The renowned author Paul J. Meyer once said, “Communication – the human connection – is the key to personal and career success” (Paul J. Meyer Quotes). The key to achieving success in all facets of life is through communication. In truth, communication is how individuals get by in their day-to-day lives. It is how we express our feelings, how we acquire that which we need from our peers, and how we tackle the different ventures in our day. Speech is at the core of interpersonal relationships, and an inability to speak to others hinders “personal and career success” (Paul J. Meyer Quotes). Childhood Apraxia of Speech (CAS) is one pathology that considerably inhibits interpersonal communication in everyday life.
The National Institute on Deafness and Other Communication Disorders defines Apraxia as a “neurological disorder that affects the brain pathways involved in planning the sequence of movements involved in producing speech” (Apraxia of Speech 2018). Children with Apraxia of Speech know what they wish to say, however, they struggle with the motor skills necessary to form verbal utterances. Childhood Apraxia of Speech can be a devastating pathology, as children wish to interact with people and the world around them, yet their inability to speak holds them back.
Childhood Apraxia of Speech affects 1-2 children in every 1,000 (Iuzzini-Seigel, Hogan, & Green 2017). Effects of this congenital condition can last beyond childhood. Adults that retain their Apraxia are reported to have lower socio-economic status than those with normal speech and an increased incidence of depression. Regardless of intelligence, adults with CAS have also been found to choose jobs that require a limited amount of socialization (Murray, McCabe, & Ballard 2012). Clearly, Childhood Apraxia of Speech is a debilitating pathology that can affect individuals throughout their lives.
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Childhood Apraxia of Speech has distinct features that illustrate the child’s inability to plan their utterances. Although CAS symptoms vary across children, it is generally characterized as a constant struggled speech with distortions of vowels and consonants and voicing errors. Children with CAS tend to stretch out and interrupt the transitions between sounds and syllables, and their prosody, especially in the realization of phrasal stress, is erroneous. These issues may carry over and language problems may occur as children with CAS struggle with word order and a reduced vocabulary (Vellman 2011).
Children with CAS will characteristically have tentative and hesitant jaw, lip, or tongue movements as they struggle to make the correct speech sound. They may have inappropriate placement of the stress in words, such as an initial stress in the word “banana” as they say “BUH-nana” as opposed to stressing the syllable at the end as it should. Sometimes, children with CAS will exhibit an emphasis on all syllables of a word when only one syllable of a word requires stress as well as place a gap between the syllables of a word. Children will struggle to imitate easy words and display inconsistent errors as their mispronunciation the second time they say a word will differ from the first (Childhood Apraxia of Speech 2017).
There are multiple possible causes for Childhood Apraxia of Speech. CAS can come together with neurological etiologies such as infection, trauma, a tumor in the brain, and an early childhood stroke. It may come along with neurobehavioral disorders such as epilepsy, autism, and Rett syndrome. However, generally, it is also quite common that a doctor cannot determine the cause of a child’s Apraxia of Speech (Childhood Apraxia of Speech 2017). The KE family sought to find a genetic aspect involved with Childhood Apraxia of Speech, being that many members of the family had Apraxia of Speech. They found that there is a deficit in the FOXP2 gene which adversely affects the development of neural networks associated with learning and execution of the motor aspect of speech (What Do Researchers Know about Genetics and CAS?).
Speech Language Pathologists (SLPs) will often have children with Childhood Apraxia of Speech on their case load. SLPs find that those with CAS make slow therapy progress and they tend to lose the skills as treatment ends with no carry over. This may be due to the child’s impaired learning or a lack of knowledge on effective treatment options. Therefore, it is integral to aim the treatment at a long-term maintenance of the skills that the client is learning and generalization of these learned skills to affect all speaking contexts.
Nuffield Dyspraxia Programme – Third edition (NDP3) has a list of five hundred words to be worked on in therapy for children with Childhood Apraxia of Speech. The idea behind this therapy is that learning is hierarchical and needs to be reviewed and practiced to master base levels in order to move on to harder levels of speech. Success in this therapy is considered independent, fluent, and automatic speech productions. Five case studies show successful results for this type of treatment.
Rapid Syllable Transition Treatment (ReST) is another treatment option used by Speech Language Pathologists for clients with Childhood Apraxia of Speech. In this method the goal is to maintain the skills learned in the therapy long- term. In this therapy, clients undergo intense and rigorous practice in saying multisyllabic words. This helps to progress their accuracy of speech sounds, their capability to transition between syllables fluently, and their control of prosody in their utterances. Evidence has shown that using fake words in this practice has actually improved production of real words that are simpler. Two case studies with ten children who underwent this treatment have shown positive outcomes and improvements leading to further studies in this therapy (Murray, McCabe, & Ballard 2012).
Another treatment option that has proven to be somewhat effective is the K-SLP approach. In this treatment, a word that the client cannot say is selected and the clinician finds the closest approximation that the child is able to say to mimic that word. For example, if the child cannot say the /t/ phoneme, the therapist would teach the child to say “mado” instead of “tomato”. Once the child masters this approximation, the therapist gradually teaches the child more approximations until the client can produce the word in an adultlike manner.
This idea stems from B. F. Skinner’s approach of verbal shaping. Skinner holds that through “progressive approximations,” or reinforced smaller easier utterances, a child can eventually learn to imitate adultlike complex linguistic structures. Therefore, in K-SLP, the therapist will focus on taking the consonants and vowels that are already in the child’s repertoire and use them to shape them into higher and more complex areas of speech.
A study was conducted by Gomez, McCabe, Jakielski, and Purcell to test the effectiveness of this method. They administered this test to two children with Childhood Apraxia of Speech where the treatment was done for three weeks in one-hour intervals, twelve times. At the end of the three weeks, the percentage of correct phonemes were observed and the numbers illustrated that the children did respond well to the treatment. In fact, one of the two children improved significantly in her segmental and suprasegmental skills. Her fluency was maintained in her follow up a week later and at the follow up three months later, her speech was nearly stutter free. However, the other child did not respond as well to the treatment as the first one did.
Although he did display an accurate pronunciation of target words during the session, there was no generalization of his learning external to the therapy session. Therefore, the researchers suggest that, “Further research is needed to determine if these results are replicable before the K-SLP approach can be interpreted as demonstrating adequate and reliable research evidence for clinical practice” (Gomez, McCabe, Jakielski, & Purcell 2018).
Children who are diagnosed with Childhood Apraxia of Speech have a devastating situation in which they cannot verbalize that in which they wish to say. This can take a great toll on the emotions of a child. A research interview was conducted to understand the emotions that a child with Childhood Apraxia of Speech, as well as parents undergo. Fraser, a seventeen-year-old boy with Childhood Apraxia of Speech reported his struggles in school due to his difficulty in this interview. He reported, that he continually struggles with spelling, reading, and auditory memory. Fraser did not have much intervention as a child although he did receive some early intervention where he was taught to communicate using Makaton key word signing, a method of communication similar to sign language. Fraser never had direct speech therapy due to the lack of services where he lived.
However, his mother had access to some speech therapy activities and she administered them to her son herself. The interviewer noted that at the time of the meeting, Fraser’s speech was intelligible aside for the occasional articulation error such as /f/ for /ð/ and /w/ for /r/. Fraser described his difficult childhood experience with his peers. He explained that, “There were very few that actually tried to understand, and they would be closer friends. The rest of them just didn’t really care – they’d just walk away.”
Fraser even experienced bullying for his disability so he began to, “walk away from it [bullying] – I learn it from the past. If it’s verbal … I do it back to them or I walk away. If it’s physical, well there’s nothing I can do. So, I have to stand there – either get hit myself or fight back. And after a while I started to fight back and it started to work.” Fraser reported his inability to join extracurricular activities such as debating out of fear of being ridiculed (McCormack, McAllister, McLeod, & Harrison 2012). Evidently, Childhood Apraxia of Speech has a major impact, not just on the speech of a child, but their overall quality of life.
Communication is essential for an individual to thrive in his or her every day life. When that ability is hindered, especially for a child with Childhood Apraxia of Speech, it can be extremely torturous for the individual as well as for the family. A close friend of mine has a sister who had Childhood Apraxia of Speech as a young girl. She reports that she would sit on the steps in her house, cross her arms, and cry because she could not express herself to her siblings and parents. This is the effect of a lack of communication. Our ability to speak is how we thrive on a day to day basis and when that ability is limited, it can affect an individual’s disposition dramatically.
Although the causes are not all that evident to researchers, there are numerous treatment options such as Nuffield Dyspraxia Programme – Third edition (NDP3), Rapid Syllable Transition Treatment (ReST), and K-SLP which can assist a child with planning their utterances in terms of the motor aspect of speech. It is important for Speech Language Pathologists to keep in mind that they do not see the whole story of the child when they are coming into the session. Children with CAS have reported to be bullied, and their abilities to contribute to those around them feel limited, as reported by Fraser. It is in the hands of the Speech and Language Pathologist to show the child that although they may be lacking at the moment, it will not be long before they have the confidence and ability to take on the world around them with their improved ability to communicate.
Work Cited
- Apraxia of Speech. (2018, April 30). Retrieved from https://www.nidcd.nih.gov/health/apraxia-speech
- Childhood apraxia of speech. (2017, August 09). Retrieved from https://www.mayoclinic.org/diseases-conditions/childhood-apraxia-of-speech/symptoms-causes/syc-20352045
- Iuzzini-Seigel, J., Hogan, T. P., & Green, J. R. (2017). Speech inconsistency in children with childhood apraxia of speech, language impairment, and speech delay: Depends on the stimuli. Journal of Speech, Language and Hearing Research (Online), 60(5), 1-17. doi:http://dx.doi.org/10.1044/2016_JSLHR-S-15-0184
- Gomez, M., McCabe, P., Jakielski, K., & Purcell, A. (2018). Treating childhood apraxia of speech with the Kaufman speech to language protocol: A phase I pilot study. Language, Speech & Hearing Services in Schools (Online), 49(3), 524-536. doi:http://dx.doi.org/10.1044/2018_LSHSS-17-0100
- McCormack, J., McAllister, L., McLeod, S., & Harrison, L. (2012). Knowing, having, doing: The battles of childhood speech impairment. Child Language Teaching and Therapy, 28(2), 141-157. doi:http://dx.doi.org/10.1177/0265659011417313
- Murray, E., McCabe, P., & Ballard, K. J. (2012). A comparison of two treatments for childhood apraxia of speech: Methods and treatment protocol for a parallel group randomized control trial. BMC Pediatrics, 12, 112. doi:http://dx.doi.org/10.1186/1471-2431-12-112
- Paul J. Meyer Quotes. (n.d.). Retrieved from https://www.brainyquote.com/quotes/paul_j_meyer_190945
- VELLEMAN, S. L. (2011). Lexical and phonological development in children with childhood apraxia of speech – a commentary on stoel-gammon’s ‘relationships between lexical and phonological development in young children’*. Journal of Child Language, 38(1), 82-6. doi:http://dx.doi.org/10.1017/S0305000910000498
- What Do Researchers Know about Genetics and CAS? (n.d.). Retrieved from https://www.apraxia-kids.org/library/what-do-researchers-know-about-genetics-and-cas/
