According to the American Speech-Language-Hearing Association, "children with CAS have difficulty saying sounds, syllables and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (i.e., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words."
"The signs of CAS can begin in infancy, although it is extremely difficult to diagnose CAS in children younger than 3," says Paula R. McGuire, a speech-language pathologist and director of the Evanston Campus Speech and Language Clinic at Northwestern University’s School of Communication.
Referring to the association’s Web site, she offers signs parents can watch for:
n does not coo or babble as an infant
n first words are late and may be missing sounds
n uses only a few different consonant and vowel sounds
n problems combining sounds and possible long pauses between sounds
n may have problems eating
n can understand language much better than can talk
n may appear to be groping when attempting to produce sounds
n appears to have more difficulty when he or she is anxious
n sounds choppy, monotonous or stresses the wrong syllable or word
Current estimates suggest CAS occurs in 3 to 5 percent of speech-impaired preschoolers. McGuire notes at least three reasons for the increase in diagnoses, including birth-to-3 legislation.
"Since the passage of early intervention statutes speech-language pathologists are asked to evaluate and identify communicative disorders as early as possible in infants and toddlers," she says. "For children who have not yet begun to talk, the diagnosis must be based on variables other than speech itself, such as failure to coo, oral hypersensitivity or difficulty in feeding."
She says there’s also increased information regarding CAS available to professionals through seminars and workshops and to the general public via the Internet.
Finally, she says, reimbursement issues might be a reason for more diagnoses. CAS may be used as a diagnostic classification because insurance companies frequently require a child to have a medical diagnosis to approve coverage.
Children with CAS may have other symptoms, including expressive language problems like word order confusions, word recall and difficulties learning to read, spell and write.
"These children may have limited experience in conversation with other children," says McGuire, which "may limit their opportunity to learn skills such as turn-taking, topic maintenance, initiating conversations and so on."
So what should you do? "If you are concerned about your child’s development, trust that instinct and seek evaluation," says McGuire.
Your pediatrician can provide a referral to a licensed speech-language pathologist or you can go to the ASHA Web site to find a local professional.
McGuire also recommends professional online resources, like www.asha.org and www.apraxia-kids.org, the Web site of the Childhood Apraxia of Speech Association of North America.
"Although the disorder can require very intensive treatment, children do improve," McGuire says. "The sooner treatment is initiated, the better the prognosis."
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