In Childhood Apraxia of Speech vs Other Speech Isms and Childhood Apraxia of Speech vs Other Speech Isms, we discussed the differences between childhood apraxia of speech (CAS) and other speech disorders. These distinctions are important for understanding and obtaining an accurate diagnosis and appropriate treatment for your child. In this article, we will discuss three steps to help you attain these goals.
Locate a Speech-Language Pathologist with Appropriate Experience
Not all speech-language pathologists (SLPs) are trained equally. The field of speech-language pathology is very broad, and SLPs have different types and levels of training and experience. Additionally, few children have what is considered “pure” CAS, so many SLPs do not gain extensive CAS experience. Therefore, try to look for an SLP who knows and understands the specific characteristics of CAS versus other speech disorders as discussed in the articles above.
What to Look For
Has experience with appropriate assessments (1) such as:
The Verbal Motor Production Assessment for Children,
The Apraxia Profile, the Kaufman Speech Praxis Test for Children, and/or
The Assessment of Verbal Dyspraxia.
Can identify concurrent speech problems such as those found in a child who has both childhood dysarthria and CAS as discussed in What is Childhood Apraxia of Speech?.
Explains assessment findings and treatment planning in a way that “makes sense” to you.
Develops a detailed treatment plan that incorporates systematic, mindful and meaningful speech practice that will lead to usable speech.
What Does Effective Childhood Apraxia of Speech Treatment Look Like?
There are many combinations of approaches that may help your child. Beware of “cookie cutter” or “cookbook” approaches that reportedly work for all children with a particular disorder. Each child is unique and requires individualized treatment. Here are a few components that may be part of an effective CAS treatment plan. (2)
Two Basic Treatment Approaches
I personally use a combination of bottom-up and hierarchical speech treatment approaches, while other therapists may primarily use one or the other.
A bottom-up approach usually begins with vowel sound production. Then moves to consonant-vowel words such as “me”, vowel-consonant words such as “up”, and so on.
The Kaufman Speech Praxis Treatment Kit for Children is a well-known example of a bottom-up approach.
A hierarchical approach begins with the sounds a child can already say and expands speech from those sounds. David Hammer, a well-known SLP who teaches about CAS internationally, uses a hierarchical approach where he devises a personalized speech program for each child by expanding upon the speech sounds and sound combinations a child can say.
For example, if a child can say “bah,” then speech may be expanded into words such as “bus” and “bun.”
Systemic, Mindful & Meaningful Speech Practice
Since many children with CAS have difficulty imitating speech, I often begin practicing speech in unison with the child. This technique is also known as simultaneous production or chorale speaking. This takes the pressure off of the child because the child and the facilitator are doing the work together.
As the child is successful, cues are faded and speech practice moves systematically through stages. For example, mouthing/whispering words, imitating words, or saying words in response to pictures/questions/situations, until usable, functional speech is attained.
This approach is based on the work of Edythe Strand and Jay Rosenbek. Systematic, mindful and meaningful speech practice is where words are practiced in a variety of meaningful contexts with the child paying attention to the practice. It is not repeating like a parrot. Systematic, mindful and meaningful speech practice leads to the generalization needed for usable speech.
Hands-On Speech Facilitation
When a child cannot say targeted vowels or speech sound sequences in unison with the therapist, some form of hands-on speech facilitation may be needed. This is recommended if you and your child are comfortable with this approach.
Hands-on speech facilitation means that the therapist and trained parent show the child how speech is produced by placing hands, fingers, and/or tools on specific mouth structures to help the child learn speech movements.
Two Forms of Hands-On
Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) by Deborah Hayden
Pamela Marshalla and Sara Rosenfeld-Johnson also practice hands-on speech sound placement through the use of many specific tools. Tools such as bite blocks or popsicle sticks are placed between the back molars to attain appropriate jaw heights for specific speech sounds.
Cues at the Place of Articulation
When a child does not or no longer needs hands-on help to produce speech, speech cues presented at the place of articulation such as the mouth may be used.
These are specific hand gestures completed near the therapist’s or parent’s own mouth to cue specific speech sounds and sound combinations. A list of such cues can be found in A Parent Guide to Verbal Dyspraxia by Judy Jelm.
Cued speech is another form of this type of cueing.
Hands and mouths are meant to work together. Just image what it would be like to speak without moving your hands. Speech approximations are often heard along with hand movements. Consider gestures, sign language, the manipulation of pictures, and the use of pacing boards.
Many parents express the concern that their children will not need to speak if using sign language or pictures to communicate. However, increased speech attempts are often heard during the use of these methods, and research supports this finding.
Explore More >> Develop Language with PECS and Sign Language
Pacing boards are used to encourage speech sound blending, as well as word, phrase, and sentence production. Circles can represent consonants, and lines can represent vowels.
For example, o—o— could be used to encourage the production of words such as “mama,” “moomoo,” “baabaa,” etc.
When using a pacing board, the child’s hand or finger moves along the circles and lines as the child attempts the word. I was truly surprised the first time I heard children producing speech using this method.
A Phonics-Based Reading Program
Children with CAS are at risk for reading and associated academic difficulties. A phonics-based reading, spelling, and vocabulary development program may be used to teach speech as well as related academics. I prefer one that begins with the teaching of long vowels because long vowels are more readily heard and said than short vowels.
On such program is the Stevenson Language Skills Program.
Become a Partner in Your Child’s Treatment Process
With the assessment complete and a systematic treatment plan outlined, you will become a partner in your child’s treatment. The amount of practice needed outside of therapy will depend upon the severity of your child’s CAS.
You will likely work with your child daily. The SLP will ask you to follow through with strategies used in treatment to provide repeated practice opportunities throughout each day.
As we said in What is Childhood Apraxia of Speech?, children with CAS need to systematically “practice, practice, practice speech sound combinations” to develop the motor programs for speech, and parents are part of this process.
Below are three websites that can help parents become partners in the CAS treatment process:
Cherab – a website designed for parents of children with verbal and oral apraxia/dyspraxia
Practical Parenting…With a Twist – a blog by Leslie Lindsay, author of Speaking of Apraxia: A Parents’ Guide to Childhood Apraxia of Speech
I hope I have helped you understand the very complex nature of CAS through this 3-part article series. I wish you and your child the best in resolving your child’s CAS/verbal dyspraxia.
(1) Bahr, Diane Chapman., and Argye Elizabeth. Hillis. Oral Motor Assessment and Treatment: Ages and Stages. Boston: Allyn and Bacon, 2001. Print.
(2) Bahr, Diane Chapman. Nobody Ever Told Me (or My Mother) That!: Everything from Bottles and Breathing to Healthy Speech Development. Arlington, TX: Sensory World, 2010. Print.