has been receiving traditional language based therapy for a long period of time and is not progressing, a diagnosis of suspected childhood apraxia of speech should be considered. I have a mini course called Suspected Childhood Apraxia of Speech which details my clinical decision making progress in making this diagnosis.  Click here for more information.

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