Diagnosis of CAS: When and by whom?

[MUSIC PLAYING] CAS typically occurs with other problems, for many reasons. Sometimes children that are slow in developing in one area might have difficulty in developing other areas as well. Another thing that, of course, happens, is if a child has problems planning movement, that will undermine their ability to actually learn the sounds of their language because they have more trouble practicing them. So children with childhood apraxia frequently have coexisting language problems and often coexisting phonologic problems. It’s important, though, for the speech pathologist to determine whether the childhood apraxia is a primary problem in the child’s difficulty learning to talk, because it really helps the speech pathologist plan the focus of treatment.

CAS is really fairly uncommon in terms of the types of speech sound disorders. Our estimates are that, in the general population, only about 5% of children who have speech sound disorders would be diagnosed with childhood apraxia.

It really doesn’t relate to a particular age. In my experience, childhood apraxia of speech can be diagnosed as soon as the child is able to at least attempt direct imitation of words that vary in length and phonetic complexity. Many people ask, at what age can we discern this? What age can we tell when a child has apraxia of speech? There’s really no one particular age, but when that child can attempt direct imitation, then the speech pathologist is able to see whether or not they exhibit those characteristics that we associate with the label CAS.

If a child is too young or not able yet to imitate even simple words, there are a number of other observations we can make that we consider to be red flags and then we would watch the child and see them again in the near future for reevaluation because we’re worried that there might be an apraxia of speech. These red flags might include things such as very little or no babbling as a baby, perhaps a very reduced number of sounds for their age, and certainly a lack of differentiating vowels. Many children will, even if they don’t have many consonants, will use a variety of vowels, “ahh, ee, ahh, da-dah!” Whereas a child with apraxia might be more likely to just use “uh.” “Uh-uh uh. Duh uh. Duh duh.” And we look at that as a red flag.

Well parents are frequently going to go to the pediatrician first if they have worries about speech delay and the pediatrician will certainly know whether or not that child is at a level they should be for their age. But the pediatrician isn’t trained in differentially diagnosing what might be wrong with respect to the type of language or speech disorder, and for that reason, pediatricians will frequently refer the parent to a speech language pathologist, for that differential diagnosis and for the speech pathologist’s ability to plan the appropriate treatment.