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3291 Childhood Apraxia of Speech: Focus on Treatment
Thursday, July 10, 2008: 2:15 PM-3:30 PM
Sarasota 2 (Gaylord Palms Resort & Convention Center)
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Children with Autism Spectrum Disorder frequently exhibit deficits in motor planning, including Apraxia of Speech. These children typically don’t benefit from traditional articulation therapy techniques. This seminar will describe primary considerations for developing appropriate treatment programs for children with CAS. Visual, auditory and tactile cuing techniques which offer significant benefit for children who struggle with sound acquisition and phoneme sequencing will be demonstrated through lecture and video clips. Dozens of materials and activities for encouraging repetitive practice will be shared.
Individuals with Childhood Apraxia of Speech (CAS) typically don’t benefit from traditional speech and language treatment programs. It’s not unusual for children and parents to become frustrated when minimal gains have been realized after months of speech and language treatment. Motor planning is frequently an area of significant challenge for children with Autism Spectrum Disorder. Motor planning can encompass speech motor planning or speech praxis. For children having difficulty with speech motor planning, working on individual phonemes or cycling through phonological processes may achieve limited results.
When developing treatment programs for individuals with CAS, many factors must be considered. It is essential to understand the child’s developmental and physical capacities (cognitive capacities, sensory awareness and processing, attention, social skills, memory, muscle tone) as well as determine the specific challenges to speech praxis, including current speech sound repertoire, phoneme sequencing skills, imitation abilities and the ability to work the articulators in various planes of movement. Suprasegmental characteristics of speech also need to be addressed.
Once the current developmental, social and motor speech capacities have been identified, an appropriate treatment program can be developed. An understanding of motor learning theory will help guide speech and language pathologists toward setting appropriate goals, determining systematic treatment objectives and utilizing specific techniques and materials to promote improved motor planning. While children with Autism Spectrum Disorder present with unique sets of skills and needs, there is a sequential process in articulatory development, where skills build upon skills. When children are provided with a solid base in speech motor planning, target vocabulary are carefully chosen to build success, and challenges to move through a hierarchy are provided, children begin to gain greater volitional control over their speech.
A number of visual, auditory and tactile cuing techniques offer significant benefit for children who struggle with sound acquisition and phoneme sequencing. Visual cuing systems can be incorporated into treatment in several ways. Photographs or drawings of the mouth during production of phonemes offer cues for specific sound placement. Clinician models, mirror cuing and an array of visual symbols (blocks, felt squares, written letters) also provide visual cues and feedback for children struggling with phoneme placement and movement from sound-to-sound and syllable-to-syllable. Children benefit from auditory cues. Providing auditory models for a child to match or verbal descriptions of how the articulators should be positioned can help a child who does not have good volitional control over the articulatory system. Reducing the rate of the speech model and encouraging the child to attempt words using slower rate, significantly reduces the challenges associated with phoneme sequencing. When greater capacities are established in motor sequencing, rate can gradually be increased. The Prompt program and other tactile cuing systems incorporate specific tactile cues, providing individuals with strong feedback to assist in acquiring sounds, moving articulators in varied planes (vertical, horizontal and anterior/posterior) and making connections between phonemes.
Repetition is an essential element for improving praxis. Keeping children interested and motivated throughout the therapy process can be particularly challenging when working with young children and children who present with concomitant needs in attentional, social and cognitive capacities. Choosing toys, games, repetitive line books and songs which interest children, while still providing the necessary repetition of sounds, words and phoneme sequences, is essential to maintaining interest and cooperation throughout treatment. In addition, increasing the functionality of the treatment program, particularly for children with greater limitations in language and vocabulary or older children who have already received years of speech and language therapy, is of utmost importance.
When developing treatment programs for individuals with CAS, many factors must be considered. It is essential to understand the child’s developmental and physical capacities (cognitive capacities, sensory awareness and processing, attention, social skills, memory, muscle tone) as well as determine the specific challenges to speech praxis, including current speech sound repertoire, phoneme sequencing skills, imitation abilities and the ability to work the articulators in various planes of movement. Suprasegmental characteristics of speech also need to be addressed.
Once the current developmental, social and motor speech capacities have been identified, an appropriate treatment program can be developed. An understanding of motor learning theory will help guide speech and language pathologists toward setting appropriate goals, determining systematic treatment objectives and utilizing specific techniques and materials to promote improved motor planning. While children with Autism Spectrum Disorder present with unique sets of skills and needs, there is a sequential process in articulatory development, where skills build upon skills. When children are provided with a solid base in speech motor planning, target vocabulary are carefully chosen to build success, and challenges to move through a hierarchy are provided, children begin to gain greater volitional control over their speech.
A number of visual, auditory and tactile cuing techniques offer significant benefit for children who struggle with sound acquisition and phoneme sequencing. Visual cuing systems can be incorporated into treatment in several ways. Photographs or drawings of the mouth during production of phonemes offer cues for specific sound placement. Clinician models, mirror cuing and an array of visual symbols (blocks, felt squares, written letters) also provide visual cues and feedback for children struggling with phoneme placement and movement from sound-to-sound and syllable-to-syllable. Children benefit from auditory cues. Providing auditory models for a child to match or verbal descriptions of how the articulators should be positioned can help a child who does not have good volitional control over the articulatory system. Reducing the rate of the speech model and encouraging the child to attempt words using slower rate, significantly reduces the challenges associated with phoneme sequencing. When greater capacities are established in motor sequencing, rate can gradually be increased. The Prompt program and other tactile cuing systems incorporate specific tactile cues, providing individuals with strong feedback to assist in acquiring sounds, moving articulators in varied planes (vertical, horizontal and anterior/posterior) and making connections between phonemes.
Repetition is an essential element for improving praxis. Keeping children interested and motivated throughout the therapy process can be particularly challenging when working with young children and children who present with concomitant needs in attentional, social and cognitive capacities. Choosing toys, games, repetitive line books and songs which interest children, while still providing the necessary repetition of sounds, words and phoneme sequences, is essential to maintaining interest and cooperation throughout treatment. In addition, increasing the functionality of the treatment program, particularly for children with greater limitations in language and vocabulary or older children who have already received years of speech and language therapy, is of utmost importance.
Learning Objectives:
- Describe how Childhood Apraxia of Speech is associated with complex neurobehavioral disorders, such as Autism Spectrum Disorders
- List at least 5 visual, auditory and tactile cuing techniques for supporting sound acquisition and improving phoneme sequencing
- Apply motor learning theory to develop an appropriate treatment program for a child with CAS
- Name 5 or more materials and activities to promote repetitive practice when treating children with apraxia
Content Area: Communication
Presenter:
Margaret A. Fish, M.S., CCC-SLP
Speech-Language Pathologist
Margaret A. Fish, Ltd.
Ms. Fish has been a practicing speech-language pathologist for over 25 years. She works in private practice, primarily with children with severe speech sound disorders, language disorders and autism. She has provided several workshops to professionals on the topics of assessment, differential diagnosis and treatment of Childhood Apraxia of Speech.
