Is it CAS (Childhood Apraxia of Speech)? Differential Diagnosis and Treatment™


1.2 ASHA CEUs • 1.2 AOTA CEUs - click through for more info on our ASHA CEU Policy and Process

Instructor: Renee Roy Hill

Course Description 

Day 1: Childhood Apraxia of Speech:  Part 1: Where Do I Begin?  Differential Diagnosis and Best Practice Therapy Planning 

In this one-day presentation, Renee Roy Hill will focus on the current assessment and treatment strategies recommended for clients diagnosed with Speech Sound Disorders. The course will focus on differential diagnosis to identify those with childhood apraxia of speech from other SSD’s and the recommended treatment strategies when CAS is the primary diagnosis.  These will be discussed in detail and the benefits and challenges will be included.

In some cases, our clients with diagnosed or suspected CAS do not initially respond to, or do not yet meet the criteria for those techniques that focus on whole word speech planning using primarily auditory and visually-feedback.   They may also have difficulty attending/participating in therapy for the needed amount of time for those treatment strategies to work, have difficulty with vocal imitation, or perhaps may not have enough consonants and vowels to work with. 

This class will continue with instruction on how to address some of these complex issues as a prerequisite to moving into speech motor planning for words and sentences.  The difference between phonetic placement and NSOME will be addressed as a core concept of Renee Roy Hill’s tactile approach.  A systematic bottom-up approach using additional sensory motor cues to access the motor system will be taught.  The participant will learn how to then transition from these prerequisite activities into the recommended programs for CAS.  Included but not limited to will be considerations for clients with Autism, Down Syndrome and related disorders affecting tone and pre-verbal.  

The course will: 1) Define characteristics of various speech sound disorders; 2) Side by Side look at characteristics from each SSD for differential diagnosis; 3) Provide participants with an understanding of considerations needed when a dual diagnosis is identified; 4) Discuss current assessment tools available that assist in differential diagnosis of SSD’s; 5) Review current literature and recommended treatment programs for CAS.  These will not be taught specifically but will be reviewed in depth to allow the participant to have better decision making skills for the individual client; 6) Define Phonetic Placement and how it differs from NSOME; and 7) provide strategies for planning and implementing a multi-modality motor speech program. 

Learning Outcomes 

Participants will be able to:

  • Define Speech Sound Disorders and have knowledge of each of their characteristics. 
  • Learn the key characteristics to Childhood Apraxia of Speech. 
  • Understand which Motor Speech Assessment is appropriate based on individual client skills. 
  • Learn more about research based therapy techniques ASHA recommends for CAS. 
  • Learn when a phonetic placement/sensory motor approach might be helpful and how to include current techniques recommended for CAS. 
  • Discover a hierarchy of working from teaching a client to vocalize on command to verbal communication. 
  • Understand what steps might be addressed prior to diagnosing CAS or working on speech-motor planning.

Day 2: Sensory-Motor Approach to Working with Motor Speech Disorders and Dual Diagnosis:  The Technique

Historically, clinicians are taught to develop speech by modeling (look at me, copy me).  Most techniques, regardless of the diagnosis rely on this method and many clients do well.  However, there are many students who cannot make a change to speech with only auditory and visual cues.  These clients with “oral placement disorders”, a term coined by Sara Rosenfeld-Johnson and Diane Bahr to describe the client who cannot make a change to speech using auditory and visual cuing alone, often struggle to make the progress we hope to see.  These clients may benefit from a multi-sensory approach to include tactile input based on phonetic placement and motor learning theories.  This class will discuss how and when a sensory-motor approach might benefit.  These principles and techniques can be applied with a variety of clients to include clients with Speech Sound Disorders (SSD’s) as well as those with dual diagnosis (Oral-Motor Disorder (OMD) and apraxia, Dysarthria and Down Syndrome, Autism and Apraxia) to name a few.  Participants will learn how a stable motor system is key to speech development and the necessary underlying skills for each sound.  Motor development will be reviewed and its place in assessment and treatment will be discussed.      

The course will: 1) Review the underlying motor system as a pre-requisite to the standard production of speech sounds, 2) Review OPT as a modern extension of phonetic placement theory, 3) Discuss dual diagnosis, 4) Review important components of a motor speech assessment to include the sensory and motor system when identifying a dual diagnosis such as apraxia and dysarthria/OMD, 6) Bottom up approach to speech production- learn the systems, 6) Teaching vocalizing on command, 7) Using a tool/tactile cue to facilitate speech motor planning, 8) Teach a therapy approach using techniques for motor sequencing with a bottom up approach when a client is not able to vocalize on command and has a limited phonemic repertoire, and 9) Discuss how this approach is intended as an adjunct to current therapy techniques.

Learning Outcomes:  

  1. Define goals of therapy using a Motor Based approach.
  2. Understand the role of the muscle system in speech clarity. 
  3. Learn what oral placement disorders and oral placement therapy are as related to speech clarity.
  4. Discover what components of an assessment assist in identifying OPD in speech.
  5. Learn Sensory-Motor Techniques to teaching a client to vocalize on command. 
  6. Implement phonetic placement techniques to build a clients phonemic repertoire using tools and tactile cues as well as target persistent articulation errors.
  7. Develop a framework for when to use tactile phonetic placement techniques and how to fade them. 


    Timed Agenda

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