Childhood apraxia of speech

Question 1

What are the 3 diagnostic criteria of CAS?

Answer 1

1. Inconsistency of speech productions across repetitions - don’t have stored representations of words and have to put it together each time (eg. same word different on repetition, >40% inconsistency on DEAP)
2. Lengthened and disrupted co-articulatory transitions - atypical phon errors, epenthesis, phoneme omissions, vowel errors, voicing errors, oral-nasal resonance contrast errors, many errors per word, syllable level dysfluency
3. Inappropriate fluency - volume, rate, pitch, often equal-excess stress
   BUT these are not necessary and sufficient signs of CAS!

Question 2

What was the first gene associated with speech

Answer 2

FOXP2 - leading to autosomal dominant inheritance of CAS

Question 3

Other common genes linked with CAS?

Answer 3

SETBP1, ZNF142

Question 4

Where are genes associated with CAS heavily expressed?

Answer 4

In the brain

Question 5

Are genes associated with CAS more often inherited or de novo?

Answer 5

De novo

Question 6

Advantages of a genetic explanation for CAS (5)

Answer 6

1/3 kids with CAS will have a genetic diagnosis
- Ends diagnostic journey
- More targeted guiding of symptom-based therapies
- Genetic counselling on recurrent risk for families
- Strengthens access to funding/services
- Support groups available

Question 7

Advantages of a genetic explanation for CAS (5)

Answer 7

1/3 kids with CAS will have a genetic diagnosis
- Ends diagnostic journey
- More targeted guiding of symptom-based therapies
- Genetic counselling on recurrent risk for families
- Strengthens access to funding/services
- Support groups available

Question 8

Common features from case history (9)

Answer 8

• Feeding problems
• Little babbling/vocal play
• Little imitation in infancy
• Delayed language onset
• Use of word token once only
• Gross/fine motor incoordination
• Body dyspraxia/body awareness in space
• ‘Soft’ neurological signs
• Slow progress in therapy

Question 9

How to differentially diagnose CAS? (5)

Answer 9

1. Single word speech sound test - test for artic and phone errors, if there are atypical phon errors then perform inconsistency test
2. Inconsistency test, eg. DEAP
3. OME to test for neuromotor signs (dysarthria) or oral praxis (can be associated with CAS)
4. Gozzard polysyllable test if child is able - test prosody
5. Conversational speech sample - test for prosody and lengthened/disrupted co-articulatory transition, use checklist

Question 10

Motor learning principles of practice for CAS therapy (4)

Answer 10

• Large amount of practice
• Distributed over long period
• Variable targets
• Random targets practice intermixed

Question 11

Motor learning principles of feedback for CAS therapy (3)

Answer 11

• Knowledge of results (KR), whether sound was correct/incorrect
• Low KR, feedback only after some attempts
• Delayed feedback, eg. 5 secs

Question 12

Name 4 CAS interventions

Answer 12

1. Nuffield Dyspraxia Program (NDP-3)
2. Rapid Syllable Transition Treatment (ReST)
3. Prompts for restructuring oral muscular phonetic targets (PROMPT)
4. Dynamic temporal and tactile cueing (DTTC, like the Nuffield)

Question 13

Goals of CAS treatment (2)

Answer 13

1. Address motor planning and programming (motor learning principles)
2. Treat all 3 features of CAS

Question 14

RCT of NDP3 vs ReST 2015 findings

Answer 14

• Significant gains in treated items for both groups
• NDP3 had greater initial gains, ReST had better maintenance

Question 15

What is the Nuffield Programme?

Answer 15

• Published intervention for children 3-7 with severe SSDs esp CAS (can use it for older children)
• Based on motor learning theory, to build up skills from single sounds to connected speech
• Creates a contrastive system at each syllable-structure level

Question 16

Theoretical rationale for NDP3

Answer 16

Motor programs part of stored lexical representations and consist of series of gestural targets for the articulators designed to achieve acceptable production
Eg. to correctly produce ‘tea’ - initiate airstream, close velopharyngeal sphincter, make closure with margins of tongue at alveolar ridge, release closure, assume raised front tongue body posture, spread lips, initiate voicing

Question 17

What is motor programming?

Answer 17

Online output process through which new motor programs can be created - thought to include store of phonological units which can be combined to create new motor programs for unfamiliar words
Eg. if a child can say /s/ in iso but tends to swap /s/ with /t/, motor programming is needed when child is asked to blind /s/ with /i/ to create a new motor program for ‘sea’ then may take lots of repetitive practice to establish this in place of ‘tea’

Question 18

What is motor planning?

Answer 18

The stage at which a plan for the whole utterance is formed
Eg. ‘I want a cup of tea’ involves retrieving motor programs for individual words, assembling gestural target in correct sequences and incorporating appropriate grammatical structure and prosodic features

Question 19

What are the 3 sections to the Nuffield programme?

Answer 19

1. Single sounds (consonants, vowels, diphthongs)
2. Words of different phonotactic structure (CV, VC, CVCV, CVC, CCV) and polysyllabic words
3. Combinations of words in phrases, clauses and sentences

Question 20

What is the service delivery of the Nuffield programme?

Answer 20

• Ongoing weekly SLP sessions 30-60mins with daily practice at home/school
• Usually 1:1 therapy or small groups if working on similar targets
• Delivered by qualified SLP
• Those assisting with daily practice should observe therapy and demonstrate ac

Question 20

What are the 3 sections to the Nuffield programme?

Answer 20

1. Single sounds (consonants, vowels, diphthongs)nw
2. Words of different phonotactic structure (CV, VC, CVCV, CVC, CCV) and polysyllabic words
3. Combinations of words in phrases, clauses and sentences