Childhood Apraxia of Speech - How Can I Evaluate?

CAS Evaluation

[This series explores issues related to Childhood Apraxia of Speech, including assessment and treatment.]

Childhood Apraxia of Speech (CAS) can be difficult to properly identify because diagnostic guidelines and tools are inconsistent. CAS also shares characteristics with other speech sound disorders, including dysarthria and even dysfluency/stuttering. As a result, careful evaluation and diagnosis are essential.

To date, there are no screening materials available that are specific to CAS. And to complicate matters further, CAS is typically identified through observations made over the course of treatment.

Any evaluation of CAS needs to include some of the following elements to account for the multi-faceted nature of the condition and its similarities to other disorders:

1. Case history
2. Oral mechanism examination
3. Speech sound examination
4. Motor speech examination
5. Language testing, if needed

Especially in motor speech testing, consistency and accuracy of production are key to differentiating between CAS, dysarthria, and other speech disorders. Motor speech tasks can include nonspeech articulatory postures such as smiling, single sounds vs. words, speech production at every length of utterance from syllable to sentence, and repetitive CVCV patterns (i.e., papapa, etc.)

If CAS is suspected, clinicians should monitor productions for fluency, rate, consistency, and lexical stress. Dynamic assessment procedures (Test-Teach-Retest) can also be enormously helpful in cases of CAS due to the inconsistency of errors. Using dynamic assessment, clinicians may use varying degrees of verbal and gestural cueing to determine how much cueing is necessary or beneficial.

For children under three years old, CAS diagnosis can be challenging because many of the hallmarks of CAS can be obscured by the potential presence of other conditions or disorders, features of typical emerging speech, and the lack of a single, validated list of reliable diagnostic features. Recent research indicates that the speech of children with CAS may differ subtly from that of other children with similar development, even at this age. Differences pointing to CAS include:

1. Fewer vocalizations
2. Fewer consonants
3. Later consonant acquisition
4. Less diverse phonetic skills (Overbey, Caspari, & Schreiber, in review).

Given all of the many factors at play, ASHA recommends a provisional diagnostic label for children under 3, including "suspected to have CAS" or "CAS cannot be ruled out."

Future installments in this series will explore treatment options and activities for children with CAS.

Have questions about CAS or other speech disorders? Ask a Sidekick therapist today!

Paul Rice, M.S., CCC-SLP