Are you saying that children with DS don’t have CAS?
No! Children with DS most certainly can have CAS. However, from my experience with literally hundreds of children with DS, the incidence of this specific speech disorder is very low. By and large I see children with multiple issues that affect spoken language. Here is a classic example of what I see:
John is a little 4-year-old boy with DS and a history of reflux, 3 sets of pressure equalization tubes, and moderate sleep apnea. He has had his tonsils and adenoids removed surgically 2 years ago. While he doesn’t actively spit up any more, John is a very picky eater. John is very active and enjoys playing ball with his siblings. Actually, he likes throwing everything. John uses about 20 signs, but has only about 10 spoken words. Of those words only his family and close friends really understand him. He is able to imitate some facial movements and is able to mimic some sounds like p, b, and d when he wants to. He doesn’t have any k or g sounds. He has vowels like o and uh, but can’t do ee (like in me). Sometime John will say a word as clear as day and not be able to repeat it again. He has had speech therapy since infancy. John’s parents are frustrated with his slow speech progress and wonder if he could have apraxia.
Children with DS are children. While I would like every child I see to be a textbook case, they simply are not. John’s example illustrates that. Each child is uniquely, beautifully, their own person and this includes the way they acquire speech communication. The case example above may be common, but it is not the whole picture. This child may have apraxia or he may have a different speech disorder. The most important thing to keep in mind is that a one-time evaluation with a new SLP is typically not going to yield a diagnosis of CAS. Since CAS is difficult to accurately diagnose, several sessions may be needed to differentiate the type of speech sound disorder the child demonstrates.
My child doesn’t have the CAS label but the therapist treats it as such. The techniques she uses have been working, so does it matter if we aren’t “officially” diagnoses with CAS?
Good question. For speech therapy to be effective the SLP needs to treat the observable characteristics and understand the underlying cause of the difference. If a therapist suspects CAS and progress with apraxia-focused treatment is documented, then continue to move forward in therapy. The purpose for official diagnosis is first and foremost in order to accurately be able to treat the disorder – so that the child can develop and use speech as clearly as possible. There are very different techniques used for CAS then other speech sound disorders. I’m not talking about materials or programs that can be purchased. Instead I’m referring to fundamental differences in the treatment approaches SLPs are trained to provide. A child with a phonological disorder may make slower progress in speech therapy if they are incorrectly diagnosed as having CAS.
Please continue to share your thoughts and critiques! More to come soon – Jennifer