CAS - Ppt Presentation

8/12/2019 CAS - Ppt Presentation

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Childhood Apraxia of SpeechChildhood Apraxia of Speech

Checklist:Checklist:A Ser ies of Characterist ics toA Ser ies of Characterist ics to

Facili tate DiagnosisFacili tate Diagnosis

Kay Giesecke, MS, CCCKay Giesecke, MS, CCC--SLPSLP

Specialist in CAS since 1995Specialist in CAS since 1995

Heather MacFadyen, MA, CCCHeather MacFadyen, MA, CCC--SLPSLP


General Definition:General Definition:

1.1. Previously known as:Previously known as: Developmental/Verbal Apraxia, verbalDevelopmental/Verbal Apraxia, verbal

dyspraxia, etcdyspraxia, etc. ASHA and CASANA now use. ASHA and CASANA now useChildhood Apraxia of Speech (CAS)Childhood Apraxia of Speech (CAS)

common among all titles is the wordcommon among all titles is the word praxispraxis..

2.2. Motor Speech disorder:Motor Speech disorder:

a disruption in motor planning and/ora disruption in motor planning and/orprogrammingprogramming

What is Praxis?:What is Praxis?:

PraxisPraxis

planned movementplanned movement

neurological process by which cognitionneurological process by which cognition

directs motor actiondirects motor actionability to formulate orability to formulate or

plan different actionsplan different actionsbefore the actualbefore the actual

motor executionmotor execution (Ayres, 1985)(Ayres, 1985)

ApraxiaApraxia lack of praxislack of praxis

What is Motor Planning?What is Motor Planning?

The execution of a motor plan is the result ofThe execution of a motor plan is the result of

praxispraxis

the visible result of a successful invisible processthe visible result of a successful invisible process

Not simply a series of postures, must includeNot simply a series of postures, must include

information about theinformation about the sequencingsequencing of theseof these

postures;postures;

In regards to speech, how the articulators willIn regards to speech, how the articulators will

transitiontransition from one posture to the next.from one posture to the next.(Vellem(Velleman, 2003)an, 2003)

More specific definition of CASMore specific definition of CAS

Symptom complexSymptom complex/syndrome/syndrome

No one feature is adequate for diagnosisNo one feature is adequate for diagnosis

Each child has a different combination ofEach child has a different combination of

speech errorsspeech errors

thus the need for a checklist of CASthus the need for a checklist of CAS

characteristics.characteristics.

Top 3 Features from ASHATop 3 Features from ASHA

1.1. Inconsistent errors on consonants andInconsistent errors on consonants andvowels in repeated productions ofvowels in repeated productions ofsyllables or wordssyllables or words

2. Lengthened and disrupted co2. Lengthened and disrupted co--articulatory transitions between soundsarticulatory transitions between soundsand syllablesand syllables

3. Inappropriate prosody3. Inappropriate prosody

In addition, ASHA lists 18 other speechIn addition, ASHA lists 18 other speechfeatures that might be present.features that might be present.


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CAS Assessment ProtocolCAS Assessment Protocol

Traditional assessment which includes:Traditional assessment which includes:

Case HistoryCase HistoryHearingHearingPure Tone and TympanometryPure Tone and Tympanometry

Developmentally appropriate exp. and rec.Developmentally appropriate exp. and rec.

language measurement (if possible)language measurement (if possible)

Language SampleLanguage Samplecalculate MLU, examinecalculate MLU, examine

morphology and intelligibilitymorphology and intelligibility

Oral Mechanism ExamOral Mechanism Exam

Oral Motor Screening TestOral Motor Screening Test

CAS Assessment Protocol Cont.CAS Assessment Protocol Cont.

Speech:Speech:

Single word articulation test (if possible); childSingle word articulation test (if possible); childmay have to imitate items after examinermay have to imitate items after examiner

Formal or informal phonological analysis,Formal or informal phonological analysis,including syllable and word shapesincluding syllable and word shapes

Consonant inventoryConsonant inventoryisolation and stimulabilityisolation and stimulability

Vowel/diphthong inventoryVowel/diphthong inventoryisolation andisolation andsyllablessyllables

Prosodic analysisProsodic analysis

CAS ChecklistCAS Checklist


ChecklistChecklist

Developed by Kay Giesecke in 1996Developed by Kay Giesecke in 1996

Used in her private practice to facilitateUsed in her private practice to facilitate

diagnosis of CASdiagnosis of CAS

Based on previous research in the area ofBased on previous research in the area of

apraxiaapraxia

OneOne of the tools used in the diagnosticof the tools used in the diagnostic

processprocess

CAS Checklist ItemsCAS Checklist Items

1. Severely delayed speech development (Jaffe, 1984;1. Severely delayed speech development (Jaffe, 1984;Watkins, 1992)Watkins, 1992) *Persistent speech sound disorder; ASHA Ad hoc*Persistent speech sound disorder; ASHA Ad hoc--CAS,CAS,20072007

2. Language comprehension superior to language2. Language comprehension superior to languageproduction (Jaffe, 1984; Watkins, 1992; Velleman,production (Jaffe, 1984; Watkins, 1992; Velleman,2003)2003)

3. Slow or minimal improvement despite intervention (Hall,3. Slow or minimal improvement despite intervention (Hall,Jordan, & Robin, 1993; Velleman & Strand, 1994;Jordan, & Robin, 1993; Velleman & Strand, 1994;ShribergShriberg, et al., 1997; ASHA Ad hoc, et al., 1997; ASHA Ad hoc--CAS, 2007)CAS, 2007)**delayed progress may be due to inappropriate intervention**delayed progress may be due to inappropriate intervention

4. Single words more intelligible than conversation (4. Single words more intelligible than conversation (CraryCrary,,1993; Hall et al., 1993)1993; Hall et al., 1993) *Reduced Intelligibility; ASHA Ad hoc*Reduced Intelligibility; ASHA Ad hoc--CAS,CAS,20072007

CAS Checklist Items, cont.CAS Checklist Items, cont.

5. Strong occurrence of phonological processes5. Strong occurrence of phonological processes((CraryCrary, 1993), 1993)

6. Omission errors are the most prominent (6. Omission errors are the most prominent (CraryCrary,,

1993; Hall et al., 1993)1993; Hall et al., 1993)7. Initial consonants tend to be more misarticulated7. Initial consonants tend to be more misarticulatedthan final (than final (KamenKamen, 1995), 1995)

**initial consonants may be as affected as final consonants in t**initial consonants may be as affected as final consonants in t he case ofhe case of

severe speech disorderssevere speech disorders

8. Difficulties in sound sequencing (8. Difficulties in sound sequencing (CraryCrary, 1993;, 1993;Hall et al, 1993)Hall et al, 1993) *Syllable sequencing, ASHA Ad hoc*Syllable sequencing, ASHA Ad hoc--CAS, 2007CAS, 2007


9. Isolated movements better than sequenced9. Isolated movements better than sequencedmovements (Hall et al, 1993;movements (Hall et al, 1993; KamenKamen, 1996), 1996)

10. Errors increase as word length or performance10. Errors increase as word length or performanceload increases (load increases (CraryCrary, 1993; Edwards, 1973;, 1993; Edwards, 1973;

Velleman & Strand, 1994Velleman & Strand, 1994))11. Probable differences between repetition and11. Probable differences between repetition and

conversation (conversation (CraryCrary, 1993), 1993)

12. Prosodic aspects of speech are abnormal12. Prosodic aspects of speech are abnormal((CraryCrary, 1993; Hall et al., 1993;, 1993; Hall et al., 1993; RosenbekRosenbek &&Wertz, 1972;Wertz, 1972; YossYoss && DarleyDarley, 1974; Top 3, ASHA, 1974; Top 3, ASHA

Ad hocAd hoc--CAS, 2007)CAS, 2007)


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13. Presence of groping behaviors or salient posturing of13. Presence of groping behaviors or salient posturing ofarticulators (Hall et al, 1993; Jaffe, 1984;articulators (Hall et al, 1993; Jaffe, 1984; KamenKamen, 1996), 1996)

**Effortful productions; ASHA Ad hocEffortful productions; ASHA Ad hoc--CAS, 2007)CAS, 2007)

14. Inconsistency of errors14. Inconsistency of errors--misarticulate a word one time,misarticulate a word one time,then say it correctly another time (Hall et al, 1993;then say it correctly another time (Hall et al, 1993;KamenKamen, 1996;, 1996; RosenbekRosenbek & Wertz, 1972; Top 3, ASHA& Wertz, 1972; Top 3, ASHAAd hocAd hoc--CAS, 2007)CAS, 2007)

15. Variability of errors15. Variability of errors--different errors in the same worddifferent errors in the same wordand word position during repeated trials (Hall et al, 1993;and word position during repeated trials (Hall et al, 1993;KamenKamen, 1996; Top 3, ASHA Ad hoc, 1996; Top 3, ASHA Ad hoc--CAS,2007)CAS,2007)

16. Problems with nasality (Hall et al, 1993; Jaffe, 1984)16. Problems with nasality (Hall et al, 1993; Jaffe, 1984)


17. Voicing errors (Hall et al, 1993; Jaffe, 1984;17. Voicing errors (Hall et al, 1993; Jaffe, 1984;YossYoss && DarleyDarley, 1974; AHSA Ad hoc, 1974; AHSA Ad hoc--CAS, 2007)CAS, 2007)

18. Vowel and18. Vowel and dipthongdipthong errors (Hall et al, 1993;errors (Hall et al, 1993;Watkins, 1992; ASHA Ad hocWatkins, 1992; ASHA Ad hoc--CAS, 2007)CAS, 2007)

19. Most difficulty with fricatives, affricates, and19. Most difficulty with fricatives, affricates, andconsonant blends; least difficulty with bilabialsconsonant blends; least difficulty with bilabialsand nasals (Jaffe, 1984;and nasals (Jaffe, 1984; KamenKamen, 1996; Dean, 1996; Dean2008)2008)

20. Epenthesis20. Epenthesis--addition of schwa in consonantaddition of schwa in consonantclusters (Hall et al, 1993; Dean, 2008)clusters (Hall et al, 1993; Dean, 2008)

**Difficult to assess if the child is not producing consonant cl**Difficult to assess if the child is not producing consonant clustersusters

Administration of the checklistAdministration of the checklist

Information obtained from observations, formal testing,Information obtained from observations, formal testing,and parent report.and parent report.

If the child demonstrates the listed characteristic= 1 pointIf the child demonstrates the listed characteristic= 1 point

If the child does not demonstrate the characteristic = 0If the child does not demonstrate the characteristic = 0pointspoints

If the child does not produce sufficient spontaneousIf the child does not produce sufficient spontaneousspeech to determine the presence/absence of thespeech to determine the presence/absence of thecharacteristic and/or the errors are so severe thecharacteristic and/or the errors are so severe thecharacteristic does not apply= 1 point undercharacteristic does not apply= 1 point under N/AN/A

Add the totalAdd the total N/AN/A items to the total characteristicsitems to the total characteristicsexhibitedexhibited to obtain the severity ratingto obtain the severity rating

Interpreting the ResultsInterpreting the Results

Based on a review of 80 different caseBased on a review of 80 different case

studies the following guidelines werestudies the following guidelines were

developed for interpreting the results fromdeveloped for interpreting the results from

the CAS checklistthe CAS checklist

Diagnostic CategoriesDiagnostic CategoriesSpeech delay/disorder, not CASSpeech delay/disorder, not CAS

Group 1Group 1

Score = 0 to 12 (out of 20)Score = 0 to 12 (out of 20) -- 26 cases26 cases

Demonstrated 5 to 12 of theDemonstrated 5 to 12 of the

characteristics listed on the checklist.characteristics listed on the checklist.

Features not sufficient for diagnosis ofFeatures not sufficient for diagnosis of

CASCAS

Prognosis same as type and severity ofPrognosis same as type and severity of

disorder diagnosed.disorder diagnosed.

Severe Speech delay, not CASSevere Speech delay, not CAS

Case History #1Case History #1

Jacob, 3;8 (at initiation of therapy)Jacob, 3;8 (at initiation of therapy)

Was previously in speech therapy with noWas previously in speech therapy with no

progressprogress

Previous therapist did not encouragePrevious therapist did not encourage

parent involvementparent involvement

Enrolled in intensive speech therapy andEnrolled in intensive speech therapy and

was dismissed in 14 monthswas dismissed in 14 months


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Pre-test

3/19/1998

53 errors

PR= -1%

Post-test

5/13/1999

4 errors

PR= 71%

Severe Speech delay, not CASSevere Speech delay, not CAS

Case History #2Case History #2

Michelle, 2;6Michelle, 2;6

Previously enrolled in individual and groupPreviously enrolled in individual and grouptherapy, strong parent involvementtherapy, strong parent involvement

Previous SLP diagnosed her with CASPrevious SLP diagnosed her with CAS

Received a brief assessment and scored aReceived a brief assessment and scored a 66on the CAS checkliston the CAS checklist

Parent sent a tape to Kaufman to confirmParent sent a tape to Kaufman to confirmdiagnosis ofdiagnosis of apraxiaapraxiaKaufmanKaufman stated that thisstated that thischildchild maymay have been apraxic but was not anyhave been apraxic but was not anylongerlonger

Assessment

Results

43 errors

PR= 8%

CAS Characteristics

Demonstrated:

-Severely delayed speech

-Lang comp superior to

Lang exp

-Single words more

intelligible than

conversation

-Isolated movements

better than sequenced

movements

-Differences between

repetition and

conversation

-Most difficulty with

affricates, fricatives and

blends (age appropriate)

Group 2Group 2Severe Articulation & PhonologicalSevere Articulation & Phonological

Disorder with Apraxia ComponentsDisorder with Apraxia Components

Score= 13 to 15 (out of 20) 16 casesScore= 13 to 15 (out of 20) 16 cases

Presented with severe speech sound errors,Presented with severe speech sound errors,expressive language delays, and groping, butexpressive language delays, and groping, butexhibited:exhibited:NoNo problems with vowel productionproblems with vowel production

NoNo difficulties with prosody (a differential diagnosticdifficulties with prosody (a differential diagnosticcharacteristic according to research bycharacteristic according to research by ShribergShriberg et al,et al,1997)1997)

NoNo initial consonant omissionsinitial consonant omissions

NoNo variability in errors in the same word duringvariability in errors in the same word during

repeated trialsrepeated trials

Group 2Group 2Severe Articulation & PhonologicalSevere Articulation & Phonological

Disorder with Apraxia ComponentsDisorder with Apraxia ComponentsRequireRequire use of apraxic therapy techniquesuse of apraxic therapy techniques, such, such

as: drill and repetition, use of hierarchies, andas: drill and repetition, use of hierarchies, and

adjustment of performance load.adjustment of performance load.

Continue toContinue to struggle with production of newstruggle with production of newwordswords even after dismissal from therapy (basedeven after dismissal from therapy (based

on parent surveys).on parent surveys).

Prognostic implicationsPrognostic implicationsdemonstrated speechdemonstrated speech

skills within normal limits afterskills within normal limits after 11 to 2 years ofto 2 years of

intense therapy.intense therapy.

Severe Articulation & PhonologicalSevere Articulation & Phonological

Disorder with Apraxia ComponentsDisorder with Apraxia Components

Case HistoryCase History

Carl, 3;11 (at initiation of therapy)Carl, 3;11 (at initiation of therapy)

Demonstrated 15 out of 20 characteristicsDemonstrated 15 out of 20 characteristics

on checklist.on checklist.

Did NOT demonstrate vowel errors,Did NOT demonstrate vowel errors,

abnormal prosody, problems with nasality.abnormal prosody, problems with nasality.

Demonstrated final consonant deletion,Demonstrated final consonant deletion,

fronting, syllable reduction, deaffricationfronting, syllable reduction, deaffrication

Dismissed from therapy in 22 monthsDismissed from therapy in 22 months


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Pre-test

9/15/1999

55 errors

PR= -1%

Post-test

7/2/2001

5 errors

PR= 52%

Group 3Group 3

Moderate to Severe CASModerate to Severe CAS

w/out Major Concomitant Disordersw/out Major Concomitant Disorders

Score= 16 to 20 (out of 20)Score= 16 to 20 (out of 20) 1313 casescases

All but oneAll but one case (who scored a 16),case (who scored a 16),demonstrated vowel errorsdemonstrated vowel errors. That one case. That one caseproduced mostly vowels and a few initialproduced mostly vowels and a few initialconsonants.consonants.

These children also all had problems withThese children also all had problems withprosody, inconsistency and variability ofprosody, inconsistency and variability oferrors, and disrupted coerrors, and disrupted co--articulatoryarticulatorytransitionstransitions..

Group 3Group 3

Moderate to Severe CASModerate to Severe CAS

w/out Major Concomitant Disordersw/out Major Concomitant Disorders

Prognostic ImplicationsPrognostic Implications

Two out of nine of these students wereTwo out of nine of these students were

able to have speech that sounded normalable to have speech that sounded normal

after 2 to 4 years of intense individualafter 2 to 4 years of intense individual

apraxia therapy with extensive parentalapraxia therapy with extensive parental

involvement.involvement.

The other 7 are still in therapy.The other 7 are still in therapy.

Moderate to SevereModerate to Severe


Case HistoryCase HistoryAndrew, 5.1 (at initiation of therapy)Andrew, 5.1 (at initiation of therapy)

Demonstrated 18 out of 20 characteristics onDemonstrated 18 out of 20 characteristics onchecklist.checklist.

Demonstrated vowel errors, abnormal prosody,Demonstrated vowel errors, abnormal prosody,inconsistency of errors, disrupted coinconsistency of errors, disrupted co--articulation.articulation.

Demonstrated final consonant deletion,Demonstrated final consonant deletion,backing, syllable reduction, cluster reduction,backing, syllable reduction, cluster reduction,deaffricationdeaffrication

Had gross motor problems & learningHad gross motor problems & learningdifferences.differences.

Left to finalize therapy goals in public schoolLeft to finalize therapy goals in public schoolafter 46 months of therapy with Apraxia Dallas.after 46 months of therapy with Apraxia Dallas.

Case StudyCase Study

At initiation of therapy at Apraxia DallasAt initiation of therapy at Apraxia Dallas

Andrew was unable to complete anAndrew was unable to complete an

Articulation Test but on 16 imitativeArticulation Test but on 16 imitative

productions he said:productions he said:

tuhtuh/tub dada/pajamas nah/knife/tub dada/pajamas nah/knife pupu/spoon/spoon

guhguh/girl/girl muhtimuhti/monkey/monkey wawa/watch/watch kahkah/car/car

bubu/blue/blue ka/carrotka/carrot buhbuh/brush/brush tehteh/chair/chair

Post-test

7/21/2008

0 errors

PR= 99%

After 8

months

9/3/2004

51 errors

PR= -1%


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Group 4Group 4

Severe Childhood Apraxia of SpeechSevere Childhood Apraxia of Speech

with Major Concomitant Disorderswith Major Concomitant Disorders

Score= 16 to 20 (out of 20)Score= 16 to 20 (out of 20) 18 cases18 cases

Demonstrated all 3 top features from ASHADemonstrated all 3 top features from ASHAThe presence of other complicating issues, suchThe presence of other complicating issues, such

as cognitive delays, medical conditions, andas cognitive delays, medical conditions, and

disorders/syndromes will effect the childdisorders/syndromes will effect the childss

progress in therapy.progress in therapy.

Prognostic implicationsPrognostic implications -- unlikely to beunlikely to be

dismissed from therapy as within normal limitsdismissed from therapy as within normal limits

but can usually improve speech.but can usually improve speech.

Severe Childhood Apraxia ofSevere Childhood Apraxia of

Speech Case HistorySpeech Case History

Joseph, 7;6 (at initiation of therapy)Joseph, 7;6 (at initiation of therapy)

Diagnosed withDiagnosed with hypoplasiahypoplasia and MRand MR

Previously enrolled in therapy for 6 years,Previously enrolled in therapy for 6 years,pursuing augmentative communicationpursuing augmentative communication

Demonstrated 20 out of 20 items on theDemonstrated 20 out of 20 items on thechecklist (didnchecklist (didnt demonstrate initialt demonstrate initialconsonants worse than final orconsonants worse than final orepenthesis)epenthesis)

Discontinued private therapy after 7 yearsDiscontinued private therapy after 7 years

Pre-test:

4/15/2002

66 errors*

PR= -1%

*all items were

imitated

After 6 months

of therapy:

11/4/2002

33 errors

PR= -1%

After 1 year

of therapy:

5/2003

27 errors

PR=


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Unable to complete checklistUnable to complete checklist

Case HistoryCase HistoryHannah, 3;8Hannah, 3;8

Diagnosed withDiagnosed with PraderPrader--WilliWilli SyndromeSyndrome

Only produced /n, m/ and a few vowels at theOnly produced /n, m/ and a few vowels at theevaluationevaluation

Could not complete formal speech/languageCould not complete formal speech/languagetesting or the CAS checklisttesting or the CAS checklist

Received additional therapy at school, whereReceived additional therapy at school, wherethey diagnosed her with a severe receptive andthey diagnosed her with a severe receptive andexpressive speech disorder, severe speechexpressive speech disorder, severe speechdisorder, moderate oraldisorder, moderate oral--motor impairment, andmotor impairment, andhypernasalhypernasal vocal quality.vocal quality.

ReferencesReferences

ReferencesReferences

American SpeechAmerican Speech--LanguageLanguage--Hearing Association (2007) Childhood Apraxia of Speech PositionHearing Association (2007) Childhood Apraxia of Speech Position Statement;Statement; www.asha.orgwww.asha.org/policy./policy.

Ayres, A. J. (1985).Ayres, A. J. (1985). Developmental dyspraxia and adultDevelopmental dyspraxia and adult--onset apraxia.onset apraxia. TorrenceTorrence, CA: Sensory Integration International., CA: Sensory Integration International.

CraryCrary, M. (1993)., M. (1993). Developmental motor speech disordersDevelopmental motor speech disorders .. San Diego, CA: Singular Publishing Group, Inc.San Diego, CA: Singular Publishing Group, Inc.

Dean, Lucinda. (Feb.,2008) Short Course on CAS at the Texas SpeeDean, Lucinda. (Feb.,2008) Short Course on CAS at the Texas Speech and Hearing Association Convention.ch and Hearing Association Convention.

Edwards, M. (1973). Developmental verbal dyspraxia.Edwards, M. (1973). Developmental verbal dyspraxia. British Journal of Communication Disorders,British Journal of Communication Disorders,8, 648, 64--70.70.Hall, P., Jordan, L., & Robin, D. (1993).Hall, P., Jordan, L., & Robin, D. (1993). Developmental apraxia of speech: Theory and clinical practiceDevelopmental apraxia of speech: Theory and clinical practice . Austin, TX: Pro. Austin, TX: Pro --Ed.Ed.

Jaffe, M. (1984). Neurological impairment of speech production:Jaffe, M. (1984). Neurological impairment of speech production:Assessment and treatment. In J. Costello (ed.),Assessment and treatment. In J. Costello (ed.),Speech Disorders inSpeech Disorders inChildren.Children. (pp. ?). City?: College(pp. ?). City?: College--Hill Press.Hill Press.

KamenKamen, R. (1996). Class handouts on Developmental Apraxia of Speech., R. (1996). Class handouts on Developmental Apraxia of Speech. Dallas, TX: UTD.Dallas, TX: UTD.

Morley, M., Court, D., & Miller, H. (1954). Developmental dysartMorley, M., Court, D., & Miller, H. (1954). Developmental dysarthria.hria. British Medical Journal,British Medical Journal, 1, 81, 8--10.10.

RosenbekRosenbek , J.C., & Wertz, R.T. (1972). A review of 50 cases of developmen, J.C., & W ertz, R.T. (1972). A review of 50 cases of developmental apraxia of speech.tal apraxia of speech. Language, Speech, and HearingLanguage, Speech, and HearingServices in SchoolsServices in Schools, 3, 23, 3, 23--33.33.

ShribergShriberg , L.D.,, L.D.,AramAram, D.M., & Kwiatkowski, J. (1997). Developmental apraxia of speec, D.M., & Kwiatkowski, J. (1997). Developmental apraxia of speech: III. A subtype marked by inappropriate stress.h: III. A subtype marked by inappropriate stress.Journal of Speech, Language and Hearing ResearchJournal of Speech, Language and Hearing Research , 40(2), 313, 40(2), 313--337.337.

StrubStrub, R.L., & Black, F.W. (1981)., R.L., & Black, F.W. (1981). Organic brain syndromes: An introduction to neurobehavioral disoOrganic brain syndromes: An introduction to neurobehavioral disorders.rders. Philadelphia: Davis.Philadelphia: Davis.

Velleman, S., & Strand, K. (1994).Velleman, S., & Strand, K. (1994). Developmental Verbal Dyspraxia.Developmental Verbal Dyspraxia. inin J.BernthalJ.Bernthal& N.& N. BanksonBankson (Eds.)(Eds.) Child Phonology:Child Phonology:Characteristics, Assessment, and Intervention with Special PopulCharacteristics, Assessment, and Intervention with Special Populationsations (pp. 110(pp. 110--139). New York:139). New York: ThiemeThieme Medical Publishers.Medical Publishers.

Velleman, S. (2003).Velleman, S. (2003). Childhood apraxia of speech research guide.Childhood apraxia of speech research guide. Clifton Park, NY: Thomson Delmar Learning.Clifton Park, NY: Thomson Delmar Learning.

Watkins, R. (1992). Class notes on Developmental Apraxia of SpeeWatkins, R. (1992). Class notes on Developmental Apraxia of Speech. Dallas, TX: UTD.ch. Dallas, TX: UTD.

YossYoss, K.A., &, K.A., & DarleyDarley, F.L. (1974). Developmental apraxia of speech in children., F.L. (1974). Developmental apraxia of speech in children. Journal of Speech and Hearing ResearchJournal of Speech and Hearing Research, 17, 399, 17, 399--416.416.

**Additional speech assessment measures:**Additional speech assessment measures:

--Verbal Motor Production Assessment for Children (VMPAC; Hayden &Verbal Motor Production Assessment for Children (VMPAC; Hayden & Square 1999)Square 1999)

--Test of Syllable Sequencing Skills (packaged with Moving AcrossTest of Syllable Sequencing Skills (packaged with Moving Across Syllables; Kirkpatrick et al., 1990)Syllables; Kirkpatrick et al., 1990)

-- Profiling Elements of Prosodic SystemsProfiling Elements of Prosodic Systems--Child version (PEPSChild version (PEPS--C; Wells &C; Wells & PeppePeppe 2003)2003)

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