Speech Therapy for Children with CAS

Diagnosis of CAS

Childhood apraxia of speech, otherwise known as CAS, is a neurologically-based speech disorder in which the child struggles with the motor planning and execution of the complex oral movements required to produce sounds into motor units.  Although there are no standard diagnostic criteria to determine if a child has childhood apraxia of speech, professionals agree upon three primary features which include:

1. Inconsistent errors on consonants and vowels in repeated productions of syllables or words, which means a word may not be said the same way each time it is attempted by the child.
2. Lengthened and disrupted coarticulatory transitions between sounds and syllables, which means the sounds, syllables, and words may be distorted or altered resulting in broken or choppy sounding speech.
3. Inappropriate prosody, especially in the realization of lexical or phrasal stress between sounds and syllables, which means the rhythm and inflection may sound off and stress may be placed on the wrong syllable or word.  

A child with CAS may be very difficult to understand. Principles of motor learning are often incorporated into the treatment plan for a child with CAS. However, to treat a child with CAS, a plan should be based on individual needs and the strengths of the child.  Continue reading to understand what is important to address in therapy to successfully treat children with childhood apraxia of speech.  ​

​Treatment for CAS Explained

​Speech therapy for childhood apraxia of speech or CAS should be tailored to the child's specific needs, but most treatment plans aim to improve speech clarity.  Children with CAS initially require frequent direct speech therapy sessions.  Treatment may begin with imitation of motor movements and quickly transition to imitation of sound combinations.   Specific targets chosen should be individualized and functional for the child.  Treatment should focus on frequent practice of functional motor units (whole words) so that sounds are practiced within coarticulatory contexts.  Therefore, a speech-language pathologist may progress from consonant-vowel syllable combinations such as “no,” to consonant-vowel-consonant-vowel combinations such as “no no,” to consonant-vowel-consonant combinations such as “nope.”  Additional sounds or structures are added into order to teach longer and more complex words.  Once the child masters targeted words, then treatment may focus on gradually increasing the length and complexity of phrases, sentences, and connected speech to address improved flow while addressing stress and rhythm through changes in pitch, rate, and volume.

In order to improve accuracy of productions, additional strategies may be utilized such as tacile (or touch) cues, visual cues, or auditory (listening) cues.  Cues are faded as the child succeeds in order to increase independence.  Childhood apraxia of speech does not always occur on its own.  Frequently, it is accompanied by additional articulation or phonology disorders.  Therefore, additional treatment strategies may be implemented based upon individual strengths and weaknesses.  In some cases, severe cases of CAS may require alternative/augmentative communication (AAC) if speech skills are not adequate to support functional communication.  AAC is the use of non-verbal communication (for example: gestures, pointing, leading caregivers), signs, symbols, pictures, books, and/or devices which assist with communication.  AAC will help supplement or, in some cases, replace natural speech and writing with symbols.  

​The Goal of Treating CAS

Although the treatment for a patient with CAS needs to be individualized to meet the child’s strengths and weaknesses, there are common goals attached to every case.  Through treatment, we target planning and making the movements necessary to improve speech production and intelligibility.  Frequent consistent therapy should help the individual child achieve the highest level of speech function.  Intervention should prepare the child for participation in daily activities through functional communication.  This is achieved by improving speech production for effectiveness, efficiency, and naturalness. However, every case will vary slightly, which means that every therapy plan will be individualized.  Some children with CAS might have other underlying disorders or challenges to address.  Treatments for those disorders are taken into consideration when coming up with a therapy plan and are often addressed alongside the treatment for childhood apraxia of speech.  The one common goal is improving the patients’ speech production.