Working Guidelines for the Assessment and Treatment of Childhood Apraxia of Speech: A Review of ASHA's 2007 Position Statement and Technical Report

Introduction

In March of 2007, the American Speech-Language-Hearing Association (ASHA) published its first-ever official policy on childhood apraxia of speech (CAS). Increased requests for information about the disorder prompted the development of this policy. The committee charged with this endeavor (Larry Shriberg [chair], Christina Gildersleeve-Neumann, David Hammer, Rebecca McCauley, Shelley Velleman, and Roseanne Clausen) reviewed the "scientific foundations of CAS and trends in professional practice" (ASHA, 2007b, p.1) and published a lengthy (75 pages) technical report (ASHA, 2007b) and a concise 3-page position statement (ASHA, 2007a). Despite the combined length of these documents, the compilation of information into a technical report and a position statement falls short of ASHA's desired outcome of also being able to specify a "knowledge and skills statement" and "practice guidelines" for CAS. This is because there is not enough research evidence to support more specific recommendations and guidelines (ASHA, 2007a, p.1).

However, practically speaking, the committee's position statement and technical report are working documents that clinicians can use to guide assessment and treatment of CAS, and that caregivers can use to help advocate for appropriate speech and language services for their children based on what is currently the best available information. Additionally, the documents present a call for research to researchers and clinicians alike, so the disorder can become better understood and so more definitive practice guidelines can ultimately be established. This paper synthesizes the current position of ASHA on the assessment and remediation of CAS in the form of working guidelines, and makes suggestions for practice based on those guidelines.

Working Guideline #1: CAS Is a Recognized Clinical Disorder

"Apraxia of speech exists as a distinct diagnostic type of childhood (pediatric) speech sound disorder" (ASHA, 2007a, p. 1).

ASHA Position

ASHA (2007a) recognizes childhood apraxia of speech as a unique disorder in which distinct characteristics of speech production and prosody separate it from other speech sound disorders. According to ASHA (2007a), childhood apraxia of speech, with these core features, exists in the following three contexts:

1. "causally with known neurological etiologies (e.g. intrauterine stroke, infections, trauma);
    
2. as a primary or secondary sign in children with complex neurobehavioral disorders (e.g., metabolic, genetic); and
    
3. not associated with any known neurological or complex neurobehavioral disorders...as an idiopathic neurogenic speech sound disorder" (p. 1).

Suggestions for Practice

Ensure that childhood apraxia of speech is on the list of diagnostic categories used by SLPs at your institution. Develop a protocol to differentially diagnose childhood apraxia of speech from other speech sound disorders (e.g., phonological delay, dysarthria), and to determine its relative contribution to a child's communication disorder, especially when it occurs in the context of other neurobehavioral disorders.