L7 Childhood Apraxia of Speech Flashcards
what is CAS
A neurological childhood speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits. (ASHA)
speech errors
features
- 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
- Inappropriate prosody
- Lengthened and disrupted coarticulatory transitions between sounds and syllables
motor features of CAS
- Associated mild motor difficulties
- Reduced diadochokinetic rates
- Impaired volitional movements
- Groping
language
features of CAS
- Co-morbid expressive language difficulties
- Relatively unimpaired receptive abilities
variability
features of CAS
- Behaviours vary from child to child and from time to time within the same child
- Severity of expression may vary from mild to severe
other features of CAS
- limited V and C repetoire
- slow response to therapy
Impact of CAS on a child
- Frustration and sadness due to being misunderstood
- Reticence to start conversation
- Reduced opportunities to engage in communication exchanges and learn social cues
- Isolation from peers and community
- Treated as a younger child, or as if they have cognitive problems
- Impact on social, behavioural and academic development
Criteria for CAS
Shriberg et al (2011)
- Vowel distortions
- Difficulty achieving initial articulatory configurations
- Equal stress or lexical stress errors
- Distorted substitutions
- Syllable segregation
- Groping
- Intrusive schwa
- Voicing errors
- Slow rate
- Slow DDK
- Increased difficulty with polysyllabic words
what is praxis
- infant motor control
- motor maturation
- motor learning
what is involved in motor maturation
- Control of speed
- Force
- Precision
- Direction
- Coordination of movement
how does praxis develop
Experience of motor movement and its consequences, beyond automatic movement, increases level of control, - ability to bring to conscious level if necessary
lack of praxis causes impaired ability to:
- Learn general schemes about classes of motor actions
- Use appropriate perceptual cues within the environment
- Organise and integrate information from the body
- Solve problems and adapt behaviour
- Analyse task demands and components
- Prepare for upcoming actions
DSM V criteria for diagnosis of developmental co-ordination disorder (dyspraxia)
- Performance in daily activities that require motor coordination substantially below that expected
- The motor disturbance significantly interferes with academic achievement or ADL
- Onset of symptoms is in the early developmental period.
- 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).
characteristics of dyspraxia
- 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
differential diagnosis of CAS
- Some features occur in other conditions and are less useful for diagnosis
- Deficit is at programming or planning level
- NOT at representational level (though flow back effects possible)
- NOT primarily executive (though production affected)
