Differences between CAS and other disorders: examples of phonologic impairment and dysarthria

Children with CAS are more likely to make sound distortions than other children with different kinds of speech sound disorders. And this is because of the difficulty they have in making accurate movement gestures. Children who have other kinds of speech sound disorders might be more likely to substitute one sound for another, or perhaps always leave off a final sound. They tend to make errors that are more consistent. For example, some children don’t continue the airflow for sounds like sss, and instead will stop the air flow. The next example will actually show you a child who has phonologic impairment where the errors are more consistent and predictable, and there’s very little difficulty with the actual accuracy of the movement. He’s just producing the wrong sounds.

This is a child who does not have childhood apraxia. Her speech sound errors are quite predictable. We call these phonologic errors. She doesn’t have inaccurate movements but is simply using the wrong sounds. Examples from this clip are nipe instead of knife, poon instead of spoon, and out tide pool for outside pool. Note that she is starting to correct her errors. Her vowels, speech rate, melody, and stress patterns are all quite good. This type of speech sound disorder is much more common than childhood apraxia of speech. House. What’s this? Window. What’s that? Tree. OK, let’s put him onto the side, he’s making noise, we can’t hear you. Say this one again for me. [INAUDIBLE] Say this one. [? Tree ?] OK. [INAUDIBLE] Good job. Gup. Nipe. Poon. We have big poon and little poon, and big hort and little hort. The spoon a big one, but what’s this one? Cup. A cup, but what did you say? A big? A big spoon, and a little spoon, and a big fork, and a little fork. Are these forks or knives? What’s that? Pebble. OK, who’s that? Monkey. Banana. Tree. Good. OK. Zipper. Zipper. OK. Say it one time. Zipper. Whoa, you were thinking about your sounds. Zipper. OK. Duck. What color? Yellow. What’s a duck say? Quack, quack. Good job. What’s that thing? Sweeper. A sweeper? Yeah, we have a little one and a big one, but we just bought a red one. You just bought a red one? Yeah, and we can take [INAUDIBLE] on our new red one. It’d be good. You could do what? We could take our new one [INAUDIBLE] the other way, [INAUDIBLE]. It’d be good. Oh, OK. Swimming. She’s swimming. Good job. I want to swim in the outside pool. You want to swim in the what? Outside pool. Oh, in the outside pool.

The second clip that you’ll see is a child who has dysarthria. And that is also a motor speech disorder, but occurs for very different reasons than CAS. In dysarthria, the children actually have weakness or paralysis of the muscles of the face — either the tongue, lips, jaw, et cetera — and that weakness causes sound distortions. It is easy to tell the difference between children with dysarthria and apraxia some of the time. At times, though, it can be very difficult, and a speech-language pathologist will need to help in determining which of those the child has.

This first example of dysarthria is characterized by decreased breathing support and distortion of sounds that likely reflect weakness. He also has some spasticity that we hear as strain in his voice and his slow rate of speech. His comprehension and intelligence, however, are quite good.

This child also has dysarthria, although his speech sounds different than in the previous example. That is because there are a number of different types of dysarthria, depending on what areas of the brain are involved. This child has hypernasality, or too much air coming out of his nose. He also has a strained quality to his voice, which is very unusual in childhood apraxia, but is often heard in dysarthria. His speech rate is slow, and he has reduced ability to move his lips and tongue. During therapy, he is working hard to learn strategies to compensate for this weakness. Tell me how you play that game. We play with players four and six turn people. Four to six people. Or three to play the game. To play the game. If six, you want three teams or two teams. OK. If you have six, there are three teams or two teams. Good job. Then what happens? There is two teams. There’s only two teams. Two teams. And then how do you win? When you get a one-eyed jack. What’s next? Oh, you take away a player one to six. On the player six, you put yours on that one. If you have a two-eyed jack, that’s a wild one. That’s a wild one. If you have a what? Two-eyed jack. A two-eyed jack. That’s a wild one. OK.