Red flags for CAS in young children

Childhood apraxia of speech is a complicated disorder that can be difficult to identify, due to its huge variability in presentation and similarities with phonologically-based speech sound disorder. The task is even more challenging when working with very young children with limited vocalizations. But what if there were specific red flags to look for in young children, similar to those we use for suspected autism or hearing impairment?

Overby et al. reviewed hours of home video footage of infants and toddlers to determine if there are clinical red flags that are reliably associated with a later diagnosis of CAS or speech sound disorder. Turns out, the speech characteristics of young children who later receive a diagnosis of CAS are markedly different from those of typically developing children. Between birth and 24 months, the following atypicalities were observed in children with a later diagnosis of CAS: 

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  • Limited vocalizations with few “speech-like” sounds

  • Lack of a speech-like consonant by 12 months

  • Limited consonant repertoire

    • specifically, < 3 consonants at 8–16 months and/or < 5 consonants at 17–24 months

  • Lack of velar productions and favoring of bilabials

  • Favoring stops & nasals

  • Limited syllable structures

    • productions between 13–18 months were largely vowels, lacking CV or CVC structures

As an early interventionist, being aware of these red flags may help to tease out language versus speech difficulties and provide appropriate interventions at a younger age. Infants and toddlers with a later diagnosis of speech sound disorder showed a similar, but less severe profile, and the results did not quite reach significance. However, it is important to be aware of this pattern so that we can provide all children with the most optimal early intervention services.

 

Overby, M.S., Caspari, S.S., & Schreiber, J. (2019). 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. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2019_JSLHR-S-18-0046.