Apraxia seems to be a "hot diagnosis" of late and quite overused.
Parents and even professionals seem to be a bit confused on the difference between apraxia and articulation disorders. I intend to clear up this confusion right now.
Definition of Apraxia
First things first, the most accepted term now is Childhood Apraxia of Speech (CAS).
CAS is a speech sound disorder which is neurologically based. There is no presence of muscle weakness or decreased tone. Only about 3-4% of children with speech sound disorders have CAS so it is rarer than most might think.
Key Characteristics of Apraxia
There are some key characteristics of CAS that differentiate it from other articulation disorders.
1. Motor difficulties
- Groping of facial muscles during speech tasks
- Difficulty voluntarily moving articulators or initiating speech
- Reduced coordination of articulators, especially on diadochokinesis tasks “pa-ta-ka”
2. Speech Sounds Errors
- Inconsistent errors - children will produce some sounds correctly some of the time and incorrectly at other times.
- The number of errors increases with longer and more complex syllables. This can be seen in some articulation disorders but not always.
- Regression of previously learned sounds
- Automatic speech tasks such as counting, singing, and yawning are easier
- May speak with an odd rate
- May use a monotone voice
4. Speech Perception
- May have difficulty with auditory discrimination
- Expressive and receptive language deficits are VERY common in conjunction with CAS. This is not always true with other speech sounds disorders.
At this time, I am not aware of any standardized measure for diagnosing CAS. This is a HUGE problem!
My current suggestions for assessment:
- Complete an articulation standardized test
- Complete an expressive/receptive language standardized test
- Take a language sample
When evaluating the results, consider these following questions:
- Articulation: Are errors typical or atypical? Are speech errors consistent across speech tasks and/or setting?
- Language: Is there a language delay?
- Coordination of articulators: Can the child complete diadochokinesis tasks appropriately?
- Prosody: Does the child speak with an appropriate rate of speech?
- Volitional oral motor skills: Does the child have difficulty initiating speech? Is he or she better at automatic speech tasks?
- Motor delays, fine and gross: Does the child have other gross or fine motor delays? Is the child seeing a physical or occupational therapist?
Treatment, in general, is more intense (more and/or longer sessions) when compared to typical articulation therapy.
1. Motor learning approach
- Uses verbal, visual, and tactile cues
- Productive feedback is crucial
- Fade cues as child improves
- Encourage and teach self-monitoring
- Consistent practice across settings
2. Integral Stimulation **Research proven to work**
- Bottom-up approach with fading cues
- Encourage child to look at therapist while therapist uses max cueing when needed
- Child has to be able to imitate
- Uses tactile cues
- Touch stimulates articulation movements
- Creates new motor patterns
- Behavior approach
- Errorless teaching
- Systematic approach
- Begins with approximations and works up to more complex syllables/consonants
5. AAC devices (more severe cases)
- Decreases frustration with difficulty communicating
- Gives a child a voice
- Gets child motivated to work on communication since communication is power!
5. Rapid Syllable Transition (ReST) **Research proven to work**
- Uses principles of motor learning
- Teaching/learning components
- Use of non-sense words
- Manage beats, sounds, smoothness of non-sense words
- Amount of feedback will vary
6. Dynamic Temporal and Tactile Cueing (DTTC) **Research proven to work**
- Usually used for severe, non-verbal children who are not imitating
- Form of integral stimulation
- Strict 8-step continuum for tasks and cueing
7. Integrated Phonological Awareness Intervention
- Linguistic treatment
- Understand word sound structure/phonological awareness
*** No oral motor exercises: There is no evidence that working on non-speech tasks will improve speech production for CAS...so just don't do it.