What is CAS also called?
Childhood apraxia of speech (CAS) also called developmental apraxia of speech (DAS)
What is CAS?
Motor programming disorder of neurogenic origin
What does CAS affect?
Affects articulatory and prosodic parameters of speech production
A child with CAS has difficulty with what?
Child has great difficulty with fine, rapid, voluntary movements of speech.
By adolescence:
most children with CAS are intelligible
Children with CAS have persistent what?
Persistent language processing problems
Children with CAS may have disorder of what?
May have disorders of reading and spelling
Treatment for CAS children may be:
- Tx: sequential organization; simple to complex speech tasks
- We can progress from CV or VC combinations -> CVC->CCVC ->syllable shapes ->words ->phrases -> sentences ->conversational speech
General principles of CAS treatment:
- children may have experienced failure, need initial success in treatment
- Don’t focus on individual sound productions; focus on movement patterns and sequence of sounds (syllables)
- treat more frequently-occurring sounds
- Treatment may start with vowel errors if these are dominant.
- Initial treatment targets: stimulable, early-developing, visible sounds
- treat sounds in order of increase phonetic difficulty (ex: begin with vowels, end with affricates)
- Start with voiceless sounds, progress to voiced sounds
- treat sounds first in word-initial position
- have short breaks; these kids get tired
- do repeated trials (program muscle memory)
- select a core vocab of meaningful words for initial treatment
- Make sure child speaks slowly
- Use a variety of carrier phrases (ex: “here is ___” “I want ____”
What is Multimodality approach?
-For children with severe CAS, may need sign lang or augmentative communication
Phonetic Placement Techniques to Elicit Sound Production:
- Detailed descriptions of “how to”
- Diagrams, pictures
- Get in there and get physical! Use tongue depressors, cotton swabs, mirrors
Prompt:
- Prompts for Restructuring Oral Musculature Phonetic Targets
- Uses kinesthetic, touch pressure, and proprioceptive cues (proprioception: sense of how our bodies are positioned)
- SLP puts her fingers on child’s face and neck to prompt place and manner of production
- These movements may be used in isolation and eventually to chain sounds together into words
- Deborah Hayden
- Used in various countries around the world
- Offers training and certification workshops
- Especially effective for severely involved child (CAS, cerebral palsy, dysarthria (TBI))
Shaping/Progressive Assimilation:
- To get a child to produce a sound, use non-speech gestures or sounds that are not affected
- For example, if child cannot produce /v/, she may be asked to bite her lower lip, turn on her voice, and breathe out
Contrastive Stress Drills:
-Work especially well to teach stress and rhythm of spoken language as well as promote better articulation
-Example for /k/:
SLP: Is your name Ben?
Child: No, my name is Ken.
SLP: Is his name Ken?
Child: No, my name is Ken.
Remember…
- CAS treatment takes years
- Child quickly lose gains if not constantly reinforced!
