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Procedural Learning, Grammar, and Motor Skills in Children With Childhood Apraxia of Speech, Speech Sound Disorder, and Typically Developing Speech
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This case–control study sought to determine if (a) children with childhood apraxia of speech (CAS), other speech sound disorders (SSDs), and typical development would perform differently on a procedural learning assessment and (b) whether grammatical ability would impact group differences. Method
Communication, motor, and procedural learning abilities were assessed in 48 children with CAS (n = 13), SSD (n = 20), and typical development (n = 15), between 43 and 97 months of age (M = 66 months, SD = 12 months). Results
On average, children with CAS demonstrated grammatical and motor impairments and required an increased number of exposures to the visuospatial sequence to demonstrate procedural learning, compared to peers with SSD or typical development. A subset of children from each group demonstrated an unanticipated procedural learning pattern wherein they evidenced an uptick in reaction time during the second sequenced block. Children with CAS with this pattern still evidenced procedural learning gains by the fifth sequenced block. In contrast, children with SSD and typical development with this pattern showed poor procedural learning outcomes and were characterized by lower scores on language and motor assessments as well. Conclusions
This research provides partial support for the procedural learning deficit hypothesis in children with CAS and for a subset of children with SSD as well. Future research should examine the role of a serial reaction time task in identifying children at risk of multisystem communication and motor deficits
Research Priorities for Childhood Apraxia of Speech: A Long View
No full textThis article introduces the Journal of Speech, Language, and Hearing Research Special Issue: Selected Papers From the 2022 Apraxia Kids Research Symposium. The field of childhood apraxia of speech (CAS) has developed significantly in the past 15 years, with key improvements in understanding of basic biology including genetics, neuroscience, and computational modelling; development of diagnostic tools and methods; diversity of evidence-based interventions with increasingly rigorous experimental designs; and understanding of impacts beyond impairment-level measures. Papers in this special issue not only review and synthesize the some of the substantial progress to date but also present novel findings addressing critical research gaps and adding to the overall body of knowledge. A second aim of this prologue is to report the current research needs in CAS, which arose from symposium discussions involving researchers, clinicians, and Apraxia Kids community members (including parents of children with CAS). Four primary areas of need emerged from discussions at the symposium. These were: (a) What questions should we ask? (b) Who should be in the research? (c) How do we conduct the research? and (d) How do we move from research to practice? Across themes, symposium attendees emphasized the need for CAS research to better account for the diversity of people with CAS and improve the timeliness of implementation of high-level evidence-based practice across the lifespan. It is our goal that the articles and prologue discussion in this special issue provide an appreciation of advancements in CAS research and an updated view of the most pressing needs for future research
Motor Performance in Children with Childhood Apraxia of Speech and Speech Sound Disorders
Get PDFPurpose: This study sought to determine if (a) children with childhood apraxia of speech (CAS), other speech sound disorders (SSDs), and typical development (TD) would perform differently on a standardized motor assessment and (b) whether comorbid language impairment would impact group differences.
Method: Speech, language, and motor abilities were assessed in children with CAS (n = 10), SSD (n = 16), and TD (n = 14) between the ages of 43 and 105 months. Motor skills were evaluated using the Movement Assessment Battery for Children-Second Edition (Henderson, Sugden, & Barnett, 2007), a behavioral assessment that is sensitive in identifying fine/gross motor impairments in children with a range of motor and learning abilities. Data were reanalyzed after reclassifying children by language ability.
Results: The CAS group performed below the normal limit on all components of the motor assessment and more poorly than the TD and SSD groups on Aiming and Catching and Balance. When children were reclassified by language ability, the comorbid CAS + language impairment group performed worse than the SSD-only and TD groups on Manual Dexterity and Balance and worse than the TD group on Aiming and Catching; all 7 children with CAS + language impairment evidenced performance in the disordered range compared to 1 of 3 children in the CAS-only group and 2 of 6 children in the SSD + language impairment group.
Conclusions: Children with CAS + language impairment appear to be at an increased risk for motor impairments, which may negatively impact social, academic, and vocational outcomes; referrals for motor screenings/assessments should be considered. Findings may suggest a higher order deficit that mediates cognitive-linguistic and motor impairments in this population
Prologue to the Forum: Care of the Whole Child: Key Considerations When Working With Children With Childhood Apraxia of Speech
Get PDFPurpose: This prologue introduces the LSHSS Forum: Care of the Whole Child: Key Considerations When Working With Children With Childhood Apraxia of Speech. The goals of the forum are to provide (a) an overview of several co-occurring conditions and challenges that may affect children in this population and (b) methods and materials to enhance diagnostic accuracy and treatment efficacy to help children with childhood apraxia of speech (CAS) to thrive.
Method: The prologue provides an overview of what it means to care for the whole child and introduces the five articles in the forum, including research and clinical focus articles as well as tutorials. Infographics, assessment templates, video examples, case studies, and treatment goals are included throughout the forum to promote translation from research to practice.
Conclusion: Children with CAS may experience a breadth of skills, challenges, and diagnoses. By learning (a) to identify possible co-occurring conditions, (b) when to make referrals, and (c) how to best accommodate and treat children when different conditions are present, speech-language pathologists can further increase the quality of care provided and ability to advocate for some of our most vulnerable clients and their families
Evaluation of a Combined Treatment Approach for Childhood Apraxia of Speech
No full textThe current study investigated the impact of a dual treatment approach that included stimulability training protocol (STP) paired with a modified core vocabulary treatment (mCVT) on the speech sounds produced by children with CAS. The combined treatment was assessed for changes in consistency and expansion of the phonetic inventories of four participants. The children participated in 20 treatment sessions over the course of 10 weeks. Each session was comprised of 10 minutes of stimulability training and 45 minutes of mCVT that included words that were chosen by the child and his or her parents. The words were restricted to contain at least one complex phoneme that was omitted from the child\u27s inventory. All children evidenced inventory expansion (average of five sounds) and increased percentage consonants correct (PCC; average of 20% increase), and three of the four children evidenced increased consistency in sound use. The effectiveness of STP paired with mCVT is explained by principles of motor and phonological learning
A Comparison of Oral Motor and Production Training for Children with Speech Sound Disorders
Get PDFDespite the many debates about the usefulness of nonspeech oral motor exercises (NSOMEs) in the treatment of speech disorders, few controlled experiments have evaluated their efficacy in the remediation of phonological/articulatory disorders (PADs). More importantly, the relative effect of NSOMEs compared with traditional production treatment (PT) has not been established. The current study employed an alternating treatment design to evaluate changes in production of sounds targeted by NSOMEs and PT in nine children with PAD. Each subject received treatment on two linguistically distinct sounds in which one sound was treated with NSOMEs and the second sound was targeted with PT. The difference in treatment efficacy, measured as the percentage change in target production for NSOMEs versus PT, was compared using a paired t test. Because NSOMEs typically are used to ready a child for subsequent PT, comparison of PT treatment accuracy was made between NSOME-first and PT-first sessions. Results demonstrated a statistically significant effect of treatment type with greater production gains with PT compared with NSOMEs. Further, no facilitative effect of NSOMEs on PT was noted; however, the choice of distinct treatment targets may have contributed to this null effect. Although additional investigation is warranted, the current investigation does not support the efficacy of NSOMEs in the treatment of PAD
An Investigation of Developmental Coordination Disorder Characteristics in Children with Childhood Apraxia of Speech
Get PDFPurpose: Children with childhood apraxia of speech (CAS) evidence a high rate of co-occurring fine and gross motor deficits. This clinical focus article reports a preliminary investigation of characteristics of developmental coordination disorder (DCD), a neurodevelopmental disorder categorized by poor motor proficiency and functional limitations, in this population. Method: Children with CAS underwent a comprehensive motor evaluation using the Movement Assessment Battery for Children–Second Edition, the Developmental Coordination Disorder Questionnaire, and a developmental history questionnaire to determine if they met criteria for a DCD diagnosis as specified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Results: Six out of seven participants met DCD criteria based on the DSM-5 criteria. Four of these children had a co-occurring diagnosis of developmental language disorder, and all met criteria for DCD. Conclusions: Consistent with previous research, the majority of participants demonstrated motor deficits and 85% met criteria for DCD. Despite this high rate of motor deficits, only 57% had previously undergone a physical/occupational therapy evaluation and intervention and only one had a previous diagnosis of DCD. These findings suggest that formal movement assessments are essential for children with a CAS diagnosis
Speech Assessment in Children With Childhood Apraxia of Speech
No full textThis article uses the International Classification of Functioning (ICF) framework to outline the assessment needs of children with apraxia of speech. Specifically, the level of breakdown for children with apraxia of speech—that of motor planning and programming at the level of body functions—is delineated using operationally defined criteria for greater diagnostic transparency.</jats:p
Retrospective Case–Control Study of Communication and Motor Abilities in 143 Children With Suspected Childhood Apraxia of Speech: Effect of Concomitant Diagnosis
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This study sought to determine if children with childhood apraxia of speech (CAS) plus another major diagnosis (CAS+) are equivalent in communication and motor profiles to those with a primary diagnosis of CAS and no indication or report of any other diagnosis (CAS-Primary). Method:
This retrospective case–control study included a chart review of 143 children who were suspected of having CAS at Children\u27s Hospital-Wisconsin between 1998 and 2004. Participants were between 30 and 127 months old and included 107 males. Participants were assigned to the suspected CAS-Primary group (n = 114) if they had characteristics of CAS but no other major diagnosis (e.g., galactosemia) and to the CAS+ group (n = 29) if a comorbid diagnosis was present. Groups were compared across demographic, communication, and motor characteristics. Results:
Children with CAS+ evidenced more severe motor profiles than those with CAS-Primary, χ2 = (1, n = 122) = 4.952, p = .026, and a small-to-medium effect size (Ф = .201). On average, communication profiles also tended to be more severe among those with CAS+ wherein receptive language was poorer and phonemic inventories were smaller than those with CAS-Primary. Conclusions:
These retrospective data suggest that comorbid diagnosis may play an important role in communication and motor development in children with suspected CAS. These exploratory findings should motivate future prospective studies that consider the role of concomitant diagnoses in symptom profile and response to treatment in children with CAS
Efficacious Treatment of Children With Childhood Apraxia of Speech According to the International Classification of Functioning, Disability and Health
No full textThere is increasing evidence for treatment approaches designed for children with childhood apraxia of speech (CAS). Despite this, no treatment has conclusive evidence to date. The CAS population is heterogeneous, with children presenting with varying symptom profiles, severity levels, and comorbidities. Consequently, treatment planning for children with CAS represents a clinical challenge. To assist clinicians in providing optimal care, this paper uses the International Classification of Functioning, Disability and Health (ICF) as a framework for identifying the body structures and functions, activities, and personal/environmental factors that should be considered when working with children with CAS. Evidence-based interventions are described and resources outlined to help guide the treatment planning process
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