Childhood Apraxia of Speech (CAS)
Childhood Apraxia of Speech (CAS) is a label for a type of speech sound disorder where children have difficulty planning and programming for speech. Children diagnosed with CAS exhibit characteristics that include inaccurate movement resulting in vowel and consonant distortions.
The muscles involved in speech are not found to be weak in children with CAS rather the errors associated with this type of speech sound disorder are due to inefficiencies in the neural processing for the precision and accuracy of movement.
Unless they have coexisting dysarthria, children with CAS will not have difficulty moving muscles with the correct range, speed, and force for non-speech activity, including chewing and swallowing.1
Treatment is tailored to meet the child’s needs and optimize outcomes. Therapy is specialized to focus on improving the awareness, and coordination of motor movements, utilizing principles of motor learning.
Dynamic Temporal Tactile Cueing (DTTC)
DTTC is a treatment method designed specifically for children with severe CAS, especially those who were not successful with more traditional forms of therapy, and has been used successfully with moderate CAS as well. DTTC is a motor-based approach, meaning it is designed to improve the brain’s ability to plan and program movements for speech, which most experts believe is the underlying cause of CAS. The goal of DTTC is to improve the efficiency of neural processing for the development and refinement of movements. The incorporation of a number of principles of motor learning helps the child maintain accurate movement over time. In DTTC, the therapist selects specific word targets to shape movements of the mouth that are necessary for speech. DTTC is based on motor learning theory and research, integrating Dr. Strand’s personal research and clinical experience treating children with CAS over a span of more than 40 years.
How is DTTC different from other CAS treatment methods?
Like some other methods of treatment, DTTC was designed specifically for children with CAS. A primary difference is that the focus of treatment is on the movement gesture, rather than an individual sound.
MOVEMENT, NOT individual sounds is the focus during treatment.
- Vowels and prosody begin early in treatment.
- The session is structured to provide the child with lots of practice because it is critical for learning any motor skill.
- The cues provided to help the child are dynamic meaning more cues are provided when needed so the child is successful, but cues are removed or faded as soon as possible to promote independence.
LKS & Associates speech therapists use PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) in treatment sessions. PROMPT is a multi-dimensional approach to speech production disorders incorporating physical-sensory aspects of motor performance, cognitive-linguistic, and social-emotional. PROMPT may be used to facilitate production, revise or change production, or integrate motor production.
Intensive speech and language therapy is highly recommended three to five times a week on an individual basis. The cognitive motor learning literature contains a great deal of evidence to show that in order to learn motor skills, frequent practice of the movement is needed. For young children, frequent practice may be accomplished by careful identification of targets so they can be embedded in play activities that keep the child engaged.
Below please find a list of articles either cited above or found to be useful materials for understanding Childhood Apraxia of Speech:
Apraxia–Kids Because It’s Your Child (Gretz)
Apraxia-Kids Children with Apraxia and Reading (Stackhouse)
ASHA Leader article on EBP
ASHA Technical Report on CAS (2007)
Cochrane Review on treatment for CAS (2008)
Allen, L.F & Babin, E.A. (2012). Associations between caregiving, social support, and well-being among parents of children with childhood apraxia of speech. Health Communication, http://dx.doi.org/10.1080/10410236.2012.703120
Clark, H. (2003). Neuromuscular Treatments for Speech and Swallowing: A Tutorial. AJSLP, 12, 400-415.
De Thorne, L.S., Johnson, C.J., Walder, L., Mahurin-Smith, J. (2009). When “Simon
Says” doesn’t work: Alternatives to imitation for facilitating early speech development. American Journal of Speech-Language Pathology, 18, 133-145.
Gillon GT, (2007). Effective Practice In Phonological Awareness Intervention for
Children With Speech Sound Disorder. SIG 1 Perspectives, 18–23.
Maas, E., Gildersleeve-Neumann, C. E., Jakielski, K. J. Stoeckel, R. (2014). Motor based intervention protocols in treatment of childhood apraxia of speech (CAS). Current Developmental Disorders Reports, 1 (3).
Maas, E., Robin, D., Austermann Hula, , Freedman, S., Wulf, G., Ballard, K, & Schmidt, R. (2008). Principles of Motor Learning in Treatment of Motor Speech Disorders. American Journal of Speech-Language Pathology, 17, 277–298.
McCauley, R.J., and Strand, E.A. (2008). A review of standardized tests of nonverbal oral and speech motor performance in children. American Journal of Speech– Language Pathology, 17, 81-91.
Miron, C. (2012). The parent experience: When a child is diagnosed with childhood apraxia of speech. Communication Disorders Quarterly, 33: DOI: 10.1177/1525740110384131
Murray, E., McCabe, P., & Ballard, K. (2014). A systematic review of treatment outcomes for children with childhood apraxia of speech. American Journal of Speech Language Pathology Vol. 23.486-504
Shriberg, L.D., Lohmeier, L., Strand, E.A., & Jakielski, K.J. (2012). Encoding, memory, and transcoding deficits in childhood apraxia of speech. Clinical Linguistics and Phonetics, 26, 445-482.
Strand, EA, McCauley, RJ, Weigand, SD, Stoeckel, RE, Baas, BS. (2013) A Motor Speech Assessment for Children with severe Speech Disorders: Reliability and Validity Evidence. JSLHR, 56, 505–520.
Rupela V, Velleman SL, Andrianopoulos MV. (2016). Motor speech skills in children with Down syndrome: A descriptive study. International Journal of Speech-Language Pathology http://dx.doi.org/10.3109/17549507.2015.1112836