A Survey of Clinicians With Specialization in Childhood Apraxia of Speech

Abstract

Purpose Little is known about how clinicians develop expertise in childhood apraxia of speech (CAS), a rare speech disorder with heterogeneous presentation. The purpose of this survey study was to examine the beliefs and practices of clinicians specializing in CAS. Method Speech-language pathologists who self-identify as having expertise in CAS ( n = 165) completed an online survey regarding influences on clinical practice and beliefs about CAS. Practice patterns and perspectives regarding CAS were analyzed for respondents who self-identify as having expertise in CAS, across 4 experience bands (1–5, 6–10, 11–15, and 15+ years). Results A majority of the respondents to this survey provide treatment to preschool-age children with CAS. Respondents report features used in differential diagnosis aligned with the American Speech-Language-Hearing Association's (2007 ) technical report, with inconsistency as a key feature. Results suggest that continuing education courses are highly influential in the perceived development of expertise and perspectives regarding CAS. Respondents expressed uncertainty about comorbidity of CAS with other communication disorders. Overall, beliefs and practices are relatively uniform across levels of clinical experience. Conclusions Practices and perspectives of clinicians who self-identify as having expertise with CAS are influenced by factors noted in previous literature. Results of this survey highlight the need for research on the development of expertise in the clinical management of CAS, updated consensus statements that reflect advances in current research, clarification regarding comorbidity of CAS with other communication disorders, and evaluation of continuing education opportunities. Supplemental Material https://doi.org/10.23641/asha.9755459

Diagnostic Uncertainty in Childhood Motor Speech Disorders: A Review of Recent Tools and Approaches

“…Although the diagnostic features of both CAS and childhood dysarthria are reasonably well documented, speechlanguage pathologists report diagnostic uncertainty, having low confidence in diagnosing these conditions [5••]. For example, Randazzo [52] reported that clinicians with specialist CAS practice in the United States were confident in diagnosing standalone CAS in children; however, they felt less comfortable in diagnosis where a child may have either multiple speech disorders or other non-speech conditions. This diagnostic uncertainty can be seen in the research literature and clinically in labels such as "suspected CAS" (e.g.…”

Clinical practice of childhood apraxia of speech in Hong Kong: A web-based survey study

“…Obtaining information from clinicians using surveys is one direct method to achieve these goals. Information about clinical practice with English speakers who have CAS has been obtained from SLPs via survey with respect to diagnostic criteria [49] and clinical management [50,51], as well as the development of expertise [52]. These survey studies have provided the basis for further investigation of specific topics.…”

“…This underscores the need for investigation of the effectiveness of available evidence-based treatment programs in real clinical settings. Randazzo [52] suggested that clinicians develop their CAS expertise mainly based on continuing education programs. This drew attention to the content of these profit-making courses.…”

“…The high use of the traditional articulation approach may be due to the plentiful availability of relevant clinical resources. The two approaches that require attendance at continuing education courses have a strong influence on clinicians' practice [52]. Evidence for or against using traditional articulation approaches or Talktools1 Oral Placement Therapy with speakers with CAS is needed.…”

The Need for Increased Study of Infants and Toddlers Later Diagnosed With Childhood Apraxia of Speech

“…Although recent genome research offers multiple new gene variants associated with the disorder (Hildebrand et al, 2020), few known or putative causal genes have been identified to date (Carrigg et al, 2016;Peter et al, 2016). A second approach is to examine the trajectory of speech sound development across time for infants later identified with CAS (Highman et al, 2008), an approach that is of interest to clinicians (Randazzo, 2019) and has the potential to assist in the very early detection of the disorder (Allison et al, 2020). This approach to the study of CAS could open new paths of treatment techniques, much like increased inquiry into the developmental trajectory of disorders such as ASD, Fragile X syndrome, and Rett syndrome led to suggestions for their early identification and, in the case of ASD, subsequent toddler treatment protocols.…”