Apraxia can be challenging to diagnose. Here are tips and resources to help school SLPs find clarity in diagnosing and treating childhood apraxia of speech.

<div>
  <h2>A Challenging Diagnosis</h2>

  <div>
    Childhood apraxia of speech (CAS) can be a difficult and challenging
    diagnosis for many speech therapists. This may be partly because the word
    &ldquo;apraxia&rdquo; is often misused or overused when describing speech
    deficits in children. Some school districts avoid the term, while others
    overuse it.&nbsp;
  </div>

  <div>
    Childhood apraxia of speech can be officially diagnosed by a physician or by
    a speech-language pathologist. Even then, the diagnosis can be tricky: how
    many times have you suspected a child has apraxia only to discover upon
    further evaluation that the issue is phonological in nature?&nbsp;
  </div>

  <h2>Characteristics and Markers of Childhood Apraxia of Speech</h2>

  <div>
    The American Speech-Language-Hearing Association (<a
      href="https://www.asha.org/practice-portal/clinical-topics/childhood-apraxia-of-speech/"
      >ASHA</a
    >) and the
    <a
      href="https://www.mayoclinic.org/diseases-conditions/childhood-apraxia-of-speech/symptoms-causes/syc-20352045"
      >Mayo Clinic</a
    >
    have outlined several characteristics and markers which can help speech
    therapists with a differential diagnosis of childhood apraxia of speech:
  </div>

  <ul>
    <li>
      Inconsistent errors with consonants and vowels (e.g., the child may
      produce the same word in a variety of ways when asked to repeat it several
      times; this may be more apparent with longer more complex words such as
      &ldquo;buttercup&rdquo;)
    </li>
    <li>
      Longer pauses between sounds and syllables due to difficulties
      transitioning from sound to sound or syllable to syllable
    </li>
    <li>
      Inconsistent or inappropriate stress on syllable which can distort the
      prosody or melody of speech making it sound odd
    </li>
    <li>
      Difficulty moving smoothly from one sound, syllable, or word to another
    </li>
    <li>
      Groping movements with the jaw, lips or tongue to make the correct
      movement for speech sounds
    </li>
    <li>
      Vowel distortions, such as attempting to use the correct vowel but saying
      it incorrectly
    </li>
    <li>
      Using the wrong stress in a word, such as pronouncing &quot;banana&quot;
      as &quot;BUH-nan-uh&quot; instead of &quot;buh-NAN-uh&quot;
    </li>
    <li>
      Using equal emphasis on all syllables, such as saying
      &quot;BUH-NAN-UH&quot;
    </li>
    <li>
      Separation of syllables, such as putting a pause or gap between syllables
    </li>
    <li>
      Inconsistency, such as making different errors when trying to say the same
      word a second time
    </li>
    <li>Difficulty imitating simple words</li>
    <li>
      Inconsistent voicing errors, such as saying &quot;down&quot; instead of
      &quot;town&quot;
    </li>
  </ul>

  <h2>How to Evaluate a Student for Childhood Apraxia of Speech&nbsp;</h2>

  <div>
    <a
      href="https://www.apraxia-kids.org/apraxia_kids_library/how-is-cas-diagnosed/"
      >Apraxia Kids</a
    >
    has a step-by-step guide on how to evaluate and/or diagnose for childhood
    apraxia of speech. The speech-language therapist will:
  </div>

  <ul>
    <li>
      Take a complete inventory of the sounds, syllable shapes (consonant and
      vowel combinations that makeup syllables), and words a child can make or
      attempts to make, as well as any &ldquo;mistakes&rdquo; the child makes
      when doing so.&nbsp;
    </li>
    <li>
      Make observations about how the child combines sounds and whether the
      length or difficulty level of words or phrases makes a difference in the
      accuracy with which the child says words.
    </li>
    <li>
      Evaluate the child&rsquo;s ability to both use and understand words,
      phrases, word endings, grammar, etc. and compare to what is typical for
      their age range.
    </li>
    <li>
      Examine oral structures and the oral cavity to determine whether they
      appear normal and are in good working order for speech.&nbsp;
    </li>
    <li>
      Make note of the child&rsquo;s intentions to communicate, engage in social
      interaction, listen, and respond. Observe what other forms of
      communication the child uses, such as pointing and gesturing.
    </li>
    <li>
      Observe what effect certain types of help have for the child&rsquo;s
      speech accuracy. For example, the SLP may slow down their own speech and
      ask the child to try a word or phrase with them simultaneously. Or the SLP
      may use words or other types of cues to help the child figure out how to
      form the mouth or how to place the tongue and lips to produce the desired
      target word.
    </li>
    <li>
      If CAS is suspected, perform a motor speech exam. Try to get the child to
      repeat increasingly difficult and challenging syllables, words, and
      phrases and observe how length and complexity impact the child&rsquo;s
      intelligibility. Try using the cueing mentioned above to observe the
      impact.
    </li>
  </ul>

  <h2>Resources for Treating Childhood Apraxia of Speech</h2>

  <div>
    <a href="https://www.apraxia-kids.org/about-apraxia-kids/">Apraxia Kids</a>
    is a non-profit organization designed to strengthen the lives of children
    with apraxia of speech by educating professionals and families, facilitating
    community engagement and outreach, and investing in the future through
    advocacy and research. They have an article library, on-demand webinars,
    national conferences, intensive training, and a virtual education series
  </div>

  <div>
    <a
      href="https://www.northernspeech.com/articulation-speech-motor/childhood-apraxia-of-speech-kaufman-methods-for-evaluation-and-treatment-k-slp/"
      >Kauffman Methods</a
    >
    presents apraxia solutions, including a four-hour comprehensive training to
    teach participants how to evaluate and treat children with apraxia of
    speech. Additionally, apraxia expert Nancy Kauffman offers materials for
    teaching children with apraxia how to combine consonants and vowels into
    words, and words into the functional expressive language.
  </div>

  <div>
    <a href="https://www.bjoremspeech.com/">Bjorem Speech</a> was founded by
    Jennie Bjorem, MA, CCC-SLP, and features her Bjorem Speech Cue Cards. Her
    goal is to bring fresh new, innovative ideas that engage children while
    treating CAS. She presents instructional videos and is continually adding
    new products to her site.
  </div>

  <div>
    <a
      href="https://www.grahamspeechtherapy.com/blog/what-is-childhood-apraxia-of-speech"
      >Graham Speech Therapy</a
    >
    is hosted by SLP Amy Graham, who offers innovative ideas on the treatment of
    CAS through her blog as well as her Instagram account. Videos on Instagram
    depict actual therapy sessions featuring practical solutions and treatment
    methods.
  </div>

  <h2>School SLP Opportunities</h2>

  <div>
    We hope these tips and resources for diagnosing and treating childhood
    apraxia of speech make a useful addition to your
    <a
      href="https://www.crosscountryeducation.com/job-search-results?what=slp&amp;where="
      >school SLP</a
    >
    toolbox. Find out where your specialized skills as a school SLP are needed
    most with Cross Country Education today.<br />
  </div>
</div>


Childhood Apraxia of Speech – Diagnosis, Treatment, and Resources for School SLPs