Five Things Speech-Language Pathologists don’t know about Verbal Apraxia (CAS).

1.) It’s more than a childhood disorder; it’s a lifelong disorder that represents itself differently case by case and differently throughout the individual’s lifetime.

A prevalent misconception people have is that the term “Childhood” in Childhood Apraxia of speech, means that this neurological disorder will be something the child outgrows. However, the Childhood term means it has been present since birth, which differentiates it from different cases of Apraxia, such as acquired Apraxia. – Jordan Christian.

SLP’s can be very caught up in the present moment. Many times this means spending unnecessary time on a treatment approach that doesn’t work, or not seeking out the most Evidence-Based up to date treatment for the child (which is always changing). What I want SLP’s to realize is that this disorder persists into adulthood, and we need to have a sense of urgency and an obligation to seek out other methods if our current method isn’t working.  – Laura Smith.

2.) The additional impact of Verbal Apraxia has beyond motor planning and speech difficulties.

As we are seeing adults self report about the impact that Verbal Apraxia had on them in childhood and current life, we see frequent reports of anxiety. Since Verbal Apraxia is known for inconsistent and unpredictable speech errors, individuals are unsure when they may not be able to get their next word out. Naturally, this causes feelings of anxiety. The act of struggling to articulate words correctly will cause the person’s facial muscles to become tense, and that sends the presence of that discomfort can provoke feelings of anxiety.; it is vital we focus on each of their comfort levels. – Jordan Christian.

The more I’m immersed and have interactions with adults who have grown up with CAS, the more I am aware of how similar their social/emotional reports are to those of individuals who grew up stuttering. We have never had access to these reports as SLP’s before since ASHA only officially recognized CAS in 2007. It was important when we had adults who stutter tell us their experiences because it helped spur change in the treatment, and this should be true of Verbal Apraxia as well. – Laura Smith.

3.) The use of AAC can be an essential and integral part of treatment, but this should be in combination with providing the best evidence-based therapy to facilitate verbal communication in these individuals as well.

My second grade SLP told me I wouldn’t ever be able to communicate on my own, that my mom and I should accept that, and have a computer device speak for me. SLP’s were and are still not aware that speech should always be encouraged while using alternative communications. If we were to listen to this SLP and stop treatment, it is improbable I would be speaking right now. Speech-Language Pathologists need to know how their decisions can potentially impact life outcomes. Verbal Apraxia isn’t something you outgrow. If treatment isn’t given, the less favorable the prognosis will be. AAC and alternative communications should be encouraged and are helpful; however, we should not stop the treatment of intensive and frequent speech therapy. – Jordan Christian.

As a pediatric SLP, I’ve seen the positive effects AAC has had on children’s lives. It allows a way for a child who is pre-verbal to communicate, and it facilitates language development. That being said, AAC is not going to help a child speak verbally who has a motor speech disorder. In cases of CAS, SLP’s should work on verbal speech production in tandem with AAC using evidence-based practice. I realize it is challenging to work on both, but it’s what is best for the child. I have had numerous kids come to me ready and able to work on verbal speech, but were only receiving an hour a week of AAC therapy in a group. In my practice, I refer the pre-verbal child to an AAC expert, and the child sees both providers separately. I also have AAC experts who refer to me to work on verbal speech while they focus on AAC. – Laura Smith.

4.) Speech therapy needs to happen outside of the SLP room as well because Verbal Apraxia can represent itself differently in life to life situations.

Speech-Language Pathologists already know that an individual with Verbal Apraxia may articulate words better in the speech therapy room because they are getting that individual practice with only one other person present in the room. However, in the next decade, Speech-Language Pathologists need to work on promoting the person’s speech skills outside of the classroom. Like for example, many individuals with Verbal Apraxia as adults report difficulties speaking over the phone. Typically, you are not going to talk over the phone in a speech therapy room and as a child. However, we should be practicing these speech skills that they need in their every day to day life in the future. As they grow older, life circumstances will change, and different life situations will become present that will most likely provoke additional difficulties with speech. Such as a college professor calling on you spontaneously in the classroom setting, job interviews, restaurant ordering, and so forth. – Jordan Christian.

Practicing outside the therapy setting is also rooted in evidence-based practice for Apraxia within the principles of motor learning. Mass, targeted practice in ideal conditions is excellent for the acquisition of targets; however, it does nothing to facilitate generalization. That element of motor learning is termed distributed practice and variable practice in which we change the conditions (including place) to promote carryover into spontaneous speech. – Laura Smith.

5.) That the best SLP’s in Verbal Apraxia are the ones who don’t have the most experience but the ones who are willing to learn more about this diagnosis.

Although my second grade SLP wanted to give up on my speaking, after getting the school district on her, she was willing to learn more about Verbal Apraxia and help me. After that, I made great strides, and I learned how to read and spell. SLP’s must be ready to learn beyond their current knowledge. You can help so many people. – Jordan Christian.

The academic landscape and current knowledge of CAS continue to grow and expand. New research is coming out yearly on best practices for treatment, along with comorbid conditions and potentially research into adulthood. As mentioned before, since CAS is a relatively new and accepted diagnosis, research and best practice continue to evolve. SLP’s who recognize the need for continued education around this disorder may be the best professional to help provide optimally, and life-changing results for the individuals they treat. – Laura Smith.

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