Diagnosis and Management of Childhood Apraxia of Speech (CAS)

Introduction

• Speaker: Edie Strand
• Hosted by: Once-Upon-A-Time Foundation
• Focus: Diagnosis and management of Childhood Apraxia of Speech (CAS)

Disclosures

• Advisory board member for Childhood Apraxia of Speech Association of North America (CASANA) - unpaid
• Royalties from Pro II D and TEMA publishers
• Stipend received for this course

Paradigm Shift in Treatment

• Move focus from phonemes/sounds to movement
• Importance of learning and sustaining movement accuracy

Key Points

• CAS is a speech sound disorder, not a medical diagnosis
• Treatment focuses on movement accuracy, not phonemes
• Frequent, shorter therapy sessions recommended
• Emphasize motor skill improvement over linguistic phonemes
• Incorporate principles of motor learning into treatment

Treatment Approaches

• Focus on movement accuracy and dynamic shaping
• Maximize response trials per session
• Use quick, novel reinforcers
• Encourage child to watch the clinician’s face for feedback
• Organize practice in a modified block approach, progressing to random

Feedback Strategies

• Initially provide frequent, specific feedback
• Gradually reduce feedback frequency to improve generalization

Probe Testing

• Use to assess treatment effectiveness without queuing

Differential Diagnosis

• Distinguish between linguistic, phonological, and motor planning impairments
• CAS involves deficits in planning and programming movement gestures

Characteristics of CAS

• Vowel and consonant distortions
• Inconsistent voicing errors
• Prosodic errors (e.g., equal stress and segmentation)
• Awkward transitions and groping behaviors

Evidence of Non-Weakness in Speech

• Normal strength despite low muscle tone
• Good respiratory support and lack of nasality indicate non-weakness

Motor Planning and Programming

• Continuous movement is essential in speech production
• Motor planning areas specify movement parameters using proprioceptive feedback

Differentiating Disorders

• Apraxia vs. Dysarthria: Apraxia involves planning/programming deficits; dysarthria involves execution deficits
• Nonverbal Oral Apraxia: Difficulty in planning non-speech movements

Challenges in Diagnosis

• Overlap between ataxic dysarthria and childhood apraxia
• Importance of understanding movement and neurology

Conclusion

• Labels like CAS are necessary for communication but are not always discrete
• Understanding of disorders should adapt to developmental changes
• Encourage confidence in clinical decision-making and explanation to parents

Next Steps

• Further exploration into differential diagnosis of speech sound disorders