This question, dealing with long-term outcomes and prognosis, is one that virtually all parents will wonder and ask at some point after learning that their child has CAS. This question might arise during the childs initial assessment, or later, sometime during intervention. It is an important question for both parents and speech-language pathologists (SLPs) to consider. Unfortunately, there is no research published to date that expressly addresses the answer to this question, so the response, at best, will be an educated guess based on the particular childs symptoms and the SLPs clinical experience with CAS.
Many children with CAS ultimately do achieve normal speech, but some do not. It can be difficult predicting which children are likely to achieve normal speech by adulthood and which children are unlikely to do so. There are indicators that SLPs can use to help distinguish these two groups of children. In my experience, the most important indicators are child-specific, and include the severity of the child’s CAS, the child’s initial progress in intervention, and the presence and severity of co-occurring symptoms. The co-occurring symptoms that can affect prognosis most significantly, also in my experience, include language impairment, cognitive impairment, and oral/limb apraxias. Although the interaction of these disorders with CAS is unknown, the more severe the accompanying symptoms, the more challenging it can be for a child to achieve completely adult-like speech. Other child-specific indicators requiring consideration include the child’s motivation, cooperation, attention, continued progress, and accessibility to services. The more favorable these latter factors, the more positive a child’s prognosis will be.
I have worked with children with CAS in both research and clinical capacities for 20 years. During this time, I have observed children with CAS whose speech has resolved to normal (or near normal) status with intervention. Even children with moderate or severe CAS can achieve normal speech given appropriate and extended intervention services; however, I have found that this prognosis is most favorable for children with fewer and less severe co-occurring symptoms. Children with fewer and/or milder co-occurring symptoms tend to progress to normal speech by adolescence, when provided appropriate and sufficient speech intervention, even when the speech apraxia was more severe at the time of diagnosis. After discharge from speech intervention, one might notice mild speech errors when the older child or teenager is fatigued or stressed; otherwise speech remains well produced and understandable to any listener.
There also are other children with moderate or severe CAS whose prognosis for achieving normal speech by adulthood is poor. In my experience, these children initially present with multiple and more severe co-occurring symptoms. These children often continue to make progress in speech intervention throughout adolescence, and although they never achieve normal speech, progress is made and speech often remains their primary means of communication. Connected speech can remain challenging, as does the correct production of at least some of the suprasegmental aspects of speech (melody of speech, syllable stress, rate of speech, etc.). For the most severe of these children, alternative communication systems might be used in combination with verbal output to enhance communication. Using a combination of communication techniques can be particularly helpful to teenagers/young adults who find themselves in a variety of changing communication settings.
Overall, it is important to remember that children with CAS can and do make progress in speech intervention. The prognosis for normal speech will depend on a variety of factors; many of these factors are both child-specific and subject to change over time. Continue to believe in the child’s ability to progress and try to celebrate each positive step along the way!
(Dr. Kathy Jakielski is an Assistant Professor of Communication Sciences and Disorders at Augustana College in Rock Island, Illinois. She received her Ph.D. in 1998 from the University of Texas at Austin. Dr. Jakielski has a wide range of experience as a clinical speech language pathologist through her work in Head Start and public schools, hospital systems, as well as private practice. She has a particular interest in Childhood Apraxia of Speech and is coauthor of one of Apraxia-KIDS most popular articles, “Developmental Apraxia of Speech: Information for Parents.” Recently, she helped to facilitate our first Spanish translation article of this title, “Apraxia del Habla Infantil: Informacion Para Padres.” She is also a member of CASANA’s Professional Advisory Board.)