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CHILDHOOD APRAXIA OF SPEECH (CAS) :

Childhood apraxia of speech, sometimes referred to as developmental verbal dyspraxia, is a neurological pediatric (childhood) speech sound disorder in which the precision and consistency of movements underlying speech are impaired despite the absence of neuromuscular deficits i.e. no abnormal reflexes or muscle tone.

In this disorder, the accuracy and consistency of the movements generating speech are compromised, resulting in errors in speech sound production and prosody.

THE CORE FEATURES OF THIS DISORDER INCLUDE:

• Inconsistent errors on consonants and vowels in repeated productions of syllables or words
• Lengthened and disrupted coarticulatory transitions between sounds and syllables
• Inappropriate prosody, especially in the realization of lexical or phrasal stress.
• Some clinicians believe that the core problem of this disorder includes input processing as well as production. Thus, auditory, sensory, and prosodic aspects of perception can be expected to occur among the manifestations of this deficit.

Whereas some of the definitions of CAS view the core problem as one of planning and programming the spatiotemporal properties of movement sequences underlying speech sound production, others propose that the deficit extends to representational-level segmental and/or suprasegmental units in both input processing and production.

It is unclear whether the deficits that commonly associate CAS are primary deficits or flow-on effects from CAS, comorbid impairments, or perhaps compensatory behaviors, as children with CAS develop their linguistic, phonological, and motor skills concurrently

Theories of the nature of CAS can be divided into the following two general categories: frameworks that focus on suprasegmental perspectives and those that emphasize sensorimotor perspectives.

The complex of behavioral features reportedly associated with CAS places a child at increased risk for early and persistent problems in speech, expressive language, and the phonological foundations of literacy as well as the possible need for augmentative and alternative communication and assistive technology. Therefore, careful assessment procedures are important, because accurate diagnosis leads to appropriate treatment. Identifying specific targeted phonemes a starting point for therapy is very crucial in cases having CAS.

During the evaluation of cases suspected to have CAS, clinicians try to find out if there is sufficient evidence to make the diagnosis of CAS versus (or in addition to) other speech-language problems. While making a diagnosis for CAS, the contribution of abilities that include cognition, language, motor praxis and motor execution have to be considered. Unfortunately, and despite all these considerations, in some cases, it may not be possible to rule in/rule out CAS initially. Moreover, in some cases where CAS is present, it may not be the primary impairment.

Evaluation includes obtaining a full developmental and medical history from parents / caregivers, evaluating the child's communication skills, oral structure, function and motor abilities, oral oscillatory and sequential movements, motor speech production including rapid alternating oral movements (oral diadochokinesis), speech sound inventory, phonological awareness, cognitive evaluation. Evaluation should also involve excluding the existence of any associated difficulties such as Autism Spectrum Disorder.

Treatment of CAS involve many strategies and techniques including, but not limited to; strategies based on motor learning process, articulatory drills, segmentation (syllabification), phonological awareness tasks, feedback techniques in addition to treatment of all other difficulties that may accompany or occur secondary to this disorder such as literacy and fine motor difficulties.

Consistent intensive therapy is crucial to retention of skills acquired and their generalization and transfer to different contexts and settings that the child might be exposed to outside the therapy structured settings.