Ax of CAS

Question 1

General case history qs

Answer 1

• Babbling
• Use of gesture
• Feeding, swallowing
• Family history, including academic
• Motor development, self-help skills
• Socialization

Question 2

Non-speech motor function in case history

Answer 2

• General sensorimotor organisation
• Oral sensorimotor organisation

Question 3

General sensorimotor organisation

Answer 3

• Posture and gait, movement
  patterns
• Gross and fine motor coordination

Question 4

Oral sensorimotor organisation

Answer 4

• Overt paresis, asymmetry
• Mouth posture, saliva control

Question 5

ICF components

Answer 5

Body functions and structures, activity, participation, environmental factors, personal factors

Question 6

body structure

Answer 6

• CAS is associated with functional impairment rather than structural impairment
• Comorbidity? - DLD/hearing impairment as well?
• Oro-motor examination
• Onward referral e.g. ENT is needed

Question 7

body function (11)

Answer 7

1. Vowel error
2. Consonant distortion
3. Stress errors
4. Syllable segregation
5. Groping
6. Intrusive schwa
7. Voicing error
8. Slow rate
9. Increased difficulty with multisyllabic words
10. Resonance or nasality disturbance
11. Difficulty achieving initial articulatory configurations or transitional movement gestures

Question 8

Vowel errors

Answer 8

• obvious sign of apraxia
• Iuzzini-Siegel et al., 2017: 100% of participants with CAS (n=20) had vowel errors, only 10% of children with speech delay

Question 9

vowel errors implication

Answer 9

ensure vowels are assessed in single word pronunciation and in imitation

Question 10

Consonant deletion

Answer 10

• not a defining feature
• Precision is impaired, but
  phonological knowledge is present

Question 11

consonant deletion implication

Answer 11

ensure data sample
includes range of target sounds in single word and connected speech

Question 12

stress errors

Answer 12

• Can only be identified in contexts that contain contrastive syllable stress.
• Difficulties with lexical stress (Murray et al., 2015)
• Difficulties with sentential stress (Shriberg et al., 2011)

Question 13

stress errors implication

Answer 13

Must assess using multi-syllable words and phrases

Question 14

Syllable segregation

Answer 14

• Equalization of stress, duration, intensity and pitch across syllables; stress
  may not vary appropriately
• 5% of children with CAS vs 30% of children with other SSD
• Moderately sensitive and specific feature

Question 15

Syllable segregation implication

Answer 15

include varying stress in stimuli, diacritics are important

Question 16

Groping

Answer 16

• Long established
• Compensatory or core?
• Murray et al., (2015): groping
  accurately identified 54% of
  preschool participants with CAS
• Consistent with CAS, but not
  mandatory
• May be specific, but not sensitive

Question 17

Intrusive schwa

Answer 17

• Schwa insertion (epenthesis) within cluster
• Common error in SSD
• Consistent with CAS, but also with many other disorders

Question 18

Intrusive schwa implication

Answer 18

careful transcription

Question 19

Voicing errors

Answer 19

• Common error, but may persist far longer in children with CAS
• Lewis et al. (2004): 90% of preschool and 40% of school aged children with CAS; IzzuniSiegel et al. :17/20 persisted with voice errors

Question 20

voicing errors implication

Answer 20

single word and connected speech

Question 21

Slow rate

Answer 21

• Core or compensatory
• Consistent with CAS but also with many other SSD
• Only 18% accurate in predicting expert
  diagnosis

Question 22

Slow rate implication

Answer 22

Consider speech rate

Question 23

Increased difficulty with multisyllable words

Answer 23

• Occurs across many SSD
• Requires careful assessment and balancing of stimuli
• Questionable

Question 24

Increased difficulty with multisyllable words implication

Answer 24

careful selection of target multisyllable words in assessment

Question 25

Resonance or nasality disturbance

Answer 25

• Inconsistent resonance patterns
• May be difficult to assess reliably
• If persistent, consider referral to ENT
• Motor rather than structural explanation

Question 26

Resonance or nasality disturbance implication

Answer 26

collect data over time; record and evaluate

Question 27

Speech sound inconsistency

Answer 27

• Extent of inconsistency is relevant: at the phonemic level
• Children with high inconsistency (18% or higher) also presented
  vowel and voicing errors: convergence of features
• Phonemic inconsistency may be more sensitive than lexical
  inconsistency
• “buy Bobby a puppy” x 5

Question 28

3 key areas that suggest CAS over other SSDs:

Answer 28

1. Inconsistent errors on consonants and vowels in repeated productions of syllables and words.
2. Lengthened and disrupted coarticulatory transitions between sounds and syllables (e.g. pauses in inappropriate places, sounds jerky).
3. Inappropriate prosody, especially in lexical or phrasal stress.

Question 29

Comprehensive ax includes: (6)

Answer 29

Case history
Oral-motor skills, including DDK rates
Speech assessment with repeated attempts
Repetitions of multi-syllabic words
Connected speech sample
Receptive and expressive language assessment

Question 30

What is DEMSS?

Answer 30

Dynamic Evaluation of Motor Speech Skill

Question 31

What is the DEMSS scoring like?

Answer 31

Articulatory accuracy
◼ 0=correct on first attempt
◼ 1=consistent developmental substitution error
◼ 2=correct after first cued attempt
◼ 3=correct after two or three additional cued attempts
◼ 4=not correct after all cued attempts

Vowel accuracy
◼ 0=correct
◼ 1=mild distortion
◼ 2=frank distortion

Question 32

What does DEAP stand for?

Answer 32

Diagnostic Evaluation of Articulation and Phonology

Question 33

What does the DEAP consist of?

Answer 33

• Diagnostic screen
• Articulation Ax
• Oro-motor Ax
• Inconsistency Ax

Question 34

DEAP diagnostic screen procedure

Answer 34

If the child cannot imitate sounds that 90% of children their age can imitate, the Articulation and Oro-Motor assessments need to be administered. If the child has an inconsistency
rating of 50% or more, administer the Inconsistency and Oro-Motor assessments.

Question 35

DEAP Articulation Ax procedure

Answer 35

Compare the child’s consonant errors to the norms on P.11 of the Irish Standardisation manual (90% of children) to determine if a speech difficulty is present. Any vowel errors are considered a sign of an articulation difficulty.

Question 36

DEAP oro-motor Ax procedure

Answer 36

Calculate the standard scores and percentile ranks for DDK, Isolated movement and Sequenced movement in the Irish manual. Standard Scores of 7-13 denote typical performance.

Question 37

DEAP Inconsistency Ax procedure

Answer 37

A score of 40% or more suggests either an inconsistent phonological disorder or CAS

Question 38

Differential Diagnosis between Developmental Verbal Disorder
(CAS) and Inconsistent Phonological Disorder, according to DEAP Manual:

Answer 38

DVD
- Poor Oro-motor Ax
- Worse word prod. in imitation than spontaneous speech
- Difficulty with speech sounds in isolation and may have C&V distortions
- Slow laboured speech with atypical intonation patterns

Inconsistent disorder:
- Normal Oro-motor Ax
- Word prod. better in imitation than spontaneous speech
- Can produce most speech sounds in isolation
Fluent speech with normal intonation patterns despite lack of intelligibility

Question 39

Nuffield Dyspraxia Ax: elicit __ (2) by imitation?

Answer 39

• Elicit consonants and vowels by imitation
• Elicit phrases and sentences by imitation, supported by pictures.

Question 40

Nuffield Dyspraxia Ax: elicit __ (5) by picture naming?

Answer 40

• Elicit CV and VC words by picture naming.
• Elicit C5)VC words by picture naming.
• Elicit CVCV words by picture naming.
• Elicit complex and multisyllabic words by picture naming.
• Elicit consonant cluster words by picture naming.

Question 41

Nuffield Dyspraxia Ax: other tools

Answer 41

• Record a sample of typical spontaneous connected speech in conversation or a story-retelling task.
• Oro-motor assessment: Lips and Jaw, Tongue, Airstream, Voice, Palate.
• DDK assessment: Syllables and words.
• Throughout there are questions such as “Are sounds joined smoothly?” “Any voice/prosodic features to comment on?”