Childhood apraxia of speech

CAS

a motor speech disorder

• motor planning or motor programming problems

motor planning

• selecting and sequencing movements

• deciding the order of gestures

• impaired → sounds out of sequence

motor programming

• specifying speed, force, direction

• fine-tuning how movement executes

• impaired → groping, inconsistent movement

the three hallmark diagnostic features

inconsistent errors, disrupted transitions, inappropriate prosody

inconsistent errors

different error, same target, repeated errors

disrupted transitions

lengthened, effortful movement between sounds

inappropriate prosody

flat or misplaced stress patterns

other features

• vowel distortions

• groping/silent searching

• limited sound repertoire

• harder with long utterances

• automatic speech easier than on demand

early red flags

• limited/absent babbling

• family history

• receptive-expressive gap

• frustration, reduced talking

receptive-expressive gap

understands more than they can say

treatment foundations

high practice intensity, simple to complex, multisensory cueing, fading support

high practice intensity

more reps than traditional artic therapy

simple to complex

sequences build gradually

multisensory cueing

auditory, visual, tactile input

fading support

cues withdrawn as accuracy improves

evidence based treatment approaches

dttc, prompt, rest, core vocab

dynamic tactile and temporal cueing (DTTC)

watch, listen, do together; cues fade

prompt

tactile kinesthetic approach - touch cues guide movement

ReST - Rapid syllable transitions

varied-stress nonsense words

core vocabulary - functional word approach

small word set, practices intensively

treatment considerations across settings

dosage over approach, session structure, family involvement, aac as support, measuring progress