CHILDHOOD APRAXIA OF SPEECH

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CHILDHOOD APRAXIA OF SPEECH

• (pp. 519-top of 523)

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I. INTRODUCTION

• Childhood apraxia of speech (CAS) is also called
  developmental apraxia of speech (DAS)
• Priimarily a sensory-motor disorder affecting the
  articulatory and prosodic parameters of speech
  production
• Child has great difficulty with fine, rapid, and
  voluntary movements necessary to produce speech

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Nelson 2010
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Nelson 2010 (continued)
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In general

• Therapy tends to follow a sequential
  organization, progressing from simple to complex
  speech tasks
• We can progress from CV or VC combinations ? CVC
  ? CCVC ?syllable shapes ? words ? phrases ?
  sentences ? conversational speech

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II. GENERAL PRINCIPLES OF TREATMENT

• 1. A child with CAS may have experienced failure
  make sure there is initial success in tx
• 2.
• 3.

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• 4. Treatment may start with vowel errors if these
  are dominant
• 5. Auditory discrimination is not important
• 6. Initial treatment targets may include sounds
  that are stimulable, early-developing, and
  visible
• 7. Sounds should be treated in order of
  increasing phonetic difficulty (e.g., begin with
  vowels, end with affricates)
• 8. Start with voiceless sounds, then progress to
  voiced sounds

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• 9. Train sounds first in word-initial position
• 10. Have short breaks these kids get tired!
• 11. Do repeated trials of the same movement
  (program muscle memory)
• 12. Practice each target word or phrase several
  times before moving on
• 13. Select a core vocabulary of meaningful words
  for initial treatment

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4-year old child with CAS entering preschool for
the first time
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• 14. Make sure the child speaks slowly
• 15. Use a variety of carrier phrases (e.g.,
  Here is ____ I want ___)

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III. SPECIFIC TREATMENT APPROACHES

• A. Introduction
• Always remember to use a multimodality approach!
• For children with severe CAS, sign language or
  augmentative communication may be necessary

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B. Phonetic Placement Techniques to Elicit Sound
Production

• We can give detailed descriptions of how to
• Use diagrams and pictures
• Get in there and get physical! Use tongue
  depressors, cotton swabs, mirrors

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C. PROMPT
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PROMPT
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D. Shaping/Progressive Assimilation

• To get a child to produce a sound, use non-speech
  gestures or sounds that are not affected
• For example, if a child cannot produce /v/, she
  may be asked to bite her lower lip, turn on her
  voice, and breathe out

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E. Contrastive Stress Drills

• Work especially well to teach stress and rhythm
  of spoken language as well as promote better
  articulation
• Example for /k/
• SLP Is your name Ben?
• Child No, my name is Ken.
• SLP Is his name Ken?
• Child No, my name is Ken.

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Remember.

• CAS therapy takes years
• Children quickly lose the gains they have made if
  these gains are not constantly reinforced!