Childhood Apraxia of Speech (CAS) is a label for a specific motor speech disorder that makes it difficult for children to speak. Children with Apraxia of Speech have difficulty with the planning and programming of the complex sequenced movements that are necessary to produce speech sounds and words. Unlike a true developmental speech delay, where children follow a “typical” path of speech development at a slower rate, a child with CAS has difficulty planning the motor movements required to produce speech. This may result in difficulties with smooth transitions from sound to sound, or syllable to syllable, and inconsistent speech errors.

Childhood Apraxia of Speech (CAS) is a label for a specific motor speech disorder that makes it difficult for children to speak. Children with Apraxia of Speech have difficulty with the planning and programming of the complex sequenced movements that are necessary to produce speech sounds and words. Unlike a true developmental speech delay, where children follow a “typical” path of speech development at a slower rate, a child with CAS has difficulty planning the motor movements required to produce speech. This may result in difficulties with smooth transitions from sound to sound, or syllable to syllable, and inconsistent speech errors.

Children with Childhood Apraxia of Speech often generally have a good understanding of language and know what they want to say, but have difficulty efficiently programming the complex sequence of movements that are necessary to produce clear speech. Although sometimes CAS can co-occur with other diagnoses, such as Autism Spectrum Disorder, there are certain key characteristics, in the absence of any consistent developmental errors, that help differentiate CAS from other speech sounds disorders. CAS is a difficulty in the planning and execution of the muscle movements needed to produce speech. This is unlike developmental delays, in which motor planning occurs in a “typical” but delayed timeline. Some of the characteristics that differentiate CAS from other speech disorders include:

• Difficulty moving from one articulatory configuration to another
• Groping or trial-and-error behavior
• Presence of vowel distortions
• Prosodic errors
• Inconsistent Voicing Errors

Research has started to demonstrate some early warning signs of CAS in infants and toddlers, which SLPs and parents should consider. The following symptoms do not diagnose a child with CAS; rather they are red flags which indicate early intervention speech therapy is advisable, and which have been linked in studies to a later label of CAS. Here are some early warning signs for CAS in toddlers that were found to correlate with a later diagnosis of CAS,by Overby, Caspari, and Schreiber (2019):

• Limited vocalizations, in the first two years old
• No consonants by the time a child is one year old
• Less than 3 consonants by one-and-a-half-years old
• Less than 5 consonants by two-years-old
• Limited production or not able to produce /k/ and /g/ sounds (velar consonants)
• Limited speech productions at 13-18 months, characterized mostly by vowels, and very limited use of other syllable shapes

Overby MS, Caspari SS, Schreiber J. Volubility, Consonant Emergence, and Syllabic Structure in Infants and Toddlers Later Diagnosed With Childhood Apraxia of Speech, Speech Sound Disorder, and Typical Development: A Retrospective Video Analysis. J Speech Lang Hear Res. 2019;62(6):1657‐1675. doi:10.1044/2019_JSLHR-S-18-0046

Appropriate treatment for CAS should focus on the motor planning and programming needed to produce speech, since the main problem of CAS is in motor programming for speech. Unique motor planning based therapy treatment for CAS, including Dynamic Temporal Tactile Cueing (DTTC) or PROMPT, focuses on planning of the sequenced movements of the articulators (tongue, lips, jaw, vocal folds) and muscles that need to move during speech attempts. Therapy for CAS concentrates on the motor movements in order to help the child produce more precise sounds, words, phrases, and spontaneous speech.

We encourage you to watch this video about treatment for CAS with Dr. Edythe Strand, Emeritus Professor and Consultant, division of Speech Pathology, Department of Neurology, Mayo Clinic, in which she discusses basic approaches to treatment of CAS and provides a number of video examples of therapy.
https://www.youtube.com/watch?v=sq7vFWLqodM

Dynamic Temporal Tactile Cueing (DTTC) was developed by Dr. Edythe Strand Ph.D. CCC-SLP to treat students with Childhood Apraxia of Speech (CAS). DTTC is based on the Integral Stimulation Method (i.e., “watch me, do what I do”). DTTC also applies the Principles of Motor Learning to motor speech treatment to help make the motor programming for speech more efficient, and make the speech movements more precise. DTTC treats the motor programming needed to produce accurate speech movements at the level of the tongue, lips, jaw, vocal folds, and vocal tract. DTTC utilizes a unique and specific hierarchy of cueing and practice which facilitates motor speech learning, with prosodic (melodic, intonation) variation built into every level of the hierarchy. This helps encourage flexibility and generalization of motor speech skills. A careful analysis of each child’s motor speech skills and communication needs are considered in treatment planning and selection of motor targets, and the process of shifting the amounts of cueing and support is dynamic and fluid as progress is made over time. The use of DTTC has proven to be an effective method for treatment of CAS in current literature. Within our practice, we have also found DTTC treatment techniques and strategies to be efficient and successful for treatment of other motor speech disorders as well.

Strand, Edythe. (2019). Dynamic Temporal and Tactile Cueing: A Treatment Strategy for Childhood Apraxia of Speech. American Journal of Speech-Language Pathology. 29. 1-19. 10.1044/2019_AJSLP-19-0005.