Skip to main content

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

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., mental retardation or hearing loss), or who are seen by speech-language pathologists whose clinical definitions of speech sound disorders exclude the concept of CAS altogether. Finally, this group may include children who 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. Does this mean, then, that speech-language pathologists should strive to develop measures that will facilitate earlier diagnosis, work to broaden clinical definitions beyond the strict categories used for research, and educate members of the profession about emerging knowledge concerning CAS? Absolutely yes! And from a parental perspective, does this mean that parents should work to make sure that the clinician serving their child is knowledgeable about CAS? Absolutely yes again! Nonetheless, even in the absence of a diagnosis of CAS, speech-language pathologists can and should make use of strategies that are thought to help young learners who appear to have motor planning difficulties.

Symptoms that imply a motor planning problem will be the same as those found in CAS, but will be fewer in number. They include greatly reduced phonetic repertoires that remain stable over several months, atypical patterns of intonation and stress (especially equal, excessive stress), vowel errors, and difficulty in transferring correct productions within simple syllable shapes (e.g., CV) to longer or more phonetically complex utterances. A child’s failure to respond to treatment methods in which the goal is to teach the child phonologic patterns (e.g., the Cycles Approach or 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 most wide applicability are

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

In addition, close tracking of retention and generalization through 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 childs sound system. Adoption of these strategies may help address 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 CASANA’s Professional Advisory Board.]

© Apraxia-KIDS℠ – A program of The Childhood Apraxia of Speech Association (CASANA)