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    Default Childhood Apraxia of Speech (Speech Dyspraxia)

    My nearly 3 year old son was diagnosed with CAS today and I'm wondering if anyone out there has any information or advice that could help us through our journey?? I have a lot of general information but would be great to hear from anyone with first hand experience/advice.
    THANKS!!

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    Default Childhood Apraxia of Speech (Speech Dyspraxia)

    I am a speech pathologist. CAS is a complicated, dynamic condition. 3 is rather early to have a definitive diagnosis of CAS opposed to CAS-like behaviour. What therapy routine has your clinician outlined for your son? Will he see an OT as well as the speech pathologist?
    Unfortunately we don't know a huge amount about CAS; we don't know exactly how to 'fix' it or what causes it. Generally therapy focuses on trying to set down a stable phonemic (sound) inventory that the child will draw on in speech- CAS happens when the child doesn't have this stable inventory or they have trouble mentally accessing the sounds they want to use, and then mentally putting them together (programming) before saying them. They then can't plan out the sounds in the words that they want to use and so their speech is really hard to understand- the wrong sounds are used (I'd like to give an example but there's so much variation!)
    Is there any specific q's about CAS that your therapist hasn't answered for you that I could advise you about?

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    Thanks so much for your reply!! I have had my suspicions about CAS for a little while...the signs and symptoms seem to make sense.We have been advised that our son will probably need speech therapy for a few years...to start with repeating the few words that he has (very few) over and over in a fun environment and then slowly build up to 2 words joined together and then progressing to sentences. No OT as he shows no signs of eating difficulties/dribbling etc. The main fear I have for him is that he may be "different" when he starts school and I would hate for him to be teased/ostracized (I know its early days but.....). If you have any techniques/strategies that you have found particularly useful I would be very grateful to hear. I guess its just hard at the moment as there are so many uncertainties. I just hope we can have him speaking legibly before he starts school.
    I do appreciate your speedy reply...THANKS!!!

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    Default Childhood Apraxia of Speech (Speech Dyspraxia)

    Could you tell me a little more about your son? Who diagnosed him (not a name, just profession), explain as much of the process they used as you can, what exactly do you see in his speaking and his behaviour with language? What is his temperament like? What caused you to initially be concerned? Why do you personally believe/feel it's CAS? CAS is misdiagnosed in 75% of cases in children under 3. I just want to get a better understanding, I don't want to pry overmuch but I'm very curious about the diagnosis, and I'd love to give you some direction based on your son's current abilities
    Last edited by Marepoppin; 21-12-2012 at 00:17.

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    My son has been in speech pathology since he turned 2 as he was not verbalising any words at all. We recently had a new speech pathologist who, after 5 sessions, expressed a concern re CAS and we had a second opinion from a senior SP yesterday who also thought he has dyspraxia. He is a very happy little guy most of the time although is getting frustrated quite easily now when he is not understood. He says Mama and Dada well and spontaneously but other than that he really can't be understood. I know what he is trying to say most of the time but that's because he's my son rather than me being able to actually understand the words. He doesn't put 2 attempted words together yet and the thing that seems to fit most with CAS to me is that when he attempts words he can often say the last half (eg ink for drink, ar for car) or if he does say both syllables there is a gap between them (eg munk....eeee for monkey). He replaces "p" with "b" (poo is boo, pool is bool). If I repeat, repeat, repeat a word such as "me" he will often say it well after a few tries, but then a few minutes later he can no longer say it, as if he can't remember the correct word, it becomes "wa" which is his general word for just about everything he can't say! Hard to explain in writing but that's generally where he's at at the moment.
    Thanks so much for your interest...hope to hear back from you!!

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    Default Childhood Apraxia of Speech (Speech Dyspraxia)

    There's 2 ways to look at this, IMO, and that's as follows: 1) he has a significant language delay (meaning he doesn't talk much, he only uses simple words, but he understands what you say to him) and elements of dyspraxia (meaning after a few demos from you he will say the target sounds but then will not be able to do it again spontaneously and without prompting), and typical phonological development (the sounds he should be able to say at his age) with some typical elements we see in kids his age (first sound/s in word left out eg (dr)ink, and some troubles with multi-syllable words eg monkey).
    2) he has CAS.
    Now. I'd be far more inclined to treat him for the first condition than the second, and the senior SP seems to agree. Dyspraxia is a 'catch all' phrase when the evidence points to problems in organization and output, whereas CAS is a significant condition that takes years of assessment to diagnose. IMO, and it's my opinion only, never having seen or spoken to your boy, that he definitely has some developmental verbal dyspraxia, and some language delay as a result of this.
    What I would recommend to you as homework, if you were my clients, Is repetition, repetition, repetition. Dyspraxia has a motor element- this means that you can train clear speech through muscle memory. Imagine you're a tennis player- you must mentally plan out the moves of the serve and volley, but you must also physically carry out those moves until you can't get them wrong. Your body knows what to do when you have practiced and practiced.
    Twice a day, for 5-10 mins, you need to work on sounds. You should ask your SP for homework tasks that focus on contrast, on sequencing, and make sure you do them.
    I also want to recommend an ipad app if you have an ipad, it's called Speech therapy for apraxia - NACD and it was $5.99 when I purchased it earlier this year. There are multiple levels of sound and challenge and you can set it for your littlie to follow. Ask your SP how best to integrate it into your therapy.
    Look, you've been aware for a long time that your littlie needs some help and it's fantastic to see you are so invested in his speech there's many years until he starts school and while we can't say for sure what his abilities will be like at age 5 you're doing the very best thing to help. Finally, ask your SP for info and activities from the Nuffield Dyspraxia Program for homework tasks too

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    Thank you SO MUCH. It is so kind of you to take an interest in my little boy and give some very good advise. I agree with you that he has language delay probably as a result of elements of dyspraxia and have to admit that I didn't know there was a difference between verbal dyspraxia and CAS. The senior SP I saw said they were one and the same. I am not seeing our SP again until January so will follow your advise of 5-10mins twice a day of repetition...I have a few target words that I shall use in these "sessions"...words he finds easiest and maybe that way his confidence will build up. I have looked at the speech therapy for apraxia-NACD and I can download onto my computer (so will do so with hubbies help when he get home!!) Will also ask SP about the Nuffield Dyspraxia Program.
    We are going through the public system at this stage and will probably be assigned fortnightly sessions for a while. Do you think this is sufficient therapy at this point?
    Thank you so much for your time and help

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    Default Childhood Apraxia of Speech (Speech Dyspraxia)

    IF you can keep up a great routine of frequent practice, increasing the time spent on the activities over time (not more than 20mins at a time) as he gets older and has more stamina and attention, then I would say that you wouldn't do any harm to his progress with fortnightly sessions. You definitely still need a professional guiding you and assessing his progress until his speech is normal or until no further progress is expected to be made.
    In an ideal world, a child with dyspraxia would see a SP 2-4 times a week for 30 mins at a time. This is very rarely possible for anybody, usually for financial reasons. Ultimately, and I'm not saying this to be negative, but without therapy dyspraxic children don't improve and that is why YOU are the most important therapy tool your son has. Practice, repetition, experience. Don't expect miracles. This is going to be a hard slog. He'll go backwards and forwards and plateau, but together with you and the SP, he will improve

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    Hi again! Could you just clarify for me the difference between verbal dyspraxia and CAS? I'm a bit confused after doing some "googling"!!
    Thanks again for all your help

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    Default Childhood Apraxia of Speech (Speech Dyspraxia)

    Hi again, I've just gone back to the books to make sure I'm correct in saying this, and it's consistent what I said before... Ok so CAS and DVD are used interchangeably to describe the same sort of disorder; I think I've tripped you up when I said 'some DVD'... What I was saying is that evidence of verbal dyspraxia is present when I could also have said some apraxia of speech is present. The reason I use the word 'verbal' in front of dyspraxia is to distinguish between dyspraxia when speaking versus 'oral dyspraxia', which is when there's a breakdown in all oral movements such as blowing kisses then smiling, etc, not just in speech programming.
    Mostly what I was trying to get across is that at 3 yrs, CAS is a significant diagnosis that should be taken seriously, but that often there's some typical behaviors such as leaving sounds out of words, changing them from 'voiceless' eg /p/ to 'voiced' eg /b/, that might resolve on their own as he gets older. I really hope that I haven't served to confuse you further
    A website that you have probably stumbled across already is www.apraxia-kids.org it might have some info for you

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