Childhood apraxia of speech

Question 1

What is CAS?

Answer 1

A rare neurological childhood speech sound disorder with primary difficulty in the planning and production of movements underlying speech

Question 2

What % of children have CAS according to Dodd’s Subtype Classification (1995)?

Answer 2

3%

Question 3

What is the impact of CAS on sound repertoire?

Answer 3

limited C and V repertoire

Question 4

What is the impact of CAS on speech?

Answer 4

• Frequent omission errors
• High incidence of vowel errors
• Increased errors on longer units
• Inconsistent errors on consonants and vowels in repeated productions of syllables and words (say 3 times - consistent or inconsistent)
• Inappropriate prosody
• Lengthened and disrupted coarticulatory transitions between sounds and syllables (especially with clusters)

Question 5

What is the impact of CAS on motor movements?

Answer 5

• Associated mild motor difficulties
• Reduced diadochokinetic rates
• Impaired volitional movements
• Groping

Question 6

What is the impact of CAS on language?

Answer 6

• Co-morbid expressive language difficulties
• Relatively unimpaired receptive abilities

Question 7

What is the response to therapy?

Answer 7

slow response to therapy

Question 8

CWCAS have __ of the following on __ or more tasks:

Answer 8

4 of the following on 3 or more tasks:
1. Vowel distortions
2. Difficulty achieving initial articulatory configurations
3. Equal stress or lexical stress errors
4. Distorted substitutions
5. Syllable segregation
6. Groping
7. Intrusive schwa
8. Voicing errors
9. Slow rate
10.Slow DDK
11.Increased difficulty with polysyllabic words

Question 9

What are the causes of CAS?

Answer 9

• Neurological impairment (e.g. trauma, infection, stroke), with neurobehavioural disorders of known or unknown origin (e.g. a genetic or metabolic disorders like Down Syndrome or Galactosemia), or as an idiopathic (i.e. cause unknown) neurogenic speech sound disorder.

Question 10

What is praxis?

Answer 10

Movement

Question 11

What happens with motor maturation?

Answer 11

• speed control
• force
• precision
• direction
• coord of movement

Question 12

How does praxis develop?

Answer 12

First, it requires the experience of motor movement and understanding its results, which includes gaining control over movements and being able to consciously control them if necessary. Praxis also involves action in space, implying the need for spatial perception. The relationship between action, sensation, and perception is also key. Lastly, praxis involves modifying a movement pattern based on sensory feedback to ensure it is effective in space.

Question 13

How does motor speech develop?

Answer 13

1. Production of a range of language-appropriate vowels and consonants i.e. range of movements in space
2. At an appropriate speed with app transitions
3. Precisely to preserve mutual intelligibility
4. Sufficiently consistently
5. At segmental (v/c/words) level
6. At suprasegmental (prosody, loudness, stress, pitch, resonance etc) level

Question 14

If lacking praxis?

Answer 14

Impaired ability to:

• Learn general schemes about classes of motor actions
• To use appropriate perceptual cues within the environment
• To organise and integrate info from the body
• solve problems and adapt behaviour
• analyse task demands and components
• prepare for upcoming actions

Question 15

What is developmental co-ordination disorder?

Answer 15

1. Performance in daily activities
   that require motor coordination
   substantially below that
   expected
2. The motor disturbance
   significantly interferes with
   academic achievement or ADL
3. Onset of symptoms is in the
   early developmental period.
4. motor skills deficits are not
   better explained by intellectual
   disability or visual impairment
   and are not attributable to a
   neurological condition affecting
   movement (e.g. cerebral
   palsy).

Question 16

Characteristics of Developmental Co-ordination disorder

Answer 16

• disordered behaviour
• hyperactivity (up to 50%)(Wilson et al., 2004)
• Short attention
• Emotional lability
• Social difficulties
• Impulsiveness
• Specific learning disorders
• DLD
• Poor transfer of learning

Question 17

Does Developmental Co-ordination disorder exist?

Answer 17

1. Conflicting descriptions
   * Production of sounds = motor speech act
   * Production of speech = linguistic act
   * Continuum of severity
2. Differential diagnosis
    Some features occur in other conditions and are less useful for diagnosis e.g. severe phonological disorders or those with dysarthria
    Working assumption = Level of deficit is in programming or planning motor activity for production of speech
    NOT at representational level (though flow back effects possible) - know how it should be pronounced
    NOT primarily executive (though production affected) - not about ability of muscles although lack of practice can lead to muscle weakness

Question 18

Effect of soothers on speech development

Answer 18

• Most parts of speech development not associated with soother use
• link between increased daytime use and atypical speech disorders
• Pros: soothing, SIDS protection
• Cons: increased risk of otitis media and dental malformation

Question 19

Prevalence and predictors of persistent SSDs at 8 years old

Answer 19

• Predictors: boys, kids from non-homeowner families
• Early predictors: weak sucking at 4 weeks, limited word combos at 24 months, speech unintelligibility at 38 months
• School-age predictors: sound pronunciation difficulty, hearing impairment at 7 years old, tympanostomy tube insertion and history of coordination problems

Question 20

Risks and protective factors of S&L impairments in 4-5 year olds

Answer 20

• Risks: male, ongoing hearing problems, more reactive temperament
• Protective: more persistent and sociable temperament, higher levels of maternal well-being