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Childhood Apraxia of Speech (CAS) in children with CVI

Learn about the promising practices for the unique needs of children with CVI and Childhood Apraxia of Speech

Aiden smiles for the camera with his hands by his mouth and elbows out wide. He's wearing a red sport's jersey.

Some children with CVI have Childhood Apraxia of Speech (CAS). The CVI visual behaviors must be considered at every turn when designing a total communication plan and intervention approach. Every child with CVI has their own unique needs, and therefore a whole-child, collaborative approach to assessment and intervention is critical. 

What is Childhood Apraxia of Speech (CAS)?

The American Speech-Language and Hearing Association (ASHA) defines Childhood Apraxia of Speech as:

“A neurological childhood (pediatric) speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g. abnormal reflexes, abnormal tone). CAS may occur as a result of known neurological impairment, in association with complex neurobehavioral disorders of known and unknown origin, or as an idiopathic neurogenic speech sound disorder. The core impairment in planning and/or programming spatiotemporal parameters of movement sequences results in errors in speech sound production and prosody.” (ASHA, 2007b, Definitions of CAS section, para. 1)

In other words, it’s a brain-based issue with motor planning, leading to what may be significant challenges with speech sound production, intonation and rate of speech (prosody). 

It’s important to note that in this demographic, Childhood Apraxia of Speech may co-occur with delayed language development. It is absolutely critical for speech therapy to target language development in tandem with speech sound production. Without the underlying conceptual development of basic communication skills, the speech-sound development has nothing to “stick” to. That’s why therapy must target language development as well (if that is at all impacted and it often is). The treatments overlap in a helpful way!

Unique challenges for individuals with CVI and Childhood Apraxia of Speech 

The CVI visual behaviors make treating Childhood Apraxia of Speech (CAS) uniquely difficult. CAS interventions often rely on visual modeling of articulators (movement of lips, tongue, teeth) to produce a sound.

  1. Impact of motion. Some individuals with CVI have impaired motion perception (difficulties understanding the speed, distance or direction of motion of objects). Any treatment approach that expects the child to look at an adult modeling how to produce a sound will not be an ideal option for the child. They won’t be able to perceive the model, because speech sounds are produced by a series of quick movements. 
  2. Access to People. Some individuals with CVI might have difficulty looking at faces, difficulty with facial recognition, and interpreting facial expressions. Many CAS treatments expect individuals to visually attend to faces, then interpret the movements of the articulators (lips, tongue, teeth) appropriately in order to copy them and produce the associated sound. In other words, in order to follow a visual model, the student must be able to access faces and facial expressions. Many students with CVI struggle with this—and many don’t want to look at faces. This is another reason that visual modeling of speech sound production is uniquely challenging for this demographic. 
  3. Sensory integration. Individuals with CVI may have a lot of difficulty processing multiple sensory inputs at once—noise, visual clutter, distracting movement and light, internal sensory input, tactile information. Often vision is the first to go. Most CAS treatment approaches expect the student to be able to look and listen at the same time: to watch a visual model of a speech sound or word and listen to it being produced. Looking and listening at the same time can be quite difficult for many children with CVI. 

Promising practices 

Here are some ways to bring together the adaptable parts of the evidence-based CAS approaches to best serve the needs of children with CVI and Childhood Apraxia of Speech.

Model, model, model! 
Aiden and his sister on playing uno on their living room carpet. Aiden uses his AAC as he plays.
Practice, practice, practice!

Childhood Apraxia of Speech is challenging because the only way to grow is to practice, practice, practice. We all need repetition to learn a motor plan (imagine learning to throw a frisbee—you have to try several times, in order to even get it to fly flat!), and children with CAS need lots of repetition to learn the highly precise and delicate movements to produce speech sounds. 

Learn more about CVI and communication right here on CVINow.org!

Get an inside look into Aiden’s communication journey living with CVI and Childhood Apraxia of Speech. 

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