Telepractice and Childhood Apraxia of Speech

In another article in this series, we looked at two types of speech sound disorders in children: articulation and phonology. Recall that “articulation” refers to issues with movement that may be caused by the child’s anatomy, weakness, or range of motion. “Phonology” refers to the complex patterns and rules we use for producing sounds. Some of the patterns we associate with speech sound disorders are actually part of the typical speech development process. However, when a child persists in these speech behaviors after a certain age, they may benefit from extra help by a SLP to acquire more adult speech patterns.

What is Childhood Apraxia of Speech?

Childhood Apraxia of Speech (CAS) is another impairment that impacts how children produce speech; however, there is a fundamental difference between apraxia and other speech disorders. A child with CAS experiences a motor planning / coordination issue, (ASHA, 2007). To make even simple speech sounds, we use a highly complex system that requires an amazing amount of coordination. In a specifically-timed way, our brain interacts with different parts of our body to do things like:

• Tell our respiratory system how much air to push out of our lungs
• Tell our vocal folds, (sometimes called our “voice box”), when to start and stop vibrating to make sound
• Activate different muscles so that sound resonates in a specific way in our mouth or nose
• Move our tongue and lips to control air flow and produce vowels and consonants

Childhood Apraxia of Speech Symptoms

When a child has Childhood Apraxia of Speech, she or he demonstrates difficulty coordinating some, (or all), of these types of movements in a way that can’t be completely explained by anatomy, weakness, range of motion, or phonological patterns and rules. Likewise, CAS is not related to patterns of typical development and is not something that children “outgrow” on their own. CAS isn’t as common as some other communication impairments, although we don’t currently have strong data regarding how many children in the U.S. are affected by apraxia. We are also still learning about what causes CAS. What is clear is that children who experience have unique needs for support.

Children with CAS may present with any combination of the following concerns:

• Making inconsistent sound errors
• Difficulty with vowel sounds and voicing
• Increased challenges with longer words
• Challenges with “prosody,” or the rhythm and intonation we use when speaking
• Difficulty putting stress on correct syllables
• Groping behaviors when speaking, in which there is visible tension in the face, tongue, lips, etc.

These children may also experience some language delays or difficulties with other fine motor movements. (See: ASHA, 2007; Davis et al. 1998; Lewis et al., 2004; McCabe et al., 1998)

Treatment for Childhood Apraxia of Speech

Treatment for Childhood Apraxia of Speech is also something we need to learn more about as a profession, (Morgan & Vogel, 2008). However, there is some evidence that more frequent treatment sessions, (three – five per week as opposed to the traditional one – two), can give the most benefit to these students.  It has also been shown that children with CAS may make more progress in individual treatment session than they might by working in groups, (Hall et al., 1993; Skinder-Meredith, 2001; Strand & Skinder, 1999). Likewise, students may do better being seen in multiple, natural environments to help them generalize the motor practice that happens during therapy, (ASHA, 2007).

How Does Telepractice Help Kids with CAS?

Unfortunately, there is no published evidence on the outcomes of telepractice to serve children with Childhood Apraxia of Speech. However, the “ready-to-go,” portable, and individualized nature of telepractice may be a great fit for the unique treatment needs of students with CAS- particularly when it’s used in a home-based setting. Children receive great speech/language services in their schools!

However, SLPs are often taxed with high caseloads. This can make it difficult to schedule individual sessions, multiple times throughout the week. It can also disrupt students’ classroom participation and their exposure to the curriculum if they are taken into a different setting three to five times per week. Families who try to supplement school services with private therapy may find it cumbersome to arrange their schedules and travel to and from a clinic every few days. Telepractice can bring those services right into the home with intensive, individualized support that may not be as available in other settings. Bringing intervention into the home, and the potential to interact with people and activities that are part of the student’s natural environment, increases that child’s likelihood of generalizing motor speech practice to other situations.

Summary

Childhood Apraxia of Speech is a complex issue. Unfortunately, navigating the treatment options that are available can also be complex. As discussed, our profession is still in the process of learning how to best serve children with CAS- both in on-site and remote settings. However, the unique nature of telepractice holds exciting possibilities for meeting the unique needs of these kids! If you’re a therapist looking for a better way to work, check out our VocoVision Telepractice Services here!

References

• American Speech-Language-Hearing Association. (2007). Childhood apraxia of speech[Technical Report]. Available from asha.org/policy.
• Davis, B., Jakielski, K., & Marquardt, T. (1998). Developmental apraxia of speech: Determiners of differential diagnosis. Clinical Linguistics and Phonetics, 12, 25–45.
• Hall, P. K., Jordan, L. S., & Robin, D. A. (1993). Developmental apraxia of speech: Theory and clinical practice. Austin, TX: Pro-Ed.
• Lewis, B. A., Freebairn, L. A., Hansen, A. J., Iyengar, S. K., & Taylor, H. G. (2004). School-age follow-up of children with childhood apraxia of speech. Language, Speech, and Hearing Services in Schools, 35, 122–140.
• McCabe, P., Rosenthal, J. B., & McLeod, S. (1998). Features of developmental dyspraxia in the general speech impaired population? Clinical Linguistics and Phonetics, 12, 105–126.
• Morgan, A. T., & Vogel, A. P. (2008). Intervention for Childhood Apraxia of Speech. Cochrane Database of Systematic Reviews (3).
• Skinder-Meredith, A. (2001). Differential diagnosis: Developmental apraxia of speech and phonologic delay. Augmentative Communication News, 14, 5–8.
• Strand, E., & Skinder, A. (1999). Treatment of developmental apraxia of speech: Integral stimulation methods. In A. Caruso & E. Strand (Eds.), Clinical management of motor speech disorders in children(pp. 109–148). New York: Thieme.