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What in the World is Childhood Apraxia of Speech?

Educational, Featured, General, Speech Therapy | May 31, 2023 3 min read

What is CAS?

Childhood Apraxia of Speech, or CAS for short, is a speech disorder that results in children being unable to form the words they intend to, even though they know what they want to say. It is associated with very low intelligibility and is arguably one of the most frustrating speech challenges kiddos and their parents face. CAS is also sometimes also called Developmental Apraxia, but unlike this name suggests, children do not often improve spontaneously; skilled speech therapy is required to treat it.

Origins of CAS

CAS is estimated to occur in only 1 or 2 of every 1,000 children in America. Unlike acquired apraxia, which is most often seen in adults who have had strokes or traumatic brain injury, the cause of CAS is unknown. Rarely are there any observable differences in the brain, though CAS can sometimes occur as a symptom of a syndrome, genetic disorder, or metabolic condition (e.g., galactosemia). CAS is known to exist at higher rates in children who have other neurodevelopmental conditions such as ADHD, Autism, and epilepsy.

Mechanics of CAS

The act of speech is a series of incredibly precise fine motor skills that requires very refined movement of the lips, tongue, and jaw. If the neurological planning of these movements is disrupted, as in the case of CAS, low intelligibility results. Recent research indicates that children with CAS may have difficulties with sensory feedback loops required to learn and judge the accuracy of speech. Sensory feedback is important for the subliminal knowledge of proximity between speech structures (e.g., lips, tongue, teeth, palate) during speech, which plays a role in execution of movement.

What CAS is Not

CAS does not involve physical issues with the mouth, such as muscle weakness or muscle coordination difficulties. It also does not involve the brain itself, but rather nerve pathways responsible for planning speech movements.

CAS vs Phonological Disorder

Many times, parents of children who exhibit very low intelligibility research causes online and conclude that Childhood Apraxia of Speech is to blame for their child’s unintelligible speech. However, children with severe phonological disorders can be just as unintelligible, or even more so, than children with CAS. Your speech-language pathologist will need to analyze your child’s speech to discern whether distinct error patterns (e.g., deleting or substituting certain sounds in various word positions) are present, as in a phonological disorder, or whether the errors are inconsistent or random, as in CAS. CAS and phonological disorders can also coexist.

Errors related to CAS often change as a word is repeated, and these errors cannot be grouped into categories, unlike phonological errors. Other characteristics of CAS which distinguish it from a severe phonological disorder include errors on vowels, prosodic errors (relating to stress and intonation), increased errors as utterance length increases, and increased errors in spontaneous speech over rehearsed speech. When your child’s speech is evaluated, your speech-language pathologist will provide an appropriate diagnosis in order to follow with appropriate treatment methods.

By Kathleen Winger MS CCC-SLP

Gestalt Language Processing

Educational, Featured, General, Speech Therapy, Therapy | May 01, 2023 3 min read

Let’s unpack some buzz words that you may have been hearing lately:

“Echolalia” is the repetition of language spoken by others. It can be repeated either immediately or after some delay. With echolalia, language is stored as a “chunk”, or a whole unit.

“Scripting” is another term that refers to echolalia. “To infinity…and beyond!” is an example of a script from media. “See you later alligator” is an example of a script that may be heard in conversation. When children are “scripting”, they may be observed reciting dialogue from a TV show, singing lyrics from a YouTube song, or copying phrases they’ve heard other people use. The message is often identical to the source where they heard it, and has the same melody.

“GLP” stands for Gestalt Language Processing. This is a form of language development where children learn the meaning of language in chunks first, then over time learn to break the chunks down and formulate their own original language.

Let’s bust some myths:

Are most autistic children GLPs? YES!

Does being a GLP automatically mean a child is on the Autism Spectrum? NO! Some neurotypical children learn language via chunks as well.

Unsure if your child may be a “GLP”? Here are some common signs:

1. They echo back what you say or the last part of phrases you say, without appearing to process the language.

2. They have difficulty answering questions in conversation.

3. They like to hum or sing songs rhythmically.

4. They have a preference for intonation-rich sound input, such as music or videos.

5. They replay certain portions of video clips over and over.

6. They like to repeat play scenes in the same way over and over.

7. They like to play with the WHOLE set – if a figurine is missing, they are not pleased. They are seeing the world in a “gestalt” way.

8. They like to label objects they see around them and can recite their ABCs or count 1-2-3, though have trouble using their language to ask for help or communicate other important functions.

I think my child is a GLP… Now what?

1. Find a Speech-Language Pathologist near you that has been trained in Gestalt Language Processing. They can help determine which stage of the Natural Language Acquisition framework your child is in and give tailored advice on how to support your child’s language development at home.

2. Follow social media accounts such as @meaningfulspeech and @bohospeechie, which provide brief, useful posts related to GLP.

3. Take a look at free resources on the website www.meaningfulspeech.com. If you have extra time, consider taking Meaningful Speech’s parent friendly course.

4. Check out Marge Blanc’s book, “Natural Language Acquisition on the Autism Spectrum. The Journey from Echolalia to Self-Generated Language.”

Things to Keep in Mind:

Echolalia is not just a “stimming behavior” that should be ignored, decreased or extinguished… Echolalia communicates.
We should acknowledge children’s scripts by nodding our heads or repeating back what they say, even if we are unsure what they mean.
Speech therapists are here to help!

By Julia Navarra MA CCC-SLP

My child was just diagnosed with autism spectrum disorder… Now what?

Educational, Featured, Therapy | Sep 02, 2022 3 min read

Step 1: Take a deep breath!

Learning that your child has been diagnosed with Autism Spectrum Disorder, or ASD,
can understandably flood parents and caregivers with a range of overwhelming emotions.
It’s easy to feel trapped or condemned by a label. When the “what ifs” start to invade,
remember that this new information does not change who your child is or who you
already know them to be. It is simply an identification of a root cause for various
symptoms and the first step to helping your child reach their full potential.

Step 2: Free your child (and yourself) from expectations

Following a diagnosis of ASD, it is common for parents and caregivers to experience a
period of mourning for “normality” and feelings of uneasiness when thinking about the
future. However, the new diagnosis is not a predictor of the future, let alone a sentence to
a life of failure or unhappiness. Taking one day at a time and celebrating any progress,
no matter how small, is key in cultivating both acceptance and a sense of hope.

Step 3: Advocate for your child

With a new diagnosis comes a plethora of recommendations from medical and school
professionals. Always remember, though these recommendations are backed by research
and have been proven to help, you have the final say in your child’s treatment. Though
30 hours of therapy per week might be recommended, you may feel that is too much. Go
with your instinct! Your child’s team of professionals will work with you to ensure the
best possible treatment to match your child’s individual needs.

Step 4: Find community

No one has to face the journey alone! Consider joining a virtual or in-person support
group for parents and caregivers of children with Autism, or an online forum. Sometimes
well-meaning family and friends can misunderstand and unintentionally cause more pain,
so it can be important to connect with people who do understand. Autism Society San Diego offers both support groups for parents/caregivers and fun events for the entire family. Military families can take advantage of the Exceptional Family Member Program
(EFMP) for a range of family support. When in doubt, meetup.com is a great place to
start!

Step 5: Take care of yourself!

Self-care is often placed on the backburner when caring for a child who has an ASD
diagnosis. However, burn-out is not only emotionally draining for you, but is also
unhelpful for your child. It’s important to seek Respite Care services if you don’t have a
friend or family member to babysit while you take time for yourself to recharge. In
addition, pick your battles with your child. Rome wasn’t built in a day, so anticipating
immediate results and/or perfection can contribute to high stress levels.

Checklist, in no particular order:

Developmental evaluation (medical) through your doctor or San Diego Regional Center. It is important to get a medical diagnosis, not just an educational label
through the school district. This is not the same as a formal diagnosis.
Speech therapy (medical/outpatient)
Occupational therapy (medical/outpatient)
Behavioral therapy (e.g., ABA) (in home or in facility)
Apply for school services at age 2 and 10 months to begin at age 3. This will determine eligibility for services through the school district such as, speech
therapy, occupational therapy, and behavioral therapy. Your child can receive these therapies in both the medical and school setting, as medical and educational
services are autonomous from one another.

Written by: Kat Winger, MS CCC-SLP

What is Pediatric Occupational Therapy and how would I know if my child would benefit?

Educational, Featured, Psychology, Speech Therapy, Therapy | Apr 04, 2022 6 min read

Occupation refers to functional tasks or activities that bring meaning to your life. And our children’s main activity is PLAY. Did you know that kids play to learn and that play requires motor, sensory processing, cognitive, and social skills? All these skills work together for learning. However, when the necessary skills for play are observably difficult, it can make grasping new competencies challenging for kids.

Occupational therapy addresses all the skills needed for play. It works on strength, coordination, and control to support their movement. OT also helps with sensory processing difficulties by identifying the way your toddler receives or responds to sensory input and teaching fun ways for you to support your child. And finally, Occupational Therapy promotes executive function skills building on motor, attention, and regulation foundations for learning.

Though play can look different and vary from child to child, there are general toddler development skill ranges necessary for learning to happen. When these are not progressing or missing, they can inhibit engaging in and learning through play.

The development of sensory processing and motor skills begins immediately at birth. The brain is where all the magic happens. Newborns take in sensations, but their body is unable to organize them—their reflexes are neurological responses to stimulation, including the senses of light, sound, touch, or pressure input such as stroking and vestibular sensory input with sudden movement.

The sensory processing and motor skill development looks random and clumsy at first with the baby’s initial kicking of their legs or trying to find their mouth with their hand. As they continue to be exposed to the sensation and repeat the movement, it becomes more purposeful.

Babies are holding, pulling, pushing, and dropping toys as they learn about cause and effect. More and more skills work together to explore and learn through play.

For your toddler, the years from 1 to 3 are very busy. They are essential years of curiosity, trial and error, and learning about what they can do. At age one, toddlers are very active. Give them a container, and everything comes out; maybe a few things go back inside. Set something on the table, and they pull up to see if they can get it. They make sounds and babble and may tug on your heart with Ma Ma or Da Da words!

Toddlers are in a transition of building more independence. During the terrible twos, a stage that everyone stresses about, they continue to learn about their environment, manipulate things, and communicate their experiences. Their development takes all the work that the baby’s brain and body did and uses it in play to build confidence, control movement, and explore new sensations. Toddlers experience big emotions. They must learn about these feelings and how their body responds to them. How we react and support them is important.

They also learn to transition from one activity to another, even when they don’t want to.
For example, two-year-olds usually can stack a few blocks, string a few large beads on a shoelace, feed themselves with a spoon, drink from an open cup or a straw, remove/pull on clothing, brush teeth, help wash their body at bath time, jump, run, and walk up and down a few steps. They can also throw a small ball toward a target, help clean up, and put toys away. Though the terrible twos try on parents and toddlers, they don’t last long. And both parents and kids learn a great deal!

As we strive to develop more patience during these times, our toddlers are growing far more in their quest for independence. Two-year-olds should be able to attend and learn a new play activity for 4-6 minutes. Some research even suggests that this age group should be able to focus on a task for 10 minutes.

Though many toddlers can sit and play for extended periods of time with preferred toys or activities they have initiated themselves, a better learning opportunity is to give them a new task to work on to develop manipulation skills like using a tool to scoop, fill a container, feed themselves with a spoon or fork, stack or build with blocks, lace beads on a string, or roll a ball back and forth.

Notice how your child works through activities. When development is not smooth, there will be clues in how your child moves, plays, speaks, or acts. See if you observe any of these challenges:

unable to manipulate toys in play, they continue to dump, empty containers, or throw them around the room
difficulty using tools to scoop, squeeze, hammer, draw
unable to demonstrate repetitive play activities. May run around, only roll the car back and forth
moves between many play activities quickly, not engaging in any of them
requiring or demanding your attention and unable to initiate or engage in play by themselves for short periods
difficulty imitating actions in movement, imitating mouth or tongue movements, silly faces, or being unable to throw a ball at a target. Difficulty moving from sitting to moving under structures, crawling through a tunnel
unable or very clumsy with jumping, climbing, moving between different level surfaces, climbing ladder to slide
unable to take turns in play activities such as rolling ball back to you, stacking blocks
seems fixated on the television, tablet, or phone and unable to engage with other toys in play
difficulty putting things together such as connecting blocks, lacing, and beads
unable to tolerate play on a swing, on a slide
unable to play near or with other children
unable to tolerate tactile messy play or engagement with media like play-doh, finger paint, or shaving cream
difficulty removing pull on clothing from dress-up activities

Play is one of the most significant areas that can provide clues about your toddler’s development. As we’ve outlined, there is so much growth happening during this time. If you see your child struggling in any of the areas we mentioned, occupational therapy can help develop and strengthen the skills needed for learning.

Occupational therapists are experienced experts and can help identify the areas inhibiting your child’s primary occupation and introduce fun activities for successful skill development.

Children are tiny individual humans with varied interests and gifts. We embrace and work together with parents to help children reach their greatest potential.

Come in and check us out in April for Occupational Therapy month!

Author: Pamela Vasiloff, OT