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Evaluation, Assessment and Diagnosis of Childhood Apraxia of Speech

The professional who is most qualified to investigate, assess, and provide diagnosis for children’s speech disorders is the Speech-language Pathologist. It may be that after speech/language evaluation, the clinician has reason to refer a child to other health-related professionals in the fields of occupational therapy, behavioral and developmental pediatrics, or pediatric neurology. However, a speech-language pathologist should diagnose the communication (speech) disorder. Reportedly, some service settings discourage SLPs from providing diagnoses; though note that per the American Speech-Language Hearing Association, the SLP is qualified to diagnose CAS.

While there are a number of packaged evaluation kits available, many clinicians use common evaluation techniques to assess children with suspected CAS. Young children with CAS can be especially challenging to evaluate and may be non-risk takers with their speech attempts. In some cases, especially with very young children, an extended period of evaluation in order to elicit sufficient speech samples to make diagnosis is warranted. Overall, tasks used in the assessment process in order to differentiate CAS from other speech sound disorders should include:

  • Speech production tasks graded from simple to more complex (from simple syllables to challenging multisyllabic words)
  • The effect of increased length on accuracy (i.e.: me, meet, meeting)
  • The effect of context on speech accuracy (more; more milk, want more)
  • Observation of performance on repeated productions of the same target
  • Documentation of differences between elicited or imitated productions vs. volitional and spontaneous productions
  • An analysis of types of errors, including omissions, distortions and substitutions
  • Observations concerning prosody (stress, intonation, rate)
  • Observations of nonspeech movement sequencing (show me how you bite. Show me how you blow. Bite, then blow)

Common articulation tests alone will not provide the information needed for differential diagnosis, although such tests can provide some information necessary to the process. Additionally, traditional child language tests can provide helpful information about the child’s communication profile but will not provide the type of information necessary to make a differential diagnosis. If clinicians work in settings in which they administer expressive/receptive language testing in order to determine eligibility for services and the clinician suspects the child could have CAS, referral for in depth evaluation of speech production should occur.

Additional Assessment Considerations

While the previous assessment and evaluation discussion centered on the speech production difficulties of children with suspected CAS, several other considerations for planning and conducting assessments should be considered. The literature documents co-morbid language related deficits, thus both expressive and receptive language evaluation should be a part of the evaluation process of documenting a complete communication profile for the child with CAS. Narrative language skills should be a part of that battery, as appropriate, given the current functioning of the child. A structural-functional evaluation should be performed as well in order to document any observations of abnormalities in structures, sensation, strength, range, symmetry, etc. For children who are school age or approaching school age, the evaluation of phonemic awareness and early literacy related skills should be included in assessments. A propensity for literacy related deficits in phonemic awareness, reading, spelling and written expression has been substantiated in children with CAS in recent research and should be considered, regardless of the child’s current level of speech production capability.

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