We consider CAS a motor speech disorder because of the fact that the primary difficulty is this planning and programming of movement. And that's probably the way it's different from other speech disorders. It's important, however, to remember that Childhood Apraxia of Speech occurs in the context of the child learning all aspects of language and speech. So most children that have apraxia of speech also have other disorders, maybe a language problem, and certainly a problem in learning the rule governed system of sounds for their language. The primary way, though, that are apraxia is different is because it involves specifying movement parameters, treatment has to be focused on helping that child acquire more accurate movement.
Some children do have very severe difficulty with praxis or planning these movements and will have a very difficult time learning to talk. Other children, though, may have moderate to more mild motoric difficulties, and will need less frequent or won't be in therapy quite as long. It's sort of like coordination where it's on a continuum. Where some people have very severe problems with speech praxis, and others have very little difficulty.
The following examples can show you some of the variation in severity in childhood apraxia. The following examples are from evaluations and are not examples of therapy. This clip shows word repetition during an evaluation. Again, we're not providing therapy here, but just examining speech characteristics as he tries to repeat. Notice the inaccurate movements resulting in sound distortions.
Good job. Bye. Ah. Up. Up. Moo. Moo. Dad. Dat. Home. Ome. Out. Ow. Out. Ow. Knee. Knee. No No. Hi. I. Use your breath. Hi. Good. Mom. Mom. Me. Me. My. My. Hi, Mom. Hi, Mom. My knee. My knee. Oh no. No. Oh no. Good job. [MAKING VARIOUS VOWEL NOISES] Very good, and how old are you? [INAUDIBLE] Good job.
In this next clip, you will see a child who exhibits a number of characteristics of childhood apraxia, including groping for sound positions and off target movements that distort sounds. Notice how he is inconsistent over repeated tries at the same word. Toward the end of the clip, notice how he does better if he's looking at the clinician's face. Wa. Pie. Pa. Pot pie. Pa pa Two. Two. Op. Day. Ah. Dad. Da. Very good. No. Wo. No. Wo. Nana. Ah up. Key. Ee. Go. Oh. Now say, eye. Eye. What's this? Eh. I. Say out. Oup. Out. Up. Pa. Up. Pa. Up. Up. There you go, very good. Say it again. Ba. Pa. Look at me, say up. Pa. Up. There you go. Do it again. Up. Do it again. Wa. Do it again. Pa.
In this next clip, you will see more probe testing where we are looking at the child's ability to say the phrases on which he has been working. Notice his deliberate manner of speaking, his slower rate, and the concentration he needs to use. He will need to use less concentration as the movement accuracy becomes more automatic with continued practice. I sit — oh, who's turn? Turn. My turn. I sit on my bed. I sit ah my bed. Bed. Bed. I need my Ben 10. I need my Ben 10. I heard all those good sounds. I won't fight. I won't fight. Good job, look at me over here. I will have fun. I will have fun. Let's try that again. I — watch — I will — I will have fun. I will have fun. How about this one. I write with my pen. I write wif my pen.
In this clip, you will see the child naming some pictures and talking with the clinician. Note that he has typical developmental sound errors, such as substituting T for K and D for G, as well as difficulty with the R sound. We call these phonologic errors, and they are not associated with difficulty with movement planning. These errors are consistent, in that he always does them the same way. However, he also exhibits some sound distortions and slower and more deliberate speech, which is often seen in children with childhood apraxia. Many children with apraxia also make developmental or phonological errors. Hey, can you tell me what these are? What is this? A house. Good job. What's this part of the house? A roof. This is the roof and this is, you look out the — Window. Good job. What's this? A flea. Good job. What's this? A phone. What's the long name for it? Is it a telephone? Yup. Can you tell me that? Telephone. Good job. This is a — Teacup A teacup, that's right it is a teacup. I have some yuckies in my ear. You have some yuckies in your ear? What happened? Um started hurted when I was playing in swimming pool last night. You were playing in the swimming pool last night? Yup. And Dalton hurt my foot. Daddy hit your foot? No. What is? Dalton. Oh Dalton, is that your brother? Yeah, Dalton hit your foot. Well tell me what you were doing? I'm playing on the blue slide. Oh, playing on the blue slide. What was this? A teacup. A cup, good. What's this one? And knife. And this is a — Spoon! Good job. What is this. A wagon we put sand in it. Uh-huh, a wagon you put sand in it. Can you say the name again? It's a — Wagon with sand, with — What's this? It's — we put sand in it. That's right. We need a wagon, but we need sand.