Ax of CAS Flashcards
General case history qs
- Babbling
- Use of gesture
- Feeding, swallowing
- Family history, including academic
- Motor development, self-help skills
- Socialization
Non-speech motor function in case history
- General sensorimotor organisation
- Oral sensorimotor organisation
General sensorimotor organisation
- Posture and gait, movement
patterns - Gross and fine motor coordination
Oral sensorimotor organisation
- Overt paresis, asymmetry
- Mouth posture, saliva control
ICF components
Body functions and structures, activity, participation, environmental factors, personal factors
body structure
- 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
body function (11)
- Vowel error
- Consonant distortion
- Stress errors
- Syllable segregation
- Groping
- Intrusive schwa
- Voicing error
- Slow rate
- Increased difficulty with multisyllabic words
- Resonance or nasality disturbance
- Difficulty achieving initial articulatory configurations or transitional movement gestures
Vowel errors
- 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
vowel errors implication
ensure vowels are assessed in single word pronunciation and in imitation
Consonant deletion
- not a defining feature
- Precision is impaired, but
phonological knowledge is present
consonant deletion implication
ensure data sample
includes range of target sounds in single word and connected speech
stress errors
- 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)
stress errors implication
Must assess using multi-syllable words and phrases
Syllable segregation
- 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
Syllable segregation implication
include varying stress in stimuli, diacritics are important
Groping
- 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
Intrusive schwa
- Schwa insertion (epenthesis) within cluster
- Common error in SSD
- Consistent with CAS, but also with many other disorders
Intrusive schwa implication
careful transcription
Voicing errors
- 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
voicing errors implication
single word and connected speech
Slow rate
- Core or compensatory
- Consistent with CAS but also with many other SSD
- Only 18% accurate in predicting expert
diagnosis
Slow rate implication
Consider speech rate
Increased difficulty with multisyllable words
- Occurs across many SSD
- Requires careful assessment and balancing of stimuli
- Questionable
Increased difficulty with multisyllable words implication
careful selection of target multisyllable words in assessment
Resonance or nasality disturbance
- Inconsistent resonance patterns
- May be difficult to assess reliably
- If persistent, consider referral to ENT
- Motor rather than structural explanation
Resonance or nasality disturbance implication
collect data over time; record and evaluate
Speech sound inconsistency
- 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
3 key areas that suggest CAS over other SSDs:
- Inconsistent errors on consonants and vowels in repeated productions of syllables and words.
- Lengthened and disrupted coarticulatory transitions between sounds and syllables (e.g. pauses in inappropriate places, sounds jerky).
- Inappropriate prosody, especially in lexical or phrasal stress.
Comprehensive ax includes: (6)
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
What is DEMSS?
Dynamic Evaluation of Motor Speech Skill
What is the DEMSS scoring like?
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
What does DEAP stand for?
Diagnostic Evaluation of Articulation and Phonology
What does the DEAP consist of?
- Diagnostic screen
- Articulation Ax
- Oro-motor Ax
- Inconsistency Ax
DEAP diagnostic screen procedure
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.
DEAP Articulation Ax procedure
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.
DEAP oro-motor Ax procedure
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.
DEAP Inconsistency Ax procedure
A score of 40% or more suggests either an inconsistent phonological disorder or CAS
Differential Diagnosis between Developmental Verbal Disorder
(CAS) and Inconsistent Phonological Disorder, according to DEAP Manual:
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
Nuffield Dyspraxia Ax: elicit __ (2) by imitation?
- Elicit consonants and vowels by imitation
- Elicit phrases and sentences by imitation, supported by pictures.
Nuffield Dyspraxia Ax: elicit __ (5) by picture naming?
- 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.
Nuffield Dyspraxia Ax: other tools
- 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?”
