CHILDHOOD APRAXIA OF

SPEECH

Information from the Conference by:

Margaret Fish MS,CCC-SLP

DEFINITION OF CHILDHOOD APRAXIA OF

SPEECH

� “A neurological childhood speech sound disorder

in which the precision and consistency of

movements underlying speech are impaired in

the absence of a neuromuscular deficit (e.g.,

abnormal reflexes, abnormal tone).”

� In simple terms it is a disorder of motor

planning.

CHARACTERISTICS

� Inconsistent errors in production of consonants

and vowels with repeated productions of syllables

and words.

� Lengthened and disrupted co-articulatory

transitions between sounds and syllables

� Inappropriate prosody (not always, sometimes

their prosody is the best thing they have going for

them)

� Connected speech more unintelligible than

expected given phoneme repertoire of results of

single-word articulation test.

CHARACTERISTICS (CONTINUED)

� Limited vocalizations/babbling during infancy.

(“very easy baby, was so quite”)

� Automatic speech (counting, singing, etc) better

than volitional productions.

� Groping or silent posturing

� Regression (loss of sounds and words)

� Poor diadochokinetic rates (pa-ta-ka), accuracy,

and rhythm.

� Difficulty producing volitional oral movements

� Possible feeding difficulties during infancy

(unrelated to significant muscle tone weakness)

CHARACTERISTICS (CONTINUED)

� Receptive language (typically) exceeds expressive

language

� Late in attaining first words

� At risk for literacy difficulty

ESSENTIAL ELEMENTS OF MOTOR SPEECH

EXAM

� Provide opportunities for child to:

� Produce words imitatively and spontaneously

� Produce words with increasingly complex syllable

shapes

� Repeat test items 3-4 times (not necessarily

sequentially)

� Execute non-vocal oral movements

� Produce phrases and sentences

� Produce challenging words with the benefit of cueing

(visual/tactile/proprioceptive)

FORMAL ASSESMENT INSTRUMENTS

� KSPT- Kaufman Speech Praxis Test for Children

(Kaufman)

� VMPAC- Verbal Motor Production Assessment

for Children (Hayden and Square)

� The Apraxia Profile (Hickman)

TREATMENT CONSIDERATIONS

� Focus on Phoneme Sequencing

� Provide Opportunities for repetitive practice

� Provide the appropriate intensity of service

� Select vocabulary thoughtfully (functional vocabulary)

� Incorporate multisensory cues and feedback

� Focus on vowels

� Address prosody early on in treatment

� Incorporate phonetic modifications as necessary

�Move quickly to phrases and sentences

� Facilitate carryover

MOTOR LEARNING THEORY

�When teaching new movement patterns mass

practice is recommended. (Hi mom, hi mom, hi

mom)

�When trying to habituate skills, distributed

practice is recommended. (I got ball, give me, roll

down, got it)

INCREASING PRACTICE OPPORTUNITES

� Divide activities into three phases

� Set-up the activity

� Complete the activity

� Review the activity

(mailman activity example)

MATERIALS AND ACTIVITIES TO PROMOTE

REPEATED PRACTICE

� Echo microphone

� Puzzles

� Sound Puzzles

� String beads or pop beads

� Fisher Price Farm

� Fisher Price cash register

� Cars, trucks and ramps

� Train track and trains

�Mr. Potato Head

�Marble works

� Books and songs

MATERIALS AND ACTIVITIES TO PROMOTE

REPEATED PRACTICE

� Books and songs (The big book of exclamations)

� Bubbles

� Zoo animals

� Playdough and accessories

�Wind up toys

� Games (my turn, your turn, #’s, colors, teach

vocabulary so they can play with friends)

� Familiar characters with accessories

� Dollhouse with family characters

QUICK GAMES FOR REPETITIVE PRACTICE

� Pop-up pirate

� Cariboo

� Crocodile dentist

� Don’t spill the beans

� Silly six pins

� Lego creator

�Mousetrap

� Animal buddies

� Barnyard bingo

� Lucky ducks

�Milk and cookies

� Silly faces

� Colorforms

�Memory games

� Lotto games

� Holiday and seasonal

game boards (super

duper)

ACTIVITIES FOR CHILDREN WHO ENJOY

MOVEMENTS

� Bowling

� Basketball

� Long jump: put pictures of words on floor and

jump over them. Add a new word each time. (“ I

jumped over a ____”, “ I jumped over a ___and

___and ____)

� Picture hop

� Treasure hunt

�Mailman

ACTIVITIES FOR CREATIVE CHILDREN

� Block designs

� Tall tower

� Dominoes

� Stickers

� Progressive drawing (guess what I’m drawing)

� Earn it now-make it later crafts

MISCELLANEOUS ACTIVITIES

� Go fish

�Memory

� Simon says

� Louder/softer (say word louder or softer)

� Hidden puzzle pieces (hide under target words)

INTENSITY OF SERVICE

�Motor learning research suggests that motor

skills are:

� Acquired more quickly

� Attained more accurately

� And are better retained

With shorter, more frequent sessions

***She said in a perfect world a minimum of 3-5, 20-

30 minute sessions a week is ideal.***

MULTISENSORY CUEING

� Specific cueing techniques

� Rate variations

� Choral speaking (simultaneous production)

� Direct or delayed imitation

� Mirror

� Mime (take away your voice)

� Hand motions/positions (Pam’s place on youtube)

� Written letters and words

� Tapping/clapping out syllables

� Syllable manipulatives

� Sound names

� Phoneme placement cues

� Mouth pictures

PAM’S PLACE- VOWELS (FIND ON

YOUTUBE)

VISUAL SYLLABLE WORDS

Toe May Toe

moo Vee

GIVE A LOT OF FEEDBACK

�When teaching a NEW motor skill:

� Provide frequent feedback

� Provide immediate feedback

� Provide knowledge of performance

� Tell what was not correct about the movement

� Tell what should be done differently next time

*Limit the amount of information provided- don’t overload*

FEEDBACK CONTINUED

� Progressively fade extrinsic feedback

� Provide intermittent reinforcement and feedback

� Begin to provide extrinsic feedback in form of

knowledge of results (was the target correct or

incorrect)

� Begin to delay feedback as skill level increases

PHONETIC MODIFICATIONS

� Four ways to modify targets:

� 1. Choose simpler words

� “Nana” for grandma

� “Uh huh” for yes

2. Teach alternate articulatory placement (e.g. dental placement for alveolors)

3. Consider normal phonological patterns (Kaufman)

� Syllable reduction, reduplication, cluster reduction, final consonant deletion, liquid gliding, or vowelization

4. Vowel simplification (e.g. pure vowels for dipthongs)

• This gives children power and a function vocabulary

• Honoring the modifications increases vocabulary

KAUFMAN’S SUCCESSIVE

APPROXIMATIONS

� “Day no”

� “di no”

� “di no so”

� “di no saur”

FACILITATION GENERALIZATION

� Increase practice opportunities

� Increase flexibility by using many phoneme

contexts

� Reduce cueing

� Increase rate

� Reduce pausing between syllables/words

� Change feedback from descriptive (knowledge of

performance) to correct/incorrect (knowledge of

result)

� Choose functional vocabulary

� Enlist help of family/teachers

EXTRA INFO THAT I THOUGHT WAS COOL BUT

DIDN’T REALLY PERTAIN TO APRAXIA MUCH…

� Teach children to ask appropriate follow-up

questions discretely:

� Use question cue cards

� Limited choices of cue cards

“I’m feeling kind of sad today”

Where? Why?

CONVERSATIONS

� Integrating the three basic conversation

extenders through discrete practice:

�What type of conversation extender is the

student predominantly using?

�Who is doing the most talking?

� Use chipper chat tokens, each person has their own

color. Put token on card when they do it.

Ask a

question

Make a

comment

Tell

something

about you or

someone you

know

THE CONVERSATION TRAIN

� Colored strips or small trains, one color for each

person in the conversation

� Lay strips side by side for each conversational

turn

� Include “talk over” or interruption strip

� Include “off topic” card

Talk over card

Off topic card