Childhood Apraxia of Speech (CAS) is a severe speech disorder where children have significant difficulties planning, coordinating and using their articulators to speak clearly. These difficulties involves the use of their tongue, lips, and jaw which make them very difficult for others to understand and are often observed when the child is first learning to speak. Their ability to “program” and “plan” their movements for speech is significantly affected.
In Ontario, only doctors are able to convey any kind of medical diagnosis, including Childhood Apraxia of Speech. This is a connundrum in that knowledgeable Speech-Language Pathologists are actually the most appropriate professional to diagnose CAS, not a doctor. In other parts of Canada as well as in the United States, Speech-Language Pathologists are able to use their assessment results as well as clinical judgment to make this diagnosis. So in Ontario, we often use a larger, umbrella term of “Motor Speech Disorders” to refer to children who would otherwise be diagnosed with Childhood Apraxia of Speech.
These types of difficulties can significantly affect how easy it is for others to understand what your child is saying.
Children with Motor Speech Disorders have difficulty planning and moving their articulators such as their tongue, lips, jaw, and using their facial muscles to produce specific movements for speech. Sometimes it affects the way they make vowel sounds such as “ah” (as in “got”), because they are not opening their jaws large enough and it sounds like “uh” (as in “gut”).
Maybe they are having difficulty planning and moving their lips so they do not put their top and bottom lips together for the sounds “m”, “b”, “p”. Or they might not be making their lips round enough for sounds like “oh” and look like they are smiling all the time when they are talking. These types of difficulties can significantly affect how easy it is for others to understand what your child is saying.
For children with suspected Childhood Apraxia of Speech, the best approach is to start with a thorough assessment looking at your child’s ability to plan and move their articulators for speech production. The Speech-Language Pathologist will then be able to confirm the presense of a Motor Speech Disorder and to figure out what movements and sounds they need to work on.
Some popular therapy techniques and programs for targeting Motor Speech Disroders include:
The Kaufman Speech to Language Protocol
There is varying and limited amount of evidence-based research supporting the use of each specific program mentioned for the treatment of Motor Speech Disorders and caution is recommended when evaluating how much your child benefits from a specific treatment technique.
PROMPT therapy (Prompts for Restructuring Oral Muscular Phonetic Targets) involves the use of touch cues on the child's articulators and face to help them learn how to properly move their articulators.
For example, the child might be having difficulty with using round lips to produce the sounds “oo”, “oh”, “sh”, and “w”, the trained Speech-Language Pathologist might gently pinch their cheeks in order to help them to use a round mouth.
The Kaufman Speech to Language Protocol targets simplified versions of words using word shells starting with the easiest version of a word and progressively becomes closer to the actual word.
For example, the word “apple” might be too difficult for a child with motor speech difficulties to produce. They would first attempt to produce “ah-o” and as they improve their ability to produce “ah-o”, then they would target “ah-puh”. As they progress, they would target less simplified word shells and move closer and closer to the actual word.
Talk Tools© is an oral motor placement therapy that uses programs such as horn blowing and jaw strengthening bite blocks. The use of their tools is to provide tactile cues and support while targeting the related sounds.
For example, specific horns will encourage lip rounding due to a round mouth piece and the child is encouraged to make repetitive blowing using that horn to work on skills such as breath support, lip rounding, and tongue retraction.
Although Talk Tools is a popular program, please note that the use of oral motor exercises in the absence of targeting speech sounds is a controversial approach as there is little research support for improvement in speech production if ONLY oral motor exercises are used.
Basically if you practice blowing cotton balls with a straw, you will become really good at blowing cotton balls, but it would have little effect on your ability to produce challenging sounds without actually practicing those sounds.
At Smile Speech Therapy, we have Speech-Language Pathologists who are knowledgeable about Motor Speech Difficulties with training in PROMPT, Kaufman Speech to Language Protocol as well as TalkTools. We look forward to discussing the different treatment options available and look forward to hearing from you!Contact Us
1. CASANA--Childhood Apraxia of Speech Association of North America. http://www.apraxia-kids.org/
2. The PROMPT Institute
Phone: (416) 488-7807
Fax: (416) 488-7815