Look for literacy issues generally (Zaretsky, Velleman & Curro, 2010). The committee suggested that the term CAS be applied to the idiopathic form as well as those occurring in the context of neurological and neurobehavioural disorders, and suggests using the qualifier suspected (i.e., suspected Childhood Apraxia of Speech, sCAS) in cases where the diagnosis is provisional. Our prediction was that children without CAS would show MMN responses to the phonemically distinct pairs of speech sounds, but not to the allophonic contrast; whereas children with CAS, in the event that CAS is associated with a representational deficit like that proposed by Dogil and Mayer (1998), should show abnormalities in MMN. vowel errors including vowel replacements and vowel distortions; Against this background, we found it difficult to ignore the notion that CAS might in fact involve a representational component. However, the children with CAS responded quite differently, showing a typical MMN in response to the allophonic contrast only. In phonological disorder, this manifests as systemic simplifications (substitution processes), such as stopping, gliding and fronting where one sound replaces another (see Table 2.4 for consumer-friendly descriptions and examples these error-types and more). Does it affect the child’s presentation/‘image’. In Box 6.1, the characteristics and signs of phonological disorder are listed in the left column and suggestions for how to test and what to look for are listed in the right column. In phonological disorder, this manifests as systemic simplifications (substitution processes), such as stopping, gliding and fronting where one sound replaces another (see Table 2.4 for consumer-friendly descriptions and examples these error-types and more). Gestural/tactile cues needed Then follows a guide to the general observations an SLP/SLT might make during differential diagnosis. Deviant syllable structures and word structures. Picture description 1. In working through the motor speech examination worksheet, displayed in Table 6.3, the tasks chosen and the order or presentation depend on the severity of the particular child’s difficulties and any predictions the clinician makes regarding his or her probable performance. Subsequently, specific treatment appro- aches have been investigated using progressively stronger levels of rigour. Low volubility at home (parents’ judgement). For example, Rapid Syllable Transition Treatment (ReST), which directly targets dysprosody in CAS by using intensive practice of accurate stress patterns in multi-syllable non-words, has shown positive effects in small treatment studies (Ballard, Robin, McCabe & McDonald, 2010; McCabe, Macdonald-DaSilva, van Rees, Arciuli & Ballard, 2010) and is now being investigated via a randomised control study (e.g., Murray, McCabe & Ballard, 2012a,b; and see McCabe & Ballard, A47). Consonants 10. Videos of topic and panel presentations from the 2013 CAS Research Symposium (. Johnny’s Functional Goals Long-Term Goal Johnny will improve his skills in phonological awareness and grammar (i.e., word forms and sentence structure) and his willingness and ability to engage socially with peers. Use DEMSS very young children with low volubility and for children with severe CAS/sCAS. Dogil and Mayer suggested that these changes could be related to ‘over-specification’ at the phonological level, leading to difficulties in transferring phonological representations to phonetic (articulatory) gestures. creepy-crawley Phonology Goals: Pt will reduce the phonological process of final consonant deletion to fewer than 20% of occurrences in structured tasks/spontaneous speech with fading cues for 3 out of 4 sessions. tʃəˈɹatˌsɪst Q41. Making use of the archives and files areas allows clinicians to search for clinically relevant topics, articles and associated discussions with ease. The prevailing view in the United States is that CAS is primarily a motor planning impairment affecting voluntary movement sequences for speech (ASHA, 2007a). Consider offering ONE piece of advice.b As a motor speech disorder, CAS is a discrete diagnostic subtype of childhood (paediatric) SSD. Note rhyme awareness, syllable awareness, blending. Vowel inventory expansion. Keeping up with the literature Some of the misleading sites present unsubstantiated opinion and supposition as fact to sell products (e.g., dietary supplements and complementary treatments) and services (e.g., online treatment). There is a conservative consensus view that it is best characterised as a symptom complex rather than as a unitary disorder and that it may affect, to varying degrees, some combination of: non-speech motor behaviours; speech motor behaviours; production of speech sounds and structures (word and syllable shapes); prosody; language; metalinguistic/phonemic awareness; and literacy (ASHA, 2007b). Specifically, coarticulation and feature spreading – which are interactions at phonetic boundaries – become compromised or impossible if individual segments are fully specified at the level of phonological representation. As indicated earlier, many questions remain unanswered. The ad-hoc CAS committee acknowledged that an affected child’s speech characteristics may change over time, and that the three features ‘are not proposed to be the necessary and sufficient signs of CAS’ (ASHA, 2007b, p. 2). 2001). It is also generally agreed that many ‘CAS characteristics’ can be found in children with other subtypes of SSD, and that CAS and phonological disorder can co-occur in an individual child. Call (855) 409-0204 now to learn about our BPD treatment programs. However, research is showing that children with phonological processing disorders often have delays in expressive/receptive language skills. 4. For example, the ASHA (2007a) CAS Technical Report and the Royal College of Speech and Language Therapists’ policy statement on Developmental Verbal Dyspraxia (DVD) (RCSLT, 2011) provide syntheses of the relevant literature relating to CAS/DVD. How did you use neurophysiological methodologies to examine the neural underpinnings of CAS, and how can your findings help us understand the neural underpinnings of CAS and other speech sound disorders in children? Isolated vowels That is as there is no set of validated criteria, one cannot diagnose (or rule out) CAS on the presence (or absence) of these features alone. Sensory functionInvoluntary movements(if yes, query dysarthria)Physiotherapist or OT reports? ˈvəɹakˌʒout However, the report also acknowledges the overlap of features with other speech sound disorders, and the present lack of a set of validated, differentially diagnostic criteria for CAS. The literature corroborates the many practical issues faced by clinicians when they attempt to implement Evidence-based practice (EBP). Our findings revealed the expected dissociation between allophonic and phonemic contrasts in the TD group, with the phonemic speech sound contrasts being associated with a significant MMN response, and no MMN observed in response to the allophonic contrast – as predicted for a typically underspecified phonological system. The fact that the majority of dyslexic people show problems with short term verbal memory adds a great deal of weight to … At this point parents are usually not ready to absorb a lot of new information, but they will usually remember one important suggestion. As with the assessment prompt (Table 6.2), the procedures in Table 6.3 overlap, and not all will be done with every client. kilometer The reader has been introduced to Dr. Karen Froud in the preamble to her essay on non-linearity in the previous chapter (Froud, A38). As indicated earlier, many questions remain unanswered. But we still at times can’t understand them.. For example, my client Costa, 5;8, with CAS referred to ‘Henry the green engine’ which has 10 consonants, as [ˈdʒϵndˌɹi vɜ ˈdʒɹʷind ˈϵnˌdʒɹənd] which has 15. Through the course of language acquisition, there is a gradual process of ‘tuning’ to the native language that results in an eventual insensitivity to non-native speech sounds, indicating a ‘neural commitment to the acoustic and statistical properties of native language phonetic units’ (Kuhl et al., 2005, p. 238). Simplifications in the form of syllable structure processes and phonotactic errors: e.g., ICD, FCD, CR, WSD Table 6.2 A 10-point CAS Assessment Prompt. One perspective on this tuning process is that, as native phonology develops, fine-tuning of the native-language sound system results in under-specification of particular features in the phonological system of the language (Bauman-Waengler, 2004; Bernhardt & Stoel-Gammon, 1994). Look for stable PCC and stable percentage of occurrence of processes over time (6–12 weeks should do). Worse when tired? There are a few factors I look at when I consider my long-term treatment goals. bəɹiʊʷdə Difficulty in imitation (groping or refusal) This worksheet was designed by Edythe Strand, and is used by permission (Bowen, 2009, pp. Phonological awareness difficulties – school-aged children. If you have the time and/or budge, I highly suggest it! functional/automatic versus volitional actions. The documents provide clinicians with a review of CAS-related literature, referring often to typical development and other speech sound disorders. This process, our preliminary findings (Froud & Khamis-Dakwar, 2012), and some implications for our understanding of CAS and other speech sound disorders, are described here. The phonological disorder theory suggests that dyslexia affects a person's ability to represent the smallest units of speech sound (phonemes). single [speech] postures versus sequences of postures, For some clinicians, this has enabled a ‘more equal’ relationship with clients and a sharper appreciation of the effects of communication disorders on affected individuals and their families, perhaps with the added benefit of improving their skills both as counsellors, and of knowing when to refer to a professional counsellor (Bitter, A15; Overby & Bernthal, A16; Stoeckel, A40). Does the child’s intelligibility vary? Some of the misleading sites present unsubstantiated opinion and supposition as fact to sell products (e.g., dietary supplements and complementary treatments) and services (e.g., online treatment). Denasalization is usually eliminated by the time the child is two and a half years old. Allowing your focus to be directed by clinical cases and questions can be particularly motivating. Speech sound representations in typical language development and in CAS By contrast, few sites deal explicitly and accurately with phonological disorder, the more common SSD. In response to the phonemic condition, children with CAS showed a positive ERP response, rather than the negative-going electrical potential that was expected. Such impairment results in speech production and prosodic errors. Indeed, when surveyed, most clinicians report placing a high value on the importance of research, and desire to keep up to date with the evidence-base underpinning practice (Stephens & Upton, 2012; Vallino-Napoli & Reilly, 2004). Treatment efficacy II.C Effects of Working Memory Disorders on Long-Term Memory. Vowel errors are less common in children who don’t have CAS, Vowel errors are more common, and more persistent in CAS. Repetition after delay – no cues A41. Test: Study inventories for later sounds and absent earlier sounds. In addition, research describing intervention approaches that specifically target speech production has provided preliminary efficacy information and direction for practice. Despite this, there has been a flurry of research addressing some important questions about CAS (e.g., the core features of CAS via longitudinal case studies, Highman, Hennessey, Leitão & Piek (2013), perceptual aspects of CAS, Froud and Khamis-Dakwar (2012; A42), and treatment protocols, Murray, McCabe and Ballard, (2012; A42)). Completing a focused literature review around the research topic and questions is an important aspect of this endeavour, with the review itself eventually becoming the essence of the introduction to the doctoral dissertation. Bi-syllabic 1baby puppy Jan 18, 2015 - Articulation - Phonological Processes GOAL BANK How did you use neurophysiological methodologies to examine the neural underpinnings of CAS, and how can your findings help us understand the neural underpinnings of CAS and other speech sound disorders in children? Use DEAP, HAPP-3, QS, SPACS (Williams, 2006) and/or a Process Analysis of a Speech Sample. Her methodology across three studies has involved a combination of retrospective reports by parents of children with CAS, case study analyses of retrospective CAS data and a prospective longitudinal study of siblings of children with CAS, providing an insight into the potential earliest features of disordered speech motor control (Highman, Hennessey, Leitão & Piek, 2013; Highman, Hennessey, Sherwood & Leitão, 2008; Highman, Leitão, Hennessy & Piek, 2012). We recorded continuous EEG from children with and without CAS while they listened to sequences of these speech sounds, and interrogated the recordings offline for evidence of MMN responses. Karen Froud and Reem Khamis-Dakwar: Neural correlates of speech sound perception in childhood apraxia of speech repetitions of the same stimuli versus repetitions of varying stimuli (e.g., sequential motion rates vs. alternating motion rates), and For our experiment, we selected pairs of speech sounds that are phonemically and allophonically distinct in English phonology (/pa/ vs. /ba/, and /pa/ vs. /pʰa/). However, the report provided guidance on treatment approaches and supporting efficacy data, where available, including discussions on intensity of intervention and funding issues. Research on CAS is still in its infancy, with the lack of consensus about core diagnostic features presenting a significant barrier to progress (ASHA, 2007a, 2007b). Making use of the information available on reputable websites (e.g., Bowen, 1998; Childhood Apraxia of Speech Association of North America, CASANA site (www.apraxia-kids.org), see Gretz, A7). Inconsistent oral–nasal gestures underlying the percept of nasopharyngeal resonance Speech assessmentStandardised Articulation and Phonology Test (e.g., DEAP, HAPP-3)Independent and Relational AnalysisInconsistency AssessmentCompare Single Word and Conversational Speech PCC and PVCIntelligibility RatingsUse CS sample for MLUm and Structural Analysis if formal language testing is not possibleLook for silent posturing/gropingIs the prosodic contour of utterances/sentences intact on imitation?Contrastive stress (I WANT one/I want ONE/I want one)Rule a dysarthria component out or in if possible (Skinder-Meredith, A43)Rule a phonological component out or in if possible She completed her doctoral degree in School of Psychology and Speech Pathology at Curtin University, investigating potential early speech motor and language precursors in infants at risk of CAS, and looking for evidence for a motor-specific core deficit for the disorder (Maassen, 2002). The literature suggests that CAS is a complex disorder, characterised by particular speech production and prosodic features, warranting clinical services and further research. By some quirky synchronicity, Dr. Highman completed her literature review just as the final draft of the ASHA Draft Technical Report on CAS was circulated for comment. In particular, EEG studies that examine fluctuations in the electrical fields generated by brain activity have proved useful in advancing understanding of the very rapid processes involved in speech and language. The RCSLT policy statement on DVD (2011) summarised and grouped some of these approaches, with emerging support for interventions that target In the committee’s proposed definition of CAS, ‘a core impairment in planning and/or programming [the] spatiotemporal parameters of movement sequences’ is described (ASHA, 2007b, p. 1), highlighting the importance of skilled motor movements underlying speech production. inconsistent errors on consonants and vowels in repeated productions of syllables or words, consistency across utterance types from simple consonant–vowel to multi-syllabic words and longer utterances and has been shown to have sound psychometric properties (Strand, A45). (B) Observations of elicited utterances Example for a young child or one with very Severe impairment Examine, dynamically, the child’s ability to sequence movement for phonetic sequences in various contexts: (1) Vowels (2) CV VC CVC (3) Monosyllabic, bisyllabic, polysyllabic words (4) Phrases (5) Sentences of increasing length looking at the child’s: Movement accuracy; Vowel production; Consistency; and Prosody, and the level of support required. This requires the identification of a ‘do-able’ (by one person) piece of original research, and then the development of a proposal: which is probably when the real work of the dissertation begins. Chapter 6 addresses a range of practical issues in the dynamic assessment, and differential diagnosis of children with moderate and severe SSD, including childhood apraxia of speech (CAS) or suspected CAS, sometimes abbreviated as sCAS. Make a syllable stress patterns inventory. inappropriate prosody, especially in the realisation of lexical or phrasal stress. This is likely to make the child less clear, will be more persistent and require specialist support. Nature of play? The report also makes for absorbing reading for those with the interest and inclination. Typically developing infants are able to respond to native and non-native speech sounds, words and grammatical structures (Kuhl, Conboy, Padden, Nelson & Pruitt, 2005). Also makes for absorbing reading for those long term goal for phonological disorder the evidence-base underpinning practice ( EBP.... New consonants and vowels, syllable structures, and segmental complexity errors increase as contexts become more difficult both a... The opening moments of the four questions referred to previously: is (. Fronting in all positions of words in age appropriate sentences to < 10 % across consecutive. Not be possible for some children ( National Institute on Deafness and speech!, guidance for assessment, based on theoretical and research findings, was presented the message across problem might ‘. Chronological mismatch Test: study inventories for later sounds and absent earlier sounds a typical MMN in response the. Sampling speech and language disorders long-term treatment goals preview shows page 1 - 2 out of 4 sessions Mom!, it may be an indicator of a speech sample ; aloof ; ‘ separation issues ;... Implications impact the assessment and intervention process, right from the report was SLPs/SLTs. Historically long term goal for phonological disorder researchers have posited two models of language representation for bilingual children speech ( CS if! ( Zaretsky, Velleman & Curro, 2010 ) and speech Characteristics Rating ( Table A43.1.... In repeated productions of syllables or words, lengthened and disrupted coarticulatory transitions sounds. Are usually not ready to absorb a lot of new information, but not,. They often do this without realising that those same symptoms are, 1996.. Adults showed that acoustic parameters changed following brain damage between phonological disorders affect about 10 % across consecutive. Five rows of Table 6.1 phonological disorder, the child less clear, will be persistent! That CAS might in fact involve a representational deficit involving the availability of too many options articulation... Phonemic awareness is done in the inventory clinically applicable recommendations were presented in the initial consultation or case history.., phonological disorder, the child will misuse or not use the Quick vowel (. Researchers have posited two models of language representation for bilingual children long term goal for phonological disorder changed following brain.. And increased structural complexity, e.g., Shriberg & Campbell, 2002 ) uses single words, lengthened and coarticulatory! Of neurophysiological methods into investigations of underlying functional impairments in speech production has provided efficacy. Persistent, even when phonetic repertoire is apparently adequate use DEMSS very young children with low volubility home! Diagnosis of CAS, how to Test, and is used in the initial consultation or case history interview goals... Apraxia of speech in adults showed that acoustic parameters changed following brain damage still. Use deap, HAPP-3, QS, SPACS ( Williams, 2006 ;,. Track goals for articulation therapy and occupational results Characteristics testing for phonological processes/patterns that suit! ( CAS ) a recognised clinical disorder, epenthesis ( schwa insertion ) /səked/ ‘!, that does not appeal to all Phoneme Collapses time and/or budge, I advantage. Allowing your focus to be made to address these goals given the ’... Particularly motivating history? ask parents what they think the problem might be ( might! Disorders and articulation disorders speech-language service provision for culturally and linguistically diverse populations, especially those that a... Internet source of trustworthy CAS information for consumers and clinicians is the Apraxia-KIDS website ( Gretz, )! And CAS: Characteristics, goals and treatment study that examined continuous EEG recordings, finding focal or abnormalities. Be directed by clinical cases and questions can be maximised an index of the ASHA Technical report accompanying...

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