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Running head: DEVELOPMENT OF CHILDHOOD APRAXIA OF SPEECH

Development of Childhood Apraxia of Speech

Kenneth Parker Chambliss

University of North Alabama

PY 344-01 Developmental Psychology

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DEVELOPMENT OF CHILDHOOD APRAXIA OF SPEECH

Abstract

Childhood apraxia of speech (CAS), also known as developmental verbal dyspraxia, involves

a deficit in the child’s ability to accurately synchronize phonological information with the

physiological means of speech production (Dale & Hayden, 2013). CAS differs from other motor

speech disorders like Dysarthria, in that Dysarthria is characterized by a deficit or paralysis in the

musculature involved in speech production, while CAS involves an inaccuracy of the planning or

“programming” of speech (Childhood Apraxia of Speech, 1997). The diagnosis of CAS is

problematic due to discrepancies with diagnostic features of the disorder as well as its pathology.

In this paper, a background on the physiological and cognitive mechanisms involved in the

diagnosis and treatment of CAS is provided.

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Introduction

The intricate process by which humans are able to perceive and make sense of sound, at the

most basic level, involves the detection of pressure waves (i.e. vibrations) (Schacter et al., 2011).

Various physiological and cognitive processes are required in order for those vibrations to “make

sense”. Considering a developmentally “normal” adult, these synchronized processes and

mechanisms are easily taken for granted. Communication using language is possible, facilitating

social integration, a strong sense of self, a mechanism for defense (survival), and basic spatial

orientation. However, various genetic or traumatic conditions may have deleterious effects on the

development of human auditory/speech/motor systems during childhood and adolescence. It is

the purpose of this paper to inform a college-level reader on the physiological and cognitive

mechanisms involved in the diagnosis and treatment of childhood apraxia of speech.

Physiological Mechanisms of Audition and Oration

In order for sound to be perceived in any meaningful way, attenuation of the primary

sense organs (i.e. the ears) involved in hearing must occur (Kalat, 2009). From there, pressure

waves travel through the middle and inner ear and are transduced into electrical impulses that

travel down the cochlear nerve into the brain (Spoendlin & Schrott, 1989). From here, auditory

processing takes place in a parallel distributed manner between certain brain structures.

The areas of the brain concerned with speech production and processing reside typically in

the left hemisphere of the parietal, temporal and frontal lobes. For language production

specifically, Broca’s area of the frontal lobe is a key brain structure. This is due to its location

being very close to the motor cortex, making it a primary area of focus concerning apraxia of

speech. For language comprehension, the Wernicke’s area of the temporal lobe is a key structure.
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This is due to its location in the temporal lobe which is characterized by auditory and perceptual

processing (Goldstein, 2014).

Phonological information is conveyed overtly by synchronized mechanisms such as

respiration, phonation, resonance, articulation and prosody. This is a complex task that involves

rapid feedback between many sound producing structures and the brain. These structures

include: the lungs, glottis, larynx, pharynx, the oral cavity and the nasal cavity (Weinberg &

Westerhouse, 1971).

Language Production

In order to understand how physiological feedback systems interact to produce

recognizable speech, language and its processing must be reviewed. Language is defined by a

system of communication using sounds and symbols to express feelings, thoughts, ideas and

experiences. Properties of language include an ability to communicate, relationships and

associations of meaning, structured non-arbitrary patterns, limitless combinatorial generation,

and a dynamic system of change (Clark & Clark, 1977).

In 1957, B.F. Skinner (the founder of radical behaviorism) argued that language was acquired

through a system of operant conditioning, specifically reinforcement. He believed that the

consequences of behavior (such as communicating) would not only influence, but be the basis of

a person’s ability to learn a language. Noam Chomsky (known as the father of modern

linguistics) argues that the principles of human language are coded within the genome, resulting

in an underlying linguistic structure shared by all humans (Goldstein, 2014). Both of these

theories are useful when applied to discussion on speech and language disorders.
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DEVELOPMENT OF CHILDHOOD APRAXIA OF SPEECH
Speech Segmentation

The ability to tell when a word ends and another begins is known as speech segmentation

(Jusczyk & Houston, 1999). The idea of “boundaries” between words is something most people

take for granted. However, people with apraxia of speech have difficulties with producing

appropriate speech segmentation. This may arise due to underlying issues with the linguistic

properties of phonemes and morphemes. A phoneme is a single speech sound that serves as the

basic unit of speech. There are roughly 200 possible phonemes given the anatomical structures

involved in speech production by humans (around 45 in the English language). A morpheme is

the smallest unit of meaning constructed by phonemes. Morphemes can be arranged into words

and are categorized as content or functional morphemes. A further step up in the linguistic

hierarchy leads to syntax (the rules that govern morpheme combinations) and finally semantics

(the link between language and concepts. Motor speech disorders, such as apraxia of speech

(AOS) involve issues at the level of phoneme and morpheme production (Goldstein, 2014). It is

important to note that there is often no indication of any intellectual disabilities associated with

apraxia of speech (although some do exist). Language comprehension and creation (within the

mind) normally remains unimpaired.

Symptoms

Common symptoms that arise due to childhood apraxia of speech largely depend on their

onset. For infants and very young children (around 1 to 4 years old), an absence of babbling,

cooing, combining sounds and even eating may be indicators of a developing speech sound or

motor speech disorder. For older children (around 4 to 8+ years old), symptoms may include the

child making inconsistent sounds, having difficulties saying longer words, seeming to fumble

with speech, and stressing the wrong syllables. These issues with communicating simple phrases
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with other individuals often lead to language development problems, difficulties with fine motor

movement and coordination, problems with social anxiety, and problems learning to read and

write (Childhood Apraxia of Speech, 1997).

Diagnosis

Diagnosing childhood apraxia of speech is a difficult process due to the lack of

empirically validated diagnostic features. This is largely due to the idiopathic nature of the

disorder. However, the American Speech-Language-Hearing Association has narrowed the

diagnostic features down to “(a) inconsistent errors on consonants and vowels in repeated

productions of syllables or words, (b) lengthened and disrupted coarticulatory transitions

between sounds and syllables, and (c) inappropriate prosody, especially in the realization of

lexical or phrasal stress.” (Dale & Hayden, 2013). The cause (or more realistically “causes”) of

childhood apraxia of speech are not currently known. However, it is hypothesized that genetic

disorders and/or neurological impairment are involved in the development of the disorder

(Childhood Apraxia of Speech, 1997).

Treatment

A consensus on the most appropriate treatment plan for childhood apraxia of speech has

yet to be reached. However, various treatment programs have been proposed. During the 1980’s,

Dr. Deborah Hayden of the PROMPT Institute in Sante Fe New Mexico began to develop a

treatment program for childhood apraxia of speech. The Prompts for Restructuring Oral

Muscular Phonetic Targets (PROMPT) approach is based on building motor control within

speech subsystems in a bottom-up fashion. These subsystems are ranked from stages one to

seven and include: tone, phonatory control, mandibular control, labial-facial control, lingual

control, sequenced movements, and prosody. Dynamic cues are used in conjunction with
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auditory and visual inputs to guide the child’s speech movements during the treatment.

Eventually, the cues are faded out when the child reaches a proficient level of speech movement

within a speech subsystem (Dale & Hayden, 2013).

Prevalence and Conclusion

Childhood apraxia of speech is a rare motor speech disorder with relatively little known

about its pathology. The prevalence of the disorder is also unknown due to a lack of population

data. However, it is estimated that one to two children per thousand are diagnosed with

childhood apraxia of speech. The prevalence of the disorder has also increased significantly

based on clinical referral data provided within the last decade (Shriberg, Aram & Kwiatkowski,

1997). With proactive exposure to extensive treatment programs early on, a child diagnosed with

childhood apraxia of speech has the ability to overcome the disorder and lead a normal life.

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