Assessment and Therapy in Childhood Apraxia of Speech

Year 2023, Volume: 6 Issue: 3, 362 - 387, 30.12.2023

Nazmiye Atila Çağlar Ayşın Noyan Erbaş

https://doi.org/10.58563/dkyad-2023.63.6

Abstract

Purpose Childhood apraxia of speech (CAS) is a neurological speech sound disorder not accompanied by neuromuscular deficits, characterized by disorders in the planning and/or programming of spatio-temporal parameters of movement sequences. Both congenital and acquired CAS can occur in association with known neurological events, as primary or secondary symptoms of complex neurobehavioral disorders, or as idiopathic neurogenic speech sound disorder. Many of the behaviors and symptoms associated with CAS are also found in children with other speech sound disorders, so differential diagnosis is very important. For the differential diagnosis of CAS, the features specified by ASHA (2007) (inconsistent vowel and consonant errors in repeated productions of syllables or words, inappropriate prosody and/or impaired and prolonged coarticulation transitions between sounds and syllables) and Strand's 10-item clinical checklist are frequently used. After the diagnosis of CAS, it is very important to choose the appropriate assessment and intervention methods for these children. This review aims to present speech and language assessment methods and evidence-based intervention methods applied to children with CAS.

Method: In this study, the traditional review method was used. A literature review was conducted regarding speech-language assessment and intervention methods applied to children with CAS.

Results: A comprehensive CAS assessment should include both formal assessments and informal tasks to accurately address the children's speech motor system. Assessment of a children with suspected CAS; include case history, oral examination, speech analysis, assessment of suprasegmental features, stress, rhythm, pauses, tone of voice, stimulability and cues, as well as language, literacy assessment. Formal tests that can be used in the assessment of CAS are Apraxia Profile, Dynamic Evaluation of Motor Speech Skill, Kaufman Speech Praxis Test, Verbal Motor Production Assessment for Children, Orofacial Praxis Test, Madison Speech Assessment Protocol. Since the age ranges and areas evaluated differ in each formal test, the speech and language therapist should take these factors into consideration when choosing appropriate assessment tools for children. After speech and language evaluations are completed, an individualized intensive intervention program is required for children. The starting point and progression of therapy are shaped depending on the assessment data received from the children. Speech and language therapy in children with CAS progresses systematically, in a hierarchical manner, becoming increasingly difficult. Therapeutic approaches used for children with CAS fall under three headings: motor-based approaches, linguistic-based approaches and multi-modal communication approaches. Evidence-based therapy methods for children with CAS in the field of speech and language therapy are Dynamic Temporal and Tactile Cueing, Rapid Syllable Transitions Therapy, Nuffield Dyspraxia Programme, Integrated Phonological Awareness Intervention.

Conclusion: Speech and language therapists should have comprehensive knowledge and experience about different assessment and therapy methods used for children with CAS and choose the most appropriate therapy method for a child diagnosed with CAS.

Keywords

Childhood Apraxia of Speech, Speech Sound Disorder, Speech and Language Therapist, Speech and Language Assessment, Speech and Language Therapy.

Çocukluk Çağı Konuşma Apraksisinde Değerlendirme ve Terapi

Abstract

Amaç: Çocukluk çağı konuşma apraksisi (ÇÇKA), hareket sıralamalarının uzamsal-zamansal parametrelerinin planlanması ve/veya programlanmasındaki bozukluklar ile karakterize nöromüsküler defisitlerin eşlik etmediği nörolojik bir konuşma sesi bozukluğudur. Bu derleme ile, ÇÇKA’ lı çocuklarda uygulanan dil ve konuşma değerlendirme yöntemlerini ve kanıta dayalı müdahale yöntemlerini sunmak amaçlanmaktadır.

Yöntem: Bu çalışmada geleneksel derleme yöntemi kullanılmıştır. ÇÇKA’ lı çocuklarda uygulanan dil-konuşma değerlendirme ve müdahale yöntemlerine ilişkin alan yazın taraması yapılmıştır.

Bulgular: ÇÇKA şüphesi olan bir çocuğun değerlendirmesi; vaka öyküsünü, oral muayeneyi, konuşma analizini, suprasegmental özellikleri, vurgu, ritim, duraklamalar, ses tonu, uyarılabilirlik ve ipuçlarının değerlendirilmesini ve ayrıca dil, okuryazarlık değerlendirmesini içermektedir. ÇÇKA değerlendirmesinde kullanılabilecek formal testler, Apraksi Profili (Apraxia Profile), Motor Konuşma Becerisinin Dinamik Değerlendirmesi (Dynamic Evaluation of Motor Speech Skill), Kaufman Konuşma Praksis Testi (Kaufman Speech Praxis Test), Çocuklar için Sözel Motor Üretim Değerlendirmesi (Verbal Motor Production Assessment for Children), Orofasiyal Praksis Testi (Orofacial Praxis Test), Madison Konuşma Değerlendirme Protokolü (Madison Speech Assessment Protocol) şeklindedir. Dil ve konuşma terapisi alanında ÇÇKA’ lı çocuklar için kanıta dayalı terapi yöntemleri ise, Dinamik Temporal ve Taktil İpucu (Dynamic Temporal and Tactile Cueing), Hızlı Hece Geçişleri Terapisi (Rapid Syllable Transitions Therapy), Nuffield Dispraksi Programı (The Nuffield Dyspraxia Programme), Entegre Fonolojik Farkındalık Müdahalesi (Integrated Phonological Awareness) şeklindedir.

Sonuç: Dil ve konuşma terapistlerinin, ÇÇKA’ lı çocuklarda uygulanan farklı değerlendirme ve terapi yöntemleri hakkında kapsamlı bilgi ve deneyime sahip olması ve ÇÇKA tanısı konan bir çocuk için en uygun terapi yöntemini seçmesi gerekmektedir.

Keywords

Çocukluk Çağı Konuşma Apraksisi, Konuşma Sesi Bozukluğu, Dil ve Konuşma Terapisti, Dil ve Konuşma Değerlendirmesi, Dil ve Konuşma Terapisi

References

• American Speech-Language-Hearing Association. (2007). Childhood apraxia of speech.
• Atila Çağlar, N., & Noyan Erbaş, A. (2022). Vaka Çalışması: Çocukluk Çağı Konuşma Apraksisi Olan Bir Çocukta Dil ve Konuşma Müdahalesinin Etkililiğinin İncelenmesi. Ergoterapi ve Rehabilitasyon Dergisi, 10(3), 127-132. https://doi.org/10.30720/ered.868211.
• Baas, B. S., Strand, E. A., Elmer, L. M., ve Barbaresi, W. J. (2008). Treatment of severe childhood apraxia of speech in a 12-year-old male with CHARGE association. Journal of Medical Speech-Language Pathology, 16(4), 181-191. Bearzotti, F., Tavano, A., ve Fabbro, F. (2007). Development of orofacial praxis of children from 4 to 8 years of age. Perceptual and motor skills, 104(3_suppl), 1355-1366.
• Case, J., & Grigos, M. (2020). How the study of speech motor control can inform assessment and intervention in childhood apraxia of speech. Perspectives of the ASHA Special Interest Groups, 5(4), 784-793.
• Crary, M. A., & Anderson, P. (1991, November). Speech and motor performance in developmental apraxia of speech. Technical session presented at the Annual Convention of the American-Speech-Language-Hearing Association, Atlanta, GA.
• Davis, B., Jakielski, K., ve Marquardt, T. (1998). Developmental apraxia of speech: Determiners of differential diagnosis. Clinical Linguistics & Phonetics, 12, 25–45.
• Davis, B. L., & Velleman, S. L. (2000). Differential Diagnosis and Treatment of Developmental Apraxia of Speech in Infants and Toddlers. Infant-toddler intervention: The transdisciplinary Journal, 10(3), 177-92.
• Delaney, A. L., & Kent, R. D. (2004, November). Developmental profiles of children diagnosed with apraxia of speech. In Poster presented at the annual convention of the American Speech-Language-Hearing Association, Philadelphia, PA.
• Dewey, D., Roy, E. A., Square-Storer, P. A., ve Hayden, D. (1988). Limb and oral praxic abilities of children with verbal sequencing deficits. Developmental Medicine and Child Neurology, 30, 743–751.
• Fish, M. (2015). Here's How to Treat Childhood Apraxia of Speech. Plural Publishing.
• Gillon, G. T., & Moriarty, B. C. (2007, February). Childhood apraxia of speech: Children at risk for persistent reading and spelling disorder. In Seminars in speech and language (Vol. 28, No. 01, pp. 048-057). Copyright© 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA..
• Grigos, M. I., & Kolenda, N. (2010). The relationship between articulatory control and improved phonemic accuracy in childhood apraxia of speech: A longitudinal case study. Clinical linguistics & phonetics, 24(1), 17-40.
• Gubiani, M. B., Pagliarin, K. C., ve Keske-Soares, M. (2015, November). Tools for the assessment of childhood apraxia of speech. In CoDAS (Vol. 27, pp. 610-615). Sociedade Brasileira de Fonoaudiologia.
• Hall, P. K., Jordan, L. S., ve Robin, D. A. (1993). Developmental apraxia of speech: Theory and clinical practice. Pro Ed. Hayden, D., Namasivayam, A. K., Ward, R., Eigen, J., ve Clark, A. (2020). The PROMPT approach: Theory, Evidence, Use and Application. Interventions for Speech Sound Disorders, 2, 477-504.
• Hayden, D., & Square, P. (1999). Verbal motor production assessment for children.
• Hickman, L. A. (1997). The Apraxia Profile: A descriptive assessment tool for children. Communication Skill Builders-a division of the Psychological Corporation.
• Iuzzini-Seigel, J., Allison, K. M., ve Stoeckel, R. (2022). A Tool for Differential Diagnosis of Childhood Apraxia of Speech and Dysarthria in Children: A Tutorial. Language, speech, and hearing services in schools, 53(4), 926–946. https://doi.org/10.1044/2022_LSHSS-21-00164.
• Iuzzini-Seigel, J., Hogan, T. P., ve Green, J. R. (2017). Speech inconsistency in children with childhood apraxia of speech, language impairment, and speech delay: Depends on the stimuli. Journal of Speech, Language, and Hearing Research, 60(5), 1194-1210.
• Karamete, A. (2021). Konuşma Sesi Bozukluğu Olan 3: 00-6: 11 yaş Arası Çocukların Motor Konuşma Becerisinin Dinamik Değerlendirmesi (Doctoral dissertation, Anadolu University (Turkey)).
• Kaufman, N. R. (1995). Kaufman speech praxis test for children. Wayne State University Press.
• Koçak, A. N., & Aydın, N. (2020). Çocukluk Çağı Konuşma Apraksisinde Uygulanan Terapi Yöntemleri. Dil Konuşma ve Yutma Araştırmaları Dergisi, 3(2), 218-240.
• Lewis, B. A., Freebairn, L. A., Hansen, A. J., Iyengar, S. K., ve Taylor, H. G. (2004). School-age follow-up of children with childhood apraxia of speech. Language, speech, and hearing services in schools, 35(2), 122–140. https://doi.org/10.1044/0161-1461(2004/014).
• Maas, E., Gildersleeve-Neumann, C. E., Jakielski, K. J., ve Stoeckel, R. (2014). Motor-based intervention protocols in treatment of childhood apraxia of speech (CAS). Current developmental disorders reports, 1, 197-206.
• McCabe P, Murray, E., Thomas, D. C., Bejjani, L., ve Ballard, K. J. (2013). A new evidence-based treatment for childhood apraxia of speech: ReST. In: American Speech L, Hearing Association Annual Convention., editor.; Chicago, IL.
• McCabe, P., Murray, E., Thomas, D., ve Evans, P. (2017). Clinician manual for rapid syllable transition treatment (ReST). The University of Sydney: Camperdown, Australia.
• McCabe, P., Rosenthal, J. B., ve McLeod, S. (1998). Features of developmental dyspraxia in the general speech impaired population. Clinical Linguistics & Phonetics, 12, 105–126.
• McNeill, B. C., Gillon, G. T., ve Dodd, B. (2009a). Effectiveness of an integrated phonological awareness approach for children with childhood apraxia of speech (CAS). Child Language Teaching and Therapy, 25(3), 341-366.
• McNeill, B. C., Gillon, G. T., ve Dodd, B. (2009b). Phonological awareness and early reading development in childhood apraxia of speech (CAS). International journal of language & communication disorders, 44(2), 175-192.
• Morgan, A. T., Murray, E., ve Liegeois, F. J. (2018). Interventions for childhood apraxia of speech. Cochrane Database of Systematic Reviews, (5).
• Morley, M. E. (1972). The development and disorders of speech in childhood(3rd ed.). Baltimore,MD: Williams & Wilkins.
• Murray, E., McCabe, P., ve Ballard, K. J. (2012). A comparison of two treatments for childhood apraxia of speech: Methods and treatment protocol for a parallel group randomised control trial. BMC pediatrics, 12, 1-9.
• Murray, E., McCabe, P., ve Ballard, K. J. (2014). A systematic review of treatment outcomes for children with childhood apraxia of speech. American Journal of Speech-Language Pathology, 23(3), 486-504.
• Murray, E., McCabe, P., ve Ballard, K. J. (2015). A randomized controlled trial for children with childhood apraxia of speech comparing rapid syllable transition treatment and the Nuffield Dyspraxia Programme–Third Edition. Journal of Speech, Language, and Hearing Research, 58(3), 669-686.
• Newmeyer, A. J., Aylward, C., Akers, R., Ishikawa, K., Grether, S., deGrauw, T., Grasha, C., ve White, J. (2009). Results of the Sensory Profile in children with suspected childhood apraxia of speech. Physical & occupational therapy in pediatrics, 29(2), 203–218. https://doi.org/10.1080/01942630902805202. Newmeyer, A. J., Grether, S., Grasha, C., White, J., Akers, R., Aylward, C., Ishikawa, K., & Degrauw, T. (2007). Fine motor function and oral-motor imitation skills in preschool-age children with speech-sound disorders. Clinical pediatrics, 46(7), 604–611. https://doi.org/10.1177/0009922807299545.
• Parlak, M. M., & Köse, A., (2022). Çocukluk Çağı Konuşma Apraksisi ve Tanısal Özellikleri. Sağlık Bilimlerinde Araştırma ve Değerlendirmeler-I (pp.243-256), Gece Kitaplığı. Parnandi, A., Karappa, V., Lan, T., Shahin, M., McKechnie, J., Ballard, K. J., Ahmed, B., & Gutiérrez-Osuna, R. (2015). Development of a remote therapy tool for childhood apraxia of speech. ACM Transactions on Accessible Computing, 7(3), 1–23. https://doi.org/10.1145/2776895.
• Peter, B., & Stoel‐Gammon, C. (2005). Timing errors in two children with suspected childhood apraxia of speech (sCAS) during speech and music‐related tasks. Clinical Linguistics & Phonetics, 19(2), 67-87.
• Polat, B., & Ünal Logacev, Ö. (2021). Evaluating the Differential Diagnostic Criteria of Childhood Apraxia of Speech. Dil Konuşma Ve Yutma Araştırmaları Dergisi, 4(1), 53-79.
• Rice, M. L., Sell, M. A., ve Hadley, P. A. (1991). Social interactions of speech, and language-impaired children. Journal of Speech, Language, and Hearing Research, 34(6), 1299-1307.
• Sezer, E., & Akıl, S. (2020). Türkiye’deki Dil ve Konuşma Terapistlerinin Çocukluk Çağı Konuşma Apraksisi Tanısında Kullandıkları Kriterler. Dil Konuşma ve Yutma Araştırmaları Dergisi, 3(2), 153-174.
• Shriberg, L. D. (1993). Four new speech and prosody-voice measures for genetics research and other studies in developmental phonological disorders. Journal of Speech, Language, and Hearing Research, 36(1), 105-140.
• Shriberg, L. D., Austin, D., Lewis, B. A., McSweeny, J. L., ve Wilson, D. L. (1997b). The Speech Disorders Classification System (SDCS) extensions and lifespan reference data. Journal of Speech, Language, and Hearing Research, 40(4), 723-740.
• Shriberg, L. D., Campbell, T. F., Karlsson, H. B., Brown, R. L., McSweeny, J. L., ve Nadler, C. J. (2003). A diagnostic marker for childhood apraxia of speech: The lexical stress ratio. Clinical linguistics & phonetics, 17(7), 549-574.
• Shriberg, L. D., Fourakis, M., Hall, S. D., Karlsson, H. B., Lohmeier, H. L., McSweeny, J. L., Potter, N. L., Scheer-Cohen, A. R., Strand, E. A., Tilkens, C. M., ve Wilson, D. L. (2010). Extensions to the speech disorders classification system (SDCS). Clinical linguistics & phonetics, 24(10), 795-824.
• Shriberg, L. D., & Kwiatkowski, J. (1982). Phonological disorders III: A procedure for assessing severity of involvement. Journal of speech and Hearing Disorders, 47(3), 256-270.
• Shriberg, L. D., Kwiatkowski, J., ve Mabie, H. L. (2019). Estimates of the prevalence of motor speech disorders in children with idiopathic speech delay. Clinical linguistics & phonetics, 33(8), 679-706.
• Shriberg, L. D., Potter, N. L., ve Strand, E. A. (2011). Prevalence and phenotype of childhood apraxia of speech in youth with galactosemia. Journal of speech, language, and hearing research : JSLHR, 54(2), 487–519. https://doi.org/10.1044/1092-4388(2010/10-0068).
• Strand, E. (2017). Appraising Apraxia: When a speech-sound disorder is severe, how do you know if it’s childhood apraxia of speech?. The ASHA Leader, 22(3), 50-58.
• Strand, E. A. (2020). Dynamic temporal and tactile cueing: A treatment strategy for childhood apraxia of speech. American Journal of Speech-Language Pathology, 29(1), 30-48.
• Strand, E. A., & Debertine, P. (2000). The efficacy of integral stimulation intervention with developmental apraxia of speech. Journal of Medical Speech-Language Pathology, 8(4), 295-300.
• Strand, E. A., & McCauley, R. J. (2008). Differential diagnosis of severe speech impairment in young children. The ASHA Leader, 13(10), 10-13.
• Strand, E. A., McCauley, R. J., Weigand, S. D., Stoeckel, R. E., ve Baas, B. S. (2013). A motor speech assessment for children with severe speech disorders: Reliability and validity evidence.
• Strand, E. A., & McCauley, R. J. (2019). Dynamic evaluation of motor speech skill (DEMSS) manual. Paul H. Brookes Publishing, Company.
• Strand, E. A., & Skinder, A. (1999). Treatment of developmental apraxia of speech: Integral stimulation methods. Clinical management of motor speech disorders in children, 109-148.
• Strand, E. A., Stoeckel, R., ve Baas, B. (2006). Treatment of severe childhood apraxia of speech: A treatment efficacy study. Journal of Medical Speech-Language Pathology, 14(4), 297-308.
• Thomas, D. C., McCabe, P., ve Ballard, K. J. (2014). Rapid syllable transitions (ReST) treatment for childhood apraxia of speech: The effect of lower dose-frequency. Journal of Communication Disorders, 51, 29-42.
• Tükel, Ş., Björelius, H., Henningsson, G., McAllister, A., ve Eliasson, A. C. (2015). Motor functions and adaptive behaviour in children with childhood apraxia of speech. International Journal of Speech-Language Pathology, 17(5), 470-480.
• Williams, P., & Stephens, H. (2004). Nuffield Centre Dyspraxia Programme 2004. Miracle Factory, for the Speech & Language Therapy Department, Nuffield Hearing and Speech Centre, Royal National Throat, Nose and Ear Hospital. Yoss, K. A., & Darley, F. L. (1974). Developmental apraxia of speech in children with defective articulation. Journal of Speech and Hearing Research, 17(3), 399-416.