A Goal-Writing Framework for Motor-Based Intervention for Childhood Apraxia of Speech.

PURPOSE: There are multiple frameworks for goal writing that are applicable to the practice of speech-language pathology. Motor-based speech disorders are a subset of speech sound disorders that are thought to require specific elements of intervention that are typically not addressed in the traditional frameworks used in the clinical setting. The purpose of this tutorial is to review general approaches of goal writing and suggest additional elements that may be used to improve the efficiency and effectiveness of treatment for childhood motor speech disorders, specifically childhood apraxia of speech (CAS). METHOD: Existing models of goal writing were reviewed to ascertain elements common to most of these models. A basic framework was chosen and modified to include behaviors, conditions, and approaches to goal measurement tailored to the clinical needs of children with CAS. A resource for clinical decision making for children with CAS was developed to inform goal writing at the onset of treatment and adaptations that occur over the course of treatment. Case studies are presented to demonstrate how the presented framework can be applied to writing goals for motor-based treatment for two different children with CAS. DISCUSSION: Children with CAS require a specialized approach to intervention, which requires goals to reflect the unique clinical needs of this population. This tutorial offers resources that use the best available research evidence and current understanding of effective treatment practices for CAS to guide clinical decision making for motor-based intervention and goal writing. This tutorial is intended to guide treatment planning across varied settings to facilitate progress and optimize treatment outcomes for children with CAS.

Volubility, Consonant Emergence, and Syllabic Structure in Infants and Toddlers Later Diagnosed With Childhood Apraxia of Speech, Speech Sound Disorder, and Typical Development: A Retrospective Video Analysis.

Purpose Studies of infants' early vocalizations have proven helpful in describing the developmental characteristics of various communication disorders. However, few studies have addressed the early vocalizations of infants and toddlers who were later diagnosed, as older children, with childhood apraxia of speech (CAS). We refer to these infants and toddlers as LCAS. Extant studies also often lack a comparison group of infants and toddlers who were later diagnosed, as older children, with a speech sound disorder (SSD). We refer to these infants and toddlers as LSSD. We aimed to compare the volubility, consonant emergence, and syllabic structure from birth to age of 2 years, as observed in home videos, among 3 groups of infants and toddlers: LCAS, LSSD, and typically developing (TD). Method We assessed the speech-language skills of 17 children (3.5-8.8 years old; 7 with CAS, 5 with SSD, and 5 TD) and transcribed home videos (obtained from parents) of these same children from birth to age of 2 years. Early vocalizations were coded as nonresonant or resonant. Nonresonant vocalizations could not be transcribed with the International Phonetic Alphabet. Resonant (speechlike) vocalizations were broadly transcribed, and resonant consonants were categorized by place, manner, and voicing. Results Effect size comparisons revealed LCAS infants and toddlers were less voluble, used fewer resonant consonants, had a less diverse phonetic repertoire, and acquired resonant consonants later than either the LSSD or TD participants. For LSSD infants and toddlers, means for these dependent variables were lower than the means demonstrated by the TD group, but effect size were not strong due to LSSD variability. Conclusions Findings imply there might be clinical "red flags" that could assist the identification of infants and toddlers at risk for later diagnosis of CAS. Data did not support red flags for identifying infants and toddlers at risk for later diagnosis of SSD. Because of significant study limitations, results obtained should be considered preliminary. Supplemental Material https://doi.org/10.23641/asha.8233334.

Volubility, consonant, and syllable characteristics in infants and toddlers later diagnosed with childhood apraxia of speech: A pilot study.

PURPOSE: This pilot study explored the volubility, consonant singleton acquisition, and syllable structure development between infants and toddlers (birth-24 months) with typical speech sound production (TYP) and those later diagnosed with childhood apraxia of speech (CAS). METHOD: A retrospective longitudinal between- and within-subjects research design was utilized (TYP N=2; CAS N=4). Vocalizations from participants were analyzed between birth-24 months from home videotapes, volunteered by the children's parents, according to type (nonresonant vs. resonant), volubility, place and manner of consonant singletons, and syllable shape (V, CV, VC, CVC, VCV, CVCV, VCVC, and "Other"). RESULTS: Volubility between groups was not significant but statistically significant differences were found in the number of: resonant and non-resonant productions; different consonant singletons; different place features; different manner classes; and proportional use of fricative, glottal, and voiceless phones. Infants and toddlers in the CAS group also demonstrated difficulty with CVCs, had limited syllable shapes, and possible regression of vowel syllable structure. CONCLUSIONS: Data corroborate parent reports that infants and toddlers later diagnosed with CAS present differently than do those with typical speech sound skills. Additional study with infants and toddlers later diagnosed with non-CAS speech sound disorder is needed. LEARNING OUTCOMES: Readers will: (1) describe current perspectives on volubility of infants and toddlers later diagnosed with CAS; (2) describe current perspectives of the consonant singleton and syllable shape inventories of infants and toddlers later diagnosed with CAS; and (3) discuss the potential differences between the speech sound development of infants and toddlers later diagnosed with CAS and those with typical speech sound skill.

Obstructive sleep apnea, seizures, and childhood apraxia of speech.

Associations between obstructive sleep apnea and motor speech disorders in adults have been suggested, though little has been written about possible effects of sleep apnea on speech acquisition in children with motor speech disorders. This report details the medical and speech history of a nonverbal child with seizures and severe apraxia of speech. For 6 years, he made no functional gains in speech production, despite intensive speech therapy. After tonsillectomy for obstructive sleep apnea at age 6 years, he experienced a reduction in seizures and rapid growth in speech production. The findings support a relationship between obstructive sleep apnea and childhood apraxia of speech. The rather late diagnosis and treatment of obstructive sleep apnea, especially in light of what was such a life-altering outcome (gaining functional speech), has significant implications. Most speech sounds develop during ages 2-5 years, which is also the peak time of occurrence of adenotonsillar hypertrophy and childhood obstructive sleep apnea. Hence it is important to establish definitive diagnoses, and to consider early and more aggressive treatments for obstructive sleep apnea, in children with motor speech disorders.