The Ineffectiveness of Checklists in Diagnosing Childhood Apraxia of Speech (CAS)

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By Margaret Fish, MS, CCC-SLP, author of Here’s How to Treat Childhood Apraxia of Speech, Second Edition

Sorting through evaluation findings for young children with complex speech sound disorders can be confusing and challenging. As SLPs we strive to complete thorough evaluations and make sense of our evaluation findings to achieve an accurate diagnosis; however, many of the characteristics of CAS overlap with other types of speech sound disorders. Certain key characteristics from a CAS checklist such as inconsistency, atypical prosody, groping, or vowel errors may raise red flags for a diagnosis of CAS, but these characteristics alone should not predetermine the diagnosis until a thorough analysis of the child’s speech productions is completed.

Following are case studies of two children recently seen for consultations. Both children had an incoming diagnosis of CAS, but only one child was given a definitive diagnosis of CAS at the conclusion of the consultation. The other child demonstrated a number of characteristics commonly associated with CAS, but after careful examination of the child’s speech, the underlying nature of the challenges was not consistent with the core impairment of CAS that ASHA (2007) describes as the “planning and/or programming (of) spatiotemporal parameters of movement sequences.”

Case Study 1.

Mark, age 3 years, 7 months, had recently received a diagnosis of CAS by a diagnostic team at a local hospital. The diagnosis was based primarily on the following factors:

  • Reduced speech intelligibility (judged to be 50% intelligible)
  • A nearly complete repertoire of consonants and vowels
  • Inconsistent productions of the same word
  • Occasional vowel errors
  • Atypical speech prosody

Because of Mark’s limited speech intelligibility, inconsistency, vowel errors, and prosody differences, it was understandable how a diagnosis of CAS was made, as these characteristics often are associated with a positive diagnosis of CAS. Indeed, the use of a checklist of CAS characteristics alone could lead a clinician to conclude that Mark had CAS.

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2013 Walk for Children with Apraxia of Speech

October 18, 2008 in Pittsburgh, PA marked the first ever Walk for Children with Apraxia of Speech. Sean Freiburger and his mother Sue led over 300 participants and in just two years the Walk for Apraxia has grown to over 80 walks in three countries with over 10,000 walkers and countless donors to fund new programs and research by the Childhood Apraxia of Speech Association of North America (CASANA).

apraxia walk

The 2013 Walk for Children with Apraxia of Speech promises to be even larger with upwards of 70 locations across the nation. Just to name a few:

Want to help but can’t make it to a walk? Don’t worry, there is also a virtual walk that allows anyone interested to register as a walker, receive the official walk t-shirt, and walk where ever and whenever it is convenient.