A Challenging Diagnosis
Childhood apraxia of speech (CAS) can be a difficult and challenging diagnosis for many speech therapists. This may be partly because the word “apraxia” is often misused or overused when describing speech deficits in children. Some school districts avoid the term, while others overuse it.
Childhood apraxia of speech can be officially diagnosed by a physician or by a speech-language pathologist. Even then, the diagnosis can be tricky: how many times have you suspected a child has apraxia only to discover upon further evaluation that the issue is phonological in nature?
Characteristics and Markers of Childhood Apraxia of Speech
The American Speech-Language-Hearing Association (ASHA) and the Mayo Clinic have outlined several characteristics and markers which can help speech therapists with a differential diagnosis of childhood apraxia of speech:
- Inconsistent errors with consonants and vowels (e.g., the child may produce the same word in a variety of ways when asked to repeat it several times; this may be more apparent with longer more complex words such as “buttercup”)
- Longer pauses between sounds and syllables due to difficulties transitioning from sound to sound or syllable to syllable
- Inconsistent or inappropriate stress on syllable which can distort the prosody or melody of speech making it sound odd
- Difficulty moving smoothly from one sound, syllable, or word to another
- Groping movements with the jaw, lips or tongue to make the correct movement for speech sounds
- Vowel distortions, such as attempting to use the correct vowel but saying it incorrectly
- Using the wrong stress in a word, such as pronouncing "banana" as "BUH-nan-uh" instead of "buh-NAN-uh"
- Using equal emphasis on all syllables, such as saying "BUH-NAN-UH"
- Separation of syllables, such as putting a pause or gap between syllables
- Inconsistency, such as making different errors when trying to say the same word a second time
- Difficulty imitating simple words
- Inconsistent voicing errors, such as saying "down" instead of "town"
How to Evaluate a Student for Childhood Apraxia of Speech
Apraxia Kids has a step-by-step guide on how to evaluate and/or diagnose for childhood apraxia of speech. The speech-language therapist will:
- Take a complete inventory of the sounds, syllable shapes (consonant and vowel combinations that makeup syllables), and words a child can make or attempts to make, as well as any “mistakes” the child makes when doing so.
- Make observations about how the child combines sounds and whether the length or difficulty level of words or phrases makes a difference in the accuracy with which the child says words.
- Evaluate the child’s ability to both use and understand words, phrases, word endings, grammar, etc. and compare to what is typical for their age range.
- Examine oral structures and the oral cavity to determine whether they appear normal and are in good working order for speech.
- Make note of the child’s intentions to communicate, engage in social interaction, listen, and respond. Observe what other forms of communication the child uses, such as pointing and gesturing.
- Observe what effect certain types of help have for the child’s speech accuracy. For example, the SLP may slow down their own speech and ask the child to try a word or phrase with them simultaneously. Or the SLP may use words or other types of cues to help the child figure out how to form the mouth or how to place the tongue and lips to produce the desired target word.
- If CAS is suspected, perform a motor speech exam. Try to get the child to repeat increasingly difficult and challenging syllables, words, and phrases and observe how length and complexity impact the child’s intelligibility. Try using the cueing mentioned above to observe the impact.
Resources for Treating Childhood Apraxia of Speech
Apraxia Kids is a non-profit organization designed to strengthen the lives of children with apraxia of speech by educating professionals and families, facilitating community engagement and outreach, and investing in the future through advocacy and research. They have an article library, on-demand webinars, national conferences, intensive training, and a virtual education series
Kauffman Methods presents apraxia solutions, including a four-hour comprehensive training to teach participants how to evaluate and treat children with apraxia of speech. Additionally, apraxia expert Nancy Kauffman offers materials for teaching children with apraxia how to combine consonants and vowels into words, and words into the functional expressive language.
Bjorem Speech was founded by Jennie Bjorem, MA, CCC-SLP, and features her Bjorem Speech Cue Cards. Her goal is to bring fresh new, innovative ideas that engage children while treating CAS. She presents instructional videos and is continually adding new products to her site.
Graham Speech Therapy is hosted by SLP Amy Graham, who offers innovative ideas on the treatment of CAS through her blog as well as her Instagram account. Videos on Instagram depict actual therapy sessions featuring practical solutions and treatment methods.
School SLP Opportunities
We hope these tips and resources for diagnosing and treating childhood apraxia of speech make a useful addition to your school SLP toolbox. Find out where your specialized skills as a school SLP are needed most with Cross Country Education today.