Giving a voice to individuals with apraxia of speech
Assessment of CAS in minimally verbal child
What does minimally verbal mean?
Why CAS Can Be Difficult to Diagnose in Minimally Verbal Children
Why CAS Can Be Difficult to Diagnose in Minimally Verbal Children
Diagnosing CAS in minimally verbal children presents additional challenges because many standard speech assessments require verbal responses. Assessment therefore needs to be flexible and often takes place over several sessions.
Clinicians may:
Build rapport before formal assessment
Observe communication during play
Use motivating activities and preferred toys
Adapt picture-based tasks using real objects
Collect speech samples across home, school and therapy settings
Use dynamic assessment whenever speech is produced
Assess phonetic inventory from all vocalisations
Examine syllable shapes and vocal imitation
Observe prosody where sufficient speech is available
Combine parent interviews with functional communication measures such as the Intelligibility in Context Scale (ICS) or FOCUS
Consider hearing, cognition, language, behaviour and autism as part of the wider assessment
For some children, there may not initially be enough speech to make a definitive diagnosis. In these cases, clinicians may use the term suspected Childhood Apraxia of Speech until further evidence is available. Multiple assessment sessions are often required.
Resources
Lottie Berry- A journey to a diagnosis and support for her son -Talking Speech Apraxia Podcast
https://www.patreon.com/SpeechApraxiaInternational/posts/lottie-berry-to-163189241?utm_medium=clipboard_copy&utm_source=copyLink&utm_campaign=postshare_creator&utm_content=join_link
Lottie is the founder of Tap Type Talk and a passionate parent/carer advocate for everything AAC! This podcast explores her journey through advocacy for her son to finally get him the diagnosis and support for his childhood apraxia of speech. Her 11-year-old son Joshua is autistic, uses a speech device, and until very recently, was completely non-speaking.
How to Differentially Diagnose CAS in Children with ASD and Low Verbal Ability
https://pubs.asha.org/
Discusses practical approaches for assessing motor speech difficulties in autistic and minimally verbal children.
Intelligibility in Context Scale (ICS)
https://www.csu.edu.au/research/multilingual-speech/ics
A parent questionnaire measuring how well a child's speech is understood by different communication partners.
https://onlinelibrary.wiley.com/doi/epdf/10.1111/1460-6984.13121
Buckeridge, K., Abrahamson, V., Pellatt-Higgins, T., Sellers, D. and Forbes, L. J. (2024) ‘Child, family and professional views on valued communication outcomes for non-verbal children with neurodisability: A qualitative meta-synthesis’
Literature Review: What Do SLTs Perceive as Their Knowledge in Childhood Apraxia of Speech Treatment?
https://us06web.zoom.us/j/88475461574?pwd=rZhbfjHqWnL3EfdaSuCWdlxBXZ4G0c
A recorded presentation reviewing the published literature on Speech and Language Therapists' knowledge, confidence and perceived competence in the assessment and treatment of Childhood Apraxia of Speech.
IALP Panel 2: SSD and CAS – How Should Motor Planning Disorders Be Classified in Children?
https://ialpasoc.info/
An expert international panel discussing current thinking around the classification of Childhood Apraxia of Speech, developmental speech disorders and motor planning disorders in children. The webinar explores terminology, diagnostic boundaries and implications for clinical practice.
Differential Diagnosis of Apraxia of Speech in Children and Adults: A Scoping Review
PMC (Free full text): https://pmc.ncbi.nlm.nih.gov/articles/PMC7890226/
Journal version: https://doi.org/10.1044/2020_JSLHR-20-00061
One of the most comprehensive reviews of the evidence surrounding the diagnosis of Childhood and Acquired Apraxia of Speech. The review compares current approaches to differential diagnosis, examines speech characteristics, quantitative speech measures, motor planning tasks and neuroimaging, and identifies important gaps in the evidence base. It concludes that although several promising diagnostic markers exist, there is still no single validated diagnostic test for CAS, highlighting the importance of comprehensive clinical assessment
Why CAS Can Be Difficult to Diagnose in Minimally Verbal Children
Why CAS Can Be Difficult to Diagnose in Minimally Verbal Children
Why CAS Can Be Difficult to Diagnose in Minimally Verbal Children
Diagnosis depends partly on analysing speech, but the child may produce very little speech to analyse.
That does not mean "no speech = apraxia."
This distinction needs to be extremely prominent
Minimally Verbal Does Not Automatically Mean Childhood Apraxia
Why CAS Can Be Difficult to Diagnose in Minimally Verbal Children
Minimally Verbal Does Not Automatically Mean Childhood Apraxia
Limited speech could relate to numerous developmental, motor, language, communication or neurological factors
Start With Communication, Not a Formal Speech Test
Start With Communication, Not a Formal Speech Test
Minimally Verbal Does Not Automatically Mean Childhood Apraxia
spontaneous communication
gesture
AAC
vocalisation
sounds
interaction
imitation
communicative intent
Observation Through Play
Start With Communication, Not a Formal Speech Test
Collect Every Available Vocalisation
preferred activities
familiar adults
low-demand situations
spontaneous sounds
repeated routines
singing
automatic sequences
Collect Every Available Vocalisation
Start With Communication, Not a Formal Speech Test
Collect Every Available Vocalisation
Analyse:
Consonants
What sounds occur?
Vowels
What vowel repertoire exists?
Syllable shapes
V
CV
VC
CVC
CVCV etc.
Consistency
Does the same attempted word/vocalisation change?
Transitions
Can sounds/syllables be joined?
Prosody
Where sufficient output exists.