What About Children Who Don’t Quite Meet the “Threshold” For a Diagnosis of CAS?

what about children who don’t quite meet the “threshold” for a diagnosis of CAS?

By Rebecca McCauley, Ph.D., CCC-SLP

An unknown number of children may fail to be diagnosed with CAS because of the circumstances surrounding their evaluation or because they have problems that are closely related to CAS, but don’t meet a threshold for diagnosis. This group may, for example, include children who are too young to participate fully in testing, who have other difficulties in addition to speech problems (e.g., cognitive impairment or hearing loss), or don’t meet all of the criteria used by a specific SLP to diagnose CAS, yet show some symptoms consistent with difficulties in motor planning. The existence of this last group of children is supported by studies that are often interpreted as suggesting rampant clinical over-diagnosis, but that might alternatively be interpreted as suggesting a continuum of severity in motor planning problems worthy of clinical attention.

Symptoms that imply a motor planning problem will be the same as those found in CAS, but will be fewer in number. These could include greatly reduced phonetic repertoires that remain stable over several months, atypical patterns of intonation and lexical stress (e.g. producing syllables in a multisyllabic word so that they all sound similar in pitch, loudness, and duration), vowel errors, and difficulty in transferring correct productions within simple syllable shapes (e.g., a consonant followed by a vowel [CV]) to longer or more phonetically complex utterances (e.g., CCVC, CVCVC). A child’s failure to respond to treatment methods that are described as phonological (e.g., Cycles, minimal pairs) would also suggest the possibility that greater attention to motor factors in speech learning could prove beneficial.

Many of the principles of motor learning that have been discussed in relation to treatments for CAS can also be used to adapt existing phonologic treatment approaches to enhance motor learning for such children. Among those that seem to have the widest applicability are

  1. increasing opportunities for practice – both in terms of providing more frequent treatment sessions and more productions per session
  2. identifying facilitators of more accurate productions (such as tactile or visual cues, or slowed rate).

In addition, the regular use of assessment probes may help avoid short-lived performance gains that don’t result in wider and more stable changes in the child’s sound system. Adoption of these strategies can address speech motor planning difficulties in young children when they are present – even when the diagnosis of CAS is not made.


[Rebecca McCauley, Ph.D., is a Professor in the Department of Speech and Hearing Science at the Ohio State University. She received a Master’s and Ph.D. from the University of Chicago in the social sciences and psychology, respectively, and entered the profession of speech-language pathology through postdoctoral work at the University of Arizona and Johns Hopkins University. Her areas of expertise include speech sound disorders and language disorders in children. Current research projects address variability in vowel production in severe speech disorders and regional dialects and validation of a teacher rating scale for students’ communicative competence. In addition, she is editing a book on the treatment of children with language disorders. Dr. McCauley is also a member of the Apraxia Kids Professional Advisory Council.]

© Apraxia Kids
www.apraxia-kids.org

what about children who don’t quite meet the “threshold” for a diagnosis of CAS?

By Rebecca McCauley, Ph.D., CCC-SLP

An unknown number of children may fail to be diagnosed with CAS because of the circumstances surrounding their evaluation or because they have problems that are closely related to CAS, but don’t meet a threshold for diagnosis. This group may, for example, include children who are too young to participate fully in testing, who have other difficulties in addition to speech problems (e.g., cognitive impairment or hearing loss), or don’t meet all of the criteria used by a specific SLP to diagnose CAS, yet show some symptoms consistent with difficulties in motor planning. The existence of this last group of children is supported by studies that are often interpreted as suggesting rampant clinical over-diagnosis, but that might alternatively be interpreted as suggesting a continuum of severity in motor planning problems worthy of clinical attention.

Symptoms that imply a motor planning problem will be the same as those found in CAS, but will be fewer in number. These could include greatly reduced phonetic repertoires that remain stable over several months, atypical patterns of intonation and lexical stress (e.g. producing syllables in a multisyllabic word so that they all sound similar in pitch, loudness, and duration), vowel errors, and difficulty in transferring correct productions within simple syllable shapes (e.g., a consonant followed by a vowel [CV]) to longer or more phonetically complex utterances (e.g., CCVC, CVCVC). A child’s failure to respond to treatment methods that are described as phonological (e.g., Cycles, minimal pairs) would also suggest the possibility that greater attention to motor factors in speech learning could prove beneficial.

Many of the principles of motor learning that have been discussed in relation to treatments for CAS can also be used to adapt existing phonologic treatment approaches to enhance motor learning for such children. Among those that seem to have the widest applicability are

  1. increasing opportunities for practice – both in terms of providing more frequent treatment sessions and more productions per session
  2. identifying facilitators of more accurate productions (such as tactile or visual cues, or slowed rate).

In addition, the regular use of assessment probes may help avoid short-lived performance gains that don’t result in wider and more stable changes in the child’s sound system. Adoption of these strategies can address speech motor planning difficulties in young children when they are present – even when the diagnosis of CAS is not made.


[Rebecca McCauley, Ph.D., is a Professor in the Department of Speech and Hearing Science at the Ohio State University. She received a Master’s and Ph.D. from the University of Chicago in the social sciences and psychology, respectively, and entered the profession of speech-language pathology through postdoctoral work at the University of Arizona and Johns Hopkins University. Her areas of expertise include speech sound disorders and language disorders in children. Current research projects address variability in vowel production in severe speech disorders and regional dialects and validation of a teacher rating scale for students’ communicative competence. In addition, she is editing a book on the treatment of children with language disorders. Dr. McCauley is also a member of the Apraxia Kids Professional Advisory Council.]

© Apraxia Kids
www.apraxia-kids.org



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