Frequently Asked Questions
- What is Childhood Apraxia of Speech?
Childhood Apraxia of Speech is a specific motor speech disorder. Children with Apraxia of speech have great difficulty planning and producing the precise, highly refined and specific series of movements of the tongue, lips, jaw and palate that are necessary for intelligible speech. To some degree or another, a child with the diagnosis of Apraxia of speech has difficulty programming and planning speech movements.
The act of speech begins with an intention to communicate. Next, an idea forms, outlining what the speaker wants to say. The words for the desired message are put in the correct order, using the correct grammar. Each of the words are comprised of a specific sequence of sounds (also called phonemes)and syllables that must be ordered together. All of this information is translated from an idea and information about order of sounds into a series of highly coordinated motor movements of the lips, tongue, jaw, and soft palate.
The brain must tell the muscles of these “articulators” the exact order and timing of movements so that the words in the message are properly articulated. Finally, the muscles must work properly with enough strength and muscle tone to perform the movements needed for speech. It is believed that children with CAS may not be able to form or access speech motor plans and programs or that these plans and programs are faulty for some reason.
(Gretz, 1997)
The act of speech begins with an intention to communicate. Next, an idea forms, outlining what the speaker wants to say. The words for the desired message are put in the correct order, using the correct grammar. Each of the words are comprised of a specific sequence of sounds (also called phonemes)and syllables that must be ordered together. All of this information is translated from an idea and information about order of sounds into a series of highly coordinated motor movements of the lips, tongue, jaw, and soft palate.
The brain must tell the muscles of these “articulators” the exact order and timing of movements so that the words in the message are properly articulated. Finally, the muscles must work properly with enough strength and muscle tone to perform the movements needed for speech. It is believed that children with CAS may not be able to form or access speech motor plans and programs or that these plans and programs are faulty for some reason.
(Gretz, 1997)
- How Is CAS Different Than A Speech Delay?
A developmental delay of speech is when the child is following the "typical" path of childhood speech development, but at a rate slower than normal. As well, this rate is generally in pace with the child’s cognitive skills. In typical speech/language development, the child's receptive and expressive skills increase together to a large extent.
What is often seen in a child with Apraxia of speech is a wide gap between their receptive language abilities and expressive abilities. The child's ability to understand language (receptive ability) is broadly within normal limits, but his or her expressive speech is seriously deficient, absent, or severely unclear.
However, certain language disorders may also cause a similar pattern in a child. A gap between a child's expressive and receptive language ability is insufficient to diagnose Apraxia.
(Gretz, 1997)
What is often seen in a child with Apraxia of speech is a wide gap between their receptive language abilities and expressive abilities. The child's ability to understand language (receptive ability) is broadly within normal limits, but his or her expressive speech is seriously deficient, absent, or severely unclear.
However, certain language disorders may also cause a similar pattern in a child. A gap between a child's expressive and receptive language ability is insufficient to diagnose Apraxia.
(Gretz, 1997)
- What Kind of Help Will My Child with CAS Need?
Children with CAS will need to begin speech therapy with a speech-language pathologist (SLP). The frequency of speech therapy required by a child will vary according to their individual needs. Typically, experienced SLP’s will suggest that a child with moderate to severe Apraxia of speech have 3 – 5 times a week of individual speech therapy.
Other considerations may have to do with the extent to which the child will practice at home with their parents or caregivers; how much the child can individually tolerate; how frequently the parents can bring their child to speech therapy, etc.
(Gretz, 1997)
Other considerations may have to do with the extent to which the child will practice at home with their parents or caregivers; how much the child can individually tolerate; how frequently the parents can bring their child to speech therapy, etc.
(Gretz, 1997)
- At What Age Can A Child Be Diagnosed With CAS?
Overall, while it is possible to determine that a child’s speech is not developing in the same way or at the same rate as other children and to suspect CAS, in very young (under 3-4 yrs) children it is often not possible to clearly state that the reason is due to an apraxia of speech, excluding other speech disorders or causes. However, it is possible to institute speech therapy when a problem is suspected. Early intervention is very important to children with speech and language disorders.
Parents who are concerned with their child’s speech and language development should first try to seek help from the child’s pediatrician. Keeping a record of concerns that can be discussed at an office visit can be very helpful.
(Gretz, 1997)
Parents who are concerned with their child’s speech and language development should first try to seek help from the child’s pediatrician. Keeping a record of concerns that can be discussed at an office visit can be very helpful.
(Gretz, 1997)
- How Will My Child Do Over Time?
While there are no hard and fast statistics, professional articles and experienced SLP’s report that most children with CAS, with appropriate help, eventually learn to speak clearly.
Some children may retain some minor differences in their speech patterns, such as less than crisp “r”’s or slightly “off” vowels.
In some children, their intonation may not be perfect or others may perceive some sort of accent.
However, most children will speak in a way that others understand.
A few children, despite the best efforts of everyone involved, may not develop into primarily verbal communicators. These children will also make progress but may need augmentative or alternative methods to help them communicate.
There are a number of factors that are likely to influence progress for children with CAS. Some of these factors are:
"-The right of parents to receive a complete explanation of all the procedural safeguards available under IDEA and the procedures in the state for presenting complaints
-Confidentiality and the right of parents to inspect and review the educational records of their child
-The right of parents to participate in meetings related to the identification, evaluation, and placement of their child, and the provision of FAPE (a free appropriate public education) to their child
-The right of parents to obtain an independent educational evaluation (IEE) of their child
-The right of parents to receive “prior written notice” on matters relating to the identification, evaluation, or placement of their child, and the provision of FAPE to their child
-The right of parents to give or deny their consent before the school may take certain action with respect to their child
-The right of parents to disagree with decisions made by the school system on those issues
-The right of parents and schools to use IDEA’s mechanisms for resolving disputes, including the right to appeal determinations"(NICHCY, 2012)
Some children may retain some minor differences in their speech patterns, such as less than crisp “r”’s or slightly “off” vowels.
In some children, their intonation may not be perfect or others may perceive some sort of accent.
However, most children will speak in a way that others understand.
A few children, despite the best efforts of everyone involved, may not develop into primarily verbal communicators. These children will also make progress but may need augmentative or alternative methods to help them communicate.
There are a number of factors that are likely to influence progress for children with CAS. Some of these factors are:
- the severity of the problem
- The existence or co-occurrence of other disorders or problems, such as other speech or language diagnoses, poor health, attention issues, cognitive problems, etc.
- the age at which the child began appropriate intervention
- the child’s ability or opportunity to practice outside of therapy time
- the child’s intent and willingness to make speech attempts and communicate
- As A Parent of a Child with A Speech and Language Impairment, what are my legal rights?
"-The right of parents to receive a complete explanation of all the procedural safeguards available under IDEA and the procedures in the state for presenting complaints
-Confidentiality and the right of parents to inspect and review the educational records of their child
-The right of parents to participate in meetings related to the identification, evaluation, and placement of their child, and the provision of FAPE (a free appropriate public education) to their child
-The right of parents to obtain an independent educational evaluation (IEE) of their child
-The right of parents to receive “prior written notice” on matters relating to the identification, evaluation, or placement of their child, and the provision of FAPE to their child
-The right of parents to give or deny their consent before the school may take certain action with respect to their child
-The right of parents to disagree with decisions made by the school system on those issues
-The right of parents and schools to use IDEA’s mechanisms for resolving disputes, including the right to appeal determinations"(NICHCY, 2012)
- Is College A Possibility for A Student with CAS?
- How Common Are Speech and Language Impairments?
Studies show that over 1 million students qualify as possessing a Speech or Language Impairment as defined beneath the IDEA.(NICHCYC, 2011)
- Will My Insurance Company Pay For Therapy?
This depends greatly on your particular plan.
Many parents have difficulty getting insurance companies or HMOs to pay for treatment.
One factor that seems to be extremely important is how the speech pathologist that did the evaluation describes your child's problem.
Typically, it is wise to ask the evaluator to avoid using the word "developmental" in the diagnosis. Thus insurance companies who say they do not pay for developmental delays often challenge a diagnosis of developmental disorders.
It is also important for the evaluator to describe the likely outcome for your child if they do not get appropriate treatment.
Sometimes having the evaluator recommend a trial course of therapy in order to assess how the child does sits better with insurance companies.
If your claim is denied, always appeal the decision.
Try to enroll your child's pediatrician and other medical professionals in advocating for your child.
Find out why the claim was denied and resubmit the claim addressing these issues. (Gretz, 1997)
Many parents have difficulty getting insurance companies or HMOs to pay for treatment.
One factor that seems to be extremely important is how the speech pathologist that did the evaluation describes your child's problem.
Typically, it is wise to ask the evaluator to avoid using the word "developmental" in the diagnosis. Thus insurance companies who say they do not pay for developmental delays often challenge a diagnosis of developmental disorders.
It is also important for the evaluator to describe the likely outcome for your child if they do not get appropriate treatment.
Sometimes having the evaluator recommend a trial course of therapy in order to assess how the child does sits better with insurance companies.
If your claim is denied, always appeal the decision.
Try to enroll your child's pediatrician and other medical professionals in advocating for your child.
Find out why the claim was denied and resubmit the claim addressing these issues. (Gretz, 1997)
- How Do I Know If I Have a Good Therapist?
It is important to know that not all speech-language pathologists (SLP) are equally skilled in providing treatment to children with apraxia of speech. Some are better trained and more experienced than others.
Don't hesitate to ask prospective SLP about their experience, credentials, and success with these children. A good SLP will take into account the uniqueness that your child brings.
A good SLP will involve you in the therapy process and will show they value your role as the the parent, with respect to the ultimate success your child.
Good SLPs will invite you to observe therapy sessions, give you techniques you can use at home, listen to your ideas and concerns, communicate with others in your child's life, try to provide you with helpful information, and respect your knowledge about your child.
A good SLP will readily admit what he or she doesn't know.
A good SLP will be concerned if your child is not progressing and will not let unproductive treatment go on indefinitely.
A conscientious SLP will then seek out additional information, change techniques, consult a colleague, or refer you to someone else.
It may be also helpful to identify some "warning signs" regarding speech-language pathologists. The following may be reasons you may want to consider finding a new SLP:
(Gretz, 1997)
Don't hesitate to ask prospective SLP about their experience, credentials, and success with these children. A good SLP will take into account the uniqueness that your child brings.
A good SLP will involve you in the therapy process and will show they value your role as the the parent, with respect to the ultimate success your child.
Good SLPs will invite you to observe therapy sessions, give you techniques you can use at home, listen to your ideas and concerns, communicate with others in your child's life, try to provide you with helpful information, and respect your knowledge about your child.
A good SLP will readily admit what he or she doesn't know.
A good SLP will be concerned if your child is not progressing and will not let unproductive treatment go on indefinitely.
A conscientious SLP will then seek out additional information, change techniques, consult a colleague, or refer you to someone else.
It may be also helpful to identify some "warning signs" regarding speech-language pathologists. The following may be reasons you may want to consider finding a new SLP:
- the SLP tells you that children with apraxia will never develop intelligible speech.
- the SLP tells you it doesn't matter what your child's diagnosis is, their treatment will be the same as for other speech problems.
- the SLP does not include you or teach you how to help your child.
- the SLP is not helping your child to progress and doesn't seem concerned.
- the SLP does not have experience working with children who have apraxia of speech and appears unwilling to learn.
(Gretz, 1997)