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Progress and Long Term Outcomes

With appropriate early intervention and ongoing support, most children with CAS can improve their speech production skills and develop functional speech. The period of time this outcome requires is individualized and most likely based on the unique characteristics of the child and the level and quality of the intervention provided. Previous literature had cited “slow or little progress” as a “characteristic” of apraxia. Currently it is recognized that while treatment is intensive and extends over a number of years, these children are very capable of making wonderful gains and developing intelligible speech. Progress, is of course, individualized, however unproductive therapy should not go on indefinitely. If the child is not making noticeable and meaningful progress over several months of treatment, the SLP needs to regroup and examine the reason.

If a child fails to make significant and adequate progress despite receiving speech therapy intervention, the following questions need addressed:

  • Is the diagnosis correct?
  • Is the frequency of therapy adequate for the child’s needs?
  • Is the intensity appropriate? For example, is therapy offering the child dozens and dozens of “practice moments” or is the child sitting, listening and not practicing speech much at all?
  • Is the therapy tailored toward motor speech methods and techniques to the extent required for adequate progress?
  • Is the therapeutic environment safe and motivating to this child? Is clinician – child rapport adequate?
  • Are other issues interfering with progress? (i.e., can the child sustain enough attention to participate? Has the child had health related problems? Is the family following through with practice at home or is the child willing to practice at home? Could other diagnoses contribute to lack of adequate progress?)

If after addressing these issues, progress is still not adequate, ask for consultation from a colleague with more experience with this particular disorder.

Some long-term residual issues that may persist even after the child attains intelligibility include sound distortions and prosody deficits (rate, timing, stress, intonation). If these issues are present, therapy strategies can continue to target them. Additionally, speech therapy may need to continue to address linguistic or pragmatic needs presented by some children.

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