What is Childhood Apraxia of Speech (CAS)?

What is Childhood Apraxia of Speech (CAS)?

Childhood Apraxia of Speech

Childhood Apraxia of Speech (CAS) is the term most commonly used at this time to describe a communication disorder with a specific set of characteristics affecting a child’s motor speech planning, speech sound development, and expressive oral language use.

A child knows what s/he wants to communicate but is unable to get that message to the speech articulators (i.e lips, tongue, soft palate, jaw), in a such a way that intelligible spoken words are heard.

It is important to know the history behind this disorder and more importantly to find an ASHA certified and state licensed Speech-Language Pathologist (SLP) who is trained and experienced in diagnosing and providing intensive and appropriate SLP intervention to a child exhibiting characteristics of CAS, or any other speech-language-learning-communication challenges.

Childhood Apraxia of Speech

Brief History

Until recently, the idea that a child could be diagnosed with apraxia, previously called dyspraxia or developmental apraxia was a constant battle challenging pediatric Speech-Language Pathologists who believed this was a real disorder.

The use of “developmental” in a diagnosis confounded the problem as it was interpreted as a problem which would develop over time, but in a delayed fashion. This is not true of CAS.

With an adult medical model as the only example, many believed that a child could not exhibit or be diagnosed with this type of disorder. You see, adults had their skills, maybe suffered a stroke, lost their skills, and were then diagnosed with apraxia. The prefix a- denotes the loss of a skill.

Hence, the standard of adult disorders did not allow room for a childhood diagnosis. How could a young child lose a skill they had not yet developed? They couldn’t, so this can not be the cause.

However, Speech-Language Pathologists, both in clinical and research settings fought to distinguish this real and significant childhood speech disorder.

What Resources are Trustworthy?

Families should always seek to read information from reliable resources. Blind searches on the internet can lead to misinformation. Two trustworthy sources are found below.

  1. The American Speech-Hearing-Language Association (ASHA) which offers information for the public and SLPs on their webpage. The ASHA page on Childhood Apraxia of Speech may answer some of your questions.
  2. The Childhood Apraxia of Speech Association of North American (CASANA) was established in 2000 and has a “mission is to strengthen the support systems in the lives of children with childhood apraxia of speech (CAS) so that each child is afforded their best opportunity to develop speech and communication.” CASANA offers information to professional SLPs and families.

Source: With permission, CASANA for Apraxia Awareness Day

Can a Young Child be Diagnosed with Childhood Apraxia of Speech?

The answer is Yes and No.

Testing young children brings its own set of challenges and trying to make a definitive diagnosis such as Childhood Apraxia of Speech requires a child’s participation at levels which may not yet be present. However, there are indicators which can assist the Speech-Language Pathologist in making a correct diagnosis.

The CASANA information page on toddlers and young children highlights “potential diagnostic characteristics” by Strand (2003) will serve to help readers understand what the SLP may be evaluating. Additional reading will share the challenges and goals for those SLPs working with young children and searching for a definitive diagnosis.

As with all communication concerns, early identification and intervention is paramount to a child’s success. CAS required intensive and individualized Speech-Language Pathology intervention. Read more on the ASHA and CASANA resource links above.

Photo Source: Beate Sass, 1995

Who is the Best Professional to Diagnosis CAS? 

From ASHA,An SLP can test your child’s speech and language. The SLP will test how well your child understands what he hears, called receptive language. The SLP will also test how well your child uses words to tell others what he is thinking, called expressive language. To test for CAS, the SLP will look at your child’s oral-motor skills, speech melody, and how he says different sounds.”

From CASANA, “Because Childhood Apraxia of Speech is a communication disorder, the most qualified professional to provide assessment, evaluation, and diagnosis is a licensed speech-language pathologist (SLP).  Other professionals can be helpful and necessary at some point in time for children with CAS; however, they have not typically undergone the extensive and concentrated study and certification to fully evaluate speech and/or language disorders.  Professionals such as pediatric neurologists or developmental pediatricians sometimes make diagnoses’ but more often, and more appropriately, they refer to the speech-language pathologist on their team who has the skill and extensive training to distinguish between CAS and other types of speech sound disorders.”

What Should Parents Know?

A parent is a child’s ultimate advocate and must seek the best scientifically based and supported information and SLP services for their child.

It is important to know that there are concerns within the field of CAS regarding misdiagnosing  and overdiagnosing by SLPs and other professionals.

It is imperative that SLPs establish a firm educational framework during their graduate studies, gain experience during their ASHA required Clinical Fellowship Experience (CFE) and early employment , establish a mentee-mentor relationship with an ASHA certified SLP who is experienced and knowledgeable in the area of childhood apraxia of speech and can guide the less experienced SLP.

Parents should ask questions when seeking professional help and understand the meaning of certifications and licenses as they interview to find the best SLP for their child.

Certificate of Clinical Competence

What is the Certificate of Clinical Competence? Who can earn this certification?

The ASHA certification is a process that begins in graduate school and is finalized after one completes all of the steps required to gain one’s Certificate of Clinical Competence (CCC-SLP). Learn how to earn the CCC-SLP certification here.

Next is the application for, the issuance of, and the maintaining of a state license to practice as a Speech-Language Pathologist. The Florida Board of Speech-Language Pathology & Audiology, Florida Dept. of Health, oversees licensing. Check with your state to learn more.

Last, is the completion of required approved continuing education courses to renew one’s ASHA certification and state license. In this case, completing CAS continuing education coursework AND passing the required assessments, as well as, professional experience and success in providing SLP services to children presenting with CAS.

These factors together would be essential in a search for an SLP.

Continuing Education Certificates

There are many misconceptions about “certificates”.

While there are “programs” which offer coursework and certificates of completion or certificates of training, it is important to understand that SLPs can also gain the similar and often more intensive continuing education and training through ASHA approved continuing education courses or programs which may not have a “brand name.”

Parents should not confuse a “certificate” from a specific “brand or program” with expertise or with certification as an expert, unless the organization issuing the certificate states such.

How one uses the knowledge obtained and one’s success and experience must be included in the equation when seeking an SLP for your child.

Remember, each child with CAS is an individual and no one “program” is going to fit each and every child’s needs.

Why Children’s Communication Center?

Children’s Communication Center was founded by Lori Savage Grayson in 1993 with the purpose of providing high quality, well-managed and professional Speech-Language Pathology services with an emphasis on young children and their families, especially those experiencing significant communication disorders, including childhood apraxia of speech.

Ms. Grayson’s medically based education and training along with her clinical hospital experience was welcomed in our community and with the support of medical and educational professionals, the Center opened. It is no surprise that Ms. Grayson’s first patient was a young girl who was diagnosed with childhood apraxia of speech by Ms. Grayson. Read more about this Center’s First Family.

Photo Source: Beate Sass, 2013

In speaking with Ms. Grayson, she will convey the importance of observing, understanding, and identifying how each child is communicating. She teaches parents how to listen to their child’s pattern of sounds, notice gestures and other communicative acts, decrease the frustration within the home, and provide the child and parents with success in communicating.

The importance of introducing a consistent form of communication for each child/family while simultaneously developing and expanding oral communication skills are primary goals exemplified by Ms. Grayson.

The bond established with any young child, especially one with a communication disorder, must include trust and respect. These are frightening and challenging times for both our little ones and their families.

More than 35 years of Experience with CAS

Lori Savage Grayson is one of those clinical Speech-Language Pathologists who learned about a possible disorder called “developmental apraxia or dyspraxia” while earning her Master of Medical Science Degree in Speech-Language Pathology through the Emory University Medical School.

Since 1979, Ms. Grayson has successfully provided SLP services to children with CAS in the clinical, educational and private practice settings.

She has consistently completed professional ASHA approved continuing education courses related to diagnostic and intervention techniques for children with CAS.

Ms. Grayson continues to use a combination of evidence based practice (EBP) approaches yielding the most appropriate intervention strategies for each child. For more information, this ASHA page is useful.

Lori Savage Grayson, MMSc, CCC-SLP
Certified ASHA Member Since 1980