Childhood Apraxia of speech is a motor speech disorder. Communication disorders impact the way child function not only in the areas of speech and language but in many other areas of the brain. Apraxia of speech is a neurological disorder that is very rare. Children with this disorder have trouble with sounds, syllables and words. CAS, Apraxia affects the movement of the tongue, lips, jaw and palate that is necessary for speech. Childhood Apraxia of Speech is also sometimes known as Developmental Apraxia of Speech, Verbal Dyspraxia or Developmental Apraxia of Speech. Edeal and Neumann said that a child with CAS demonstrates difficulty programming, combining, and sequencing the motor movements needed for volitional speech. This speech disorder is hard to treat.
Children with CAS may show in coordination in many different areas like problems with manual dexterity, oral motor dysfunction, below average intelligence or academic difficulties (Teverovsky, Bickel & Feldman 2009). The thing that characterizes Apraxia of speech is the errors of consonants and vowels (ASHA 2007). Due to the testing that is needed for CAS they find in many children there are other problems associated with CAS they need attention to so they put them in rehabilitation and evaluations. Velleman and Curro give three diagnostic criteria for CAS which is inconsistent errors on consonants and vowels in repeated productions of syllables or words. Lengthened and disrupted coarticulatory transitions between sounds and syllables. Lastly, inappropriate prosody especially in the realization of lexical or phrasal stress. Most of the time children are diagnosed by the age of five years old.
Teverovsky say the International Classification of Functioning is a comprehensive, systematic and scientifically-based classification system for describing function irrespective of the underlying health conditions. This is known as the ICF. This was created to see how health related conditions affect the lives of people by the World Health Organization. The ICF can be used on individuals but also on a population of people. The ICF has recently been used as a tool for describing the functional problems associated with communication disorders (Teverovsky, Bickel & Feldman 2009). The ICF has now come out with a version for children called the ICF- Children and Youth. The version was released in 2004 but the final version was published in 2007. The children’s version was focused on describing how younger children function at home and in school.
The ICF has three major domains of functioning: body functions and structures, activities and participation. The environment, personal factors, and health related conditions have an impact on the domains. The ICF has a list of codes that describe the body functions, daily activities, individual participation and the environmental factors that can have an impact. The activity section is used mostly for habilitation and education. The participation section is for social integration and community life. The environmental section is for the interaction of functional abilities. For children with CAS studies show that children have functional problems in multiple domains (Teverovsky, Bickel & Feldman 2009). Using the ICF is useful for identifying areas or needs and targeting outcomes of therapy. The International Classification of Functioning has been helpful in describing functional profiles of children with other clinical conditions (Teverovsky, Bickel, & Feldman 2009). The ICF was designed careful to keep from being biases at all.
ASHA has identified three differential signs for CAS. Inconsistent vowels and consonant errors in repeated productions of words and syllables, inappropriate prosody, difficulty with articulatory sequencing resulting lengthened and disrupted transitions between words and syllables (Edeal & Nuemann 2011). Most agree that CAS is the core of motor planning and programming. There have been many approaches to find a treatment for explored for Childhood Apraxia of Speech. When treating a motor learning disorder it is necessary for constant evaluation by a doctor. When therapy is provided to a patient with CAS one of the most important things is to set long term improvement in speech. Generalization is a key component of learning and is achieved by the four main tenets of motor learning into therapy. The four main tenets are precursors to learning, conditions of practice, feedback and influence of rate (Edeal & Neumann 2011).
Precursors to learning the concepts established with the client before treatment begins. Informing the client of goals and starting to establish trust between each other. Conditions of practice include blocked versus random practice, mass versus distributed practice and variability of practice (Edeal & Neumann 2011). In blocked versus random practice blocked practice has one target in practice at a time in random there is more than one target practiced. Mass versus distributed practice, mass practice in a long session for fewer days, like a 60 minute session once a week. Distributed are shorter sessions but more days a week for example 20 minute sessions 3 days a week. Practice variability asking the patient to practice targets set for him or her outside of treatment. There are two types of feedback intrinsic and extrinsic. Extrinsic feedback includes knowledge of results and performance. Intrinsic feedback comes from the assessment of the client or patient’s performance. The rate of speech has an influence on learning. Rate reduction decreases the metal load on the client (Edeal & Nuemann 2011).
Most of the focus for this disorder has been on determining the specific features that characterize it. One treatment combines a core vocabulary treatment with stimulability training. The treatment focuses on increasing the number of stimulable sounds a child can produce. A treatment protocol was designed which targeted enhancement of stimulability by teaching sounds (Forrest 2010). By breaking the word into syllables and then teaching the word to the child in sounds and syllables it is the best way for children to produce words. The stimulability and vocabulary treatment hold promise for treating children with Childhood Apraxia of Speech.
In Speech language pathology, motor learning principles have been found effective in treatment research for individuals with acquired Apraxia of Speech ( Edeal & Neumann 2011). Hierarchies are used for many different things. In speech therapy it is used by beginning with the easiest speech targets and moving to more challenging targets. It has been modified to target motor deficits specifically seen is Childhood Apraxia of Speech. A child with Childhood Apraxia of Speech is more likely to show more progress in frequent shorter sessions, then longer less frequent sessions.
DTTC is based on integral stimulation therapy and motor learning principles (Edeal & Neumann 2011). Speech targets are practiced at the syllable, word, phrase, or sentence level. Depending on the achievement level patients can move up and down in success also from session to session. Studies have shown that integral stimulation is a successful and effective treatment for children with Childhood Apraxia of Speech though more studies are needed to show the benefits of the treatment (Edeal & Neumann 2011). DTTC uses visual tactics for a child seeing things give them a better understanding. DTTC uses cues to help the child only when the child is struggling and is necessary otherwise the cues are down.
Treatment intensity is critical for motor learning. This treatment increases the likelihood that desired change in behavior or situation will occur (Duhon, Mesmar, Atkins, Greguson & Olinger 2009). This treatment can be one-to-one or in small groups. The different areas include duration, frequency, number of episodes, and form of treatment. Treatment intensity is most affective with shorter treatment sessions over a longer period of time to promote motor learning. Though in this treatment there is a possibility that it can decrease the performance and learning in the patient. For motor task, intensity in the form of mass practice conditions may be effective for initial performance but detrimental to learning, with shorter treatment sessions distributed over a longer time frame more likely to promote motor learning (Edeal & Nuemann 2011).
In the lexical route correct reading of familiar words can be achieved. The lexical route implies good language skills. Children that have a language or speech disorder tend to have trouble with reading also and begin to fail at it. Examining possible contributions of and interactions among all underlying linguistic and cognitive factors in such children is an important area of research (Zaretsky, Velleman & Curro 2010).
In the phonological route requires the reading non-words or unfamiliar words. This allows the child to transfer the abstract awareness of smaller linguistic units like syllables, onsets, rimes, and phonemes onto more concrete visual representations (Zaretsky, Velleman &
Curro 2010). This helps the children with speech disorders because they are at a higher risk for reading deficits. When using the phonological route children establish cognitive skills. Cleft palate and Dysarthia literacy difficulties should not be accompanied by Childhood Apraxia of Speech. Treatment for CAS should start with children before or at kindergarten level.
There are many different symptoms for CAS ranging in the age of children also. Though, some children may not show little to any symptoms at all. No children are the same so every child will show different symptoms to Childhood Apraxia of Speech. In a very young child there are many different symptoms (ASHA.org). When you child is an infant if the infant is not babbling or making noises. First words are not on time and don’t sounds correct. They don’t have many different consonant and vowel sounds. The infant has a problem combining sounds in words or a long pause in between words. May have issues eating. The infant replaces difficult sounds with easier ones or ignores the difficult sounds.
In older children there are many different symptoms in children also. Not every child is the same so many of these symptoms will change in each child. If the child is making inconsistent sound errors, that do not result from immaturity. The child can understand the language he or she speaks much better than he or she can talk. He or she has difficulty imitating speech. If the child appears to be groping, when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement (ASHA.org). If he or she has difficulty saying longer phrases then shorter ones more clearly. When your child is anxious and their speech becomes more difficult to understand. When the child is hard to understand and people who don’t know the child cannot understand him at all.
Childhood Apraxia of Speech is usually accompanied by functional problems. Children with CAS show impairments in language as well as speech. The speech and language components are independent. The First national CAS conference for parents and family member was held in Pittsburgh, Pennsylvania in 2004. For a child with Childhood Apraxia of Speech it is important to identify functional domains for further planning comprehensive evaluations, therapies, and long term follow ups with a doctor.
Childhood Apraxia of Speech also known as CAS is a very serious communication disorder found early in children. CAS effects the brain though the brain knows what it is trying to say it cannot put it in words for others to hear. There are many different treatments for Childhood Apraxia of Speech. Though it is found early in children it also is a part of other functional disorders.
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